With the pay-for-performance reimbursement model gaining ground, Medicare’s new Physician Quality Reporting Initiative offers a risk-free way to start. Or does it?
By Craig T. Williams

The concept of “pay-for-performance” (p4p) is increasingly becoming a reality in medical care.  A profession that relies so heavily on evidence-based principles in its clinical decision-making should recognize the importance of objective data in helping people make informed choices. To participate in these initiatives, neurologists need to commit to sound data collection and reporting about outcomes.  A new CMS program looming on the horizon offers a chance to “dabble” in the process and see if it might be worth instituting more formal statistical reporting that could give valuable leverage when negotiating with third-party payers down the road.

PRQI IS COMING — PDQ!
As part of the Tax Relief and Health Care Act of 2006, CMS offers a voluntary low-effort program (the 2007 Physician Quality Reporting Initiative (PQRI)) that authorizes a financial incentive for eligible professionals to participate in the quality-reporting program. Eligible professionals may earn a bonus payment of up to 1.5 percent of their charges during the period between July 1 and December 31, 2007. Those who choose to participate will need to report on a designated set of quality measures (clinical outcomes, clinical processes, structural factors, patient satisfaction) for services paid under the Medicare Physician Fee Schedule.

It is important that all providers seriously weigh the cost versus the benefit of participating in this program.

When all things are considered, you likely will find it isn’t worth volunteering for the program for the sake of money. But your practice might be best served by joining the program if only to give the pay-for-performance model a test drive. The physicians and other eligible professionals who choose to participate in the PQRI in 2007 are gaining experience in capturing and submitting data on the quality of care they submit through the claims process. For 2007, there are 74 measures on the on the final PQRI Quality Measures List (but expect more than 200 in 2008 as the current legislation will sunset at year’s end).

Please read the full article for a detailed informational outline for a report on p4p.

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