2010 Changes to the Physician Quality Reporting Initiative
PQRI is a voluntary reporting program that provides an incentive payment to identified eligible professionals (EPs) who satisfactorily report data on specific quality measures for covered professional services furnished to Medicare Part B fee-for-service beneficiaries and paid under the Medicare Physician Fee Schedule (MPFS). The program was first implemented in 2007. For calendar year (CY) 2010, participants may earn an incentive payment of 2.0 percent of the EP’s estimated total allowed charges for Medicare Part B covered professional services under Medicare Part B provided during the reporting period. For the CY 2010 PQRI, the Centers for Medicare & Medicaid Services (CMS) is offering additional reporting options and reporting periods. Some options require data on quality measures to be submitted by Dec. 31, 2010. However, EPs who submit data through registries will not be required to submit data on quality measures until 2011.
Key changes in the MPFS final rule with comment period for CY 2010:
- Add 30 individual PQRI measures and six measures groups on which individual eligible professionals may report.
- Implement provisions of the Medicare Improvement for Patients and Providers Act of 2008 (MIPPA) that will enable group practices to qualify for a 2010 PQRI incentive payment based on a determination at the group practice level, rather than at the individual EP level.
- Add an electronic health record (EHR)-based reporting mechanism to promote the adoption and use of EHRs and to provide both eligible professionals and CMS with experience on EHR-based quality reporting. Under the rule, CMS will begin accepting data from qualified EHR products on ten individual PQRI measures. In 2010, CMS will, for the first time, allow EPs to count their submission of EHR-based measures toward their eligibility for a PQRI incentive payment. Specifically, the final rule provides that EPs who satisfactorily report data on at least three of the ten EHR-based individual PQRI measures are eligible for an incentive payment. In previous years, EHR-based measure submission has been on a voluntary or “pilot” basis and has not counted towards an EP’s eligibility for an incentive payment.
- Add a six-month reporting period, which begins Jul. 1, 2010, for claims-based reporting of individual measures. In prior years, the six-month reporting period was available only for measures group reporting or for registry-based reporting.
Following the distribution of 2010 incentive payments, CMS will, as required by MIPPA, post on its Web site the names of EPs and group practices that satisfactorily report quality measures.
General PQRI Information
View general information about reporting options, qualifying for the bonus, and receiving bonus payment.
PQRI Reporting Options
2010 PQRI Group Practice Reporting Option
2010 PQRI Registry Reporting Option
2010 PQRI EHR Measure Specifications
Recognizing PQRI Problems and Improving the Program
View brief summary of documented PQRI problems and access CMS report describing actions to improve the program.
Centers for Medicare and Medicaid Services PQRI Information
CMS’s extensive PQRI resource page
Communicate with ACP and Colleagues
E-mail ACP staff your questions and/or comments on your Medicare PQRI experience.
Communicate with Colleagues about PQRI Using the Small Practice Discussion Group
Other Relevant ACP Resources
Access the ACP Diabetes Portal with Physician Tools and Resources for Managing Diabetes
Access the ACP EHR Roadmap Containing Tools for Each Stage of Electronic Health Record Adoption
Archive of 2008 PQRI Resources
Page updated: 12/23/08
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