PQRI: ‘We’re from the Government, and We’re Here to Help’

Gerard J. Gianoli, MD, a member of the ENT Today editorial board, is an otolaryngologist in private practice in Baton Rouge, LA.

In 1976, Ronald Reagan said, The nine most terrifying words in the English language are ‘I’m from the government, and I’m here to help.’ Well, one of our government’s most recent attempts to help both physicians and patients has been PQRI-the Physicians Quality Reporting Initiative (see ENT Today, December 2008, page 12). For those of you not familiar with PQRI, it is a Medicare program whose purported purpose is to improve quality of care for patients and to dispense monetary rewards to physicians who practice good quality medicine. These two goals are set up with the backdrop of reducing Medicare expenditures-presumably on poor quality care. In the PQRI program, certain quality measures reported to CMS will result in a 1.5% bonus. In order to qualify for this bonus, the reporting physicians must follow certain guidelines in at least 80% of the cases reported. If you follow the guidelines in fewer than 80% of the cases, you get nothing.

In May 2007, I wrote a pessimistic letter to the editor regarding PQRI and predicted that the program would not improve quality and compliant physicians would not receive any significant monetary reward for their efforts.(1) My predictions were more optimistic than reality has borne out over the past year and a half. Not only does the program not reward physicians, but they are also monetarily punished, and there is no documented improvement in quality of care delivered.

The ‘Bonus’

From a purely incentive standpoint, the PQRI program will fail as it stands. In order for the program to succeed, physicians need to have a significant reward for their efforts. This is currently not the case. A single specialty group consisting of 14 physicians, two nurse practitioners, and one physician’s assistant illustrates this point.(2) The members of this group are clinically very busy, and they have graciously allowed me to report their PQRI experience. This group decided to participate with the 2007 PQRI program. They did everything correctly and by the book and received their bonus check from CMS in July 2008. The check was for a total payment of less than $305. No, not per clinician-for the entire practice. That amounts to about $18 per clinician. There were 1,136 codes reported, making the bonus payment per code 26 cents.