PQRI for emergency medicine

The 2009 PQRI consists of 153 quality measures and 7 measures groups. Nine (9) may be reported as “emergency medicine” measures:
#28 Aspirin at Arrival for Acute Myocardial Infarction (AMI) †
#31
Stroke and Stroke Rehabilitation: Deep Vein Thrombosis Prophylaxis (DVT) for Ischemic Stroke or Intracranial Hemorrhage†
#34
Stroke and Stroke Rehabilitation: Tissue Plasminogen Activator (t-PA) Considered†
#54
12-Lead Electrocardiogram (ECG) Performed for Non-Traumatic Chest Pain†
#55 12-Lead Electrocardiogram (ECG) Performed for Syncope†
#56 Community-Acquired Pneumonia (CAP): Vital Signs*
#57
Community-Acquired Pneumonia (CAP): Assessment of Oxygen Saturation*
#58 Community-Acquired Pneumonia (CAP): Assessment of Mental Status*
#59
Community-Acquired Pneumonia (CAP): Empiric Antibiotic*

†The Part B claim form place of service field must indicate emergency department

* Clinicians utilizing the critical care code (99291) must indicate the emergency department place of service (23) on the Part B claim form in order to report this measure.

Source: http://m.acep.org/practres.aspx?id=32148

PQRI for Pulmonologists

There are several individual PQRI measures that apply for pulmonologists:

COPD Care

#51 - Chronic Obstructive Pulmonary Disease (COPD): Spirometry Evaluation
Measure description
Percentage of patients aged 18 years and older with a diagnosis
of COPD who had spirometry evaluation results documented
Data Collection Sheet
Coding Specifications

#52 - Chronic Obstructive Pulmonary Disease (COPD): Bronchodilator Therapy
Measure description
Percentage of patients aged 18 years and older with a diagnosis
of COPD and who have an FEV1/FVC less than 70% and have
symptoms who were prescribed an inhaled bronchodilator
Data Collection Sheet
Coding Specifications

Asthma Care

#53 - Asthma: Pharmacologic Therapy
Measure description
Percentage of patients aged 5 through 40 years with a diagnosis
of mild, moderate, or severe persistent asthma who were
prescribed either the preferred long-term control medication
(inhaled corticosteroid) or an acceptable alternative treatment
Data Collection Sheet
Coding Specifications

#64 - Asthma: Asthma Assessment
Measure description
Percentage of patients aged 5 through 40 years with a diagnosis
of asthma who were evaluated during at least one office visit
within 12 months for the frequency (numeric) of daytime and
nocturnal asthma symptoms
Data Collection Sheet
Coding Specifications

Pneumonia Care

#56 - Community-Acquired Pneumonia (CAP): Vital Signs
Measure description
Percentage of patients aged 18 years and older with a diagnosis
of community-acquired bacterial pneumonia with vital signs
documented and reviewed
Data Collection Sheet
Coding Specifications

#57 - Community-Acquired Pneumonia (CAP): Assessment of Oxygen Saturation
Measure description
Percentage of patients aged 18 years and older with a
diagnosis of community-acquired bacterial pneumonia
with oxygen saturation documented and reviewed
Data Collection Sheet
Coding Specifications

#58 - Community-Acquired Pneumonia (CAP): Assessment of Mental Status
Measure description
Percentage of patients aged 18 years and older with a
diagnosis of community-acquired bacterial pneumonia
with mental status assessed
Data Collection Sheet
Coding Specifications

#59 - Community-Acquired Pneumonia (CAP): Empiric Antibiotic
Measure description
Percentage of patients aged 18 years and older with a diagnosis
of community-acquired bacterial pneumonia with an appropriate
empiric antibiotic prescribed
Data Collection Sheet
Coding Specifications

To get the 2% PQRI bonus, a pulmonologist will need to report at least 3 of the measures above for at least 80% of the applicable Medicare patients seen during the year of 2009.

For reporting purposes, it is easier for a pulmonologist to choose the Community-Acquired Pneumonia measures because we need a set of 3 measures and the COPD and asthma sets only have 2 measures each. Technically you could pick one COPD measure, one Asthma measure and one Community-Acquired Pneumonia but then you will reporting on 3 different patient populations. With Community-Acquired Pneumonia, once you identified the patient population you can report 4 measures on each patient.

There are 2 main options to report the above measures.

1 - Add the appropriate quality codes regarding each measure to each billing claim you send to Medicare.
For example when using Community-Acquired Pneumonia add the following codes to your Medicare patients
2010F (#56 - Vital signs checked)
3028F (#57 - Oxygen saturation results documented and reviewed)
2014F (#58 - Mental status assessed)
4045F (#59 - Appropriate empiric antibiotic prescribed)

You just need to bill the same way as before but add
CPT 2010F, 3028F, 2014F and 4045F on section 24 of the billing form
and charge $0.00 or $0.01 for each code.

Example from 2009 PQRI Implementation Guide


However if you start reporting now using this method you may not be able to receive the full PQRI bonus because you already missed reporting more than half of your 2009 patients (you need to report at least 80%). So you should report PQRI using a qualified PQRI registry:

2 - Using a qualified PQRI registry like MDinteractive a pulmonologist may report 3 of the above PQRI measures and make your 2% bonus. For the complete list of 2009 PQRI qualified registries check the PQRI CMS website

For further info read:

2009 Measure-Applicability Validation Process for Claims-Based Participation

2009 PULMONARY PQRI PERFORMANCE MEASURES

PQRI Measures for Radiologists

There are several individual PQRI measures that apply for radiologists:

#10 - Stroke and Stroke Rehabilitation: Computed Tomography (CT) or Magnetic Resonance Imaging (MRI) Reports

Measure description
Percentage of final reports for CT or MRI studies of the brain
performed within 24 hours of arrival to the hospital for patients
aged 18 years and older with either a diagnosis of ischemic
stroke or transient ischemic attack (TIA) or intracranial
hemorrhage or at least one documented symptom consistent
with ischemic stroke or TIA or intracranial hemorrhage that
include documentation of the presence or absence of each of the
following: hemorrhage and mass lesion and acute infarction
AMA Data Collection Form
AMA Coding specifications

#11 - Stroke and Stroke Rehabilitation: Carotid Imaging Reports

Measure description
Percentage of final reports for carotid imaging studies (neck
MR angiography [MRA], neck CT angiography [CTA], neck
duplex ultrasound, carotid angiogram) performed for patients
aged 18 years and older with the diagnosis of ischemic stroke or
transient ischemic attack (TIA) that include direct or indirect
reference to measurements of distal internal carotid diameter
as the denominator for stenosis measurement1
AMA Data Collection Form
AMA Coding specifications

#145 - Radiology: Exposure Time Reported for Procedures Using Fluoroscopy

Measure description
Percentage of final reports for procedures using fluoroscopy that
include documentation of radiation exposure or exposure time
AMA Data Collection Form
AMA Coding specifications

#146 - Radiology: Inappropriate Use of “Probably Benign” Assessment Category in Mammography Screening

Measure description
Percentage of final reports for screening mammograms that are
classified as “probably benign”
AMA Data Collection Form
AMA Coding specifications

147 - Nuclear Medicine: Correlation with Existing Imaging Studies for All Patients Undergoing Bone Scintigraphy

Measure description
Percentage of final reports for all patients, regardless of age,
undergoing bone scintigraphy that include physician
documentation of correlation with existing relevant imaging
studies (eg, x-ray, MRI, CT, etc.) that were performed
AMA Data Collection Form
AMA Coding specifications

To get the 2% PQRI bonus, a radiologist will need to report at least 3 of the measures above for at least 80% of the applicable Medicare patients seen during the year of 2009.

There are 2 main options to report the above measures.

1 - Add the appropriate quality codes regarding each measure to each billing claim you send to Medicare. However if you start reporting now using this method you may not be able to receive the full PQRI bonus because you already missed reporting more than half of your 2009 patients (you need to report at least 80%). So you should report PQRI using a qualified PQRI registry:

2 - Using a qualified PQRI registry like MDinteractive a radiologist may report 3 of the above PQRI measures and make your 2% bonus. For the complete list of 2009 PQRI qualified registries check the PQRI CMS website

For further info read:

2009 Measure-Applicability Validation Process for Claims-Based Participation

CMS releases PQRI reporting measures that affect radiologists

Becoming a Medicare Qualified PQRI Patient Registry

This will be the first of a series of posts describing MDinteractive's experience of becoming a Medicare Qualified PQRI Registry.

General Introduction

To improve quality of the healthcare in the US, Medicare has a innovative program called Physician Quality Reporting Initiative that rewards physicians for reporting quality measures like checking cholesterol levels on diabetics patients, doing mammograms, giving smoke cessation advice, etc.

This is part of a movement to slowly change the way the system rewards physicians - right now with a fee-for-service payment system, healthcare professionals are paid more for "doing things" to patients and not for keeping patients healthy.

With the PQRI incentive program, physicians can earn an incentive payment of 2% above the regular Medicare Physician Fee charges.

The 153 PQRI Quality measures can be found here:
http://www.cms.hhs.gov/PQRI

Examples of PQRI Measures:



How to Report PQRI

There are basically two main options to report PQRI options:

- Claims Based Reporting
- Registry Reporting

Claims-Based Reporting:

In this case, a physician will need to report at least 3 PQRI Quality Measures for at least 80% of applicable patients.

For example, a pulmonary specialist would report 3 measures from all Medicare patients seen with the diagnosis of community acquired pneumonia(measures 56, 57 and 58).

Measure 56 - Community-Acquired Pneumonia (CAP): Vital Signs
Percentage of patients aged 18 years and older with a diagnosis of
community-acquired bacterial pneumonia with vital signs documented and
reviewed

When the doctor treats someone with the diagnosis of pneumonia (ICD-9 code 481), and a CPT code for a office visit like 99204 then she/he will also add the CPT II code 2010F in the same CMS-1500 billing form. This code means that vital signs like temperature, pulse, respiratory rate, and blood pressure were documented and reviewed.

The worksheet for these measures can be seen at the AMA website:
Participation Tools: Individual Quality Measures for 2009 PQRI and more specifically here for measure #56

On the same CMS-1500 claim form he also enter quality codes for measures #57 (Assessment of oxygen saturation - code 3028F) and for measure #58 (Assessment of mental status - code 2014F).

Each one of the quality codes must be submitted with a line-item charge of $0.00. Charge field cannot be left blank.

At the end of the year, if the above pulmonary specialist saw 10 Medicare patients with community-acquired pneumonia and reported measures #56, #57 and #58 on at least 8 of those patients will receive a 2% bonus over all her/his Yearly Medicare Part B Fee-for-Service revenues.

We should note that the 2% applies to all the Medicare Part B fees charged for all the Medicare patients seen by the doctor and not only to the patients with community-acquired pneumonia. For example if the the yearly revenues were $100000, the bonus would be $2000.

In the next post, we will describe an Alternative Reporting Method using a Qualified Medicare Registry like MDinteractive.