Medicare Paid Over $92 Million In Incentives For 2008 Under The Physician Quality Reporting Initiative

Main Category: Medicare / Medicaid / SCHIP
Article Date: 15 Nov 2009 - 1:00 PST

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More than 85,000 physicians and other eligible professionals who successfully reported quality-related data to Medicare under the 2008 Physician Quality Reporting Initiative (PQRI) received incentive payments totaling more than $92 million, the Centers for Medicare & Medicaid Services (CMS) announced today, well above the $36 million paid in 2007.

The number of eligible professionals who earned an incentive payment increased by one-third from 2007, when 56,700 eligible professionals earned an incentive payment. In 2007, eligible professionals could only participate in the program during a 6-month reporting period. In 2008, the program expanded to allow reporting for either a 6-month or a 12-month period.

"We are very pleased with the results for 2008," said Charlene Frizerra, Acting CMS Administrator. "More health professionals have successfully reported data, and the substantial growth in the national total for PQRI incentive payments demonstrates that Medicare can align payment with quality incentives.

Established in late 2006 by the Tax Relief and Health Care Act, PQRI is a voluntary program that allows physicians and other eligible healthcare professionals to receive incentive payments for reporting data on quality measures related to services furnished to Medicare beneficiaries. In the initial program years, physicians and other eligible professionals who satisfactorily submitted quality data for covered professional services furnished in the applicable reporting period were able to receive incentive payments of 1.5 percent of the total estimated allowed charges under Medicare Part B for covered professional services.

Physicians and other eligible professionals who satisfactorily reported PQRI quality measures data and thus qualified for an incentive payment for the 2008 PQRI received their payments this fall. The average incentive amount for individual professionals is over $1,000, with the largest payment to an eligible professional totaling over $98,000.

More than 153,600 professionals participated in the 2008 PQRI. Of those, over 85,000 physicians and other eligible professionals met statutory requirements for satisfactory reporting for the 2008 reporting period and are receiving incentive payments.

"We are not surprised that more eligible professionals participated and qualified for higher payments under the PQRI in 2008," said Barry M. Straube, M.D., CMS Chief Medical Officer and Director of the Agency's Office of Clinical Standards & Quality. "For the 2008 program year, CMS made a concerted effort to include as many provider types, and as many medical specialties, as possible in our menu of PQRI quality measures to assure that we were capturing the full spectrum of the health care services that Medicare beneficiaries receive. We also worked with national stakeholder groups to make improvements in the program from 2007 to 2008 and to promote education and outreach efforts to support eligible professionals in participation."

Eligible professionals from all U.S. states and territories participated in PQRI in 2008. Health practices with participating eligible professionals in Florida and Illinois received the highest incentive payments for the 2008 PQRI. In Florida , eligible professionals received a total of over $7.5 million, and in Illinois , they received over $6 million.

In 2008 Congress extended the PQRI under the Medicare Improvements for Patients and Providers Act (MIPPA) and authorized incentive payments through 2010. While the 2008 PQRI program included positive changes to ease the reporting of quality measures, the 2009 PQRI program provides enhancements that will make it even easier for physicians and other health care professionals to participate.

Beginning in 2009, Congress increased the incentive that eligible professionals could receive for satisfactorily reporting data from 1.5 percent to 2.0 percent of the estimate of the allowed charges under Medicare Part B for all such covered professional services furnished during the applicable reporting period for 2009 and 2010. CMS added 52 new quality measures for the 2009 PQRI year, raising the total number of measures to 153. These new measures cover all types of healthcare professionals who provide services to Medicare beneficiaries, and address areas such as osteoarthritis, back pain, coronary artery disease, and HIV/AIDS, as well as 18 measures that must be reported exclusively through PQRI-qualified registries.

CMS recently announced its plan for the 2010 PQRI Program as part of the Medicare Physician Fee Schedule final rule. A fact sheet on the 2010 PQRI Program is available online here.

Additional 2008 PQRI results, as well as information on how eligible professionals who participated in the 2008 PQRI, can access confidential feedback reports can be found in a CMS Fact Sheet here.

More information about the PQRI program, including participation guidance and the criteria to qualify for an incentive payment is available at http://www.cms.hhs.gov/PQRI.

Source
Centers for Medicare & Medicaid Services