CMS Implements a Pay-For-Reporting Program Beginning on July 1, 2007

PQRI is a pay-for-reporting program implemented by CMS to improve the quality of patient care provided to Medicare beneficiaries. CMS has approved 74 evidence-based quality measures that address a multitude of clinical areas. The most applicable quality measures for physiatrists are in the following clinical areas: osteoporosis, geriatric issues, and stroke. To participate in the program, eligible health care providers must report on a minimum of 3 of the 74 CMS-approved quality measures at least 80% of the time. If eligible health care professionals meet this requirement, they may be entitled to a bonus of 1.5 % of allowable Part B charges for all covered professional services. Participants would likely receive this bonus in 2008 along with confidential reports on performance.

Some eligible health care professionals, such as physiatrists who may treat a narrow range of patient conditions, might have difficulty identifying 3 appropriate measures that apply to the majority of patients in their practices. These health care professionals would most likely not qualify to receive the bonus according to CMS’ requirements. To address this issue, CMS is in the process of developing a validation protocol for eligible health care professionals who report on less that three measures to ensure that there were not additional measures that apply to their practices. When reporting data on inpatient diagnoses, such as stroke, physiatrists must also take into consideration CMS’ Inpatient Rehabilitation Facility Prospective Payment System. Physiatrists must use diagnostic codes that are included in both the PQRI and IRF PPS programs so that they are compliant with the requirements of both programs.

CMS encourages all eligible health care professionals to obtain appropriate identifiers and claim numbers for participation in the PQRI program. For example, eligible health care providers must have a National Provider Identifier to include on their claim forms submitted to CMS. To assist physiatrists in successfully reporting quality data for the PQRI program, the Academy has developed an educational PowerPoint presentation which is posted below. The Academy also encourages eligible health care professional to visit CMS’ website which provides frequently updated educational materials on the PQRI program.

AAPM&R PQRI Educational Tool (PowerPoint Download)
CMS Website