PQRI reporting in 2010 (Physician Quality Reporting Initiative )

The Centers for Medicare & Medicaid Services (CMS) has continued the Physician Quality Reporting Initiative (PQRI) into 2010 as required under the Medicare Improvements for Patients and Providers Act of 2008 (MIPPA). PQRI is the first CMS-crafted national program to link the reporting of quality data to physician payment. The incentive payment for those eligible professionals who successfully participate in the program is 2 percent of the total allowed charges for Medicare Part B professional services covered under the physician fee schedule and furnished during the reporting period.

How does one use the measure specifications manual?

The first step for implementing PQRI in your office is to use the 2010 PQRI Measure Specifications Manual to identify measures applicable for professional services for which a physician’s practice routinely provides. The next step is to select those measures that make sense based upon prevalence and volume in the physician’s practice, as well as their individual or practice performance analysis and improvement priorities.

What is the description of the measure?

The measure specifications describe measure #20 as “Percentage of surgical patients aged 18 years and older undergoing procedures with the indications for prophylactic parenteral antibiotics, who have an order for prophylactic parenteral antibiotic to be given within one hour (if fluoroquinolone or vancomycin, two hours), prior the surgical incision (or start of procedure when no incision is required).” This narrative gives a high-level description of measure #20.

What are the instructions?

The instructions explain when the measure should be reported and who should report it. According to the instructions, measure #20 should be reported every time the procedure is performed on patients 18 years and older, with the indications for prophylactic parenteral antibiotics. The instructions further state that “Clinicians who perform the listed surgical procedures as specified in the denominator coding will submit this measure,” clearly indicating who should report the measure. In addition, the instructions indicate that there is no diagnosis associated with this measure.