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The Centers for Medicare and Medicaid Services (CMS) launched the Physician Quality
Reporting Initiative (PQRI) program in July of 2007. The program became available
in 2008 with a January 1, 2008 through December 31, 2008 reporting period.
In April of 2008, new reporting options
were announced that allow for an additional reporting period from July 1, 2008 through December 31, 2008 as well as new reporting
methods (registries). PQRI encourages
quality improvement through the use of clinical measures which are reported through
a combination of CPTI, CPTII, and
“G” codes. These codes must be submitted with claims
data to allow participating providers to earn a bonus payment of 1.5% of total allowed charges. Those that are considering participating should
review the CMS website for the most up-to-date information at www.cms.hhs.gov/pqri.
Highlighted Changes for 2008 include:
Ø
New reporting period for July, 2008 through December, 2008
utilizing “measure groups”
Ø
New reporting methods through registries
Ø
Use of “G” codes to report measure groups
Ø
Removal of the “cap”
Measure Groups
Measure groups
are a group of measures that deal with a specific medical problem or preventive
services. In order to participate in
the reporting period beginning July 1, 2008 you must report the measure group by
using the appropriate “G” code as well as report all of the measures within the
measures group. Listed below are the measure groups with the mandatory measures
and “G” codes necessary for reporting:
Ø
Diabetes Mellitus
(G8485)
o
Measure 1- Hgb A1c Poor Control
o
Measure 2- LDL Control
o
Measure 3- High Blood Pressure
Control
o
Measure 117- Dilated Eye Exam
o
Measure 119- Urine Screening
for Microalbumin
Ø
End Stage Renal
Disease (ESRD) (G8488)
o
Measure 78- Vascular Access
for Hemodialysis (HD) Patients
o
Measure 79- Influenza Vaccine
o
Measure 80- Plan of care for
patients with anemia
o
Measure 81- Plan of care for
inadequate HD
Ø
Chronic Kidney
Disease (CKD) (G8487)
o
Measure 120- ACE or ARB
o
Measure 121- Testing for Ca,
Phos, IPTH, Lipids
o
Measure 122- Blood pressure
management
o
Measure 123- Plan of care: Elevated
Hgb for patients on ESA
Ø
Preventive Care
(G8486)
o
Measure 39- screening/Therapy
for osteoporosis in women aged 65 and older*
o
Measure 48- Assessment of urinary
incontinence in women aged 65 and older*
o
Measure 110- Influenza vaccination
for patients 65 years and older
o
Measure 112- Screening mammography*
o
Measure 113- Colorectal cancer
screening
o
Measure 114- Inquiry regarding
tobacco use
o
Measure 115- Advising smokers
to quit
o
Measure 128- Weight Screening
and follow-up
*apply to female patients only
In an ongoing effort to assist physicians and other providers who would like to participate
in PQRI, PMSCO Healthcare Consulting has developed
a tool that combines several
measure collection tools on one form.
The process for using the tool is as follows:
- Review the CMS website to determine if you are eligible.
- Review the list of 119 measures and choose the measures that best fit your clinical
practice. At least three measures should be chosen.
If choosing to report on a measure group, make sure to select all measures applicable
to the chosen group.
- Click the link below to log in to PMSCO’s tool and enter some brief demographic
information.
- When you come to the measures list, select the measures you have chosen
or select all of the measures within a specified measures group, and
click Generate Report.
- Print the report and begin using in your practice.
If you have any questions about PQRI, the measures to choose, how to incorporate measure
collection into your clinical workflow, or any other practice management topic,
please feel free to contact one of our practice management consultants at 888-294-4336.
Click here to begin using the PMSCO Healthcare Consulting PQRI Data Collection Tool.
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