Physician Quality Reporting Initiative PQRI Measures

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					Physician Quality Reporting
Initiative (PQRI) Measures

                                Prepared by:
                          Jonathan Heidt MD
                      Washington University
                  School of Medicine St. Louis
                What is PQRI?

• The 2006 Tax Relief and Health Care Act
  (TRHCA) required the establishment of a
  physician quality reporting system.
  – Reauthorized in 2007, permanent in 2008
  – Incentive payment for voluntarily reported
    data on quality measures
                What is PQRI?

• The goals of this program were to:
  1. Improve the quality of healthcare for
     Medicare recipients
  2. Transition the Centers for Medicare and
     Medicaid Services (CMS) towards becoming
     an “active” rather than “passive” payer in an
     attempt to control costs.
               What is PQRI?

• Currently, incentives are paid for simply
  reporting on designated quality measures.

• It is anticipated that PQRI will be
  transitioned to a “pay for performance”
    What Quality Measures are Included?

• The 2009 PQRI measure list identifies 153
  quality measures and 7 measure groups.

• Nine are considered to be “emergency
  medicine” measures.
    What Quality Measures are Included?

• # 28 ASA at arrival for acute myocardial
• #31 DVT Prophylaxis for ischemic stroke
  or intracranial hemorrhage
• #34 TPA considered for ischemic stroke
• #54 12 lead ECG for non traumatic chest
    What Quality Measure Are Included?

• # 55 12 lead ECG for syncope
• #56 Vital signs reviewed for community
  acquired pneumonia (CAP)
• #57 Assessment of oxygen saturation in
• #58 Assessment of mental status in CAP
• #59 Initiation of antibiotics in CAP
   Who Chooses These Quality Measures?

• Multiple public / private groups involved

• Any entity may suggest a PQRI measure
  – Majority have been by the AMA PCPI
    (Physician Consortium for Performance
  – ACEP is a member of PCPI
           How Does PQRI Work?

• Providers are eligible by choosing three
  measures to report.

• The measures are then reported to CMS

• If a reporting rate of at least 80% is
  provided, providers receive a bonus
  payment of 2%.
            Are There Problems
           Associated with PQRI?

• The underlying assumption of this program
  is that physicians will change their practice
  based on financial incentives.

• These changes in practice are then
  anticipated to improve the quality of
  healthcare and reduce overall costs.
     What Concerns about PQRI Exist?

1. Quality measures are not always easy to
   report and may reflect patient compliance
   instead of only physician performance.

2. Some of the PQRI measures may not be
   based on current evidence based
     What Concerns about PQRI Exist?

3. There is a new movement to include
   process measures such as door to
   physician and door to discharge times
   which would not be practical in many

4. Quality measures can threaten physician
   autonomy by pressuring physicians to
   complete measures which may not be the
   best course for an individual patient.
     What Concerns About PQRI Exist?

5. Quality measure performance could be
   made available to the public which could
   be misleading to patients in regards to a
   physician’s quality.
      Why Should EM Residents Care?

• The move towards a pay for performance
  system appears inevitable.
• The transition to a new payment structure
  will have an impact on emergency
  medicine in both payment and
  professional practice.
• As new physicians enter into practice, they
  will be most affected by these new
      Why Should EM Residents Care?

• Current residents are in the unique
  position to influence the structure of a
  future payment system and policy
• A passive approach will lead to the
  development of policy by lawyers and
  politicians which could be detrimental to
  the practice of medicine and patient care.

• Centers for Medicare and Medicaid Services:
• American College of Emergency Physicians
• EMRA Emergency Medicine Advocacy