Quality Improvement Resources and Tools
Physician Quality Reporting Initiative (PQRI)
Successful reporting earns a 2 percent incentive payment under Medicare. PQRI Measures Specifications (Log-in Required)
E-Prescribing Incentive Program
Successful electronic-prescribing earns a 2 percent incentive payment under Medicare. E-Prescribing Measure Specifications and Release Notes
Hospital-Acquired Conditions and Present on Admmission Indicator Reporting
IDSA's Quality Improvement-Related Letters
The Infectious Diseases Society of America (IDSA) and the HIV Medicine Association (HIVMA) remain actively involved in the quality measure development and endorsement process through the American Medical Association’s Physician Consortium for Performance Improvement (PCPI) and the National Quality Forum (NQF). Through our participation in these organizations, we led efforts to develop and implement quality measures dealing with HIV care, wound care, and preventive care.
IDSA and HIVMA would like your input regarding possible quality measures for inpatient ID/HIV services. Please contact Jason Scull, IDSA's Program Officer for Clinical Affairs, with your quality measure development ideas.
Physician Quality Reporting Initiative
Under the Physician Quality Reporting Initiative (PQRI), physicians may increase their total Medicare payments in 2010 by 2.0 percent by choosing one reporting option and successfully reporting on applicable quality measures. This bonus payment will be made in a lump sum in 2011 (eligible professionals who successfully participated in the 2009 PQRI should receive a bonus payment in 2010). IDSA and HIVMA encourage members to take advantage of the voluntary nature of the PQRI to gain experience with reporting quality metrics.
While the PQRI remains a voluntary program in 2010, plans are underway to transition the PQRI to a mandatory pay-for-performance program and to publicly report physicians' quality and efficiency data on a physician compare website. As a first step, Medicare plans to publicly report the names of physicians who successfully participate in the 2010 PQRI. The names of these physicians will be listed on the www.medicare.gov website.
PQRI Reporting Options and Instructions
The 2010 PQRI includes eight distinct reporting options, including claims- and registry-based options. No registration is required to participate in the PQRI. Physicians can participate by adding the appropriate quality-data codes (HCPCS G-codes or CPT Category II codes) to the associated diagnoses and covered services.
Under the claims-based reporting options, quality-data code (QDC) line items should be submitted with a charge of zero dollars ($0.00). QDC's should be submitted on line 24 of the electronic 837-P, or on line 24D of the CMS 1500 form if you are authorized to submit paper claims. Please contact individual "qualified registries" for information on their specific reporting processes, including applicable quality measures and reporting options.
IDSA and HIVMA staff have developed the following examples to help infectious diseases and HIV physicians understand how the various PQRI reporting options may be applicable to their service mix and patient population.
Example 1: After reviewing the 2010 PQRI measure specifications, you have determined that the eight HIV/AIDS measures are applicable to your practice. No claims-based reporting options apply for the HIV/AIDS measures--these measures must be reported through a "qualified registry". To be eligible for the 2.0 incentive payment under the registry-based reporting reporting option of individual measures, you must report at least 3 of the 8 individual HIV/AIDS measures in 80 percent of the applicable Medicare cases or you must report on all applicable measures in the HIV/AIDS measures group.
Example 2: After reviewing the 2010 PQRI measure specifications, you have determined that the eight HIV/AIDS measures and the nine Hepatitis C measures are applicabe to your practice. To be eligible for the 2.0 percent incentive payment under the claims-based reporting options, you must report at least three of the nine individual Hepatitis C measures in 80 percent of the applicable Medicare cases or you must report on all applicable measures in the Hepatitis C measures group. No claims-based reporting options apply for the HIV/AIDS measures--these measures must be reported through a "qualified registry". To be eligible for the 2.0 percent incentive payment under the registry-based reporting options, you can report any combination (but at least three) of the individual HIV/AIDS and Hepatitis C measures in 80 percent of the applicable Medicare cases or you can report on all applicable measures in either the HIV/AIDS measures group or Hepatitis C measures group.
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Please visit the Medicare website for more PQRI-related information, including tips for satisfactorily reporting PQRI measures.
PQRI Measures Reportable by ID Specialists
Several measures have been added to the PQRI in 2010 that may better enable ID/HIV physicians to participate. You may want to take an especially close look at quality measures dealing with HIV/AIDS, hepatitis C, wound care, medication reconciliation, and health information technology adoption.
IDSA and HIVMA have compiled a summary of measures that may be relevant to your practice. Please visit the PQRI Measure Specifications (Log-in Required) tool for a list of these measures as well as for more detailed reporting information, including measure-specific descriptions and coding instructions. Individual ID/HIV physicians' ability to report on specific measures depends on their service mix and patient population.
E-Prescribing Incentive Program
Under the E-Prescribing Incentive Program, physicians may increase their total Medicare payments in 2010 by 2.0 percent by successfully submitting prescriptions electronically (E-Prescribing). Medicare payments to physicians who are not successful E-Prescribers will be reduced beginning in 2012. The following table describes the annual payment adjustment amounts under the E-Prescribing Incentive Program:
Year
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Successful
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Not Successful
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2009
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+2.0 percent
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--
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2010
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+2.0 percent
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--
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2011
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+1.0 percent
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--
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2012
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+1.0 percent
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-1.0 percent
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2013
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+0.5 percent
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-1.0 percent
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2014 (& subsequent years)
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--
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-2.0 percent
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E-Prescribing Reporting Thresholds and Measure Specifications
In order to qualify for the E-Presribing incentive payment in 2010, physicians' must generate at least 10 percent of their total Medicare charges from outpatient E&M service codes and they must successfully e-prescribe at least 25 times during these situations--see the E-Prescribing Measure Specifications for applicable outpatient E&M service codes. Unlike in 2009, when physicians could earn the E-Prescribing incentive payment even if no medications were prescribed or if E-prescriptions for the drug were prohibited by law (as long as the applicable numerator G-codes were included on patients' claims), physicians must actually generate and transmit prescriptions electonically to qualify for the +2.0 percent bonus in 2010.
Practices that have Electronic Medical Records (EMRs) with e-prescribing capabilities should verify compliance with the Certification for Health Information Technology (CCHIT) standards and the Medicare Part D e-prescribing standards before participating in the Incentive Program. Free e-prescribing software is available for those practices that do not have e-prescribing capabilities.
Please download the 2010 E-Prescribing Measure Specifications and Release Notes for a list of applicable outpatient E&M service codes as well as for additional information, including what constitutes a "qualified" e-prescribing system.
2009 E-Prescribing Incentive Program Made Simple
2009 E-Prescribing Incentive Program Fact Sheet
2009 Medicare's Practical Guide to the E-Prescribing Incentive Program
Hospital-Acquired Conditions and Present on Admission Indicator Reporting
On Oct. 1, 2008, Medicare will stop paying hospitals for treating certain conditions if they are not present on admission (POA). This move is in response to a provision included in the Deficit Reduction Act (DRA) of 2005 that requires Medicare to pick at least two hospital-acquired conditions (HAC) that meet the following parameters:
- Are high cost or high volume or both
- Result in the assignment of a case to a Diagnosis-Related Group (DRG) that has a higher payment when present as a secondary diagnosis
- Could reasonably have been prevented through the application of evidence-based guidelines.
IDSA and HIVMA joined the Society for Hospital Epidemiology and the Association for Professionals in Infection Control in urging Medicare to use caution in implementing this DRA provision. Despite our concerns, Medicare included several infections on the list of secondary conditions for which hospitals no longer receive higher payments. Please click here for an overview of the HAC rule as well as the Agency's plans to add to the list in the future.
Hospital-Acquired Conditions Fact Sheet
Present on Admission Indicator Reporting Fact Sheet
Additional Quality-Improvement Related Information and Resources
For more information about IDSA and HIVMA's quality improvement-related advocacy efforts, please go to the Quality Improvement-Related Letters webpage. Please alert Jason Scull to additional PQRI-related questions that you might have, as well as problems that arise so that we may quickly address issues with CMS staff.
A PQRI help line also is available to answer questions regarding participation procedures, feedback reports, and bonus payments. Please call 866-288-8912 between 7:00am and 7:00pm Central Time to access the help line.