PHYSICIAN QUALITY REPORTING INITIATIVE (PQRI)
PQRI is a voluntary reporting program that provides an incentive payment to identified eligible professionals (EPs) who satisfactorily report data on specific quality measures for covered professional services furnished to Medicare Part B fee-for-service beneficiaries and paid under the Medicare Physician Fee Schedule (MPFS). The program was first implemented in 2007. For calendar year (CY) 2010, participants may earn an incentive payment of 2.0 percent of the EP’s estimated total allowed charges for Medicare Part B covered professional services under Medicare Part B provided during the reporting period. For the CY 2010 PQRI, the Centers for Medicare & Medicaid Services (CMS) is offering additional reporting options and reporting periods. Some options require data on quality measures to be submitted by Dec. 31, 2010. However, EPs who submit data through registries will not be required to submit data on quality measures until 2011.
Key changes in the MPFS final rule with comment period for CY 2010 will:
- Add 30 individual PQRI measures and six measures groups on which individual eligible professionals may report.
- Implement provisions of the Medicare Improvement for Patients and Providers Act of 2008 (MIPPA) that will enable group practices to qualify for a 2010 PQRI incentive payment based on a determination at the group practice level, rather than at the individual EP level.
- Add an electronic health record (EHR)-based reporting mechanism to promote the adoption and use of EHRs and to provide both eligible professionals and CMS with experience on EHR-based quality reporting. Under the rule, CMS will begin accepting data from qualified EHR products on ten individual PQRI measures. In 2010, CMS will, for the first time, allow EPs to count their submission of EHR-based measures toward their eligibility for a PQRI incentive payment. Specifically, the final rule provides that EPs who satisfactorily report data on at least three of the ten EHR-based individual PQRI measures are eligible for an incentive payment. In previous years, EHR-based measure submission has been on a voluntary or “pilot” basis and has not counted towards an EP’s eligibility for an incentive payment.
- Add a six-month reporting period, which begins Jul. 1, 2010, for claims-based reporting of individual measures. In prior years, the six-month reporting period was available only for measures group reporting or for registry-based reporting.
Following the distribution of 2010 incentive payments, CMS will, as required by MIPPA, post on its Web site the names of EPs and group practices that satisfactorily report quality measures.
E-PRESCRIBING INCENTIVE PROGRAM
MIPPA established a five-year program of incentive payments to EPs who are “successful electronic prescribers” (e-prescribers), as defined by the statute. Beginning in 2012, the program will impose penalties on EPs who are not successful e-prescribers. The reporting period for the E-Prescribing Incentive Program for 2010 will be the entire calendar year, and incentives will be paid based on the covered professional services furnished by an eligible professional during the reporting year.
Key changes for CY 2010 under the final rule will:
- Simplify the reporting requirements for the electronic prescribing measure by:
- Streamlining in what manner and how often an EP must report e-prescribing information to CMS. For 2010, the rule requires EPs to report an e-prescribing code only when a patient visit results in an electronic prescription being placed. The final rule also provides that EPs will need to report this code at least 25 times during the reporting period to be considered a successful electronic prescriber. In 2009, CMS required EPs to report one of several e-prescribing codes, based on different scenarios that characterized the presence or absence of an electronic prescription during a patient visit, and to report these codes at least 50 percent of the time.
- Providing more choices for reporting electronic prescribing measures. For 2010, in addition to the current claims-based reporting mechanism, EPs will be allowed to report the e-prescribing measure through qualified registries or through a qualified EHR product. Only registries and EHR products that qualify for the 2010 PQRI and have the capability to report the e-prescribing measure will be qualified for submitting data on the e-prescribing measure for 2010.
- Broaden eligibility for the e-prescribing incentive by including professional services furnished in skilled nursing facilities, domiciliary care, or the home care setting as part of the list of services for which the electronic prescribing measure is reportable; and
- Implement a MIPPA provision that enables group practices to qualify for a 2010 e-prescribing incentive payment based on a determination at the group practice level, rather than at the individual eligible professional level, that the group practice is a successful electronic prescriber.
Following the distribution of 2010 incentive payments, CMS will, as required by MIPPA, post on its Web site the names of individual EPs and group practices that are successful e-prescribers for the 2010 E-Prescribing Incentive Program.
To view a copy of the final rule with comment period, please see:
A fact sheet providing more information about the e-Prescribing Program and PQRI provisions can be found at:
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