Physician Quality Reporting Initiative
Physician Quality Reporting Initiative
“The 2008 Physician Quality Reporting Initiative (PQRI) program was initially launched by the Centers for Medicare and Medicaid Services (CMS) in July 2007. This program encourages quality improvement through the use of clinical performance measures on a variety of clinical conditions. Physicians and other eligible professionals who successfully report on a designated set of quality measures through claims submitted for services provided from Jan. 1 to Dec. 31, 2008, may earn a bonus payment, subject to a cap, of 1.5 percent of total allowed charges for covered Medicare physician fee schedule services.”
http://www.ama-assn.org/ama/pub/category/17432.html
I am by no means an expert on this subject but as this has become an item of concern, I am working on a solution for a customer. So far we have a method of selecting one of the measures linked to an ICD9 code. This selection basically acts as an order with a linked CPT4 code. On selection, the “order” is placed and completed and has a mechanism that warns the provider if this code has been previously selected with in a predetermined time frame. The CPT4 code is dropped into the charge module of the EHR where modifiers can be added before being submitted to the Practice Management system.
As an example
If we have a patient between the ages of 18-75 with Diabetes Mellitus 250.01 and a hemoglobin A1c greater than 9.0% within the last 12 months. Then measure 01 can be selected, which would add the CPT4 code of 4003046 to the charge module.
We are very much in the design and build phase of this project but we have made some encouraging progress. Once we get this working, it promises to have a high and positive impact on both patient care and pay for performance.
On a related note I found some interesting performance measures regarding the use and adoption of the EHR.
Measure #124
HIT – Adoption/Use of Health Information Technology (Electronic Health Records)
Note: This measure applies only to physicians who have already adopted an Electronic Health Record.
Description: Documents whether provider has adopted and is using health information technology. To qualify, the provider must have adopted a qualified electronic medical record (EMR). For the purpose of this measure, a qualified EMR can either be a Certification Commission for Healthcare Information Technology (CCHIT) certified EMR or, if not CCHIT certified, the system must be capable of all of the following:
- Generating a medication list
- Generating a problem list
- Entering laboratory tests as discrete searchable data elements
Measure #125
HIT – Adoption/Use of e-Prescribing
Note: This measure applies to physicians who have already adopted electronic prescribing.
Description: Documents whether provider has adopted a qualified e-Prescribing system and the extent of use in the ambulatory setting. To qualify this system must be capable of ALL of the following:
- Generating a complete active medication list incorporating electronic data received from applicable pharmacy drug plan(s) if available
- Selecting medications, printing prescriptions, electronically transmitting prescriptions, and conducting all safety checks (defined below)
- Providing information related to the availability of lower cost, therapeutically appropriate alternatives (if any)
- Providing information on formulary or tiered formulary medications, patient eligibility, and authorization requirements received electronically from the patient’s drug plan
- Generating a complete active medication list incorporating electronic data received from applicable pharmacy drug plan(s) if available
- Selecting medications, printing prescriptions, electronically transmitting prescriptions, and conducting all safety checks (defined below)
- Providing information related to the availability of lower cost, therapeutically appropriate alternatives (if any)
- Providing information on formulary or tiered formulary medications, patient eligibility, and authorization requirements received electronically from the patient’s drug plan
