Volume 4, #1

April 2007

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PVRP, PQRI, PCPI and How Medicare Pay for Performance is becoming Reality for EPs

Jeff Wajda, DO, MS
Vice President, Cinical Services

The Physician Voluntary Reporting Program (PVRP) was replaced by the Physician Quality Reporting Initiative (PQRI), an initiative that pays physicians for the reporting of quality measures. Under this program, a 1.5% Medicare bonus will be paid to physicians who report these measures between July 1, 2007 and December 31, 2007. Payment is scheduled to occur in the first quarter of 2008. Although this initial incentive is relatively minimal, more significant incentives are planned to follow.

Many physicians are asking about the origins of these quality reporting programs.

The Centers for Medicare and Medicaid Services (CMS) stated that they launched PVRP and PQRI to “build on Medicare’s comprehensive efforts to substantially improve the health and function of our beneficiaries by preventing chronic disease complications, avoiding preventable hospitalizations, and improving the quality of care delivered.” Accordingly, CMS is committed to the development of payment systems that will support and reward quality.” Although currently PQRI will pay for reporting, many believe that it is the first step to a program whereby payment will be tied to quality outcomes.

The ACEP Physician Consortium for Performance Improvement (PCPI) has identified 7 measures that directly apply to ED physicians. These measures were adopted by the Ambulatory Quality Foundation on January 22, 2007 and await final approval by CMS. The final list of measures is scheduled to be published in early April 2007. At this time, the measures include:

1. Electrocardiogram for Non-Traumatic Chest Pain
2. Aspirin at Arrival for AMI
3. Electrocardiogram Performed for Syncope
4. Vital Signs for Community-Acquired Bacterial Pneumonia
5. Assessment of Oxygen Saturation for Community-Acquired Bacterial Pneumonia
6. Assessment of Mental Status for Community-Acquired Bacterial Pneumonia
7. Empiric Antibiotic for Community-Acquired Bacterial Pneumonia

Although these measures apply to Emergency Medicine, a total of 45 measures have been identified by CMS. Development of additional measures is ongoing and currently 85 measures have been identified. The full set of CMS measures can be found at:

http://www.cms.hhs.gov/PQRI

Physicians will report on these measures through a defined set of five digit HCPCS codes (called “G-Codes”), which are reported on the physician claim form. The PQRI program is designed to test the validity of this “G-Code” administrative data approach. The G-Codes are an interim step until the electronic submission of clinical data through the electronic health records replaces this process. Also available, and still evolving, are Category 2 CPT codes that the AMA is developing to utilize in reporting these measures. More important than the billing specifics, however, is physician documentation. One method of capturing this reporting criteria is through the use of LYNX E/Map clinical documentation system. E/Map includes prompts to direct ED physicians in the documentation process, which can later be used to report PQRI measures.

Physician group administrators should begin the work of ensuring that these initiatives are routinely documented by practitioners. Unlike PVRP, no enrollment in PQRI is required and individual practioner performance will be tracked using national provider identification numbers. Contact your LYNX Medical Systems account executive at 800.767.5969 to ensure your group is prepared to report PQRI measures. Or, click here to learn more about reporting quality measures with LYNX.