Report on PQRI

The Hospitalist. 2008 April;2008(04):

April 1, 2008|The Hospitalist

The current pay-for-reporting program from the Centers for Medicare and Medicaid (CMS) seems tailor-made for hospitalists. Here’s a look at the voluntary Physician Quality Reporting Initiative (PQRI) program, and why and how hospitalists are—and are not—participating.

CMS has revised the reporting program that began as a six-month trial in 2007. The current PQRI runs the full calendar year for 2008 and includes 119 quality measures—11 of which hospitalists can report on. Detailed specifications for the measures are available on the CMS Web site at www.cms.hhs.gov.

The earnings in this pay-for-reporting program remain the same as 2007: Physicians who successfully report on measures can earn a bonus payment equal to 1.5% of their total Medicare-allowed charges. Some hospitalists have collected their bonus for participating in the 2007 trial; it’s likely more will participate this year.

CMS has yet to release data on participation in the 2007 PQRI trial or this year’s initiative. However, SHM has urged hospitalists to participate, and many are. During a national, SHM-sponsored conference call with CMS in summer 2007, approximately 20% of the 160 hospitalists participating in the call responded to a follow-up survey. Almost half of all respondents indicated they planned to participate in PQRI reporting.

“That percentage comes from a select group of hospitalists who were highly interested in the PQRI,” points out Patrick J. Torcson, MD, MMM, FACP, director of hospital medicine at St. Tammany Parish Hospital in Covington, La.

Unlike many specialists, hospitalists are finding reporting to be a straightforward process. “For hospitalists, PQRI reporting on specific measures harmonizes nicely with workflow,” says Dr. Torcson. “Most applicable measures take place during admission or discharge. Documentation and reporting for PQRI can take place during these times.”

Policy Points

Early P4P Program SHOWING PROMISE

Results are in from the first CMS pay-for-performance demonstration trial: Costs and mortality rates declined for hospitals participating in CMS’ Hospital Quality Initiative Demonstration (HQID), also known as the Premier Demo project. Results of the project indicate that 70,000 lives and $4.5 billion would be saved each year if the P4P program were rolled out nationwide.

Two hundred and fifty hospitals under the umbrella of Charlotte, N.C.-based Premier Inc., a nationwide alliance of not-for-profit hospitals, provided data for 34 quality measures from October 2003 to June 2007. The data they provided while reporting was compared with hospitals in a public reporting system.

CMS has extended the HQID project through 2009.

Patient Safety Organizations Proposed

In February, the U.S. Department of Health and Human Services (HHS) published a proposed rule that would allow the creation of patient safety organizations (PSOs). Hospitals, doctors, and other healthcare providers could voluntarily and confidentially report information to these PSOs that could then be used for analysis of patient safety events.—JJ

Report on Reporting

At St. Tammany, Dr. Torcson’s eight-hospitalist team is participating in PQRI. Although you need only to report on three measures to qualify for a bonus payment from the program, “we’re actually reporting on the full list of [hospitalist-applicable] measures,” Dr. Torcson says. It’s up to each St. Tammany hospitalist to remember to report on the 11 measures.

“Support for [reporting] really comes down to physician memory,” says Dr. Torcson. “Long term, this is going to have to be part of an electronic system, with decision support and billing capability from an electronic health record.”

In spite of the added step of PQRI reporting, Dr. Torcson says, “we’ve had an enthusiastic response from our hospitalists.” The payoff for the hospital medicine program and the hospital is yet to be seen. “You hope that PQRI performance reporting will result in improved quality of care,” henotes.