PQRI and Data Reporting Automation
TeamPraxis is partnering with HMSA to sponsor participation in a Centers for Medicare and Medicaid (CMS) bonus program called the Physician Quality Reporting Initiative (PQRI).
PQRI Program Details
CMS 2009 PQRI Program Details News Flash (PDF)
TeamPraxis' Role
Benefits of Participation
Frequently Asked Questions
PQRI Program Details
PQRI is voluntary quality data reporting program that offers successful participants a bonus of 1.5% of their total Medicare allowed charges during the reporting period. The reporting period for 2008 is January 1 through December 31.
Under the terms of the program, the following professionals are eligible to participate:
- Medicare physician, as defined in Social Security Act (SSA) section 1861(r)
- Doctor of Medicine
- Doctor of Osteopathy
- Doctor of Podiatric Medicine
- Doctor of Optometry
- Doctor of Oral Surgery
- Doctor of Dental Medicine
- Chiropractor
- Practitioners described in SSA section 1842(b)(18)(C)
- Physician Assistant
- Nurse Practitioner
- Clinical Nurse Specialist
- Certified Registered Nurse Anesthetist
- Certified Nurse Midwife
- Clinical Social Worker
- Clinical Psychologist
- Registered Dietician
- Nutrition Professional
- Therapists
- Physical Therapist
- Occupational Therapist
- Qualified Speech-Language Therapist
Note: Eligible professionals must have a National Provider Identifier (NPI) to participate.
Eligible professionals do not need to formally enroll in this program, but participate by reporting the appropriate quality measure data on claims submitted to their Medicare claims processing contractor.
CMS has outlined 119 total quality measures for the 2008, spanning a wide range of specialties. Every measure is endorsed by either the National Quality Forum or Ambulatory Care Quality Alliance.
- For an abbreviated list of all measures, click here (PDF).
- For a complete list of all measures and descriptions, click here (PDF).
In order to successfully participate and earn the bonus, certain reporting thresholds must be met. When three or fewer quality measures are applicable to services provided by a participant, each such measure must be reported in at least 80% of reportable cases. When four or more measures are applicable, the 80% threshold must be met on at least three measures.
At the conclusion of the reporting period, CMS will compile all of the data and create a report of individual results for each participant. This will be mailed, along with the bonus check, if earned, to the holder of the participant’s taxpayer identification number (TIN) around mid-2009.
TeamPraxis’ Role
TeamPraxis has built a “no touch” tool that automates the reporting process for physicians using TouchWorks Electronic Health Record. This system extracts the relevant patient data from TouchWorks and outside labs, and then using a clinical algorithm, it appends appropriate codes to eligible claims before submitting them electronically to CMS. All that is required from participants is to document the appropriate information within TouchWorks.
Beyond this software tool, TeamPraxis’ Clinical Analysts will help support participants throughout the entire process. At the outset, they will analyze individual practices and discuss possible reporting measures with physicians in order to determine which measures best fit their practice. Our team will also analyze and suggest any minor documentation or workflow changes, if needed, and provide participants with periodic feedback and updates on reporting results.
For physicians to participate on their own, the 1.5% bonus will often not outweigh the burden of reporting. Upon selection of measures, physicians and office staff would need to identify eligible patients for each measure reported, and then manually append each claim with an appropriate code. This process only complicates further for patients who see multiple physicians or are waiting for lab results. The delay from waiting on other sources of information would likely hold up the claim and affect the practice’s accounts receivable. And on top of that, CMS provides no way to check on an individual’s reporting status, re-file or correct any claims that may have been submitted without a code. Thus, participants have no way to know whether they are meeting the 80% threshold until they receive (or do not receive) their bonus check in mid-2009.
With TeamPraxis, however, all of these challenges are mitigated. Eligible professionals participate without any effort beyond documenting the relevant data, and claim submission is not delayed. Further, participants can check their reporting status at any time, in real-time, so they know where they stand.
Benefits of Participation
The most apparent benefit of participating in PQRI through TeamPraxis is that we can essentially guarantee successful reporting for those who sign up early enough in the reporting period – and participation will not require much effort, if any. As long as information is documented in TouchWorks, our application tool performs all of the work of reporting.
Beyond the financial reward, our system will also prepare practices for other future reporting or pay-for-performance initiatives. CMS first launched PQRI during the latter half of 2007, (during which we successfully tested our “no touch” system), and all indications point to this program only expanding in future years. Moreover, other payors, such as HMSA, tend to follow Medicare’s lead.
Similarly, TeamPraxis plans to expand this system to add other initiatives and programs in the future. Our initial launch for the 2008 PQRI is just the beginning.
Because of these trends, we strongly encourage physicians on TouchWorks EHR to sign onto our program, as HMSA has agreed to subsidize the implementation cost for TeamPraxis’ “no touch” system. The funds for this subsidy, however, are limited.