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Physician Quality Reporting Initiative

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The 2009 Physician Quality Reporting Initiative (PQRI) continues to provide a financial incentive for eligible professionals to participate in a voluntary quality reporting program. Eligible professionals who successfully report a designated set of quality measures on claims for dates of service from January 1, 2010, to December 31, 2010, may earn a bonus payment, subject to a cap, of 2.0 percent of total allowed charges for covered Medicare physician fee schedule services.

ASH Participation in Performance Measures

In 2005, Congress and the Centers for Medicare and Medicaid Services (CMS) became increasingly interested in developing a pay-for-performance (P4P) program for physicians treating Medicare beneficiaries. In part, Congress believed that it could achieve significant savings in the Medicare program by improving quality of care and consequently reducing hospitalizations. Following the approval of the ASH Executive Committee, the ASH Committee on Practice created a special task force to devise formal criteria for hematology-related performance measures. The Task Force worked closely with CMS to develop appropriate quality measures for hematology and submitted five draft measures to the agency for review. Ultimately, four hematology-related quality measures developed by ASH were approved and included in PQRI. In addition, the measures addressing electronic health records may qualify.

ASH participates regularly with the Ambulatory Quality Alliance, National Quality Forum, and American Medical Association-Physician Consortium via the Hematology Work Group, and has membership in the Oncology Work Group. ASH is also continuing to work with policy makers to ensure that future pay-for-performance programs will appropriately address hematology.

PQRI News and Resources

2010 PQRI & Electronic Prescribing Incentive Program National Provider Call with Question & Answer Session
The CMS Provider Communications Group will host a national provider conference call on the 2010 Physician Quality Reporting Initiative & Electronic Prescribing Incentive Program. This toll-free call will take place from 1:30 p.m. - 3:30 p.m., EST, on Wednesday, March 10th,  2010. Call participants can register and access a transcript one week after the call on the CMS website.

2010 Physician Quality Reporting Initiative (PQRI) Program: Participation Provides Financial Bonus
The 2010 Physician Quality Reporting Initiative (PQRI) will continue to provide a financial incentive for professionals to participate in its voluntary quality reporting program. Eligible professionals who successfully report a designated set of quality measures on claims for dates of service from January 1, 2010, to December 31, 2010, may earn a bonus payment up to 2.0 percent of total allowed charges for covered Medicare physician fee schedule services. Hematologists can participate for the entire year or for half of the year and by claims or possibly by registry. ASH strongly encourages hematologists to participate in the PQRI program. There are four hematology measures that ASH has developed. In addition, there are other measures which a hematologist may be able to submit.

2010 PQRI & Electronic Prescribing Incentive Program National Provider Call with Question & Answer Session
The CMS Provider Communications Group hosted a national provider conference call on the 2010 Physician Quality Reporting Initiative & Electronic Prescribing Incentive Program on January 12, 2010. Call participants can access a transcript one week after the call on the CMS website.

Center for Medicare and Medicaid Services' (CMS) PQRI Web Site
The CMS Web site's PQRI section has numerous useful links and documents. The following 2010 educational products are available on the website:

  • 2010 PQRI Quality Measure List: this document identifies the 179 quality selected for the 2010 PQRI.
  • 2010 PQRI Quality Data Code (QDC) Categories: a table that outlines, for each measure, each QDC that should be reported for a corresponding quality action performed by the individual EP as noted in the measures specification. This determines how each code will be used when calculating performance rates. This also clarifies those measures that require 2 or more QDCs to report satisfactorily. Insufficiently reporting the QDCs (as specified in the 2010 PQRI measure specifications) will result in invalid reporting.
  • 2010 Single Source Code Master: this file includes a numerical listing of all codes included in 2010 PQRI for incorporation into billing software.
  • 2010 PQRI Measure Specifications Manual for Claims and Registry; Reporting of Individual Measures and Release Notes: this zip file contains two documents which are the authoritative documents that describe 1) the 2010 measure specifications (including codes and reporting instructions) for the 175 individual PQRI quality measures for claims or registry-based reporting and 2) changes from the 2009 PQRI Measure Specifications in the form of release notes delineated by measure number.
  • 2010 PQRI Implementation Guide: provides guidance about how to implement 2010 PQRI claims-based reporting of measures to facilitate satisfactory reporting of quality data codes by EPs.

PQRI National Provider Call with Question & Answer Sessions
The CMS Provider Communications Group hosts national provider conference calls throughout the year. Call information, including transcripts, can be accessed on the CMS website.

The topics covered on this national provider call included:

  • Alternate feedback report request process;
  • Update on incentive payments and feedback reports;
  • Results from the 2008 PQRI and 2007 PQRI re-run; and
  • Measures issues identified in 2008 PQRI.

New and Revised Medicare Learning Network Articles on the 2009 PQRI

The following new and revised articles have been published on the CMS website:

Slide Presentation - PQRI and E-Prescribing: Nuts and Bolts

General

CMS Provides Instructions for Accessing PQRI Feedback Reports

CMS has published two articles that give step-by-step instructions for professionals and organizations to access their 2007 PQRI Feedback Reports. The articles for individual professionals and for organizations are available on the CMS Web site.

Centers for Medicare and Medicaid Services' (CMS) 2009 PQRI Tool Kit

ASH Hematology Quality Metrics

Intended Audience and Patient Population:
Any hematologist caring for patients age 18 years and older with myelodysplastic syndrome, acute leukemias, multiple myeloma, or chronic lymphocytic leukemia.

These clinical performance measures are designed for individual quality improvement. Some of the measures may also be appropriate for accountability if appropriate sample sizes and implementation rules are achieved.

The following Health Information Technology Measure may also be of use to hematologists:

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