Allscripts CQS PQRI Channel
PQRI Program Details
TeamPraxis' Role
TeamPraxis as a Registry
Benefits of Participation
Allscripts CQS Transformation Services
Frequently Asked Questions
PQRI Program Details
Physicians Quality Reporting Initiative (PQRI) is a voluntary quality data reporting program that offers successful participants a bonus of 2.0% of their total Medicare allowed charges during the reporting period.
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
- Doctor of Chiropractic
- Practitioners described in SSA section 1842(b)(18)(C)
- Physician Assistant
- Nurse Practitioner
- Clinical Nurse Specialist
- Certified Registered Nurse Anesthetist (and Anesthesiologist Assistant)
- Certified Nurse Midwife
- Clinical Social Worker
- Clinical Psychologist
- Registered Dietician
- Nutrition Professional
- Audiologist (as of 1/1/2009)
- 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 153 total quality measures for 2009, spanning a wide range of specialties. Every measure is endorsed by either the National Quality Forum or Ambulatory Care Quality Alliance.
In order to successfully participate and earn the bonus, certain reporting thresholds must be met. When three 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-2010.
TeamPraxis’ Role
TeamPraxis has built a tool that automates the reporting process for physicians using Enterprise Electronic Health Record (EHR), formerly TouchWorks EHR. This system extracts the relevant patient data from the practice management (PM) and EHR systems, and then generates results ready for registry reporting to CMS. All that is required from participants is to document the appropriate information within Enterprise EHR.
For physicians to participate on their own via claims reporting, the 2.0% bonus often will 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-2010. In 2009, registry reporting was introduced to make it easier for providers to participate in PQRI. Through a CMS approved registry, participants can report once at the end of the reporting period.
With TeamPraxis, however, all of these challenges are mitigated through CQS and our registry reporting. 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 using the Dashboard tool.
TeamPraxis as a Registry
Near the end of 2007, the Medicare, Medicaid, and SCHIP Extension Act of 2007 (MMSEA) (P.L. 110-173), authorized CMS to establish alternative reporting periods and criteria for satisfactorily reporting quality measures for PQRI 2008. In April of 2008, CMS finalized the establishment of new reporting options to make it easier for eligible professionals to participate in PQRI. The alternatives include a new reporting period and registry-based reporting.
TeamPraxis was officially selected in August of 2008 as one of 32 registries which allows TeamPraxis to extend the alternative reporting periods and criteria to eligible professionals using Allscripts CQS.
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. As long as all applicable information is documented in Enterprise EHR, Allscripts CQS 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 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.
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