Medicare pay-for-reporting: How to get your 1.5%

July 1 marks the start of Medicare's quality reporting program. Here's what physicians need to know now to get ready for it.

By David Glendinning, AMNews staff. June 4, 2007.

Next month, Medicare will take a big step toward becoming a more active health care purchaser, by launching its first program-wide quality reporting initiative for physicians.

Doctors who join the effort will be eligible for a 1.5% bonus on all of their Medicare reimbursements for the last six months of this year.

Not every physician will decide that participating in the Physician Quality Reporting Initiative is worth the money. Collecting data for the quality measures and passing it on to the government, for instance, will require extra work by doctors and their staff.

The Centers for Medicare & Medicaid Services wants physicians to understand how the program will operate so Medicare can get the data it needs and doctors can get the bonuses they deserve.

First, physicians must consult the CMS-approved list of 74 quality measures to decide how many to report and determine how many of their Medicare patients fit into those categories. To be eligible for the bonus, doctors must report on at least three measures and apply each one to at least 80% of the patients who fit that category.

Physicians who see a significant number of diabetic patients, for example, might decide to keep special tabs on whether these patients maintain their blood pressure control -- one of the CMS quality measures. To meet this requirement, a doctor would have to share with the government the individual blood pressure ranges of at least 8 out of 10 under-control diabetic patients during one or more of their follow-up office visits in the last half of the year.