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Participation tools:
Medicare Physician Quality Reporting Initiative (PQRI)

The 2008 Physician Quality Reporting Initiative (PQRI) program will begin on Jan. 1, 2008. This program, initially launched by the Centers for Medicare and Medicaid Services (CMS) in July 2007, encourages quality improvement through the use of clinical performance measures on a variety of clinical conditions. Physicians and other eligible professionals who successfully report on a designated set of quality measures through claims submitted for services provided from Jan. 1 to Dec. 31, 2008, may earn a bonus payment, subject to a cap, of 1.5 percent of total allowed charges for covered Medicare physician fee schedule services. Those considering participating in the program should carefully review the PQRI instructions and frequently asked questions posted on the CMS PQRI Web site.

To assist physicians and other eligible professionals who may elect to participate in this program, the American Medical Association, in collaboration with the CMS, Mathematica Policy Research, Inc, and the National Committee for Quality Assurance has developed participation tools. The tools are designed to:

• aid physicians and other eligible professionals wishing to participate in the program to identify measures relevant to their practice
• facilitate the data collection required to report clinical performance data

After clicking on the link View the 2008 Physician Quality Reporting Initiative (PQRI) Measures either here, in the right hand column or at the bottom of the page, you will find a list of the 119 quality measures for the 2008 PQRI program. To the right of each measure, you will find links to 3 documents, which can be printed out for easy reference, including:

1. Measure description – 1 for each measure

• An informational sheet is available for each measure in the PQRI program. This document contains additional descriptive information regarding the measure and should help users determine if it is a measure on which they would like to report. In particular, the document describes what type of information is required to report on the measure and how frequently reporting is required.

2. Data collection sheet – 1 for each measure

• A data collection sheet is provided for each measure in the PQRI program. This document is a step-by-step tool for clinical use and office/billing staff use. It allows the physician or other eligible professional to record the clinical information required for the measure by checking the appropriate box, and the coder to subsequently select the corresponding billing code.

3. Code specifications

• A coding specifications sheet is available that includes a complete list of ICD-9 (International Classification of Diseases, Ninth Revision) and CPT® (Current Procedural Terminology) codes to identify patients eligible for the measure. A list of the quality codes for each measure is also included. The coding specifications document is to be used in conjunction with the data collection sheet to determine the appropriate code or combination of codes to be reported.

Many of the measures in the PQRI were developed by the AMA-convened Physician Consortium for Performance Improvement®, in collaboration with the National Committee for Quality Assurance (NCQA) and/or a medical specialty society. For additional information on the Consortium including additional background information on the quality measures with both the rationale and evidence base for each measure, please visit the Physician Consortium for Performance Improvement Web site.

For additional information on NCQA and NCQA measures, please visit the NCQA Web site.

For additional information on the PQRI program, please visit the CMS Web site.

View the 2008 Physician Quality Reporting Initiative (PQRI) Measures.

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