Thursday, June 19, 2008

PQRI Clarification (from Bobbi Buell)

Please read this newsletter carefully, if you planned on reporting PQRI measures starting July 1, 2008. Medicare published Transmittal #355, Change Request 6104, dated June 13, 2008. This clarifies that you may only report from July 1-December 31 using one of the NEW PQRI submission methodologies. Since none of these methodologies (claims groups or registries) particularly applies to Oncology, it may not be possible for many of you to start July 1, 2008. Read the fine print here and decide what you want to do.

When CMS first published this information, they stated that they were opening up the reporting periods, but further clarification from CMS in Washington demonstrates that they were not being that generous!

On April 17, 2008, CMS posted a news article with the headline "Physician Quality Reporting Initiative (PQRI): Important New Program Changes Make It Easier than Ever to Participate!". As usual, CMS was not making anything easier. This news article stated that there was an alternative reporting period and announced new mechanisms for reporting. Many folks read this and believed that there were both: new reporting mechanisms and the ability to start reporting July 1. That was incorrect. You must use one of these new mechanisms to qualify for the new reporting period. Otherwise, unless you are using a the new claims groups or a registry, the reporting period started January 1.

To clarify this point, CMS released a new transmittal (Transmittal #355, CR 6104, dated June 13, 2008) stating the PQRI reporting requirements starting July 1, 2008 and becoming effective July 7, 2008. It clearly states the difference between what you can report starting January 1 and what you can report starting July 1, 2008. This was also clarified in the CMS conference call May 29, 2008.

There are two new ways to report starting July 1, 2008. They are:
Through a Medicare-certified registry (interesting that registries will not be named until 8/31/2008) OR
Through claims reporting groups. There are only groups for diabetes mellitus, End Stage Renal Disease, Chronic Kidney Disease, or Preventive Care (includes many different measures). If you are in a multi-specialty practice, you might look at these options on the CMS website.
The only other way you can start reporting now is to choose measures (and there are 60--but I have provided the Hem-Onc below--but there may be many others that you choose to use) that only require PQRI measures once per reporting period (for this year, that is 1/1/08-12/31/08). So, what you need to do is to search by diagnosis plus included procedure codes and make sure that you can still make at least 3 at 80% of your volume by reporting from now until the end of the year. Here are the once per year measures in Hem-Onc with abbreviated descriptors. Please read the coding guidelines in detail before you start reporting them:
Measure #67-MDS Baseline Cytogenetic Testing
Measure #68-MDS Erythropoetin Documentation of Iron Stores
Measure #69-Multiple Myeloma Biphosphonate Therapy
Measure #70-CLL Baseline Flow Cytometry
Measure #71-Breast Cancer Stages on Tamoxifen/AIs
Measure #72-Colon Cancer Stage III Chemotherapy
Measure #73-Chemotherapy Plan Documented Before Chemotherapy (limited by type of cancer)
Measure #74-Radiation Oncology in Breast-Conserving Surgery
Measure #101-Prostate Cancer Evaluation
Measure #103-Treatment Options for Localized Prostate Cancer

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