Physician Quality Reporting Initiative

The Tax Relief and Health Care Act of 2006 authorized a new physician quality reporting program, which the Centers for Medicare & Medicaid Services named the “Physician Quality Reporting Initiative.” PQRI provides bonus payments for physicians who satisfactorily report on a designated set of quality measures. The incentive payments are 1.5% of the total allowed charges for Medicare physician fee schedule services (subject to a cap).

The 2007 PQRI program covered professional services furnished to Medicare beneficiaries between July 1 and December 31, 2007. Professionals who participated in the 2007 PQRI program may continue to report quality-data codes through February 29, 2008, on claims for dates of service through December 31, 2007.

The program was renewed for 2008 through the 2008 Medicare Physician Fee Schedule final rule. The rule identifies 119 measures that CMS determined to be appropriate for eligible professionals to use to submit data under the 2008 PQRI program. Information on the PQRI program, including specifications for the 119 measures, is posted on the CMS web site.

The following 10 measures are most applicable to rheumatologists:

• 4. Screening for Future Fall Risk
• 24. Osteoporosis: Communication with the Physician Managing Ongoing Care Post Fracture
• 39. Screening or Therapy for Osteoporosis for Women Aged 65 Years and Older
• 40. Osteoporosis: Management Following Fracture
• 41. Osteoporosis: Pharmacologic Therapy
• 108. Disease Modifying Anti-Rheumatic Drug Therapy in Rheumatoid Arthritis
• 109. Patients with Osteoarthritis who have an Assessment of Their Pain and Function
• 124. HIT – Adoption/Use of Health Information Technology (Electronic Health Records)
• 125. HIT – Adoption/Use of e-Prescribing
• 131. Pain Assessment Prior to Initiation of Patient Treatment

For details about these measures, click here.

The program is voluntary, and no enrollment is required. Physicians interested in participating simply need to choose which measures they will report on and begin reporting. However, because participants are required to report on at least 80% of the cases in which each measure is reportable during calendar year 2008, physicians who plan to participate should begin as early in the year as possible to increase their chances for successful participation and bonus payment.

Physicians will need to report by using the appropriate CPT Category II codes or G-codes. When reporting the codes, reimbursement should be listed as a zero ($0.00) or minimal ($.01) charge, as this field cannot be left blank. It will appear to office staff that the codes are denied. However, the quality-data codes reported will be accepted into the system, analyzed, and considered in bonus payment eligibility calculations.

More details on PQRI requirements and coding can be found on the CMS web site. If you have specific questions about coding, please contact or phone 404-633-3777 x820.

To view and print a quick practical / coding reference guide for the measures applicable to rheumatology in pdf format, click here.

CMS provides informational conference calls on PQRI from time to time. Information about these calls will be posted here as it becomes available. To receive call-in information, you must register for the calls. For those unable to attend, a replay option will be available shortly following the end of each call. This replay will be accessible for several days following each of the calls. In addition, PowerPoint slides from recent calls are archived on the CMS web site and can be accessed at http://www.cms.hhs.gov/PQRI/02_CMSSponsoredCalls.asp#TopOfPage.

CMS has developed a Tool Kit for the 2008 Physician Quality Reporting Initiative (PQRI) that will assist eligible professionals with successful reporting. This Tool Kit consists of some existing educational resources plus new measure-specific worksheets designed to walk the user step-by-step through reporting for each measure.

The Tool Kit consists of the following:

The Tool Kit can be accessed directly by visiting http://www.cms.hhs.gov/PQRI/31_PQRIToolKit.asp.

The AMA has developed some very helpful tools to aid physicians and other eligible professionals wishing to participate in the program to 1) identify measures relevant to their practice and 2) facilitate the data collection required to report clinical performance data. For each of the 119 measures in the program, the tools are available online at http://www.ama-assn.org/go/toolsMedicarePQRI.