Managed Care Reimbursement

More Reimbursement Linked to Pathology Group's Participation in Medicare's 2008 PQRI Program

Many pathology groups seem unaware that Medicare would like to pay them additional money in 2008-if they opt to participate in the 2008 Medicare Physician Quality Reporting Initiative  (PQRI) program.  After doing an extensive amount of Internet research, Dark Daily determined that little information about the 2008 program exists online and that few pathology groups know that the opportunity exists.  Thus, we are taking this opportunity to share some details about the Medicare PQRI initiative with the laboratory community. We are also asking you to complete a brief five question survey (the link follows at the bottom of this e-briefing).

From Medicare's Web Site:  On December 20, 2006 the President signed the Tax Relief and Health Care Act of 2006 (TRHCA). Section 101 under Title I authorized the establishment of a physician quality reporting system by CMS. CMS has titled the statutory program the Physician Quality Reporting Initiative (PQRI).  PQRI establishes a financial incentive for eligible professionals to participate in a voluntary quality reporting program. Eligible professionals who successfully report a designated set of quality measures on claims for dates of service from July 1 to December 31, 2008, may earn a bonus payment, subject to a cap, of 1.5% of total allowed charges for covered Medicare physician fee schedule services.

Although Medicare has much information about the 2007 PQRI on its Web site, very little information is yet available on its 2008 PQRI Web site.  For laboratories and pathology groups interested in participating in the 2008 PQRI program, the eligible procedures cover the testing of breast and colon cancer sections. On Thursday, December 13, 2008 at 2:00-3:00 p.m. EST, the College of American Pathologists  will host its second audio conference on PQRI. The goal of the audio conference "is to assist pathologists, practice managers, and billing coders in understanding the nuts and bolts of reporting in CMS's PQRI for 2008."

Alert pathologists and lab directors will recognize that PQRI is one more step on the road to improving the quality of healthcare delivered to patients and gathering the data needed to inform evidence-based medicine initiatives.  Over time, it is likely that such data will be used to develop reimbursement incentives and pay-for-performance programs that reward physicians, laboratories, and medical facilities that meet certain quality standards.  In the short term, one goal of the PQRI is to encourage providers to more consistently follow approved clinical guidelines, thus reducing the variability in care provided by different physicians and medical facilities.

We would like your comments about Medicare's PQRI initiative.  Use this link to go directly to a brief, five-question survey. (If the link does not work, copy and paste this URL into your Web browser): http://www.surveymonkey.com/s.aspx?sm=lU7VFmwIwxFt_2f2whIJ3LvQ_3d_3d).

We will share the results with you in an upcoming Dark Daily!

Related Articles:

• CAP Schedules Second PQRI Audio Conference for Pathology-Specific Instruction
• More details on Medicare's PQRI