CHANGES TO THE PHYSICIAN QUALITY REPORTING INITIATIVE AND THE ELECTRONIC PRESCRIBING INCENTIVE PROGRAM
(INCLUDED IN THE CALENDAR YEAR 2010 MEDICARE PHYSICIAN FEE SCHEDULE PROPOSED RULE)
PHYSICIAN QUALITY REPORTING INITIATIVE (PQRI)
PQRI is a voluntary reporting program, first implemented in 2007, that provides an incentive payment to identified eligible professionals (EPs) who satisfactorily report data on quality measures for covered physician fee schedule (PFS) services furnished to Medicare Part B FFS beneficiaries during a specified reporting period. For 2010, participants may earn an incentive payment of 2.0 percent of the EP’s estimated total allowed charges for covered PFS services under Medicare Part B provided during the reporting period. The incentive program generally operates on a calendar year basis. For the CY 2010 PQRI, there are a number of proposed reporting options and reporting periods available. Some options require data to be submitted by December 31, 2010. However, data reported through registries would not be due to CMS until 2011.
Key changes in the proposed rule for Calendar Year 2010 would:
- Add 22 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 (MIPPA) of 2008 that would 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, that the group practice has satisfactorily reported data on PQRI quality measures;
- 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 would begin accepting data from qualified EHR products on ten proposed individual PQRI measures. Also new this year is the ability for EPs to count their submission of EHR-based measures towards their eligibility for a PQRI incentive payment. In 2010, CMS proposes that EPs who satisfactorily report data on at least three of these ten proposed EHR-based individual PQRI measures be eligible for an incentive payment. In years past, EHR-based measure submission has been on a voluntary or “pilot” basis, and has not counted towards an EP’s eligibility for incentive payment.
As required by MIPPA, following the distribution of 2010 incentive payments, CMS will 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 whole calendar year, and incentives will be paid based on the covered professional services furnished by an eligible professional during the reporting year.
Key changes in for Calendar Year 2010 under the proposed rule would:
- Simplify the reporting requirements for the electronic prescribing measure by:
- Streamlining how and how often an EP has to report e-prescribing information to CMS. For 2010, CMS proposes that EPs report an e-prescribing code only when a patient visit resulted in an electronic prescription being placed. CMS proposes 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 that these codes must be reported 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 would be allowed to report the 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 would 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 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.
As required by MIPPA, following the distribution of 2010 incentive payments, CMS will post on its Web site the names of the names of individual EPs and group practices that are successful e-prescribers for the 2010 E-Prescribing Incentive Program.
Title IV of the American Recovery and Reinvestment Act of 2009 (Recovery Act) authorizes CMS to make incentive payments through the Medicare and Medicaid programs to eligible professionals and hospitals who become “meaningful users” of certified electronic health records (EHRs). In this proposed rule, CMS notes that its efforts to promote the adoption and use of EHRs through the PQRI and e-prescribing incentive programs may provide a foundation for the Recovery Act’s incentives for meaningful users of EHRs, but are not directly related to implementing the Recovery Act’s EHR provisions. CMS will address the implementation of the Recovery Act’s incentive program in a separate rulemaking.
CMS will accept comments on the proposed rule until August 31, and will respond to all comments in a final rule to be issued by November 1, 2009. Unless otherwise specified, the new payment rates and policies will apply to services furnished to Medicare beneficiaries on or after January 1, 2010.
For more information on the proposed rule, please see:
For additional information on the PQRI program visit:
For additional information on the e-prescribing incentive program, visit:
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