PQRI, or Physician Quality Reporting Initiative is a Medicare program designed to measure and report physician’s (or other qualifying practitioners, such as physical therapists) performance. This is a fairly new trend and one of the first to put into practice a pay for performance program. Basically, it is trying to get clinicians and doctors to identify quality measures for their patient population and to start to create more standardized practice.
As a physical therapist, why should you invest your time and energy in this?
-First and foremost, there is a financial incentive as a bonus payment. More specifically, a lump-sum incentive payment will be invested back to you based on your total estimated allowable charges within Medicare Part B Physician Fee Schedule. The payment was 1.5% in 2008 and 2.0% in 2009. My understanding is that the percentage will decrease though until 2014.
-Secondly, this will be mandatory in 2014. Meaning, if you do not report on the quality measures, then you will be deducted a percentage. Make sure you stay tuned with CMS.
-Thirdly, you are already (at least most of us) including this information in our evaluations so really not much more work. Keep reading for the quality measures. Why not get paid more for it!?
Why am I writing this post? Well, I want to describe how easy this program is to follow based on my experience with it in the last 1.5 years. Most, if not all of us are already assessing the quality measures in our initial examination so its just a few extra steps you have to do to qualify.
What are the quality measures?
-There are at least 175 individual measures and 10 group measures finalized in 2010 by CMS. Not all of these apply to PTs of course, but so here are the ones that were used in our clinic in 2009:
-Health Information Technology (HIT): Use of Electronic Health Record (HER)
Pain Assessment Prior to Initiation of Patient Therapy and Follow-up
A standardized tool must be used. I simply use the VAS.
-Diabetes Mellitus: Diabetic Foot and Ankle Care, Peripheral Neuropathy – Neurological Examination
These patients must have diagnosis of DM. You should perform at least two motor/sensory neurological examination tools (i.e. reflexes, vibration, proprioception, sharp/dull and 5.07/10g monofilament testing).
-Preventative Care and Screening: Body Mass Index (BMI) Screening and Follow-up.
Simply take height and weight for this measure to determine if the BMI. I find a free app such as in the picture is quick and easy instead of doing the math myself! Unfortunately, at least 80% of my patients are in the overweight or obese category.
–Documentation and Verification of Current Medications in the Medical Record
You must have documentation of dosages and medications, as well as verification by the patient.
-Fall Risk Assessment and follow-up plan of care.
You will use this if the patient has fallen two or more times in the last year or a fall with an injury in the last year. Two coding options are needed for this quality measure as you need a follow-up plan if the fall risk meets the criteria. We will mainly assess gait and balance through standardized tests (BERG, TUG), or ROM and strength of LE (MMT, Timed Stand Test).
To be successful in the program, you will need to provide at least 3 quality measures in at least 80% of your cases. This includes documentation for your patient evaluation and re-evaluations.
How is this done?
1. HCPCS (or CPT) codes need to be implemented in your flow sheet.
2. Internal documentation (in your evaluation) must be recorded to show these quality measure procedures were actually performed. For most of the quality measures, you will have to document what your follow-up plan will be (if needed) to address what was found (i.e. nutrition advice to lose weight, balance training exercises for fall risk, etc).
What is your experience with PQRI? Are you finding it to be successful financially and personally with your patients?
**FYI: This post is simply giving you my experience with the program and to see how, and if, other physical therapists are implementing this too. If I included more details, then the post will be extremely boring and way too long! I recommend that you refer to the CMS website here or APTA website here for more details on the quality measures/how to document and assess; as well as updates (keep in mind the changes made annually).**