PQRI Program Continues in 2008

Specialty societies questioned the viability and utility of keep the Physician Quality Reporting Initiative (PQRI) in 2008. The societies asked CMS to use the 2008 PQRI funds to offset the anticipated physician fee reductions. CMS rejected this request. The PQRI program follows the same protocol as 2007 but covers a full year of services (January – December 2008). Expected bonus payments would be approximately 1.5% of a participants allowed charges; not to exceed 2%. The program continues to be voluntary. Results of the 2007 program are still unknown at this time.

For ophthalmology, some notable changes exist. The three cataract measures and one ARMD measure were dropped from the 2008 program. The remaining measures applicable in 2008 are:

1. Primary Open Angle Glaucoma: Optic Nerve Evaluation
2. Age-Related Macular Degeneration: Dilated Macular Examination
3. Diabetic Retinopathy: Documentation of Presence or Absence of Macular Edema and Level of Severity of Retinopathy
4. Diabetic Retinopathy: Communication with the Physician Managing Ongoing Diabetes Care
5. New – Dilated Eye Exam in Diabetic Patient

Successful reporting depends on your commitment to the process. If you plan to participate in the program, you should begin reporting on January 1, 2008. For more information on PQRI, visit the CMS website. Corcoran Consulting Group has also published a PQRI monograph specific to vision care providers including case studies and claim form examples.