On December 20, 2006 the President signed the Tax Relief and Health Care Act of 2006 (TRHCA), which authorized the Centers for Medicare and Medicaid Services (CMS) to establish and implement a physician quality reporting system. In response to the mandate, CMS created the Physician Quality Reporting Initiative (PQRI).

2007 PQRI

According to CMS, "The PQRI provides 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 July 1 to December 31, 2007, may earn a bonus payment, subject to a cap, of 1.5% of total allowed charges for covered Medicare physician fee schedule services."

Previosly, CMS announced that 2007 PQRI bonus payments would be mailed in mid-July. Only those physicains who successfully reported quality measures in 2007 will receive a bonus check.  Feedback reports were not mailed with bonus payments; rather, they were made available through CMS' IACS web site.  You must register with the IACS site to gain access and view your feedback report. 

Two CMS articles are available to help you access your feedback reports. The first article, “Steps for Individual Eligible Professionals to Access Their 2007 PQRI Feedback Reports Personally”, MM SE0830, can be accessed at, http://www.cms.hhs.gov/MLNMattersArticles/downloads/SE0831.pdf. The second article, “Steps for Organizations to Access Their 2007 PQRI Feedback Reports”, is available at, http://www.cms.hhs.gov/MLNMattersArticles/downloads/SE0831.pdf.

Register for your feedback report at http://www.cms.hhs.gov/MMAHelp/07_IACS.asp.

Additional information about reading your feedback report can be found in slides from the July 9, 2008 CMS PQRI National Provider Call (see below).

Concerns Regarding 2007 PQRI Feedback Reports and Bonus Incentive Payments

On an August 13, 2008, CMS national provider conference call, CMS officials noted that 2007 PQRI payment incentives have now been made to all providers who successfully reported.  Agency officials also noted that it is aware that a number of concerns about the 2007 PQRI feedback reports have been raised.   For example, a number of providers who participated on the call who did not receive a bonus incentive expressed concern that the feedback reports did not correlate with the practice’s records on reporting.  One practice explained that it reviewed its feedback report, which noted it did not successfully report on one of the measures. After an internal investigation within the practice, the administrator noted that the practice had successfully reported according to its billing records and associated Medicare Remittance Advice (RAs).  CMS is looking into this and other matters to determine if a system glitch was present.

ASCRS continues to receive concerns from a number of ophthalmic practices who have experienced the same or similar problems regarding the 2007 PQRI feedback reports and bonus incentive. We are working with CMS leadership and the Iowa Foundation for Medical Care, the CMS contractor responsible for PQRI analysis, to help practices troubleshoot these problems.  

If you have a specific concern or problem related to the 2007 PQRI Feedback Reports, or if you did not receive a bonus and are confident you met all the criteria, we want to hear from you. Please contact the ASCRS Government Relations Department at 703-591-2220 or egraham@ascrs.org.  

2008 PQRI

Last July, CMS proposed a 2008 PQRI. This proposal was finalized in November 2007 as part of the 2008 Medicare Physician Fee Schedule (MPFS) Final Rule.  The 2008 PQRI is similar to the 2007 PQRI in that eligible professionals who successfully report a designated set of quality measures on claims for dates of service from January 1 to December 31, 2008, may earn a bonus payment. The bonus payment will be 1.5% for those who successfully report. 

As reported in our weekly e-newsletter, the Washington Watch Weekly, new  measures were added to the 2008 PQRI and others were been removed.  A complete list of the 2008 PQRI measures and measure specifications are listed below. 

2009 PQRI

The Medicare Improvements for Patients and Providers Act (MIPAA) of 2008 authorized a 2% bonus for those who successfully report quality measures in the proposed 2009 PQRI. 

In the recently released 2009 Medicare Physicain Fee Schedule (MPFS) Proposed Rule, CMS proposed retaining the following ophthalmic measures from the 2008 PQRI:

• Measure 12 – Primary Open Angle Glaucoma (POAG): Optic Nerve Evaluation
• Measure 14 – Age-Related Macular Degeneration (AMD): Dilated Macular Examination
• Measure 18 – Diabetic Retinopathy: Documentation of Presence or Absence of Macular Edema and Level of Severity of Retinopathy
• Measure 19 – Diabetic Retinopathy: Communication with the Physician Managing Ongoing Diabetes Care
• Measure 117 – Diabetes mellitus: Dilated Eye Exam in Diabetic Patient

In addition, CMS is proposing to accept the following ophthalmic measures, which were previously adopted by the AQA Alliance, formerly known as the Ambulatory Quality Alliance (AQA):

• Measure T139 – Cataract: Comprehensive Preoperative Assessment for Cataract Surgery with Intraocular Lens (IOL) Placement)
• Measure T140 – Age-Related Macular Degeneration (AMD): Counseling on Antioxidant Supplement
• Measure T141 – Primary Open-Angle Glaucoma (POAG): Reduction of Intraocular Pressure (IOP) by 15% OR Documentation of a Plan of Care

The above measures are also available for testing beginning in September 2008 as part of the 2008 PQRI, however, no bonus incentive would be paid for testing these measures. Other measures are available to ophthalmologists who use an electronic health record (EHR) or participate in a clinical database registry that has been recognized by CMS.

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Members or their staff who have questions, or need guidance about any PQRI matter, are encouraged to call ASCRS Government Relations staff at 703-591-2220.  We are here to help you!