In December of 2006, the “Tax Relief and Health Care Act” of 2006 was signed, authorizing the Centers for Medicare and Medicaid Services (CMS) to establish a physician quality reporting system. In response, CMS created the Physician Quality Reporting Initiative (PQRI) on July 1, 2007.
Participants were required to report compliance with quality measures deemed relevant to specific diseases. Rheumatologists were involved with five pertaining to osteoporosis and one to falls. Initially, a bonus of 1.5% of total allowed Medicare physician fee schedule services was offered to physicians meeting reporting goals.
“At first blush, these goals were laudable; who can argue against Mom, apple pie, and quality in medical care?” says Herbert Baraf, MD, managing partner at Arthritis and Rheumatism Associates in Washington, D.C. “As we got further along, PQRI became an obedience test to see if you could check off a box to show that you had dealt with a quality measure. It did not matter that you had provided quality care; what mattered was whether physicians could report on parameters that other folks thought indicative of quality.”
One of the goals of the PRQI, according to CMS, is to turn Medicare from “a passive payer into an active purchaser of high-quality care by linking payment to the value of care provided.”1
“What CMS hopes to get eventually is a group of physicians who report back to the government on how well they are doing,” says David Borenstein, MD, a partner with Dr. Baraf at Arthritis and Rheumatism Associates, treasurer of the ACR, and a TR editorial board member. “To get there, CMS has to get doctors used to the idea that they have to tell CMS something other than what is owed for a visit.”
Data Capture Difficult
Initially, CMS gave physicians an incentive of a 1.5% bonus, rising to 2.0% for 2009. All experts interviewed indicated that they expect to see the bonuses end and a transition to a system where physicians may see payments lowered if they don’t meet reporting requirements.
There are indications that this transition may not be easy. The implementation of the first year of the program drew much criticism from participants. A survey by the Medical Group Management Association (MGMA) found that 25% of respondents say they rated the difficulty of data capture and submission either extremely or considerably difficult. Another 37% noted moderate difficulty.2
“I did quite a bit to get ready,” says Joseph Flood, MD, a member of the ACR board of directors and a rheumatologist in solo practice in Columbus, Ohio. “I worked with my billing company to make sure they understood the process and created the codes to report to CMS. I had to redesign the billing form I use and then educate staff on the changes and why they were important.”