Which quality measures should we activate in IM Practice Manager to participate in PQRI?

There are several factors to consider when choosing quality measures to activate for PQRI.  Let's start by analyzing the requirements for individual reporting success, identify how that relates to group reimbursement, then tie it all together by applying those elements to the measure selection process.

Successful reporting is an individual issue:
It is important to understand that successful participation in a reporting period is determined on a per-physician basis. If there are 3 or more measures during the reporting period that any given physician had the potential to report (i.e. the provided care for at least one patient during the reporting period who met the criteria to apply the measure), that physician must report on a minimum of 3 measures with an 80% or higher reporting rate over the reporting period for their participation to be considered successful.

If less than 3 measures are reportable during the reporting period, they must report with an 80% or higher rate on every measure that does apply.  Based on our experience (and especially with the expanded list of measures introduced for the 2009 reporting period) however, few physicians would trigger fewer than 3 measures in a one-year reporting period, so 80% for 3 measures should be considered the absolute minimum target for successful reporting.

Reimbursement is a group issue:
The reimbursement from CMS is based on a percentage of the total allowed charges for covered Physician Fee Schedule services provided by each successfully participating physician during the reporting period. That reimbursement rate was 1.5% for 2007 and 2008 reporting periods, and will be 2% for 2009 and 2010.  These reimbursement funds, however, are allocated at the Tax Identification Number (practice) level.  The total amount reimbursed to the practice will thus be based only on the charge totals submitted by the physicians within that group who achieved successful participation during the period.

Putting it all together:
One underlying consideration will always be the trade-off between extra time spent answering questions from multiple measures versus the risk of activating too few measures and not reaching the minimum requirement of 3 during the period.  Activating only 3 measures with the expectation that each and every physician within your group will trigger all 3 of those measures during the reporting period can be a risky proposition.  There may be some measures with such a universal applicability, depending on the nature of the practice, but that might not always be the case.  If a physician only triggers 2 of those 3 activated measures during the reporting period, but any other measure (out of the nearly 200 available) could have applied to a single patient of theirs during the period (but that measure wasn't reported on because that measure was not activated in IM Practice Manager), they will have had the "opportunity to report" on 3 measures, but will not have met the requisite 3 measure reporting minimum for the period.  

In order to prevent the scenario just described, a typical approach might be to activate a primary group of 3-4 measures that are expected most physicians will trigger with regularity, then activate a small secondary group of measures that aren't expected to trigger often, but would provide an opportunity to report on a wider selection of measures (even if infrequently) for any physicians who don't happen to trigger all of the primary group of measures.  Since measures from that secondary group are not expected to trigger very often, they would not require extra time to answer their questions very often.  Even if triggered only once during the reporting period, reporting on one such measure (or not reporting on it, as described in the previous paragraph) could make the difference between successful and unsuccessful PQRI participation for a physician.

Still not sure what to do?
If, after taking all of these issues into consideration, you are still unsure which measures you should activate to maximize the opportunities for successful participation for your physicians (while not slowing down their billing unduly with an overwhelming volume of measure questions), please consult with your Client Services representative at Ingenious Med (404-815-0862).  We may be able to analyze your past billing and provide some insight into which measures your practice has the highest and lowest history of triggering.