The next phase of the PQRI program will start on January 1. I doubt, though, that many internists are wishing it a Happy New Year.
The PQRI, which was authorized by Congress in 2006, is the Physicians' Quality Reporting Initiative, the federal government's first foray into pay-for-performance for doctors. Starting on July 1 through December 31, 2007, physicians who agreed to voluntarily report on selected quality measures were promised they could earn Medicare bonus payments of up to 1.5 percent of total allowed charges.
By the federal government's own account, the program was a less than a resounding success. The Centers for Medicare and Medicaid Services (CMS), the agency that administers the program, reports that "approximately 16 percent of eligible professionals participated (submitted at least one quality data code) in the program. Of those who participated, just over half were successful in meeting the program and reporting requirements and as a result received an incentive payment."
CMS acknowledges that there were many problems with the program, including claims-based reporting mechanisms issues, National Provider Identifier (NPI) numbers not being included on the claims forms, incorrect quality reporting data or claims submission errors and the content of the feedback reports to physicians.
It promises to do better in 2009.
In my mind, the agency will have to do a lot better. The way the PQRI program was designed and implemented almost seemed designed to discredit the idea of P4P among (already skeptical) physicians. Successful quality improvement programs provide regular feedback to clinicians on how they are doing. Rewards for reporting should be greater than the costs and hassles of reporting. The rewards should be predictable (if I do x, I will receive y). And the timing of providing the rewards should be closely linked to when the reporting took place.
None of this was the case with PQRI. PQRI physicians largely were kept in the dark about how they were doing. The maximum bonus payments likely didn't even cover their costs. Physicians didn't receive their performance-based payments, if they received anything at all, until as much as six months after the reporting year closed.
Internists now have to decide whether to give the PQRI another go in 2009. This time, the stakes are higher: successful reporting can result in bonus payments of up to 2 percent of allowed charges. ACP has extensive resources on the PQRI to help you decide, which are being updated for the new program year.
Despite the problems with PQRI, I believe that performance measurement and reporting are here to stay. Medicare views the PQRI as one of the first steps towards value-based purchasing, as do key legislators like Senator Max Baucus (D-MT) and Chuck Grassley (R-I0). Done correctly, reporting on quality measures may help internists deliver better care to patients - and earn higher payments for doing so.
Today's questions: Did you participate in the 2007 and 2008 PQRI programs? Why or why not? What was your experience if you did - and how can it be improved? Will you participate in 2009?