Physician Quality Reporting
Initiative (PQRI) Measures
Prepared by:
Jonathan Heidt MD
Washington University
School of Medicine St. Louis
What is PQRI?
• The 2006 Tax Relief and Health Care Act
(TRHCA) required the establishment of a
physician quality reporting system.
– Reauthorized in 2007, permanent in 2008
– Incentive payment for voluntarily reported
data on quality measures
What is PQRI?
• The goals of this program were to:
1. Improve the quality of healthcare for
Medicare recipients
2. Transition the Centers for Medicare and
Medicaid Services (CMS) towards becoming
an “active” rather than “passive” payer in an
attempt to control costs.
What is PQRI?
• Currently, incentives are paid for simply
reporting on designated quality measures.
• It is anticipated that PQRI will be
transitioned to a “pay for performance”
model.
What Quality Measures are Included?
• The 2009 PQRI measure list identifies 153
quality measures and 7 measure groups.
• Nine are considered to be “emergency
medicine” measures.
What Quality Measures are Included?
• # 28 ASA at arrival for acute myocardial
infarction
• #31 DVT Prophylaxis for ischemic stroke
or intracranial hemorrhage
• #34 TPA considered for ischemic stroke
• #54 12 lead ECG for non traumatic chest
pain
What Quality Measure Are Included?
• # 55 12 lead ECG for syncope
• #56 Vital signs reviewed for community
acquired pneumonia (CAP)
• #57 Assessment of oxygen saturation in
CAP
• #58 Assessment of mental status in CAP
• #59 Initiation of antibiotics in CAP
Who Chooses These Quality Measures?
• Multiple public / private groups involved
• Any entity may suggest a PQRI measure
– Majority have been by the AMA PCPI
(Physician Consortium for Performance
Improvement)
– ACEP is a member of PCPI
How Does PQRI Work?
• Providers are eligible by choosing three
measures to report.
• The measures are then reported to CMS
• If a reporting rate of at least 80% is
provided, providers receive a bonus
payment of 2%.
Are There Problems
Associated with PQRI?
• The underlying assumption of this program
is that physicians will change their practice
based on financial incentives.
• These changes in practice are then
anticipated to improve the quality of
healthcare and reduce overall costs.
What Concerns about PQRI Exist?
1. Quality measures are not always easy to
report and may reflect patient compliance
instead of only physician performance.
2. Some of the PQRI measures may not be
based on current evidence based
medicine.
What Concerns about PQRI Exist?
3. There is a new movement to include
process measures such as door to
physician and door to discharge times
which would not be practical in many
ED’s.
4. Quality measures can threaten physician
autonomy by pressuring physicians to
complete measures which may not be the
best course for an individual patient.
What Concerns About PQRI Exist?
5. Quality measure performance could be
made available to the public which could
be misleading to patients in regards to a
physician’s quality.
Why Should EM Residents Care?
• The move towards a pay for performance
system appears inevitable.
• The transition to a new payment structure
will have an impact on emergency
medicine in both payment and
professional practice.
• As new physicians enter into practice, they
will be most affected by these new
measures.
Why Should EM Residents Care?
• Current residents are in the unique
position to influence the structure of a
future payment system and policy
decisions.
• A passive approach will lead to the
development of policy by lawyers and
politicians which could be detrimental to
the practice of medicine and patient care.
References
• Centers for Medicare and Medicaid Services:
www.cms.hhs.gov/PQRI
• American College of Emergency Physicians
FAQS on PQRI:
http://www.acep.org/practres.aspx?LinkIdentifier
=id&id=30492&fid=2294&Mo=No&taxid=117956
• EMRA Emergency Medicine Advocacy
Handbook