CMS Releases Specifications for Physician Quality Reporting Initiative

The Centers for Medicare and Medicaid Services (CMS) today announced the posting of detailed specifications for the 74 measures included in the 2007 Physician Quality Reporting Initiative (PQRI).

PQRI establishes a financial incentive for physicians and other health practitioners to participate in a voluntary quality reporting program.  Eligible professionals who successfully report data for a designated set of quality measures may earn a bonus payment, subject to a cap, of 1.5 percent of total allowed charges for covered Medicare physician fee schedule services provided during the reporting period of July 1, 2007 to December 31, 2007.

 “CMS is committed to becoming an active purchaser of high quality, efficient health care, and the PQRI program is an important step in that transformation,” said CMS Acting Administrator Leslie V. Norwalk.

The 2007 PQRI quality measures relate to important processes of care that are linked to improved healthcare quality outcomes.  They are evidence- and consensus-based measures that reflect the work of national organizations involved in quality measure development, consensus endorsement, and adoption. These include the American Medical Association Physician Consortium for Performance Improvement, the National Committee for Quality Assurance, the National Quality Forum, the AQA Alliance, and other physician and non-physician professional organizations.  The professional organizations are also assisting CMS in providing PQRI education and assistance to their members.

The specifications have been posted well in advance of the statutory deadline of July 1, 2007.  This is to help eligible professionals to identify measures applicable to their practices and to prepare for submission of quality data in advance of the July 1, 2007 start date of the program.  CMS anticipates a small number of additional specification changes, which may expand the applicability of the measures to additional eligible professionals.

The PQRI measures apply to services that eligible professionals provide to Medicare beneficiaries in their offices and other settings.  CMS is implementing an extensive outreach and education plan to assist eligible professionals to understand the program and the measures and to implement processes to efficiently capture the quality data that is to be reported under the PQRI program.