Physicians Struggle With PQRI Burdens

Physician practices across the country have expressed their satisfaction and their displeasure with CMS' Physician Quality Reporting Initiative, or PQRI, in a new report released by the Medical Group Management Association, or MGMA.

In a Sept. 8 press release announcing the study, MGMA President and CEO William Jessee, M.D., said that MGMA and its members support initiatives that help physicians provide high-quality patient care, but that "these data highlight the fundamental problems with this program."

Robert Bennett, MGMA government affairs representative said the new report is important in light of the fact that future Medicare payment could be tied into a pay-for-performance program that is similar to the PQRI. "We felt obligated to conduct this research so that policymakers have some information regarding PQRI participants' satisfaction with the overall program," said Bennett.

Physicians in the study voiced frustration with the administrative burdens of PQRI, the time lapse between PQRI physician feedback on data submitted, and the absence of data that would help improve patient outcomes.

Specifically, the MGMA report showed that of responding PQRI participants,

Physician practices spent an average of five hours trying to locate and download their reports, and more than 28 percent of respondents were unsuccessful in their attempts.

A CMS administrator who has been closely involved with PQRI told AAFP News Now that he was aware of the MGMA report and of the problems physicians are encountering. "We've heard the concerns. We're obviously trying to do a lot to alleviate those concerns," he said.

Part of the challenge for physicians has been setting up the required secure-access account. "These are confidential reports," said the CMS spokesman. "The bottom line is we can't skip this process; it's a federal requirement for security for accessing data within CMS."

He stressed that the security measures are a one-time hurdle and that once physicians have an account in place, they'll be able use it for other purposes.

For FP Andrew Merritt, M.D., of Marcellus, N.Y., the PQRI security maze is only part of his frustration. After much difficulty, he finally accessed his 2007 feedback report only to find it lacked any relevant information.

"The report just says I failed to meet the required threshold. I filed 34 reports; 24 were filed correctly, the others were not. There's no information on the report saying what the error was, and since all 34 were filed in exactly the same manner, I am at a complete loss as to what the problem is," said Merritt.

"It's now September of 2008. We have been filing -- possibly incorrectly -- for an additional nine months," said Merritt, a former member of AAFP's Commission on Health Care Services. He argued that feedback should be timely and "sufficient enough to help correct whatever errors you're making."

Jennifer Brull, M.D., of Plainville, Kan., said she's invested close to eight hours trying to access her feedback report. "I still have not seen my PQRI data, nor have I seen my money. It has been a long road to hoe," said Brull.

Brull is a solo FP whose practice is registered as a corporation. She's run into complications because she reported her PQRI data under her corporate tax ID number. The PQRI security measures require corporations to designate a security person who then gives access privileges to the practice administrator.

That's hard to do when one person fills both roles, said Brull.

Brull would like to see an easier process. "Why can't CMS just send me an e-mail that says 'Here's your user name, here's the password, here's the Web site, go find your data?'" she asked

PQRI has its success stories, however. Michael O'Dell, M.D., director of the North Mississippi Medical Center Family Medicine Residency Program in Tupelo, Miss., said the physicians who earned bonus payments at his program's clinics have received them and experienced only minor glitches in accessing reports.

O'Dell, a member of AAFP's Commission on Quality, also found the feedback reports helpful. "We had some variation among our physicians in how much money they received," said O'Dell. Some physicians didn't receive any bonus, but one physician -- known as a meticulous documenter -- received the maximum amount.

"That's actually very interesting data because it helps us understand how our physicians are documenting," and that will help teach us how to better demonstrate the quality of care that we provide, said O'Dell.

"Obviously, everyone would want it to be more money at the end of the day," he added. But the process "has certainly helped us understand how we can report quality data to one of our payers in a more robust fashion."