August 14, 2008

Anesthesiologists and other providers have begun to receive their bonus payments for successfully reporting the applicable Physician Quality Reporting Initiative (PQRI) measures in 2007. As of July 12, 41 ABC clients representing 778 physicians and nurse anesthetists had received checks from Medicare. The maximum received by any one group was $12,124.31.

The PQRI payouts, while mostly under $5,000, are not out of line with expectations. Recall that the payout for 2007 PQRI reporting was 1.5 percent of the total of an individual physician’s allowed Medicare charges for the second half of the year. An average bonus check in the amount of $3,000 would represent $200,000 of Medicare allowables.

It is impossible to derive reliable summary statistics from ABC’s own sample of PQRI payments received to date. The average and the median are both implausibly low because four of the checks received by groups, which averaged 19 providers, were for less than $50. Some groups have received 2 PQRI checks so we probably do not have the final total payment for even the 41 groups who have had a PQRI remittance. There are often weird values—not to use the term “errors”—in Medicare data, which is another reason for caution.

Two things are clear, however. First, many ABC clients are submitting the PQRI documentation because Medicare payments have been so low that any increment helps. Second, and more optimistically, payment alone is not driving anesthesiologists’ attention to preventing surgical wound infection—rates of compliance with antibiotic prophylaxis protocols is becoming higher and higher in U.S. hospitals, and anesthesiologists are continuing to step up to the plate. CMS itself has noted that anesthesiologists’ PQRI participation rate far exceeded the 16 percent national average.

Do you want to see your own Medicare PQRI-2007 performance report?

To do so, you will need to follow three basic steps: (1) register as an “Individual Practitioner” on a password-protected Web site called "Individuals Authorized Access to CMS Computer Services” (IACS); (2) after you receive e-mail confirming your enrollment, request access to the PQRI feedback report application by selecting “PQRI User,” and then (3) go to your report at the web site indicated in the e-mail from CMS.  Sound complicated? That’s Medicare! Further details are available at http://www.cms.hhs.gov/MLNMattersArticles/downloads/SE0830.pdf. ABC clients may ask their account managers for help, too.

How did the PQRI change for 2008?

For 2008, the number of reportable measures increased to 119. Several of the new measures are applicable to anesthesiologists, notably:

#76 - Prevention of Catheter-Related Bloodstream Infections (CRBSI)—Central Venous Catheter Insertion Protocol

This measure may be reported for patients, regardless of age, who undergo central venous catheter (CVC) insertion with all elements of maximal sterile barrier technique followed. Report together with CPT Procedure code for catheter (CVC) insertion or replacement: 36555, 36556, 36557, 36558, 36560, 36561, 36563, 36565, 36566, 36568, 36569, 36570, 36571, 36578, 36580, 36581, 36582, 36583, 36584, 36585.

and

#75 - Prevention of Ventilator-Associated Pneumonia (VAP) – Head Elevation

This measure may be reported for ICU patients aged 18 years and older who
receive mechanical ventilation and who had an order on the first ventilator day for head of bed elevation (30-45 degrees). You can only report head of bed elevation together with the basic CPT® code for critical care, 99291.

(as we advised in our January 2008 letter to “Dear Doctors and Other Professionals.”) Whether it is necessary to report either or both of these two measures in 80 percent of your “eligible” cases – in addition to the antibiotic prophylaxis measure—is a debate that has still not been definitively resolved.

Among the other 2008 measures of interest to anesthesiologists is the one based on participation in a quality data registry, and two new measures for using health information technology and electronic prescribing. The infrastructure for these “structural measures” is not yet in place for most anesthesiologists. ABC is working both to enable our clients to use EMRs and to participate in quality data registries.

What are the most important changes in the 2009 PQRI system?

The bonus payment, which was raised to 2 percent of all allowed Medicare charges by the June Medicare legislation (The Medicare Improvements for Patients and Providers Act or “MIPPA”), will cover claims submitted for the years 2009 and 2010.

The quality measure for e-prescribing will disappear in 2009 because MIPPA itself contains an incentive for e-prescribing.

The PQRI or its successor programs are likely to be with us for some time. Do you want to help shape improvements?

The Medical Group Management Association (MGMA) is asking members to complete a 10-minute survey on their PQRI experience. MGMA, one of the most respected physician advocacy organizations in Washington, will use the aggregated information in lobbying for changes to the PQRI. MGMA members received emails from their association on August 12 and 13 with links to the Survey Monkey page where their responses will be recorded. ABC encourages all MGMA members to participate—by the August 22 deadline.