PHYSICIAN QUALITY REPORTING INITIATIVE

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PHYSICIAN QUALITY REPORTING INITIATIVE

• Dirk M. Elston, MD
• Geisinger Medical Center
• Danville, PA

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Dirk M. Elston, MD

• AAD advisor to the CPT Editorial Panel
• Co-Chair AMA Skin Cancer Performance Measure
  Workgroup
• Ad Hoc Task Force on Patient Safety and Quality,
• Chair of Practice Support group
• No conflict of interest

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Physician Quality Reporting Initiative (PQRI)

• Establishment of PQRI
• Medicare - passive payer to active purchaser
• Participation in PQRI
• Eligibility requirements
• Bonus payment

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Melanoma Quality Measures

• The three melanoma measures are evidence-based
• These measures are endorsed through multi
  stakeholder consensus organizations
• AMA Physicians Consortium for Performance
  Improvement (PCPI)
• Ambulatory Care Quality Alliance (AQA)

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Melanoma quality measures

• Reporting IS VOLUNTARY and begins July 1, 2008
  ends September 30, 2008
• No bonus payment
• Reporting is based on claims data using CPT
  Category II codes
• Individual physician data will NOT be reported

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Melanoma quality measures

• PQRI measures related to dermatology
• Measure 136 Complete skin exam, new or changing
  moles, and self-exam
• Measure 137 Enter into a patient recall system
• Measure 138 Develop a treatment plan and send to
  the primary care physician

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Reporting melanoma measures

• Reporting requirements
• CMS 1500 claim form for paper filing
• CMS 837 claim form for electronic filing
• AMA CPT Category II codes should be used for the
  numerator
• ICD-9 and CPT E/M service codes should be used
  for the denominator

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Sample 1500 Measure Claim Form
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Reporting melanoma measures Measure 136 skin
exam

• Numerator

• Denominator

• If follow-up performed CPT II 0015F
• If follow-up not performed for system reasons
  CPT II 0015F with modifier 3P (system reason)
• If follow-up not performed and reason is not
  specified CPT II 0015F with modifier 8P (reason
  not specified)

• Must include one ICD-9 diagnosis code AND one CPT
  E/M service code

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Reporting melanoma measures measure 137 Recall
the patient

• Numerator

• Denominator

• If recall system utilized CPT II 7010F
• If recall system not utilized for system reasons
  CPT II 7010F with modifier 3P (eg monitored by
  another provider)
• If recall system not utilized and reason is not
  specified CPT II 7010F with modifier 8P (not
  utilized)

• Must include one ICD-9 diagnosis code AND one CPT
  E/M service code

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Reporting melanoma measures measure 138 Send
Treatment Plan to PCP

• Numerator

• Denominator

• If patient is not eligible for this measure
  because he/she is diagnosed with a subsequent
  episode of melanoma CPT II 1128F
• If new diagnosis of melanoma AND treatment plan
  is communicated CPT II 5050F AND CPT II 1127F
• If new diagnosis of melanoma AND treatment plan
  is not communicated for system reasons CPT II
  5050F with modifier 2P (patient reason) or 3P
  (system reason) AND CPT II 1127F
• If new diagnosis of melanoma AND treatment plan
  is not communicated and reason is not specified
  CPT II 5050F with modifier 8P (reason not
  specified) AND CPT II 1127F

• Must include one ICD-9 diagnosis code AND one CPT
  E/M service code

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Additional measures for dermatologists

• PQRI measures eligible for bonus payment
• Measure 124 HIT- Adoption/Use of Health
  Information Technology (Electronic Health
  Records)
• Measure 125 HIT- Adoption/Use of e-Prescribing

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PQRI program

• 2008 program is voluntary
• Goal is more participation
• No enrollment necessary
• Information is available on the Academys Website
  at http//www.aad.org/pm/medicare/index.html and
  on the CMS Website www.cms.hhs.gov/PQRI
• Contact Peggy Eiden at peiden_at_aad.org or
• 847.240.1799 at the Academy