Part of the Equation

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Description: Jul 1, 2008 marked the first anniversary of the Physician Quality Reporting Initiative (PQRI), the pay-for-performance program of the CMS. PQRI participants are rewarded with incentive payments from CMS if they report their performance of certain evidence-based quality measures. PQRI may not be a goldmine, but it's not insignificant, either. In 2005, Medicare spent $94.5 billion on physician services, according to Congressional Budget Office testimony. If, as Medicare has stated, 15.74% of eligible healthcare professionals equates to 99,319, then there are 630,997 providers eligible to participate. Conservatively, the average Medicare reimbursement per provider therefore comes to $149,763. The average 12-month 2008 incentive payment would be 1.5% of that ($2,246). For several reasons, 2008 participation should grow. First, there will be no payment cap limiting the 1.5% calculation. Second, there are several reporting options for 2008. Third, providers have more options. Given its momentum and rapid pace of change, PQRI is not going away.
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