Public Policy: PQRI Information
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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 2008 PQRI Measures

Additional PQRI Educational Information

PQRI PowerPoint Presentations

PQRI Worksheets

Prostate Cancer

 #101. Appropriate initial evaluation of patients with prostate cancer

#102. Inappropriate use of bone scan for staging low-risk prostate cancer patients

#103. Review of treatment options in patients with clinically localized prostate cancer

#104. Adjuvant hormonal therapy for high-risk prostate cancer patients

#105. Three-dimensional radiotherapy for patients with prostate cancer

Breast Cancer

#74. Radiation therapy recommended for invasive breast cancer patients who have undergone breast conserving surgery

#71. Hormonal therapy for stage Ic-III, ER/PR positive breast cancer

PQRI FAQs

Here are answers to some frequently asked questions about the PQRI program. For additional information, please go to CMS’ Web site at www.cms.hhs.gov/PQRI.

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 1.5 percent bonus would be applied to all your allowed Medicare charges from January 1 through December 31, 2008. 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 74, “Radiation therapy recommended for invasive breast cancer patients who have undergone breast conserving surgery,” you would need to report on this measure for 80 percent of your breast 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 for the first six months of 2007. Multiply that amount by 1.5 percent. This amount is likely to be your bonus payment amount for 2008. Bonus payments are expected to be made mid-2009.

I heard you needed to report on at least three measures to receive bonus payments. What about radiation oncology?

If a physician reports on one or two measures, CMS will validate that no other measures were applicable for that physician’s practice. CMS does not want eligible professionals to select additional measures so that they can report on three and thus has excluded several broadly applicable measures from the validation process (diabetes, falls, advance care plan, medication reconciliation, etc.)

In addition to the financial incentives, are there other advantages to participating in PQRI?

Yes. 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.

Measure 74 - Radiation therapy recommended for invasive breast cancer patients who have undergone breast conserving surgery

The denominator includes all breast cancer patients. How do I identify my breast cancer patients who have had mastectomies?

This measure is only related to breast conserving surgery patients. For mastectomy patients, report G8378, “Clinician documentation that patient was not eligible candidate for radiation therapy measure.”

Measure 71 - Hormonal therapy for stage Ic-III, ER/PR positive breast cancer

I noticed that measure 71 is also related to breast cancer. Do I have to write the prescription for the tamoxifen or aromatase inhibitor to report on this measure?

No. You do not have to write the prescription in order to report on this measure.

I am not responsible for monitoring whether my patients are receiving tamoxifen or aromatase inhibitors. Must I report on this measure?

No. 

Can I report on both measure 71 and 74 on the same claim for the same patient?

Yes, if appropriate.

For additional information and FAQs, please visit ww.cms.hhs.gov/PQRI or contact Emily Wilson.

 
Last updated on 9/19/2008 5:40:38 PM