PQRI

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Physician Quality Reporting Initiative

“The 2008 Physician Quality Reporting Initiative (PQRI) program was initially launched by the Centers for Medicare and Medicaid Services (CMS) in July 2007. This program encourages quality improvement through the use of clinical performance measures on a variety of clinical conditions. Physicians and other eligible professionals who successfully report on a designated set of quality measures through claims submitted for services provided from Jan. 1 to Dec. 31, 2008, may earn a bonus payment, subject to a cap, of 1.5 percent of total allowed charges for covered Medicare physician fee schedule services.”

http://www.ama-assn.org/ama/pub/category/17432.html

I am by no means an expert on this subject but as this has become an item of concern, I am working on a solution for a customer. So far we have a method of selecting one of the measures linked to an ICD9 code. This selection basically acts as an order with a linked CPT4 code. On selection, the “order” is placed and completed and has a mechanism that warns the provider if this code has been previously selected with in a predetermined time frame. The CPT4 code is dropped into the charge module of the EHR where modifiers can be added before being submitted to the Practice Management System.

As an example”

If we have a patient between the ages of 18-75 with Diabetes Mellitus 250.01 and a hemoglobin A1c greater than 9.0% within the last 12 months. Then measure 01 can be selected, which would add the CPT4 code of 4003046 to the charge module.

We are very much in the design and build phase of this project but we have made some encouraging progress. Once we get this working, it promises to have a high and positive impact on both patient care and pay for performance.


P4P

-Pay for Performance also known as P4P are programs that offer financial rewards to certain clinicians who provide care that meets certain criteria or "standards." This criteria is intended to gauge quality and cost effectiveness.

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