From PQRI to P4P?

If the federal government has its way, a quality reporting initiative from Centers for Medicare & Medicaid Services could pave the way toward establishing a pay-for-performance system. In response to a law Congress passed in 2006, CMS implemented its Physician Quality Reporting Initiative. It is a voluntary program in which participating physicians in 2008 can receive up to a 1.5 percent bonus to their total Medicare charges in exchange for sending quality data to CMS that could be used to overhaul how the agency pays physicians for their services. (The 2009 PQRI bonus will increase to 2 percent.)

“CMS is interested in moving from an agency that pays on the basis of volume to a system that’s based on improved quality,” says Michael Rapp, MD, director of quality measurement for the agency.

Last year, the PQRI program paid $36 million in bonuses to 56,700 physicians who “satisfactorily” reported quality information. The average amount paid to a physician was more than $600, while the average physician practice group received more than $4,700 in bonuses, according to CMS. The largest payment to a participating physician group was nearly $206,000.

The 2008 PQRI program includes 119 quality measures, such as the percentage of patients who received cancer or mammogram screenings. But doctors must report only three of those measures to CMS to qualify for the full bonus, Rapp says.

While CMS collects and publishes quality data from hospitals and nursing homes, it has no plans to publish quality ratings of physicians, Rapp says. Publishing physician quality scores, as well as implementing a P4P system, would require congressional authorization, according to Rapp.

One Medicare advocate says he applauds CMS’ move toward quality reporting and P4P, but cautioned against the limitations of both. “You can’t look at quality reporting or P4P on its own as a silver-bullet solution,” says Paul Precht, director of policy and communications for the Medicare Rights Center. “You have to look at it in the context of improving coordination of care, and, in particular, putting primary care physicians at the center of coordination efforts.”