PQRI (PQRS) 2011 payments have been disbursed. If you haven't received your check yet, you didn't play the game right. What is PQRI (now known as PQRS). It stands for Physician Quality Reporting Initiative, now changed to Physician Quality Reporting System for 2011 and beyond.
PQRI/PQRS is another bloated government program trying to reward physicians for quality care as defined by CMS. Physicians report on defined ICD codes linked to defined CPT codes linked to defined PQRI, now known as PQRS codes.
In order to get paid my bonus (2% of allowed charges for 2010) from the Medicare National Bank, I have to report to CMS on at least 80% of qualified patients I see with regards to specific and defined quality parameters. I have dozens to choose from.
Here is the obnoxious list that keeps growing. I have to meet an 80% reporting threshold on at least three criteria or I don't get any of my 2% money at all. It's all or none.
For a doctor to qualify for their CMS PQRI/PQRS bonus, they had to meet an 80% reporting threshold for at least three chosen quality measures. In other words, the doctor had to report at least one of the defined codes below on 80% of their qualifying patients for all three qualifying measures chosen or no bonus money would be paid to the physician. This is an all or nothing program. We decided, as a group, to report on the following three quality measures below. There are dozens to choose from. We chose these three.
- Advanced care plan directive for patients age 65 or older-Measure #47
- 1123F: There is a documented surrogate decision-maker or advance care plan
- 1124F: Not documented for patient reason
- 1123F-8P: Not documented; reason not specified
- Antiplatelet Therapy prescribed at discharge for patients with ischemic stroke or TIA, age 18 or older-Measure #32
- 4073F: Antiplatelet therapy prescribed at discharge
- 4073F-1P: Not prescribed for a medical reason (ie patient on anticoagulant therapy)
- 4073F-2P: Not prescribed for a patient reason (ie declined, social or economic reason)
- 4073F-8P: Not prescribed, reason not specified
- Consideration of rehab svcs for patients diagnosed with ischemic stroke or intracranial hemorrhage, age 18 or older-Measure #36
- 4079F: Order for rehab svcs OR documentation that rehab svcs were not indicated
- 4079F-8P: Rehab services not considered; reason not specified
Not only do we have to report on at least 80% of qualified patients on all three quality measures, but we also must know which CPT codes these measures apply to. You see, measure #47 applies to all possible E&M codes, except discharges. While measures #32 and #36 only all inpatient discharges (
99238,
99239) or inpatient admissions (
99221,
99222,
99223). Even more complicated, before
Medicare got rid of consults, quality measures # 32 and 36 only applied to discharges and consults, but not admissions.
But it gets even more complicated. Not only do certain quality measure only apply to certain CPT codes, but only specific ICD codes apply too. For example, for quality measure #32, ICD codes 4234.91 (stroke) and 435.9 (TIA) apply, but for quality measure #32, only 343.91 (stroke) and 431 (bleed) count. If you don't get the right ICD code with the right CPT code to match with a quality measure code, and do it at least 80% of the time for all three reported quality measures, you get no bonus at all.
For all this government effort to reward quality, how much money are we talking here? The
CMS PQRS website explains.
2011 Physician Quality Reporting. To participate in the 2011 Physician Quality Reporting, individual eligible professionals may choose to report information on individual Physician Quality Reporting quality measures or measures groups: (1) to CMS on their Medicare Part B claims, (2) to a qualified Physician Quality Reporting registry, or (3) to CMS via a qualified electronic health record (EHR) product.
But don't get too comfortable with the rules because they can change without notice:
Note: The Physician Quality Reporting program requirements and measure specifications for the current program year may be different from the Physician Quality Reporting program requirements and measure specifications for a prior year. Eligible professionals are responsible for ensuring that they are using the Physician Quality Reporting documents for the correct program year.
So, how much money are we talking here?
Individual eligible professionals who meet the criteria for satisfactory submission of Physician Quality Reporting quality measures data via one of the reporting mechanisms above for services furnished during a 2011 reporting period will qualify to earn a Physician Quality Reporting incentive payment equal to 1.0% of their total estimated Medicare Part B Physician Fee Schedule (PFS) allowed charges for covered professional services furnished during that same reporting period.
For 2009-2010, the bonus was 2% of qualified charges. For 2011 that amount is 1%. For years 2012-2014, that bonus drops to 0.5% and starting in 2015, this program becomes a penalty system. If physicians do not report, they will lose 1.5% of their billed Medicare charges in 2015 and 2% starting in 2016. I guess when you're staring a 27% cut in less than a month, a 2% cut just becomes annoying.
How did Happy's group come out this year in their PQRI/PQRS reporting. Once again, only two doctors out of almost 20 succeeded in qualifying for their bonus payment. Myself and one other physician.
Again. I have never missed since the inception of the program. It's because I know how the complicated game is played. And how much did I get paid for my 2010 efforts? I got paid about $3,000, before taxes, in September, 2011. At least it's only nine months late.
All that paper work and all that manpower by the billing company to submit the data. And all that time and energy for $2,000. I'm pretty confident the opportunity cost of that bonus outweighs the benefit.Medicare at its finest.
Medicare is wasteful. PQRI/PQRS is proof of that.
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