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2008 Physician Quality Reporting Initiative (PQRI) Update (GEN)
Posted March 20, 2008
Opportunity to Suggest Measures for Consideration for Inclusion in 2009
The Centers for Medicare & Medicaid Services (CMS) is now accepting quality measure suggestions for consideration for possible inclusion in the proposed set of quality measures to be published in the 2009 Medicare Physician Fee Schedule (MPFS) Proposed Rule for the Physician Quality Reporting Initiative (PQRI).
For more information on this opportunity to suggest measures for consideration for inclusion in 2009, please go to www.cms.hhs.gov/PQRI, and select the Measures/Codes tab on the left side of the page. Next, scroll down to the Downloads section and select “Notice of 2009 Measure Suggestions.”
Updates to the 2008 PQRI Tool Kit
The PQRI Tool Kit has been updated to include a downloadable file containing Data Collection Worksheets for all 119 2008 PQRI quality measures. To access this file, please go to www.cms.hhs.gov/PQRI, and select the PQRI Tool Kit tab on the left side of the page. Then, scroll down to the Downloads section and select “2008 PQRI Data Collection Worksheets.”
New Frequently Asked Questions (FAQs)
CMS updates the frequently asked questions (FAQs) for PQRI on an ongoing basis, as inquiry volumes and new program developments indicate the need for new or updated FAQs. The following new FAQs may be of particular interest at this time, as they focus on the process for validating whether a professional participating in the 2008 PQRI is reporting on a sufficient number of measures.
#8973 – Question: Is there a Measure Applicability Validation (MAV) process for 2008 Physician Quality Reporting Initiative (PQRI)?
#8973 – Answer: Yes. The PQRI 2008 Measure Applicability Validation Process for Claims-Based Participation is described in a document available for download from the Analysis and Payment page of the PQRI section of the CMS Web site (at url: www.cms.hhs.gov/PQRI/25_AnalysisAndPayment.asp#TopOfPage).
#8974 – Question: How does the two-step validation process work for the Physician Quality Reporting Initiative (PQRI)?
#8974 – Answer: Professionals who report successfully on each of fewer than three measures are subject to the 2008 PQRI Measure Applicability Validation (MAV) process for claims-based participation. Professionals who report on three or more measures are not subject to MAV. (The 2008 PQRI Measure Finder Tool is available to assist you in finding measures that may apply to your practice, and is available for download from the PQRI Toolkit page of the CMS Web site at: www.cms.hhs.gov/PQRI/Downloads/2008PQRIMeasureFinderTool.zip.)
Step 1 of MAV relates measures to one another by placing them in closely related clusters. This test is based on the concept that if one measure in a cluster of measures related to a particular clinical topic or professional service is applicable to a professional’s practice, then other closely related measures (measures in that same cluster) may also be applicable. The 2008 PQRI MAV clusters and the measures included in each are described in the document titled “2008 Measure-Applicability Validation Process for Claims-Based Participation,” which is available for download from the Analysis and Payment page of the PQRI section of the CMS Web site. CMS has not included in any clusters certain measures that are not suited for MAV clustering in the 2008 PQRI, for reasons described in the MAV process document.
Step 2 of MAV looks to see if an eligible professional treated more than a minimum number (threshold) of eligible cases that met the requirements of other measures within the cluster. For 2008 claims-based participation in PQRI, measure-specific thresholds may be determined based on analysis of data that will become available during the reporting period. In no case, however, will any measure’s 2008 PQRI applicability threshold be less than 30 reportable instances. The cases to which a measure applies are identified by the line-item diagnosis and service codes billed for each rendering National Provider Identifier (NPI). Any complicating diagnoses on the Part B base claim are not considered in 2008 PQRI analyses for claims-based participation. Cases that count toward the applicability threshold for any individual NPI will also not include those for which the qualifying diagnosis and procedure codes are identified by another rendering professional’s individual NPI. Eligible professionals who pass Step 2 of 2008 PQRI MAV will be eligible for the PQRI incentive payment. |
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