Medicare's Physician Quality Reporting Initiative (PQRI) Continues for 20101
Medicare providers who participate in the Physician Quality Reporting Initiative (PQRI) in 2010 will be eligible for incentive payment of up to 2 percent of their Medicare physician fee schedule charges. The incentive payment is calculated based on a physician's estimated total Medicare Part B allowable charges for claims submitted within 2 months of the end of the reporting period.
For 2010, there are two reporting periods: One runs the full year from January 1, 2010, to December 31, 2010. The second runs for the last 6 months from July 1, 2010, to December 31, 2010.
For 2010, there are 125 individual measures and 8 additional measures groups to report on. Among the 2010 quality measures that your practice may be interested in:
Rheumatology
All Rheumatoid Arthritis (RA) measures can be reported as individual measures or as a measures group.
- RA: Disease Modifying Anti-Rheumatic Drug Therapy (Measure 108)
- RA: Tuberculosis Screening (Measure 176)
- RA: Periodic Assessment of Disease Activity (Measure 177)
- RA: Functional Status Assessment (Measure 178)
- RA: Assessment and Classification of Disease Prognosis (Measure 179)
- RA: Glucocorticoid Management (Measure 180)
Gastroenterology
The following measures may be reported individually.
- Hepatitis C: Testing for Chronic Hepatitis - Confirmation of Hepatitis C Viremia (Measure 83)
- Preventative Care and Screening: Colorectal Cancer Screening (Measure 113)
- Endoscopy & Polyp Surveillance: Colonoscopy Interval for Patients with a History of Adenomatous Polyps - Avoidance of Inappropriate Use (Measure 185)
The following may be reported individually or together for the Hepatitis C measure group.
- Hepatitis C: Ribonucleic Acid (RNA) Testing Before Initiating Treatment (Measure 84)
- Hepatitis C: HCV Genotype Testing Prior to Treatment (Measure 85)
- Hepatitis C: Hepatitis C: Antiviral Treatment Prescribed (Measure 86)
- Hepatitis C: HCV Ribonucleic Acid (RNA) Testing at Week 12 of Treatment (Measure 87)
- Hepatitis C: Counseling Regarding Risk of Alcohol Consumption (Measure 89)
- Hepatitis C: Counseling Regarding Use of Contraception Prior to Antiviral Therapy (Measure 90)
- Hepatitis C: Hepatitis A Vaccination in Patients With HCV (Measure 183)
- Hepatitis C: Hepatitis B Vaccination in Patients With HCV (Measure 184)
Dermatology
The following may be reported as an individual measure.
- Wound Care: Use of Compression System in Patients with Venous Ulcers (Measure 186)
The following may be reported as registry-based measures only.
- Melanoma: Follow-Up Aspects of Care (Measure 136)
- Melanoma: Continuity of Care - Recall System (Measure 137)
- Melanoma: Coordination of Care (Measure 138)
Nephrology
The following measures may be reported individually.
- Myelodysplastic Syndrome (MDS): Documentation of Iron Stores in Patients Receiving Erythropoietin Therapy (Measure 68)
- End-Stage Renal Disease (ESRD): Influenza Immunization in Patients with ESRD (Measure 79)
- Hemodialysis Vascular Access Decision-Making by Surgeon to Maximize Placement of Autogenous Arteriovenous (AV) Fistula (Measure 172)
The following may be reported individually or together as part of the Chronic Kidney Disease (CKD) measures group.
- CKD: Laboratory Testing (Calcium, Phosphorus, Intact Parathyroid Hormone (iPTH) and Lipid Profile) (Measure 121)
- CKD: Blood Pressure Management (Measure 122)
- CKD: Plan of Care - Elevated Hemoglobin for Patients Receiving Erythropoiesis-Stimulating Agents (ESAs) (Measure 123)
- CKD: Influenza Immunization (Measure 135)
- CKD: Referral for Arteriovenous (AV) Fistula (Measure 153)
Oncology
The following measures may be reported individually.
- Multiple Myeloma: Treatment with Bisphosphonates (Measure 69)
- Chronic Lymphocytic Leukemia (CLL): Baseline Flow Cytometry (Measure 70)
- Breast Cancer: Hormonal Therapy for Stage 1C-111C Estrogen Receptor/Progesterone Receptor (ER/PR) Positive Breast Cancer (Measure 71)
- Colon Cancer: Chemotherapy for Stage III Colon Cancer Patients (Measure 72)
- Breast Cancer Resection Pathology Reporting: pT Category (Primary Tumor) and pN Category (Regional Lymph Nodes) with Histologic Grade (Measure 99)
- Colorectal Cancer Resection Pathology Reporting: pT Category (Primary Tumor) and pN Category (Regional Lymph Nodes) with Histologic Grace (Measure 100)
- Prostate Cancer: Avoidance of Overuse of Bone Scan for Staging Low-Risk Prostate Cancer Patients (Measure 102)
- Prostate Cancer: Adjuvant Hormonal Therapy for High-Risk Prostate Cancer Patients (Measure 104)
- Prostate Cancer: Three-Dimensional (3D) Radiotherapy (Measure 105)
- Oncology: Medical and Radiation - Pain Intensity Quantified (Measure 143)
- Oncology: Medical and Radiation - Plan of Care for Pain (Measure 144)
- Radiology: Exposure Time Reported for Procedures Using Fluoroscopy (Measure 145)
- Oncology: Radiation Dose Limits to Normal Tissues (Measure 156)
- Thoracic Surgery: Recording of Clinical Stage for Lung Cancer and Esophageal Cancer Resection (Measure 157)
- Oncology: Cancer Stage Documented (Measure TBD2)
For more information on PQRI, including detailed guidance on methods and metrics for successful participation, please visit www.cms.gov/pqri/. You may also contact your regional or national professional society for additional information on PQRI-related information specific to your specialty.
1 Federal Register Vol. 74, No. 226. November 25, 2009. Rules and Regulations.
2 Measure is new for 2010.
Coverage policies may vary by insurer or even between plans offered by the same insurer. This information is presented for informational purposes only and is not intended to provide reimbursement or legal advice. Laws, regulations, and policies concerning reimbursement are complex and are updated frequently. While we have made an effort to be current, the information may not be as current or comprehensive when you view it. Please consult with your counsel or reimbursement specialist for any reimbursement or billing questions.
Last Modified Date: 04/26/2010