Proof of Concept
Some of these problems are likely related to the newness of the effort, and some to resource allocation at CMS. “At this time, PQRI is really in the proof-of-concept stage, and no one thinks that this is its final form,” says Dr. Borenstein. “CMS is stuck with generating a system to implement the law but has not necessarily been given the resources to make it successful.”
Even some rheumatologists who received bonuses were not sure they had covered the additional expenses incurred to comply with the initiative. “Our 12-person practice received about $8,000, and only three physicians qualified for payment,” says Dr. Baraf. “I doubt that covered the cost of paper and posting. We were very disappointed in the money for the amount of effort we put in.”
Dr. Flood agreed, noting that two-thirds of his bonus was used to cover compliance costs. In addition, much of the work done in one year must be repeated annually as the quality parameters and diseases covered expand. There do not appear to be many costs from last year to be amortized further this year.
CMS acknowledged many of the concerns voiced here in their Physician Quality Reporting Initiative (PQRI): 2007 Reporting Experience publication, released in December 2008. Included in the report is a listing of the major reporting errors that should provide at least a general overview of what kinds of mistakes were being routinely made. CMS also outlined some changes they hope will improve access without impairing security.
Among all the concerns, there have been some positive things to come out of the first year of PQRI. “We think we are giving quality care all the time and most of us try our best,” says Dr. Borenstein. “Some fall through the cracks, or we forget to follow up on something. PQRI served to raise our consciousness and reminded us to ask the patient questions we may have assumed had already been addressed.”
PQRI Help
The ACR has developed an online resource, the Rheumatology Clinical Registry, that can assist with claims-based reporting for PQRI. To learn more about PQRI, see the PQRI Update on page 10 of this issue. To learn more about the RCR, visit www.rheumatology.org/rcr.
Participants Ambivalent About Continuing
The physicians interviewed were, at best, ambivalent about continuing the program. “If I wasn’t involved with ACR, I think I would be very cautious about investing staff time and effort to PQRI,” says Dr. Kolba. “If this was my first time, I would be reluctant and probably tell others to let it go through additional iterations before committing time to it. I want to make sure that others are happy with the program before going in again.”