Physicians now have nine options for submitting quality data to Medicare under the Physician Quality Reporting Initiative.
The new options include three ways to submit claims-based data and six registry-based methods for reporting (see box). For example, physicians will have the option of reporting data on groups of related clinical measures or individual measures and they can report for a full or half year. Officials at the Centers for Medicare and Medicaid Services announced the changes in April.
Under the Physician Quality Reporting Initiative (PQRI), launched last July, physicians can earn up to a 1.5% bonus on all of their total allowed Medicare charges for covered services for reporting on certain quality measures to CMS.
“We are encouraged by the success of the program so far, and with the new options for data reporting, more health professionals should take advantage of the reporting system,” the acting administrator of the CMS, Kerry Weems, said in a statement.
In the meantime, physicians who reported data in 2007 are still waiting for their bonus checks and feedback on their performance. CMS accepted 2007 data until the end of February and is currently analyzing the information. CMS officials expect to provide results and bonus payments to physicians in mid-July.
Preliminary data show that in 2007, more than 100,000 physicians and other eligible professionals submitted quality data at least once to the voluntary reporting program. CMS estimates that about half of those who participated in 2007 will receive an incentive payment.
In 2007, CMS officials selected 74 quality measures to be used across various specialties. If three or more measures applied, physicians had to report on at least three measures for at least 80% of applicable patients. If fewer than three measures were applicable, physicians had to report on each measure for at least 80% of the eligible patients. All reporting was claims based and covered the period from July 1 to Dec. 31, 2007.
This year, CMS has expanded the list of measures to 119, with 117 clinical measures and 2 structural measures. The structural measures relate to e-prescribing and electronic health record adoption and use.
CMS will also allow physicians to report on their clinical interactions for a full year from Jan. 1 to Dec. 31, 2008, or a half-year starting on July 1. Those physicians who haven't started reporting yet should still consider the full-year option, Dr. Michael T. Rapp, director of the quality measurement and health assessment group at CMS, said during a CMS-sponsored provider call on PQRI. Because 60 of the measures require only once-a-year reporting, physicians could still meet the 80% threshold if they started in May or June, he said.
CMS is also allowing providers to report either individual measures or “measures groups.” CMS has created four measures groups with at least four measures each. The groups include diabetes, end-stage renal disease, chronic kidney disease, and preventive care.
For example, the end-stage renal disease group includes four measures: vascular access for hemodialysis patients, influenza vaccination, plan of care for patients with anemia, and plan of care for inadequate hemodialysis. In order to quality for payment using measures groups, physicians have to submit data for each of the measures in the group.
Eligible professionals will also be able to report to clinical registries instead of submitting claims directly to CMS. Physicians would report data to the registry, which would in turn report to CMS. Currently, CMS is testing submission from registries and plans to publish a list of qualified registries in late August.
Despite the late announcement of qualified registries, physicians can still consider full-year participation with this option, Dr. Rapp said, because data are often submitted to registries months after the clinical encounter has occurred.
It appears that the changes will make it easier to report data, said Dr. James King, president of the American Academy of Family Physicians. “We want to be able to get our data in.”
However, more details will be needed on registry-based reporting, said Brian Whitman, who monitors regulatory and insurer affairs at the American College of Physicians. The extent to which internists will be able to use registry-based reporting will be unclear until CMS releases the list of participating registries in late August, he said. While subspecialties such as thoracic surgery do have well-established registries, there is not a registry commonly used by all internists at this point, he said.
Another unanswered question is how CMS will ensure that the data being submitted by registries are accurate, Mr. Whitman said.