Medicare Compliance & Reimbursement

The 2008 Fee Schedule final rule includes provisions for the Physician Quality Reporting Initiative (PQRI) for 2008, and it doesn't leave out nonphysician practitioners (NPPs).

The final rule from the Centers for Medicare & Medicaid Services (CMS) lists the 119 PQRI measures for 2008, including 59 of the 2007 PQRI quality measures, as well as several new ones. "We recognize that quality extends beyond the physicians," said CMS' Susan Nedza, MD, MBA, FACEP, at the CMS PQRI National Provider Call on Nov. 28. Therefore, she emphasized the fact that NPPs such as nutritionists, CRNAs, physical therapists and other personnel can participate in PQRI.

What's new: You'll find that 38 of the new measures were developed by the American Medical Association's Physician Consortium for Performance Improvement (PCPI), including several measures related to depression, osteoarthritis, acute otitis externa (AOE), otitis media with effusion (OME) and perioperative cardiac risk assessment.

NPPs will benefit from seven new measures, including screenings for weight, hypertension, depression and cognitive impairment, as well as flu vaccine screening/counseling, medication verification and other measures.

You'll find two new structural measures related to the adoption/use of e-prescribing and electronic health records, and five preventive quality measures such as screening mammographies, screenings for colorectal cancer and advising smokers to quit.

Six of the new measures relate to misuse of pharmacologic therapy, such as inappropriate antibiotic treatment for adults with acute bronchitis, flu vaccines for patients 50 years of age or older, and pneumonia vaccines for those 65 and older. And the final two measures, which are related to diabetic foot care, were developed by the American Podiatric Medical Association.

Congress could change it: "The PQRI is better for NPPs this year, making it possible to get credit and payment," says Quinten A. Buechner, MS, MDiv, ACS-FP/GI/PEDS, CPC, CCP, CMSCS, president of ProActive Consultants, LLC. "Keep in mind that Congress hasn't decided whether or not to use PQRI as a money source for the fix of the fee schedule. In general, the program will be a plus to NPPs if it is not deleted in the fix of the fee schedule," he says.

To read more about the 2008 PQRI measures, visit http://www.cms.hhs.gov/pqri.