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PQRI program, meaningful use have headaches in common

Providers participating in the PQRI program now know what to expect when it comes to reporting for meaningful use. Some wonder how palatable the new program really will be.

Providers who have been participating in the Physician Quality Research Initiative (PQRI) program have had a taste of what to expect when it comes to reporting the criteria in the meaningful use final rule, and some wonder how palatable the new program really will be.

Beginning next year, providers who wish to receive payments through the Electronic Health Record Incentive Program, or EHRIP, will have to demonstrate they are meaningfully using health IT, including EHR systems. The Stage 1 meaningful use criteria, spelled out in a final rule, require doctors and hospitals in part to report on various quality measures. They will have to submit their information to the Centers for Medicare & Medicaid Services (CMS), which oversees the incentive program in conjunction with the Office of the National Coordinator for Health Information Technology, or ONC.

CMS already oversees another Medicare quality program, the four-year-old PQRI, which also requires doctors to submit information on measures in various areas of clinical care. Last year CMS added electronic submission to the program, so doctors can transmit data from their EHR systems. The program is voluntary, but physicians who are not submitting data by 2014 will have their reimbursement rates cut. That is similar to the meaningful use plan, which also uses incentives for five years before cutting payments to providers who do not send information electronically and demonstrate they are meeting meaningful use requirements.

Unlike meaningful use, the PQRI program requires doctors only to submit the data, not prove they are using the data to change their practices. Originally, CMS wanted to test the feasibility of reporting information and providing feedback to doctors. Physicians then could use those reports to gauge how well they provided care based on the quality measures in the program.

Just that process of reporting and receiving feedback has caused headaches, however. The lag time between data submission and feedback reports and incentive payments, is too long, doctors say -- and if meaningful use begins with similar problems, the program might not be as effective as the industry is hoping.

Retrieving and going through the feedback reports appears to be getting more difficult, not easier, according to the results of a survey conducted by the Medical Group Management Association (MGMA): Downloading the PQRI 2008 reports took almost nine hours, compared with five hours for the 2007 reports. In addition, of the practices that responded to the survey and tried to participate in the PQRI program, 48% were able to access their 2008 reports, compared with 51% the previous year.

"With the PQRI now in the fourth reporting year and Congress contemplating modifications to the program in health care reform legislation, MGMA strongly urges CMS and Congress to take note of our members' feedback and implement much-needed improvements," Dr. William Jessee, MGMA president and CEO, said in a written statement.

PQRI: A harbinger of meaningful use pain without gain?

Imagine filing taxes in January but not receiving a return until September. That's what the PQRI process is like now, said Thomas Graf, a physician who chairs the community practice of Geisinger Health System in Danville, Pa.

Doctors who join the PQRI program typically face significant up-front costs to deploy electronic systems that can capture data points and send information to the CMS, Graf said. For small practices, that's a long time to wait for the incentive payments that help offset those costs. "There is a significant disconnect."

Geisinger Health, a system that often is looked on as one of the most automated in the country, participates in a second phase of PQRI, one where reimbursement is tied to hitting specific targets on the quality measures, not just to data reporting. About 4.5% of the system's operating budget is spent on IT, Graf said.

The system completed this year's quality measures and is still waiting to know what percentage of its targets it hit, Graf said. CMS is still working on the process for data review. "They're getting millions and millions of data points," he said. If the agency wants to add meaningful use reporting to that mix, "it would be good for everyone if they were able to improve the cycle."

There is some overlap between PQRI and meaningful use, but meaningful use has many more requirements, and is much more burdensome for practices.

Bill Mallon, orthopedic surgeon, Durham, N.C.

It's not really a question of whether doctors should be reviewing information on their performance. Evidence from such quality improvement initiatives as the PQRI program suggests reporting does work, said Cynthia Shewan, director of quality, research and patient safety for the Society of Thoracic Surgeons (STS) in Chicago. "Surgeons, when given feedback, do improve."

The society maintains a data registry for its surgeons, who submit quality information and receive feedback reports on a quarterly basis. STS has offered the service for 28 years. CMS approved the STS registry as a third-party data aggregator for PQRI, which means the society submits information on behalf of its member surgeons to the federal agency for the incentive program.

Physicians can develop their own benchmarks and create processes that look at measures appropriate to their practices and clinical objectives, Shewan said. Doctors should be prepared to do that as they cope with performance mandates that are coming. "The government is really coming down with a lot of changes in the next few years," she said.

And despite the practice with data collection and reporting that doctors might have had through the PQRI program, being ready for meaningful use requirements still is a whole new ballgame. "There is some overlap between PQRI and meaningful use," said Bill Mallon, a member of the American Academy of Orthopaedic Surgeons who practices in Durham, N.C. "But meaningful use has many more requirements, and is much more burdensome for practices. In addition, PQRI can be implemented internally. [Meaningful use] requires interoperability with labs, X-ray reports, pharmacies, and patients in a way that puts certain burdens on database standardization."

For quality purposes, data collection and analysis through such programs as PQRI and meaningful use ultimately help physicians, Mallon said. "I continue to hear from most doctors that the financial incentives for PQRI were not worth it. Now the information is important, and that is a good thing. But it has become another cost that practices have had to absorb with little chance of recouping that investment."

Let us know what you think about the story; email Jean DerGurahian, News Writer.

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