AAFP Board Chair Confers With CMS, Urges Changes in PQRI Program

AAFP Board Chair Jim King, M.D., of Selmer, Tenn., personally delivered a message to CMS recently: Fix Medicare's Physician Quality Reporting Initiative, known as PQRI, or physicians may not agree to participate in the program.

King and representatives from other physician organizations met with CMS Acting Administrator Kerry Weems and other high-ranking CMS officials in Washington on Dec. 4 to ask why thousands of physicians who participated in the PQRI program did not receive a promised Medicare bonus payment of 1.5 percent. According to King, about 18 percent of the nation's physicians participated in the program, but less than 9 percent actually received payment.

"I wanted to get an explanation as to why more than half of the doctors who signed up and participated in the PQRI program did not get any money for their efforts," King said in an interview with AAFP News Now.

The PQRI program was created under the Tax Relief and Health Care Act of 2006, which authorized CMS to establish and implement a physician quality reporting system. CMS launched the initiative in 2007, agreeing to pay physicians a 1.5 percent bonus for reporting on a series of quality measures from July 1 through Dec. 31, 2007.

However, the program was plagued by coding and technical problems from the outset, resulting in nonpayment for thousands of physicians who made a good faith effort to report the data and participate in the program.

King acknowledged that only a small percentage of the problems occurred at CMS. "A lot of the problems occurred along the way, before (the claims) got to CMS," he said. "We found that every step of the way, from the codes physicians were asked to provide, all the way to CMS, there were multiple mistakes that led to physicians not being paid."

However, King told CMS officials they need to fix every part of the PQRI process that does not work properly. He also suggested that it would be cheaper and more effective in spurring physician participation to send a check to everyone who filed. Although Weems agreed, he said CMS did not have statutory authority to pay everyone who filed.

Another problem with the program was that CMS issued PQRI bonus payments to physicians whose data the agency accepted in mid-July. But the agency did not notify physicians whose data were not accepted until September or October, leaving those physicians unaware they were not going to be paid.

"CMS needs to establish a real-time method for letting physicians know whether their claims went through," King said. "There is no way for a physician to follow up and say, 'This claim went through properly, and this one did not.'"

Bruce Bagley, M.D., the AAFP's medical director of quality improvement, told AAFP News Now that the Academy recognizes there are problems with PQRI and understands members' frustrations.

"We're working with CMS to resolve the problems, so don't throw up your hands up and walk away," advised Bagley. "This program will go on for at least one more year, and our members are leaving money on the table by not participating."

Bagley added that CMS has approved a new reporting method that uses data from patient registries. He said the new system "may be very easy and much more reliable than the original reporting method that caused so many headaches for physicians."

According to Bagley, physicians should take advantage of this voluntary reporting program to become adept at the reporting process "before CMS makes it mandatory in the future."

CMS officials said during the meeting with King that they would correct all of the problems with the program that are occurring at the agency. For example, officials said they would run the 2007 claims data again to determine whether they could capture enough data to pay physician practices that submitted data but did not meet the thresholds for the program because of missing data. CMS will not issue those checks until the fall of 2009, however.

In addition, officials have agreed to a follow-up meeting in January with the AAFP and other physician organizations.