The beginning of July brought physicians a welcome change of pace from the Centers for Medicare and Medicaid Services. Under the agency's Physician Quality Reporting Initiative, doctors can receive bonus payments of 1.5 percent of certain charges until the end of the year, if they report a set of related quality measures.

The PQRI program is "paving the way for a value-based purchasing program for physicians that would comprehensively assess and reward high quality, while avoiding unnecessary costs in the provision of care," says Tom Valuck, MD, director of the Special Program Office for Value-Based Purchasing at CMS in Baltimore.

The as-yet unnamed program to follow PQRI will similarly evaluate and reward doctors. It will take effect when the U.S. Congress authorizes it, and it has no projected launch date, Dr. Valuck says. "It's en_visioned to be a voluntary program that would have enough of an incentive to encourage broad participation," he says.

Enrolled providers may report on as many as three measures applicable to their practice, and they are eligible for a bonus from each, as long as they report data on at least 80 percent of their patients who fall into each measure category, Dr. Valuck says. However, there is a limit to the bonus. "That cap would generally come into play when a physician reports only a few [measures] of quality data," he says.

Each of the 74 PQRI measures typically seeks to find out how many patients with a specific diagnosis receive a specific type of care. The measures ask doctors what happened to patients grouped in a particular CPT Category I or ICD-9 code. Within that specific group, the agency wants to know what proportion of patients have been given care defined by a CPT Category II or G code. For example, measure 13 asks physicians to report the percentage of patients over 50 years old with age-related macular degeneration that were directed to take part in the Age-Related Eye Disease Study in the past year.

This summer, CMS released a tool kit on its Web site at www.cms.hhs.gov/pqri to facilitate participation. "Each measure has a worksheet that tells you who qualifies and what the satisfying measure is, and [each] offers you the opportunity to report what you did on the measure," says Sandra Bressler, vice president of medical and regulatory policy at the California Medical Association. The forms also give physicians a way to explain patient treatments that differ from the CPT Category II codes.

So far, CMS still has a few kinks to work out of the current PQRI setup. "There are some real technical difficulties ... because they're not using codes that are preprogrammed into anybody's system," Bressler says. Providers who are submitting electronic claims or who are participating in registries may face problems. "CMS is not set up to make that happen," she adds.

When the current PQRI program ends on Dec. 31, 2007, a proposed 2008 PQRI program is ready to replace it at the start of the new year. "We expect to expand the measure set--make it more robust--and we are also hoping to test additional channels for reporting, including registry-based reporting and electronic health record-based reporting," Dr. Valuck says.