PQRI (physician quality reporting initiative) heading toward PQRS (physician quality reporting system)

On March 8th, 2011, posted in: Industry News, Tips by

Ultimately, the focus is turning to clinical quality measure data collection which will shift payment methodology to performance improvement. Clearly, the slow migration has begun to establish a pay-for-performance reimbursement system where clinical data will help drive quality improvement in health care. CMS is required to develop a plan by 2010 outlining how to integrate the PQRS measures with the EHR meaningful use incentive program. The 2011 proposed rule specifically sought comments on how best to align the two incentive programs and stated:

“In an effort to align PQRI with the EHR incentive program, we propose to include many American Recover and Reinvestment Act (ARRA) core clinical quality measures in the PQRI program to demonstrate meaningful use of EHR and quality of care furnished to individuals. We propose the selection of those measures to meet the requirements of planning the integration of PQRI and EHR reporting.”

Although claim based reporting is still allowed, CMS has reported there is only a 50% success rate (in 2009), while using a registry the success rate jumped to 90%. What’s the better option of the two? Both have negatives and positives. See the chart (as printed in AAPC) below. Decide which will work best for your practice.

To learn more about PQRS codes, go to: www.cms.ggov/PQRI/15_MeasuresCodes.asp#
Go to the link labeled “Additional 2011 Physician Quality Reporting System Measure Documents” – open 2011 PQRS measures groups specifications manual.