U.S. PHYSICIANS- A METHOD TO REPORT QUALITY MEASURES FOR CMS PAY-FOR-PERFORMANCE BONUS COMPENSATION

OBJECTIVES: The U.S. Centers for Medicare and Medicaid Services (CMS) has adopted a Medicare quality incentive pay-for-performance concept. This study explores CMS's implementation of the Physician Quality Reporting Initiative (PQRI), including measurement development, reporting guidelines and the proposed methods by which physicians will be compensated for participation. METHODS: PQRI guidance provided by CMS was collected, arranged in order of issuance, abstracted and analyzed. Ongoing corrections and modifications were noted as appropriate. A compilation of suggested PQRI-relevant resources was also created as part of the project. RESULTS: The Tax Relief and Healthcare Act (TRHCA) Division B, Title I, Section 101 provides statutory authority for PQRI. The TRHCA defines eligible professionals; quality measures themselves, as well as reporting methods and processes for obtaining bonus payment. The initial reporting period commences July 1, 2007 and ends December 31, 2007. During this period 74 quality measures may be reported. If 4 or more measures are applicable to the physician practice, the practitioner must report at least 3 correctly for 80% of applicable cases. If 3 or fewer measures are applicable to the practice, the practitioner must report each of them correctly for 80% of the cases. Cases may be either visits or patients, depending upon the particular measure. Professionals that report successfully are eligible for a 1.5% bonus payment (pay-for-performance), subject to a cap. The bonus payment calculation method is determined by using total allowed charges for covered professional services that are furnished during the reporting period and are paid under the CMS Physician Fee Schedule. CONCLUSION: Physician practices must adhere to the appropriate method for coding and reporting quality measures in order to obtain relevant bonus compensation. It is vital for physician practice decision-makers to understand and comply with the CMS reporting methodology in order to reap the accompanying monetary compensation.