The Physicians Quality Reporting Initiative (PQRI) is a voluntary program under Medicare authorized by a law passed by
Congress late in 2006. Medicare considers PQRI as the first step toward paying physicians to reward quality over volume.
PQRI is part of the president’s value-driven healthcare agenda to address preventable errors, uneven quality of care and rising healthcare costs.
ASTRO has committed numerous resources to developing measures for PQRI and educating its
membership about the program and encouraging participation. ASTRO also voiced concerns, via legislation and regulation,
about the lack of a formal evaluation of the program, use of quality measures developed outside the AMA Physician Consortium,
as well as other more technical issues about its implementation. View the Physicians Quality Reporting Initiative Overview complete article.
Background on 2009 PQRI Measures and Reporting (New!)
Background on 2008 PQRI Measures and Reporting
Additional PQRI Educational Information
PQRI PowerPoint Presentations
2009 PQRI Specifications
Oncology
Prostate Cancer
Here are answers to some frequently asked questions about the PQRI program. For additional information, please go to the CMS Web site.
Calculating Bonus Payments
What will my bonus payment be if I participate in the PQRI program?
If you meet the 80 percent reporting requirement, a 2 percent bonus would be applied to all your allowed Medicare charges from January 1 through December 31, 2009. For example, if you bill $200,000 to the Medicare program in a year, over six months you are likely to bill $100,000, so your maximum bonus payment would be $3,000.
How do I meet the 80 percent reporting requirement?
The 80 percent reporting requirement means that you must report on the measure for 80 percent of the patients who are eligible – not 80 percent of all your Medicare patients. For example, if you choose to report on Measure 156, "Radiation Dose Limits to Normal Tissues" you would need to report on this measure for 80 percent of your liver and lung cancer patients who are in the fee-for-service Medicare program.
Can I anticipate how much my bonus payment will be?
Yes. You can calculate the maximum bonus amount you will receive (assuming you meet all the requirements) by determining what your Medicare charges were in 2008. Multiply that amount by 2 percent. This amount is likely to be your bonus payment amount for 2009. Bonus payments are expected to be made mid-2010.
In addition to the financial incentives, are there other advantages to participating in PQRI?
Yes. Congress has authorized CMS to publish the names of those who participate in the PQRI program on its Web site. Additionally, it is unclear what Congress will do to address the flawed SGR formula in the future, and any congressional action may include refinement or expansion of the PQRI program. Physicians who participate in this program will enjoy the benefits of participating in this pilot program and may be better prepared for future programs in this area.
How often and what CPT service code should I report the prostate cancer measures?
The prostate cancer measures should be reported once per episode of care. These measures should be reported along with weekly management code-77427.
For additional information and FAQs, please visit ww.cms.hhs.gov/PQRI or contact Emily Wilson.
