In 2008, the only Physician Quality Reporting Initiative (PQRI) measure that applied to rheumatoid arthritis (RA) was disease-modifying antirheumatic drug therapy. For 2009, five new RA measures were included, for a total of six measures in the new RA Measures Group. The five new measures were developed in 2008 by the National Committee for Quality Assurance in collaboration with the ACR and the American Medical Association’s Physician Consortium for Performance Improvement and were subsequently adopted by Medicare.
The new measures are tuberculosis screening prior to beginning anti–tumor necrosis factor therapy, periodic assessment of disease activity, functional status assessment, assessment and classification of disease prognosis, and glucocorticoid management. Other measures on which rheumatologists can report include osteoporosis, osteoarthritis, assessment of pain, back pain, falls, and health information technology. With the exception of back pain, these measures can be reported individually or as part of a measures group.
Why Use the RCR Instead of Claims-Based Reporting?
Using the RCR for PQRI reporting provides several advantages over claims-based reporting:
- Users can collect clinical information at a pace that suits their clinical workflow.
- Users can print forms to incorporate into the paper record until Web-based data entry can be done.
- Information can be collected by a downloadable Excel spreadsheet that can be subsequently uploaded to the RCR.
- Because registry reporting does not need to occur at the same time as submitting claims for patient visits, users will have the option to employ batch reporting for 2009 PQRI as late as February 2010.
- There is no need to report any CPT II codes.
- Office managers or other designated personnel can complete the forms for the providers, who can then review and sign the forms for submission.
- The RCR is being developed to integrate with major electronic medical records.
- Outcome Sciences, the RCR development company, is a registered vendor with the Centers for Medicare and Medicaid Services. This makes reporting for PQRI using the RCR an easy, streamlined process that will have fewer errors and be more likely to be reimbursed fully than claims-based reporting would.
PQRI is voluntary and involves payment for participation in the program. Currently, the incentive to participate is a two-percent bonus on all allowable 2009 Medicare Part B fee-for-service charges during the reporting period, with no cap. It is anticipated that in future years this incentive may increase substantially or that penalties for nonparticipation may be implemented, so rheumatologists and other eligible health professionals are encouraged to get in the habit of reporting now.
There are two methods that practices can employ to report individual PQRI measures or measures groups to Medicare. The first includes claims-based reporting, which involves submitting CPT II codes or numerator codes along with the usual services for the visit. The second involves registry-based reporting, and there are several commercial vendors that facilitate registry-based reporting.
To assist its members with PQRI reporting, the ACR has partnered with Outcome Sciences to develop a Web-based quality-measures recording and reporting tool—the Rheumatology Clinical Registry (RCR). The RCR will be available to ACR members in June 2009 and will provide additional resources including the ability to record patient history, complete the ACR practice-improvement modules (PIMs; used primarily for maintenance of certification), and track data related to supplementary ACR quality measures that are not currently part of PQRI. These include measures related to gout management and drug safety.
With the RCR, the ACR has created a user-friendly, intuitive Web-based platform that allows its members to enhance the care they provide to their patients. Anyone with Internet access can record and retrieve the essential elements of PQRI and PIMs or enter and record patient demographics and history. Future enhancements will include the ability to record a physical examination and clinical decision-making elements of the patient encounter.
For the practicing rheumatologist and other health professionals who are committed to improving patient care, interested in the integration of quality reporting and performance improvement for recertification purposes, or who would like to participate in quality reporting, the RCR provides a timely, optimal tool that has been developed based on the input of clinical rheumatologists.