MANAGED CARE February 2010. ©MediMedia USA
Back in 2006 with the passage of the Tax Relief and Health Care Act, Centers for Medicare & Medicaid Services (CMS) was charged with establishing a physician quality reporting system that would include incentive payments to eligible providers. This Physician Quality Reporting Initiative (PQRI) initially targeted individual providers, but in 2010, group practices may also qualify to earn PQRI incentives equal to 2 percent of their total estimated payments under the Medicare Part B physician fee schedule.
The bonus is relatively small, says Mark L. Metersky, MD, professor of medicine in the division of pulmonary and critical care medicine at the University of Connecticut School of Medicine and author of the paper titled “The Medicare Physician Quality Reporting Initiative: What Do Chest Physicians Need to Know?” The small size may deter some physicians, but Metersky advises otherwise.
“The big reason that many physicians should consider this is that it will prepare them for the future. We’re likely to see more and more programs where this type of reporting will be linked to payment in some way or another,” says Metersky.
Commercial insurers often follow CMS’s lead in terms of payment. “All you have to do is look at the decision by CMS not to pay for consults; many payers have jumped on that bandwagon.”
There’s also no double-dipping allowed — individual providers who are members of a group practice selected to participate in the group practice reporting option (GPRO) are not eligible to separately earn a PQRI incentive payment as an individual provider.
Each group practice will be required to report 26 quality measures. A list of the measures for 2010 can be found in the “2010 PQRI GPRO Disease Modules and Preventive Care Measures.”
A description of each of the 26 measures can be found in the “2010 PQRI GPRO Narrative Measure Specifications.” Both documents are on CMS’s Web site: www.cms.gov [1].