The Pluses of PQRI: Experience, Quality Competition, Extra Income

Dr. Filipi is vice president of medical affairs at the Methodist Physicians Clinic in Omaha, Neb., and is a member of the AAFP Commission on Quality.

The nearly 50 family physicians of Methodist Physicians Clinic in Nebraska and Iowa are generally enthusiastic supporters of CMS’ Physician Quality Reporting Initiative, or PQRI.

When PQRI was first introduced, our finance managers recognized the impact of an additional 1.5 percent on the Medicare revenues of our 150-physician practice. Those managers encouraged us to devote sufficient resources to achieve this bonus.

Early on, we engaged our coding and billing department to help us develop tools and processes to successfully capture the quality codes needed. We also met with each clinical department to determine which indicators made the most clinical sense for their practices, recognizing the differences between hospitalists, surgeons and primary care physicians.

Our goal was to minimize physician work effort to capture these quality codes, adding just a few more seconds to each targeted encounter. We were able to achieve that through brightly colored stickers, affixed to the encounter sheet of each targeted diagnosis.

In addition, we added an inspection process to be certain that quality codes were present before the bill was sent to Medicare. We decided to follow this process for all targeted diagnoses for all payers.

Our physician leadership team determined that physicians earning bonuses would be directly paid 40 percent of the amount earned, with 40 percent returning to their practice overhead and the remaining 20 percent kept back for implementation and rewards for future quality projects.

We spent little time discussing the philosophy of such concepts as payment for reporting or payment for performance. Rather, we generally recognized that this is the latest in a number of insurance trends, that of clinical quality transparency.

Participation gave us experience, the opportunity to compete within our group on clinical quality outcomes, and a little extra personal income. Participation challenged us to confirm and improve our practice of medicine.

Ultimately, however, our success at Methodist Physicians Clinic came from our ability to work with coders, billers and operations personnel to make reporting easy for our physicians.