Of note, hospitals that fail to meet the reporting requirements for the hospital outpatient quality data reporting program are subject to a reduction of 2% from the market basket update to the conversion factor. It is in emergency physicians’ best interest to help their hospitals meet the program requirements. Eventually, there will be monetary penalties for physicians who don’t report quality measures.

What are the measures?

For 2009, emergency medicine has 11 measures to choose from, and the physician chooses 3 on which to report. A complete list of the measures and their descriptions is available at www.acep.org.

What do I need to know or do as a practicing physician?

First, especially for emergency physicians in an independent group, be sure the group’s billing company is capturing and successfully submitting these data. The group will need to select at least three measures it wants to report.

Then, be sure the documentation system being used helps easily document these measures. Get feedback from your coders to find out if they are having problems finding the correct documentation, including the reason the measure was not met (e.g., for aspirin within 24 hours for acute MI, aspirin was not given secondary to allergy to aspirin).

Finally, discuss how to distribute the annual bonus. One issue for groups has been that they cannot identify the payment by individual physician because it is a single payment to the group. Some groups add the extra money into a bonus pool based on productivity. Some billing companies can also provide reporting on individual physician compliance with the measures to help with distributions.

Are there any other CMS incentives for physicians?

Yes, E-prescribing. This incentive program, started for 2009, is not tied to PQRI, but has many similarities. A very important difference relates to the eventual decrease in Medicare reimbursement. The incentive bonus for 2009-2010 is 2%, for 2011-2012 is 1%, for 2013 is 0.5%, and then it starts to become a reduction in pay. Reductions will be 1% for 2012, 1.5% for 2013, and 2% for 2014 and on.

Emergency medicine received a waiver this year, because emergency physicians depend on the hospital to provide software and cannot independently control this aspect. However, in upcoming years, this may change.

Engage your hospital administrators to purchase electronic discharge programs that meet CMS’s criteria, which include an active medication list, alert systems for allergies and interactions, cost savings information, printed prescriptions, and electronic transmissions to pharmacies.