Pay for Reporting - PQRI

 

EM PQRI Open Door Forum PowerPoint Presentation 

Physician Quality Reporting Initiative (PQRI)
2010 Measure Specifications; 9 Individual Measures and 1 Measures Group Included for EM

The Medicare Improvements for Patients and Providers Act of 2008 (MIPPA) (Pub. L. 110-275) made the PQRI program permanent, but only authorized incentive payments through 2010. Legislation will be required to extend payments beyond 2010.

For 2010, the program includes 175 quality measures and 13 measures groups. Eligible professionals (EPs) may earn an incentive payment of up to 2.0 percent of their total allowed charges for Physician Fee Schedule (PFS) covered professional services furnished during the reporting period, January 1, 2010 - December 31, 2010.

EPs do not need to sign-up or pre-register in order to participate in PQRI. Submission of quality data codes for the quality measures to CMS through claims or a qualified registry will indicate suffice. Additional information is available on the CMS website: www.cms.hhs.gov/pqri.

Nine (9) individual measures may be reported as “emergency medicine” measures:*  

#28 Aspirin at Arrival for Acute Myocardial Infarction (AMI) †
#31
 
Stroke and Stroke Rehabilitation: Deep Vein Thrombosis Prophylaxis (DVT) for Ischemic Stroke or Intracranial Hemorrhage†
#54
 
12-Lead Electrocardiogram (ECG) Performed for Non-Traumatic Chest Pain†
#55 12-Lead Electrocardiogram (ECG) Performed for Syncope†
#56 Community-Acquired Pneumonia (CAP): Vital Signs*
#57   
 
Community-Acquired Pneumonia (CAP): Assessment of Oxygen Saturation*
#58  Community-Acquired Pneumonia (CAP): Assessment of Mental Status*
#59
 
Community-Acquired Pneumonia (CAP): Empiric Antibiotic*
#76  Prevention of Catheter-Related Bloodstream Infections (CRBSI): CVC Insertion Protocol.
Emergency physicians may also report the four CAP measures as a measure group:  
#56 Community-Acquired Pneumonia (CAP): Vital Signs*
#57 Community-Acquired Pneumonia (CAP): Assessment of Oxygen Saturation*
#58 Community-Acquired Pneumonia (CAP): Assessment of Mental Status*
#59 Community-Acquired Pneumonia (CAP): Empiric Antibiotic*

†The Part B claim form place of service field must indicate emergency department
* Clinicians utilizing the critical care code (99291) must indicate the emergency department place of service (23) on the Part B claim form in order to report this measure.

CMS expects to publish measure specifications before December 31, 2009.
Note: Measure #34 “Stroke and Stroke Rehabilitation: Tissue Plasminogen Activator (tPA) Considered,” was retired for 2010.

Updates and additional information are available at www.cms.hhs.gov/pqri. 

Frequently Asked Questions on Reimbursement and PQRI 

ACEP News articles on Physicians Quality Reporting Initiative 

How to Integrate PQRI Measures Into Practice 

Medicare Pay for Reporting Program Kicks Off July 1 

The Physician Quality Reporting Initiative: What Can Emergency Physicians Expect? 

Strive for Quality, Regardless of Performance Measures 

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