Medicare Physician Quality Reporting Initiative: Everything You Need to Know

1. Medicare Physician Quality Reporting Initiative: Everything You Need to Know March 4, 2009

2. Webinar Overview • Welcome and webinar housekeeping issues • CMS Physician Quality Reporting Initiative (PQRI) presentation • Description of 2009 PQRI program • Experience, lessons learned from 2007 and 2008 programs • ACP presentation of guidance, resources, and member experience • Question and answer period

3. ACP PQRI Guidance/Resources • If have you are already reporting on three individual quality measures through claims in 2009, continue to do so • It’s not to late to start reporting individual quality measures and hit the 80% threshold of eligible cases • Over 30 measures common to internal medicine practice need to be reported only once in the 12 month reporting period, including: diabetes; coronary heart disease; and some geriatrics measures • Could pick three diabetes measures, e.g. Hb A1c, LDL, blood pressure, or three screening measures, e.g. flu vaccine, pneumonia vaccine, and tobacco use inquiry

4. Individual Measure Reporting • Assess whether patients eligible for selected measures have been seen in the office in the first six months of year/are likely to be seen in second half of the year • Coding tool resources available • ACP coding tool template with seven measures common to general internal medicine available at http://www.acponline.org/running_practice/practice_management/payment_coding/pqri.htm • CMS/AMA measure-specific “PQRI Data Collection Worksheets” are available at http://www.ama-assn.org/ama/pub/physician-resources/clinical-practice-improvement/clinical-quality/participation-tools-individual.shtml

5. Measures Groups Guidance/Resources • Provides a potentially more straightforward reporting method • Ability to successfully report 80% over time enables you to earn bonus if you miss a consecutive patient • Diabetes Mellitus and Preventive Care measures group are most relevant to IM practice • Uniformity of denominator criteria—age, diagnosis, and office encounter—make diabetes measures group an attractive option • ACP coding tool for diabetes measures group at http://www.acponline.org/running_practice/practice_management/payment_coding/pqri.htm

6. Measures Groups Guidance/Resources • AMA Preventive Care measures group data collection sheet at http://www.ama-assn.org/ama1/pub/upload/mm/370/2009/Measures_Groups/wrksht_preventive_09.pdf • AMA participation tools for each measure group--description and data collection sheet—at http://www.ama-assn.org/ama/pub/physician-resources/clinical-practice-improvement/clinical-quality/participation-tools-measures.shtml

7. Registry Reporting Guidance/Resources • Can be used to reporting individual quality measures or measures groups; over 12 month or six month period • 32 CMS-selected registries currently participate • ACP provides information on registry options at http://www.acponline.org/running_practice/practice_management/payment_coding/pqri_reg.htm • Includes information obtained directly from registries most relevant to internists • CMS to announce additional eligible registries by July 31, 2009

8. ACP Member Experience • CMS reports that early internist participation similar to average all-physician participation level • ACP survey shows that less than 20% members participated, with those in 6-20 physician practice most likely • Internist report challenges and frustration, including: inability to know if participating “correctly”; not receiving a bonus thought to be earned; receiving a bonus payment amount less than expected; and problems accessing reporting/performance feedback report • ACP is challenged to reach those not participating/help those participating

9. CMS Program Adjustments • Now uniformly used NPI to improve physician attribution • More accurate reporting/performance scores • More accurate bonus payments • No longer need to code precisely by “pointing” diagnosis code to quality code(s)—CMS re-running analysis for 2007 and 2008, likely to result in more earning bonus • Agency committed to making it easier to access reporting/performance report • May be as straightforward as agency e-mailing report to participating physician

10. Conclusion • Additional PQRI improvements are needed, such as providing more timely feedback • ACP appreciates CMS outreach and openness to suggested improvements • Worthwhile for internists to participate, especially because likely to remain component of Medicare payment system • Think of all Medicare bonus payment opportunities collectively—and how to efficiently earn them • ACP Medicare e-prescribing incentive payment resources at http://www.acponline.org/running_practice/technology/eprescribing/medicare_program.htm

11. Thank You Question and Answer Period ACP Contact for questions/more information: Brett BakerDirector, Regulatory and Insurer Affairs Division of Governmental Affairs & Public Policybbaker@acponline.org202-261-4533