PQRS (formerly known as PQRI)

Program Goals

• Collect quality data from healthcare professionals across multiple settings to improve prevention, consistency of care, and outcomes 
• Reward quality of care over volume

Benefits of Participation

• 1% incentive on total Medicare Part B revenue
• No cap on incentive payments
• Potential for improved patient care
  • Establish care alerts and treatment protocol
  • Identify and track patients with common conditions
  • Promote consistent care throughout the practice

PQRI Reporting Options

Individual measures (total=175): Report on minimum of three PQRI measures on 80% of applicable Medicare patients to qualify for incentive. Measures include:

• Diabetes mellitus - hemoglobin A1c poor control
• Coronary artery disease - beta blocker therapy for CAD patients with prior MI
• Heart failure - beta blocker therapy for left ventricular systolic dysfunction (LVSD)
• Stroke and stroke rehabilitation - carotid imaging reports
• Osteoporosis - screening or therapy for women age 65 and older
• Preventive care and screening - advising smokers to quit
• Ischemic vascular disease – blood pressure management control
• HIV/AIDS – screening for injection drug use
• Hepatitis C – Hepatitis B vaccination in patients with HCV
• Rheumatoid arthritis – functional assessment management

Measures groups (total=13): Report all measures in one measures group on 30 Medicare patients or on 80% patient sample:

• Diabetes mellitus
• Chronic kidney disease
• Preventive care
• Coronary artery bypass graft surgery
• Rheumatoid arthritis
• Perioperative care
• Back pain
• Hepatitis C
• Heart failure
• Coronary artery disease
• Ischemic vascular disease
• HIV/AIDS
• Community-acquired pneumonia

Alternative Reporting Periods

• January 1 - December 31
• July 1 - December 31 (for measure group reporting)

Types of Reporting

• Claims-based
• Qualified registry
• Qualified EHR-based (available for 10 specific measures)

2008 PQRI Experience

• The government paid out $92 million in PQRI incentives.
• Of the 162,800 physicians who attempted to participate, 85,000, (52%), earned some incentive payment.
• Average payment to individual physicians: $1,082.

For more information and downloads:

• CMS Website: http://www.cms.hhs.gov/PQRI
• 2010 PQRI Measures List

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