2008 Medicare PQRI Program Starts January 1

As the 2007 Medicare Physician Quality Reporting Initiative (PQRI) comes to a close, the new and improved 2008 program is readying itself for the January 1 kickoff. The program was deemed a success by CMS during the 6 month trial period from July 1 to December 31. Physicians who successfully reported on appropriate measures will enjoy a 1.5% bonus sometime after February of 2008. This same bonus structure will be used for the 2008 program and paid out sometime after February of 2009.

This program focuses on value: value=quality/cost. Current Medicare rates are based on quantity of care; the PQRI program attempts to bring a quality element to reimbursement. CMS sees this as a first step toward a Pay for Performance program.

While the name portrays a "quality initiative," the program is better described as a "reporting initiative." The bonus is not calculated on an outcomes basis, rather it is figured as a percentage of Medicare allowed billed charges for the chosen measures as REPORTED by the physician. While there are outcomes elements in the reporting structure, they have no bearing on the bonus calculation.

A wealth of information can be found at the PQRI website: www.cms.hhs.gov/pqri

Many measures have been adjusted/changed and some have been added for the 2008 program, so it is recommended that you check your measures. As with the 2007 program, you will not need to do anything do opt out.

Please feel free to comment on any experiences you had with the 2007 program. You can also contact the Dallas County Medical Society with questions.