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Physician Pay For Performance: My 2008 Experience

It’s official. Happy has now earned his CMS physician  pay for performance PQRI Bonus for 2008, a direct deposit into Happy’s bank account. PQRI stands for Physician Quality Reporting Initiative.  How much was my PQRI Medicare pay for performance bonus for calendar year 2008? A $2,500 check written out directly to Happy by the  Medicare National Bank.  CMS gives a wonderful overview of the history of PQRI .  PQRI is the Medicare pay for performance program for physicians that was initiated by Congressional mandate in the latter half of 2007.   Doctors have an opportunity to earn back 2% of their gross Medicare collections (which the government calls a bonus but which I call legalized theft) by submitting a grotesque amount of quality performance paper work to the Medicare National Bank. It’s one giant PQRI guideline game.

PQRI reporting is currently voluntary, but legislation in future years will certainly mandate reductions in payment for not submitting data, all but making this program a punitive standard.  Many physicians failed to meet the requirements to get paid under CMS pay for performance program guidelines in the latter half of 2007, the first year for PQRI measures. Read more »

*This blog post was originally published at The Happy Hospitalist Blog*

Healthcare Red Tape Of The Week: PQRI

How has the Physician Quality Reporting Initiative (PQRI) been going? Some insights are offered from an internist in the trenches, (the only 1 of 20 physicians in his practice who was able to figure out how to comply with the PQRI rules), The Happy Hospitalist:

I found out today many docs may not have qualified because of the way the government PQRI computers crunched the data (imagine that). You see, if my quality indicator was for antiplatelet use in stroke, and I submitted to CMS stroke as the 4th ICD code, along with three comorbid conditions ( like DM, COPD, CAD), unless I submitted stroke as diagnosis #1, PQRI would reject my submission. So CMS accepts your E&M code with stroke listed as the 4th diagnosis to get paid, but when that claim makes it to the PQRI folks, because stroke was diagnosis #4 and not diagnosis#1, PQRI would reject the submission and doctors all over this country were dinged for not reporting on 80% of qualified patients…

I also found out that PQRI indicator #36 calls for rehab ordered for all “intracranial” hemorrhage. During my meeting today I found out that the only ICD codes linked to this quality indicator are “intracerebral” hemorrhage. Sub dural bleeds, which are intracranial, are excluded. So are subarachnoids. They have problems even defining what they are trying to measure.

Latest Interviews

IDEA Labs: Medical Students Take The Lead In Healthcare Innovation

It’s no secret that doctors are disappointed with the way that the U.S. healthcare system is evolving. Most feel helpless about improving their work conditions or solving technical problems in patient care. Fortunately one young medical student was undeterred by the mountain of disappointment carried by his senior clinician mentors…

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How To Be A Successful Patient: Young Doctors Offer Some Advice

I am proud to be a part of the American Resident Project an initiative that promotes the writing of medical students residents and new physicians as they explore ideas for transforming American health care delivery. I recently had the opportunity to interview three of the writing fellows about how to…

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Latest Book Reviews

Book Review: Is Empathy Learned By Faking It Till It’s Real?

I m often asked to do book reviews on my blog and I rarely agree to them. This is because it takes me a long time to read a book and then if I don t enjoy it I figure the author would rather me remain silent than publish my…

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The Spirit Of The Place: Samuel Shem’s New Book May Depress You

When I was in medical school I read Samuel Shem s House Of God as a right of passage. At the time I found it to be a cynical yet eerily accurate portrayal of the underbelly of academic medicine. I gained comfort from its gallows humor and it made me…

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Eat To Save Your Life: Another Half-True Diet Book

I am hesitant to review diet books because they are so often a tangled mess of fact and fiction. Teasing out their truth from falsehood is about as exhausting as delousing a long-haired elementary school student. However after being approached by the authors’ PR agency with the promise of a…

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