19 June 2007


Some of you may be unaware that the PVRP has been transformed into the PQRI, which starts up as of July 1. Acronym-phobic? OK, I'll elaborate. Last year, CMS -- the Center for Medicare Services -- was setting up the "PVRP," or "Physician Voluntary Reporting Program." This was essentially a pilot program of a data collection system for reporting of physician-specific quality measures.

Well, the 'voluntary' part of that didn't last very long. Now the program, as modified by the "Tax Relief and Health Care Act of 2006" is the Physician Quality Reporting Initative, or PQRI. Basically, when Congress froze the medicare cut last year, the price they exacted was to begin tying dollars to quality reporting for doctors. The amount is small -- this year it's 1.5% of your total medicare reimbursement, and is structured as a bonus on top of your regular Medicare reimbursement. It probably will amount to a few hundred dollars per doc. At this time, the bonus will be paid just for reporting the data, regardless of whether you did a good job meeting the "quality standards" or not. CMS is really just interested in testing their data collection system. As of 2008, CMS is required to have the system in place and larger dollar figures will be tied to the quality reporting (though it is likely this will be pushed back to 2010); more ominously, the reporting system will probably deduct dollars for measures not met, as opposed to the current bonus payment for reporting.

The measures which are tied to Emergency Medicine this year are:

  • Non-traumatic Chest Pain: EKG Performed
  • Acute MI: Aspirin given
  • Syncope: EKG Performed
  • Pneumonia: Vital Signs documented
  • Pneumonia: Oxygen Saturation documented
  • Pneumonia: Mental Status documented
  • Pneumonia: Antibiotics prescribed
  • Advanced Care Directive: plan documented
(Note -- ischemic stroke is no longer a measure for the ED!)

You might think that these are pretty easy quality measures to achieve. That's no accident. ACEP's Reimbursement and Coding committees have been involved in this process and the idea was that we should pick our own measures or somebody else would pick them for us. They deliberately set the bar very low. (Don't say ACEP never does anything for you!) In order to qualify for the bonus, you need to report 80% of the time on 3 measures of your choice. As long as you are aware of the requirement and document the data, your coders should be able to extract it and apply the relevant G-codes.

More information on PQRI can be found here on the CMS web site.

Truly, P4P is here and is not going away. They are too far advanced down this road to back off. This is, I think, only the first of many cost-containment measures thinly disguised as 'quality' measures. It is also an example of the most compelling arguments against a single-payor system: when there is only a single buyer of services, there will be persistent downwards pressure on prices.

Oh, brave new world!

1 comment:

  1. Of course, the cost of our current medical system is a problem for me, but not as much of a problem as our current legal system.

    Treating people fairly can be hard when it comes to important things. High costs of these important things is one significant barrier to fairness.


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