Physician Quality Reporting Initiative (PQRI) Measures

1. Physician Quality Reporting Initiative (PQRI) Measures Prepared by: Jonathan Heidt MD Washington University School of Medicine St. Louis

2. What is PQRI? • The 2006 Tax Relief and Health Care Act (TRHCA) required the establishment of a physician quality reporting system. • Reauthorized in 2007, permanent in 2008 • Incentive payment for voluntarily reported data on quality measures

3. What is PQRI? • The goals of this program were to: • Improve the quality of healthcare for Medicare recipients • Transition the Centers for Medicare and Medicaid Services (CMS) towards becoming an “active” rather than “passive” payer in an attempt to control costs.

4. What is PQRI? • Currently, incentives are paid for simply reporting on designated quality measures. • It is anticipated that PQRI will be transitioned to a “pay for performance” model.

5. What Quality Measures are Included? • The 2009 PQRI measure list identifies 153 quality measures and 7 measure groups. • Nine are considered to be “emergency medicine” measures.

6. What Quality Measures are Included? • # 28 ASA at arrival for acute myocardial infarction • #31 DVT Prophylaxis for ischemic stroke or intracranial hemorrhage • #34 TPA considered for ischemic stroke • #54 12 lead ECG for non traumatic chest pain

7. What Quality Measure Are Included? • # 55 12 lead ECG for syncope • #56 Vital signs reviewed for community acquired pneumonia (CAP) • #57 Assessment of oxygen saturation in CAP • #58 Assessment of mental status in CAP • #59 Initiation of antibiotics in CAP

8. Who Chooses These Quality Measures? • Multiple public / private groups involved • Any entity may suggest a PQRI measure • Majority have been by the AMA PCPI (Physician Consortium for Performance Improvement) • ACEP is a member of PCPI

9. How Does PQRI Work? • Providers are eligible by choosing three measures to report. • The measures are then reported to CMS • If a reporting rate of at least 80% is provided, providers receive a bonus payment of 2%.

10. Are There Problems Associated with PQRI? • The underlying assumption of this program is that physicians will change their practice based on financial incentives. • These changes in practice are then anticipated to improve the quality of healthcare and reduce overall costs.

11. What Concerns about PQRI Exist? • Quality measures are not always easy to report and may reflect patient compliance instead of only physician performance. • Some of the PQRI measures may not be based on current evidence based medicine.

12. What Concerns about PQRI Exist? • There is a new movement to include process measures such as door to physician and door to discharge times which would not be practical in many ED’s. • Quality measures can threaten physician autonomy by pressuring physicians to complete measures which may not be the best course for an individual patient.

13. What Concerns About PQRI Exist? • Quality measure performance could be made available to the public which could be misleading to patients in regards to a physician’s quality.

14. Why Should EM Residents Care? • The move towards a pay for performance system appears inevitable. • The transition to a new payment structure will have an impact on emergency medicine in both payment and professional practice. • As new physicians enter into practice, they will be most affected by these new measures.

15. Why Should EM Residents Care? • Current residents are in the unique position to influence the structure of a future payment system and policy decisions. • A passive approach will lead to the development of policy by lawyers and politicians which could be detrimental to the practice of medicine and patient care.

16. References • Centers for Medicare and Medicaid Services: www.cms.hhs.gov/PQRI • American College of Emergency Physicians FAQS on PQRI: http://www.acep.org/practres.aspx?LinkIdentifier=id&id=30492&fid=2294&Mo=No&taxid=117956 • EMRA Emergency Medicine Advocacy Handbook