Preliminary Report Offers First Glimpse of Quality Reporting Progress

Tens of thousands of health care providers -- some of them family physicians -- will collect a little extra cash later in 2008 because of their participation in CMS' 2007 Physician Quality Reporting Initiative, or PQRI. That's according to preliminary data recently released by CMS in response to an inquiry from Sen. Max Baucus, D-Mont., chair of the Senate Finance Committee, about the initiative's progress.

Specifically, the CMS report reveals that 15.74 percent (99,319 providers) of all professionals eligible to participate in the 2007 PQRI program attempted to do so. Of those providers, 92,218 individuals submitted at least one measure successfully. The report also shows that on average, providers attempted to report slightly more than three measures.

The data have not been released to the public and were described by CMS as "very preliminary, with lots of caveats."

"We are very encouraged by the participation rate," said CMS spokesperson Ellen Griffith in an interview with AAFP News Now.

Many more claims have yet to be processed before CMS can gain a clear picture of the program's impact. Griffith pointed out that although bonus payments would apply for claims filed from July 1 to Dec. 31, 2007, the preliminary results were tabulated only through November 2007. In addition, physicians had until Feb. 29 to submit PQRI claims for 2007.

Even so, "more than half of the participating professionals so far appear to be on track to receive bonuses," said Griffith. CMS will pay those bonuses later this year.

"We look forward to higher participation in 2008, and we will continue to work with our physician partners and quality organizations to strengthen the program, with a view to improving both the quality and efficient provision of care for Medicare beneficiaries," said Griffith.

The preliminary PQRI statistics also provide a glimpse of where participants are making errors in the reporting process, and that will guide future educational efforts by CMS. For example, the data show that for one of the three diabetes measures covered, nearly half of the PQRI claims submitted were rejected because of "denominator mismatches," which means the patient didn't match the age or gender descriptor for the measure. More than 10 percent of claims were filed without the required National Provider Identifier number.

Bruce Bagley, M.D., AAFP medical director of quality improvement, has urged family physicians to participate in PQRI since its inception. He shared CMS' enthusiasm regarding the participation rates.

Bagley recalled the icy reception family physicians and other providers gave CMS' voluntary reporting initiative that preceded the PQRI. "Considering that the Physician Voluntary Reporting Initiative, or PVRP, just one year earlier had near zero participation -- and that the PQRI, with a modest incentive, has generated a 16 percent participation rate -- I think that's a tremendous sign that this kind of incentive program works," said Bagley. "As more people get on board -- and as the incentives get larger -- this will be very effective," he added.

Bagley speculated that the majority of 2007 participants already had been engaged in quality improvement and measurement work. That leaves room for many newcomers to enter the arena of quality reporting in 2008 and beyond, he said.

Bagley reiterated that reporting on three measures in a family medicine practice "is a relatively low hurdle" for FPs to achieve. In addition, "If Medicare continues along its path of value-based purchasing, this will be an increasing portion of physician payment down the road," he added.