PQRI: Medicare struggles to get it right

The Centers for Medicare & Medicaid Services (CMS) have just released a report detailing experience with the Physician Quality Reporting Initiative (PQRI), the program that aims to link payment to quality of care by offering a modest incentive payment (2 percent of allowed Medicare charges in 2009) to physicians who successfully report quality measures to CMS. Since CMS began accepting data for the PQRI in July 2007, the program has been the subject of increasing criticism as growing numbers of physicians have been denied incentive payments.

Of those who participated in the program, just over half met the requirements for receiving an incentive payment, the report says.

The report also explains that implementing the PQRI by the legislatively mandated date (the Tax Relief and Health Care Act of 2006, enacted on Dec. 20, 2006, required implementation by July 1, 2007) “required rapid finalization of the detailed specifications for 74 clinical quality measures (covering hundreds of procedure and diagnosis codes), the development of an expanded infrastructure to support the reporting system and extensive outreach to more than 700,000 professionals about the requirements they needed to follow to submit data on quality measures.” In other words, the agency didn’t have enough time to get it right. The report goes on to detail plans to resolve the “unanticipated issues” that arose.

“CMS is committed to a successful PQRI program,” according to the report. We’re not sure whether this is good news or bad news. What do you think?

Posted at 05:25PM Dec 11, 2008 by Leigh Ann Backer  |  Comments[3]