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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.

After discussing concerns with my billing company, I learned why medical pay for performance was a dud for many physicians.  It was the government’s own fault. Imagine all the hard work, overhead, time and frustration that must have been encountered simply to get back 2% of gross Medicare collections.  It’s no wonder why many doctors won’t accept Medicare anymore.  You get what you pay for.

So who’s playing and winning the CMS pay for performance game?  It turns out less than 1/3 of physicians feel like battling the PQRI requirements.  That doesn’t surprise me, considering the average PQRI physician pay for performance payment for the second half of 2007 was just around $600.   In Happy’s group alone, I was the only physician of almost twenty that successfully navigated the incredibly obtuse PQRI reporting rules of 2007.  I blogged about my first experience with Medicare pay for performance and showed you the data card we used in our first attempt to capture all the PQRI data.  You can see how complicated this process was. (We reported on four PQRI measures)

PQRI-Pay-For-Performance-Card-DocumentationWith the inaugural year (2007) behind us, how did Happy’s group do for 2008?  I have heard that only Happy and two other physician’s earned their PQRI reporting pay for performance for 2008. It’s almost 2010 and I’m just now learning my 2008 PQRI  CMS pay for performance fate.  Who here thinks it’s OK to pay 2008 money in the last month of 2009?

With a horrible 2008 PQRI CMS  physician pay for performance now behind us, there is hope for Happy’s colleagues yet.  We made some drastic changes to our methods of collecting the data with the hopes of having universal success for the 2009  CMS PQRI pay for performance. My hope is that Happy’s colleagues will finally succeed in winning the PQRI physician pay for performance game of 2009 that has generated nothing but annoyance for many physicians at their lack of success.

Unfortunately, the whole PQRI CMS physician pay for performance is not about quality.  It won’t even be about saving money for the Medicare National Bank.  It’s about collecting data and documentation to perpetuate  support for the government bureaucracy.  This is just a game.  A game you just have to know how to play.

If this stuff interests you, learn more about coding here in my coding lectures or earn CME at E&M University
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*This blog post was originally published at The Happy Hospitalist Blog*

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