Quality Initiative within CMS is an Optional Reimbursement Cut

I am referring to the Physician Quality Reporting Initiative (PQRI). 

This voluntary program provides financial incentive to physicians and other eligible professionals who successfully report quality data related to services provided under the medicare fee schedule.  You have to gather approved measures on at least 80% of appropriate patients and submit the specified quality-data codes for services paid under the fee schedule during the reporting period.

Per CMS website:

“Eligible Professionals have the opportunity to use participation in the PQRI program to improve the care of the patients they serve through evidence‐based measures that are based upon clinical guidelines. Participating in PQRI is a way to prepare for future pay‐for‐performance programs.”

I can’t understand why more legit criticism isn’t leveled at this initiative.  It’s as though we are giddy celebrating as a profession being part of it simply because we are included like MD’s as part of this nonsense. 

PQRI really is an optional reimbursement cut. There is talk of making this program mandatory.  The cost of administering it properly including training, compliance, integration, and auditing for clinical and billing staff far surpasses the percent reimbursement (with caps) that you get back from CMS (or if you get back).  It is yet another example of those that have no clue as to clinic operations imposing their puritanical and philosophical views on the operators that are left having to deal with the details and execution of this misguided directive.  (side note: the response to criticism yields a predictable kneejerk “but its a start and we are included with physicians” response).

Here is a good test for PQRI now that it has been around for awhile (please comment):

1. How many practices have integrated PQRI?

2. Have you received any reimbursement for PQRI efforts by CMS?

Most practices that I know aren’t using PQRI. The one’s that I know either haven’t gotten paid a penny (much greater than a year in the waiting) or received de minimus only after multiple appeals which further increase the admin cost of the practice.

This doesn’t by any means suggest that practices not integrating PQRI are lazy or unconcerned with quality.  They are simply using standardized outcome instruments on all patient populations (not just medicare) or participate in a national process like FOTO. 

Let’s not let the consistent lack of criticism of PQRI be viewed as support of this “quality initiative”.  Let’s call it for what it is-an optional reimbursement cut.

Your thoughts, experiences, comments, and answers to the above questions are appreciated.

larry@physicaltherapist.com