New Report Analyzes 2007 PQRI Program Reporting Experience

December 17, 2008 - Authorized by Congress, the Centers for Medicare and Medicaid Services (CMS) implemented a pay for reporting program in 2007 known as the Physician Quality Reporting Initiative (PQRI). CMS recently released, “Physician Quality Reporting Initiative: 2007 Reporting Experience.” This report provides an analysis of the 2007 program as well as the Agency’s plan for reducing errors and mitigating unanticipated issues that affected the success of participants.

Data from 2007 shows that approximately 16 percent of eligible professionals participated in the PQRI program and approximately half of these participants were successful and qualified to receive an incentive bonus payment. Success was defined as accurately reporting applicable measures at least 80 percent of the time. Data was analyzed at the individual provider level (NPI) and payments were made at the tax identification number (TIN) level. The average payment at the individual NPI-level was $634.69, and the average payment to the TIN was $4,712.75 based on all NPIs associated with a particular TIN. To date, $36,000,668.96 has been paid out in incentive payments. All participants, regardless of success, received a feedback report.   

In general, incorrect coding was the most common reason cited for an error in submission. 

• Not adhering to measure specifications
  • Incorrect procedure code
  • Incorrect diagnosis code
  • Incorrect procedure and diagnosis code
  • Incorrect age
  • Incorrect gender
• Claims submissions/split billing – all information related to the measure was not on a single claim

Another common error identified by CMS was a lack of an NPI on the claim form. In its analysis, CMS found that the registration process required to obtain feedback reports was cumbersome and time consuming for many participants. Participants who were able to view feedback reports complained that they were difficult to understand and did not explain why they did not qualify for an incentive payment.

Looking forward to 2008, CMS will be making adjustments to its analytics methods for the analysis for 2008 data based on the lessons learned in 2007. Additionally, CMS is applying all modifications to the analytics for 2008 to the 2007 submissions and will rerun the 2007 analysis. The agency expects additional participants will qualify for an incentive payment.

Acceptance Rate of ASH-Related Measures for the 2007 PQRI Program

Measure	# Reported	# Accepted	% Accepted
Chronic Lymphocytic Leukemia (CLL): Baseline Flow Cytometry	9,453	7,308	77.31%
Myelodysplastic Syndrome (MDS) and Acute Leukemias: Baseline Cytogenetic Testing Performed on Bone Marrow	11,800	7.862	66.63%
Myelodysplastic Syndrome (MDS): Documentation of Iron Stores in Patients Receiving Erythropoietin Therapy	12,182	6,606	54.23%
Multiple Myeloma: Treatment with Bisphosphonates	8,478	6,191	73.02%

The full report is available on the CMS Web site. For more information on the PQRI program, visit Resources for Practitioners on the ASH Web site.