CMS Physician Quality Reporting Initiative Vol. II: PQRI's Measures, Incentives and Coding in 2007

Description

This special report provides an insider's look at the 2007 changes to the Center for Medicaid and Medicare Services (CMS) Physician Quality Reporting Initiative (PQRI). This program was formerly known as the Physician Voluntary Reporting Program (PVRP). The CMS first announced the PQRI in October 2005. The program gained momentum in late 2006 when Congress legislated a 1.5 percent financial incentive for physicians reporting on their Medicare populations beginning in July 2007. In CMS Physician Quality Reporting Initiative Vol. II: PQRI's Measures, Incentives and Coding in 2007, two physicians actively involved in the PQRI effort share their unique perspectives on performance measurement basics, review one medical group’s experience with PQRI, and venture their educated guesses regarding the future of this physician quality reporting program as it matures. In this 38-page report, you'll get details on: Who’s who in physician quality measurement; Feedback from a California Medical Group on voluntary reporting measures; Deconstructing coding and measurement reporting requirements; What the "80 percent" reporting requirement really means; Preparing for payouts for Medicare measures beginning in July 2007; What the CMS hospital reporting initiative can teach us about the direction of physician reporting; and much, much more, including 10 pages of valuable Q&A on PVRP challenges and pointers to tools, worksheets and resources to assist physicians in the reporting of patient measures. Part of the Physician Quality Reporting Initiative Resource Kit, a two-volume set and keyword searchable CD-ROM of the 74 PQRI measures and specifications - Save 15% when you order the entire collection. Contributing to this report are Dr. Bruce Bagley, medical director of quality improvement with the American Academy of Family Physicians, and Dr. Ronald Bangasser, family practice physician with Beaver Medical Group in Redlands, Calif. This special report in based on a January 9, 2007 audio conference during which these two physicians offered their views on PQRI from the perspectives of a 150-physician practice and a medical specialty society representing more than 93,700 physicians and medical students. Table of Contents Moving the Culture of Medicine from Pedigree to Performance Deconstructing Performance Measures Who’s Who in Quality Measurement Feedback from a California Medical Group on Voluntary Reporting Measures IHA Pay-for-Performance Program in California IHA, Medicare and CMS PQRI IHA Rating for PQRI Measures The Future of the PQRI Program Remaining Details of the Program PQRI is Pay for Reporting, Not Pay for Performance Deconstructing Coding and Reporting Requirements CMS PQRI Beyond 2007 Tackling Related Issues Barriers to Physician Participation References and Data Resources Q&A: Ask the Experts Guidelines for Electronic Reporting of Data to Medicare Deciphering the 80 Percent Reporting Rule Origin of the Three-Measure Requirement for Physicians Following in the Footsteps of Hospital Measure Reporting CMS PQRI and Medicare Advantage Counting Codes in the Denominator: Per Patient or Per Visit? Porting Data from Existing Systems to CMS PQRI Clarifying the Population for Medicaid Bonuses The Role of the National Provider Identifier When One Patient Sees Several Physicians Medicare Bonuses and Capped Expenses Requesting Previously Reported Data Recourse for Correcting Submitted Data Factoring in Patient Satisfaction Ratings Interpreting the Medicare Act’s Physician Measures Requirements Clarifying Patient-Specific and Visit-Specific Reporting Clarifying the Numerator and Program Intent The Status of Public Reporting of Physician Data Glossary For More Information About the Authors

Publication Date: February 2007

Number of Pages: 38