“In a sense, we’ve had the opportunity to ride that wave on the backs of the billing companies,” said Dr. Dennis Beck, chair of ACEP’s Quality and Performance Committee.

As the PQRI program expands and emergency physicians’ participation increases, ACEP has, in tandem, continued to develop additional potential measures for CMS consideration. New PQRI measures submitted to the CMS by ACEP for the 2011 period include:

• Anticoagulation for acute pulmonary embolus patients.
• Confirmation of endotracheal tube placement.
• Severe sepsis and septic shock management bundle.
• Pregnancy test for female abdominal pain patients.

All four measures have been endorsed by the National Quality Forum, said Angela Franklin, Esq., ACEP’s director of quality and health IT. “We will continue to advocate for new measures,” she added.

Dr. Beck acknowledged that emergency physicians might not agree entirely with the measures submitted for inclusion in the PQRI incentive program. But they should understand that the College is taking a proactive stance in focusing on activities emergency physicians undertake that have demonstrated quality-improvement potential and can be readily measured.

“Some members may wonder who came up with certain measures and why, but they should understand that if ACEP doesn’t engage in this area,” other entities may develop measures that aren’t a good fit for emergency medicine yet involve ED processes, Dr. Beck said. “We have to recognize that while we are active in reviewing and submitting measures, we may sometimes be criticized because our 28,000 members aren’t going to agree on everything.”

ACEP’s involvement in PQRI may soon become more important in the overall quality-improvement landscape. One indication that the program is here to stay is the CMS’s recent announcement that it will publicly report physician performance. Reporting on Core Measures is already occurring at the hospital level, as part of the Medicare Hospital Compare program (www.hospitalcompare.hhs.gov). Several of those care process measures, from pneumonia care to post-MI and heart failure treatment, involve the emergency department.

It’s a natural extension, Dr. Granovsky said, to expand performance reporting to the individual physician level because PQRI utilizes provider tax ID numbers. In fact, the CMS recently announced that for 2009 PQRI submitted data, it will post on its Web site the names of physicians who satisfactorily reported on quality measures. The posting will follow tallying of 2009 incentive payments.

It’s not clear if data on emergency physicians will be posted on an individual or group-aggregate basis, Dr. Granovsky said. Reporting to date has been conducted on a group or department basis.