FPs Can Qualify for 1.5 Percent Medicare Bonus

As of July 1, family physicians and other qualified professionals can earn a 1.5 percent bonus payment from Medicare for participating in CMS' physician quality reporting initiative, or PQRI.

PQRI incorporates a financial incentive for physicians to report on a designated set of quality measures and to do so for 80 percent of their Medicare patients to whom those measures pertain. The program, which runs from July 1 to Dec. 31, was established as a result of the Tax Relief and Health Care Act of 2006.

PQRI replaces the Physician Voluntary Reporting Program, which did not offer financial incentives to participants.

According to Bruce Bagley, M.D., AAFP's medical director of quality improvement, FPs who participate in PQRI, also a voluntary program, could earn bonus payments during the six-month reporting period that range from $400 to $1,400.

Bonus payments will be calculated on physicians' total Medicare billings for the second half of 2007 rather than only on billings that include the selected PQRI measures. Bagley said that physicians can estimate PQRI bonus earnings by dividing their total 2006 Medicare revenue from physician fee schedule charges in half and multiplying the total by 1.5 percent.

In addition to a financial incentive, Bagley said physicians who choose to participate most likely would see improved patient care and gain valuable expertise in how to handle the reporting of quality measures. And that expertise may come in handy in the future. At the AAFP's National Conference of Special Constituencies, held May 3-5 in Kansas City, Mo., Bagley predicted that during the next five years, as much as 30 percent of total physician compensation could be related to performance measures. By comparison, in 2005, just 20 percent of all physicians had a portion of their pay tied to quality measures.

Bagley suggested family physicians pick three measures that apply to the same subset of patients. For many family physicians, patients with diabetes would be a logical choice. The physician would choose three diabetes-related measures, such as hemoglobin A1c, low-density lipoprotein and blood pressure levels, and then would report those same three measures for 80 percent of his or her Medicare patients with diabetes.

Although the details of PQRI may seem daunting at first glance, Bagley broke the process down into four easy-to-understand steps for his NCSC audience. He told physicians to

No registration is required to participate, but participants must include their National Provider Identifier number on claims filed. Physician bonus payments will be made as lump sums in mid-2008. In group practices, payment will be made to the holder of the federal tax identification number. PQRI quality data will not be publicly reported, but physicians may request individual feedback reports from CMS in mid-2008.

Additional PQRI details are available on CMS' Web site, which also includes a complete list of the 74 measures (PDF file: 8 pages / 64 KB. More about PDFs.) included in the program; only 27 of those measures apply to family physicians' patients, however.

To help ensure member success with the PQRI, the Academy has developed several tools to help physicians collect performance measures at the time of service. The tools are available online in a Microsoft Excel spreadsheet format and include a physician data collection sheet and a coder data collection sheet.

The data collection sheets list the 27 reporting measures pertinent to family physicians, as well as their corresponding codes and modifiers. Users will see a description of each measure's requirements and how often the measure must be reported.

Physicians can customize the spreadsheets by deleting all measures except those they have chosen to report.

More information about how to use the AAFP's PQRI tools is available at the site. E-mail questions about the tools to Cynthia Hughes, C.P.C., AAFP's coding and compliance specialist.