ACC encourages cardiovascular community to participate in PQRI

Cardiologists have four measures to choose from among the 74 PQRI measures for 2007.

The American College of Cardiology encourages cardiovascular specialists to participate in the Physician Quality Reporting Initiative and is educating them about what it means to participate in the program.

“The ACC feels it is important to participate in this project and to analyze and reflect experiences back to Centers for Medicare and Medicaid Services,” said Janet Wright, MD, chair of the ACC Performance Assessment, Recognition, Reinforcement and Reward (PAR3) Task Force.

Participation of the cardiovascular community may increase opportunities for the ACC to work with the CMS to improve measures and the Physician Quality Reporting Initiative (PQRI) program overall, Wright said during a conference call. The call was scheduled to help ACC members decide whether to participate in PQRI and educate them about implementation, reporting requirements and quality measures for cardiology.

“Participating in PQRI is a small step toward system transformation and a giant leap to help physicians participate in the measuring frenzy going on now in the country,” Wright said. “PQRI is a starting point to test the feasibility of a claims-based quality self-reporting alternative.”

The CMS launched PQRI on July 1. Participation in the program is completely voluntary, and those physicians who successfully report quality measures for care are eligible for an additional 1.5% incentive payment based on total allowable Medicare charges.

“It is our job as cardiovascular physicians and clinical investigators to test and judge the system in the hope of future improvement,” said Joseph V. Messer, MD, chair of the ACC Carrier Advisory Committee.

Strategies

The Tax Relief and Healthcare Act Division B, Title I, Section 101, identifies how the program operates and is the statutory authority for PQRI, according to Susan Nedza, MD, MBA, chief medical officer with Region V of the CMS, Chicago regional office. The Tax Relief and Healthcare Act defines those who are eligible to participate, quality measures, form and manner of reporting, determination of satisfactory reporting, bonus payment calculation, validation and appeals.

“This program is about transformation, and Medicare is actively working to transfer itself from a passive payer of services based on volume to paying for high-quality, cost-efficient care,” Nedza said. “Efficiency is not just about money; it’s about care coordination and also about the patient’s experience.”

Quality measurement of reported data is rewarded with a financial incentive. Measurement enables improvements in patient care, and reporting is the first step toward pay for performance, according to Nedza.

She went on to discuss preparation strategies, stating that practices should select proper measures, define team roles and modify work flows and billing systems. Physicians should select measures that apply to the specific services they provide to patients. They should plan an approach to capture quality data reporting with their team prior to implementation. Nedza also suggested that physicians distinguish roles, assign responsibilities and provide the proper education. It is also important to walk through the approach to determine what system changes will be required to capture quality data codes.

Useful participation strategies include reporting quality data, understanding the analysis of satisfactory reporting and understanding the bonus payment calculation. Nedza said there are measure specifications and instructions available to assist in reporting quality data and reminded interested people that claims must reach the National Claims History file by Feb. 29, 2008. Furthermore, it is important to note that the potential 1.5% bonus is based on total allowable charges paid under the Physician Fee Schedule.

Future considerations for change in the program include opening registry-based reporting with standardized specifications for centralized reporting to reduce the burden of reporting for participants and the CMS, according to Nedza.

Implementing PQRI

John Schaeffer, MD, president of the North Ohio Heart Center and member of the ACC PAR3 Task Force, discussed some of the important features of how to successfully implement PQRI into practice.

He explained how measures are reported, stating that all reporting is claims-based. Four of the 15 cardiology-specific measures from the ACC starter set are included among the 74 PQRI measures for 2007; however there are other measures relevant to the cardiologist, according to Schaeffer. The ACC asked cardiologists to report on the following Physician Consortium for Performance Improvement measures:

• ACE inhibitor or angiotensin II receptor antagonist therapy for patients with HF with left ventricular systolic dysfunction.
• Antiplatelet therapy prescribed for CAD patients.
• Beta-blocker therapy prescribed for CAD patients with prior MI.
• Beta-blocker therapy prescribed for patients with HF and left ventricular systolic dysfunction.

The American Medical Association created CPT Category II codes for reporting quality data, according to Schaeffer.

“These codes, which supply the measure numerator, must be reported on the same claim as the payment codes, which supply the measure denominator,” he said.

The CPT Category II codes that apply to cardiology are 4009F (ACE inhibitor/AII receptor antagonist prescribed), 4006F (beta-blockers prescribed), 4011F (antiplatelet prescribed), 3021F (ejection fraction <40%), and 3022F (EF >40%). However, there may be some reasons why a patient is not on the recommended therapy and these must be documented by exclusion modifiers using the CPT II codes plus the modifier, according to Schaeffer.

“We’re giving you a chance to find out what you didn’t do, which will tell us about quality improvement, which is our goal,” he said. “We need workflow changes.”

Schaeffer also highlighted some of the challenges of the program, stating that data capture is important, and physicians should not worry about over-reporting on the same patient within a reporting period. Workflow changes should remain simple, and each person on the team should know their role, he said. Lastly, physicians must report on at least three performance measures 80% of the time.

“The bottom line is document, document, document, especially the exceptions,” Schaeffer said. – by Tara Grassia

For more information:

• To view presentation slides from the conference call, please visit http://www.acc.org/advocacy/pqri.htm.
• For more PQRI information on behalf of the Department of Health and Human Services, visit http://www.cms.hhs.gov/PQRI.