To qualify for the bonus, you must report each measure for at least 80% of the patient visits that qualify based on the patient’s diagnoses and the type of visit. Further, you need only report on three measures at the 80% level to qualify for the bonus. For example, you would qualify for a bonus if you performed and reported measures 39 (Osteoporosis: Screening or Therapy for Women 65 and Older), 41 (Osteoporosis: Pharmacologic Therapy), and 42 (Osteoporosis: Counseling for Vitamin D, Calcium Intake, and Exercise) during 80% of your office visits with patients diagnosed with osteoporosis.
In order to successfully integrate PQRI into their practices, “Professionals need to confirm that the software they are currently using to submit claims will accept the quality data CPT-II codes,” says says Susan Nedza, MD, co-lead for education and outreach for PQRI, and chief medical officer for CMS Region V. “The change in the practice is related to capturing the measurement activity in the chart and transferring to the claims process. We recommend using flow sheets, templates, or—if they have an electronic medical record—having data fields where they can record the quality data codes for submission throughout the claims process. CMS will soon have tools available to facilitate capture that will be posted on the PQRI Web site.”
David Holzman is a freelance writer based in Massachusetts.
PQRI Rheumatology Quality Measures
To qualify for a bonus in 2007, rheumatologists and health professionals must report each measure for at least 80% of the relevant cases seen between July 1 and December 31, and they must meet that goal on at least three of these measures if four or more are applicable.
#4: Screening for Future Fall Risk: Percentage of patients 65 or older who were screened for future fall risk (patients are considered at risk for future falls if they have had two or more falls in the past year or any fall with injury in the past year) at least once within 12 months.
#24. Osteoporosis: Communication with the Physician Managing Ongoing Care Post Fracture: Percentage of patients 50 or older treated for a hip, spine, or distal radial fracture with documentation of communication with the physician managing the patient’s ongoing care that a fracture occurred and that the patient was or should be tested or treated for osteoporosis.
#39. Osteoporosis Screening or Therapy for Women 65 and Older: Percentage of female patients 65 or older who have a central dual-energy X-ray absorptiometry (DXA) measurement ordered or performed at least once since age 60 or pharmacologic therapy prescribed within 12 months.