CMS data show gains in key quality indicators through Physician Quality Reporting System and ePrescribing Incentive Program

CMS data show gains in key quality indicators through Physician Quality Reporting System and ePrescribing Incentive Program

2009 data show increases in how many eligible professionals successfully participate as well as how many instances professionals report delivering evidence-based care that can lead to better patient outcomes

The Centers for Medicare & Medicaid Services (CMS) today issued a report that highlights significant trends in the growth of two important “pay-for-reporting" programs. The report also articulates key areas in which physician-level quality measures appear to show positive results in quality of care delivered to Medicare beneficiaries.

CMS’s 2009 Physician Quality Reporting System and ePrescribing Experience Report states that 119,804 physicians and other eligible professionals in 12,647 practices who satisfactorily reported data on quality measures to Medicare received incentive payments under the Physician Quality Reporting System totaling more than $234 million—well above the $36 million paid in 2007, the first year of the program. Under the ePrescribing Incentive Program, CMS paid $148 million to 48,354 physicians and other eligible professionals in 2009, the first payment year for the program. Results show that participation in the Physician Quality Reporting System has grown at about 50 percent every year, on average, since the program began.

Although the two pay-for-reporting programs are open to a wide range of health care professionals, much of the reported data relate to care provided in ambulatory settings, such as physician offices. CMS Administrator Donald Berwick, M.D., explained, “Most beneficiaries get their care in the physician office; however, this is the care setting for which we have the least amount of data about quality of that care. The Physician Quality Reporting System and the ePrescribing Incentive Program help bridge the knowledge gap so we can better understand the care millions of patients receive from physicians and other care providers every day. The significant growth in the Physician Quality Reporting System shows us that the health care community shares CMS’s commitment to improving the quality and safety of care our beneficiaries receive.”

On average, 2009 bonus payments for satisfactory reporters in the Physician Quality Reporting System were $1,956 per eligible professional and $18,525 per practice. Eligible professionals who were successful electronic prescribers received even more from the ePrescribing Incentive Program in 2009: the average bonus payment was just over $3,000 per eligible professional and $14,501 per practice. Physicians and other eligible professionals who satisfactorily reported Physician Quality Reporting System quality measures data and thus qualified for an incentive payment for the 2009 Physician Quality Reporting System received their payments in the fall of 2010. 

Along with increases in participation rates and incentive payment amounts, CMS is encouraged by data from the Physician Quality Reporting System that shows growing rates in how often health care professionals report that they are complying more often with evidence-based care practices. These increased reporting rates could signal a positive trend in the quality of healthcare Medicare beneficiaries receive from professionals who report data through the Physician Quality Reporting System. One of the Physician Quality Reporting System’s main goals is to collect information about care practices that can ultimately help improve the quality and efficiency of care for all Americans, especially Medicare beneficiaries. Accordingly, the System’s measures capture evidence-based practices that are shown to improve patient outcomes, such as providing preventive services, taking steps to reduce health care disparities, planning care for patients with chronic conditions to keep them healthy for as long as possible, and integrating health information technology solutions into how providers deliver care. These measures are created by nationally recognized experts from groups such as the American Medical Association, and are endorsed by national quality consensus organizations.

Based on reported data on the 55 measures that have been a part of the System since it began in 2007, providers have improved the frequency for which they deliver recommended care by about 3.1 percent on average. Similarly, of the 99 measures that were part of the System in 2008 and 2009, performance improved at about 10.6 percent on average. In some cases, gains have been even more dramatic.

The measures chosen for the Physician Quality Reporting System also provide increased opportunities for eligible caregiving professionals from all segments of the health delivery system to participate. Since the program began, CMS expanded the System from 74 measures (with an eligible professional participation pool of roughly 600,000) to 194 measures (with an eligible professional participation pool over 1,000,000). Currently, about one in five health care professionals who can participate do so.

“Although participation in our pay-for-reporting programs is optional now, it should be regarded as imperative in terms of medical professionals’ shared goal of improving quality of care and patient safety,” said Dr. Berwick. “I challenge every health care provider who has not yet participated to begin today. We will not improve the quality of health care in this country without knowing where we stand in delivering care and using that knowledge to continually improve our practices. Our patients deserve nothing less.”

Dr. Berwick noted that participation in the Physician Quality Reporting System and the ePrescribing Incentive Program also makes good business sense for health care providers. Both programs currently reward eligible professionals with a percentage of their estimated Part B Medicare Physician Fee Schedule (PFS) allowed charges for covered professional services furnished by the eligible professional during the reporting period.

Both programs also serve as part of a broader strategy to encourage health care providers to adopt practices that can improve patient care. In early 2011, CMS launched incentive programs for both Medicare and Medicaid that reward providers financially for becoming meaningful users of certain health information technology solutions this year.  Physicians will also see data on how well they perform against their peers on quality measures as CMS’ Physician Compare website expands to include quality information by 2013. Also, providers who are able to participate in the ePrescribing Incentive Program and the Physician Quality Reporting System Program, but who choose not to, will receive payment reductions from Medicare beginning in 2012 and 2015, respectively for each program.

To learn more about the Physician Quality Reporting System, including instructions on how to get started, visit the CMS website at http://www.cms.gov/PQRS. Information on the ePrescribing Incentive Program is available at http://www.cms.gov/ERxIncentive/.

The full 2009 PQRS and ePrescribing Experience Report is also available on CMS’ website at http://www.cms.gov/PQRS.

Additional 2009 program results can be found in a CMS Fact Sheet here:  http://www.cms.hhs.gov/apps/media/fact_sheets.asp.