Medicare Pays $36 Million to Doctors, Other Health
Professionals for Quality Reports
CMS says payments go to 56,700 health professionals
in Physician Quality Reporting Initiative
July
15, 2008 Physicians that treat Medicare patients have been fighting in
Congress to prevent a cut in their pay, but many of them will share in
more than $36 million in bonus payments being paid by the Centers for
Medicare & Medicaid Services to 56,700 health professionals for
reporting quality information to Medicare.
Creating a value-based purchasing system is a
critical way to improve our health care systems. By collecting quality
data, health care providers can use the information to improve the
quality care of beneficiaries, said Health and Human Services Secretary
Michael Leavitt.
The 2007 Physician Quality Reporting Initiative (PQRI)
established the reporting system and bonus payments.
Physicians, physician group practices, and other
PQRI eligible professionals should receive their payments by August
2008. The average incentive amount for individual professionals is over
$600 and average incentive payment for a physician group practice is
over $4,700, with the largest payment to a physician group practice
totaling over $205,700.
These payments to physicians for participating in
the PQRI are a first step toward improving how Medicare pays for health
care services, said CMS Acting Administrator Kerry Weems.
We all can agree that the current payment system
needs to be reformed to pay for high quality care rather than continuing
to pay for the volume of services. The PQRI has proven to be a
successful step towards establishing a value-based purchasing program
for physicians.
The PQRI is a voluntary program and, in accordance
with a law passed by Congress late in 2006, physicians and other
eligible professionals are able to receive bonus payments of 1.5 percent
of their total allowed Medicare charges, subject to a cap, by
satisfactorily submitting quality information for services they furnish
between July and December of 2007.
More than 109,000 professionals participated in the
2007. Of those, over 56,700 physicians and other eligible professionals
met statutory requirements for satisfactory reporting for the 2007
reporting period and are receiving incentive payments.
The 2007 reporting period received participation in
all 50 states, including D.C., Puerto Rico, Virgin Islands and Guam. Of
all the participating states and territories, health professionals in
Florida and Illinois are receiving the highest incentive payments for
the 2007 reporting period. In Florida, they will receive a total of
over $3 million and Illinois a total of over $2 million.
While the 2007 PQRI was a positive step towards
reporting quality information, the 2008 PQRI program included
significant enhancements in terms of the scope of measures that could be
reported, the opportunity to receive incentive payments for the entire
year, ability to report measures within a group for a specified number
of patients, and the use of registries to report quality measures,
according to CMS.
All eligible professionals that participated in the
2007 PQRI can begin accessing confidential feedback reports that
aggregates the data they submitted and shows them how they compare with
other participants. Providers must register with the Individuals
Authorized Access to CMS Computer Services Provider Community (IACS-PC)
to access the feedback reports.
The 2008 PQRI program has grown to include 119
quality measures which were published in the Physician Fee Schedule for
2008. Leading physician organizations participated in the development of
the PQRI program measures.
Nearly all of the measures are clinical performance
measures, such as the percentage of patients who received necessary
mammograms and cancer screenings. There are also two structural measures
that focus on the use of electronic health records and electronic
prescribing technology.
As an alternative to submitting 2008 PQRI quality
data as part of their Medicare claims submissions, eligible
professionals may choose to report data on quality measures through a
medical registry, and these registries will then report that data to
CMS.
Registry-based reporting will provide another way
for eligible professionals to qualify for an incentive
payment. Participating eligible professionals who dont report through
a registry may choose to report data on either individual measures or on
groups of measures that capture a number of data elements about common
care processes for diabetes, kidney disease and preventive medicine.
Registry-based reporting and reporting on groups of
measures will provide more ways for eligible professionals to quality
for an incentive payment.
The PQRI is the first step toward bringing about
changes in the way Medicare pays physicians and restoring stability and
predictability to Medicares physician payment program, according to a
news release from CMS.
The current payment system has been acknowledged
by many health care policy experts for its several failings, including
rewarding volume and episodic care over quality; exposing Medicare to
rapid growth in spending without evidence of more spending leading to
better care; and failing to focus on prevention and coordination of
care, the statement said.
The PQRI is part of the Presidents Value-driven
Health Care Agenda that, according to CMS, seeks to address current
problems in the health care sector regarding preventable errors, uneven
quality of care and rising health care costs.
More information about the PQRI program, including
how eligible professionals can participate and the criteria to qualify
for an incentive payment is available at
www.cms.hhs.gov/PQRI.
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July
15, 2008 Physicians that treat Medicare patients have been fighting in
Congress to prevent a cut in their pay, but many of them will share in
more than $36 million in bonus payments being paid by the Centers for
Medicare & Medicaid Services to 56,700 health professionals for
reporting quality information to Medicare. 
July
4, 2008