CMS: Physician Quality Reporting Initiative is Getting Easier

Facing criticism about Medicare's Physician Quality Reporting Initiative (PQRI), Centers for Medicare & Medicaid Services (CMS) officials acknowledged that the PQRI is "difficult and time consuming." Medicare officials say they are working to make the PQRI easier to use.

The CMS responded to a Medical Group Management Association (MGMA) survey of physicians that showed widespread frustration about reporting and feedback report requirements, and an "unreasonable lag time" to receive PQRI results. The MGMA includes more than 22,000 members, who are professional administrators and leaders of medical group practices.

The CMS "continues to improve both the claims-based reporting mechanisms and feedback reports, which are the focus of the MGMA’s survey," according to CMS spokesman Joe Kuchler.

CMS made "significant improvements for 2008 that included detailed information as to measures submitted and the degree to which these were satisfactorily reported," Kuchler says. "These improvements were based upon suggestions we received from specialty and multi-specialty medical societies following release of 2007 reports."

Kuchler adds: "We continue to look for ways to improve the content of the feedback reports and invite any specific suggestions."

The PQRI was established under the 2006 Tax Relief and Health Care Act (TRHCA) to provide an incentive payment for eligible professionals, who satisfactorily report data on quality measures for professional services furnished to Medicare beneficiaries.

The MGMA targeted mostly group rather than individual requirements for PQRI. The program released the critical research survey about PQRI at a time Congress is considering how to continue the program.

A bill proposed in the Senate imposes penalties on physicians who fail to participate in the PQRI, but the House bill does not. The program is currently voluntary.

In 2008, CMS established an alternative delivery system that allows individuals, whether members of groups or not, to use call their carriers and have the reports e-mailed "because of the difficulty of some experienced in 2007," Kuchler says.

This has proven to be a "much easier and less time consuming process for physicians," Kuchler says.

For 2010, CMS has added two reporting options—electronic health records and group practice reporting. The EHR often has a built-in a capacity of generating contemporaneous performance reports, Kuchler says.

"The tool will calculate performance information for the group practice without the necessity for CMS to do this and then send the feedback," Kuchler says.

The CMS added: "Many physicians and physician groups are now using registry based reporting, which present fewer technical issues for physicians, and physician groups are now using registry based reporting, which present fewer technical issues for physicians and provides another option for feedback information."

In 2009, physicians could earn a PQRI incentive payment equal to 2% of their billed Medicare charges. In 2007, a much lower payout was reported, with $630 the average amount, according to the American Medical Association.

Robert Bennett, a spokesman for the MGMA, says he is pleased that the CMS has responded to its report, but he adds that there are still considerable delays in processing reports involving PQRI that must be addressed.