New Radiology Performance Measures Completed for Future Inclusion in CMS’s Physician Quality Reporting Initiative (PQRI)
New Radiology Performance Measures Completed for Future Inclusion in CMS’s Physician Quality Reporting Initiative (PQRI)
On Oct. 26, 2007, eight new performance measures for diagnostic radiologists met qualifications as required by statute for inclusion in the Centers for Medicare and Medicaid Services (CMS) Physician Quality Reporting Initiative (PQRI) program.
However, because these new measures were not listed in the 2008 Medicare Physician Fee Schedule (MPFS) proposed rule, they will most likely be postponed until 2009. A number of other new performance measure sets, also developed through the AMA Physician Consortium for Performance Improvement (as were the radiology measures), will also be delayed a year, including oncology, dermatology, eye care, and back pain.
This delay is unfortunate, since the new radiology measures would have opened up PQRI reporting to a much wider group within the radiology profession. The two stroke related imaging measures which were eligible for reporting and bonus payment under the 2007 PQRI, will continue in 2008, with likely modification to expand reportability.
Description of the New Radiology Performance Measures
Developed collaboratively through the AMA Physicians Consortium for Performance Improvement (PCPI) and its Radiology Workgroup, which included six radiologists from ACR, much work went into the completion of the radiology measures. The new measures relate to mammography, CT dose reduction, monitoring of fluoroscopy exposure time and stenosis measurement in carotid imaging. Also, the current Measure #11 on carotid imaging reports was broadened to include carotid studies for other patient populations, not just those with suspected acute stroke. Complete specifications of the measures can be found at this link.
http://www.acr.org/SecondaryMainMenuCategories/quality_safety/p4p/ApprovedPayforPerformanceMeasures.aspx
ACR member and co-chair of the PCPI Radiology Workgroup, David Seidenwurm, M.D., states, “The participation of a large number of radiologists from a variety of subspecialties [in the workgroup] made the process work well for our members and for the public. The measures are based on the best available evidence and address documented gaps in care.”
According to Seidenwurm, “These measures will permit the majority of radiologists to be paid for practicing in accord with the most authoritative guidelines and standards of our organization and others. They are not unduly burdensome and are attributable to the radiologist directly.” The mammography measures will reward responsible radiologists who take steps to achieve the best possible results beyond compliance with existing Mammography Quality Standards Act (MQSA) regulations. Seidenwurm adds, “The radiation safety measures [on CT dose management and fluoroscopy documentation] reflect growing awareness of non threshold dose effect models of carcinogenesis and recognize our obligation to consider the cumulative impacts of medical radiation. As the use of CT and other imaging modalities that depend on ionizing radiation increases, it is crucial that we optimize radiation exposure to individuals and the population as a whole.” Radiation safety is a major initiative of ACR, with a full portion of the ACR Web site dedicated to this critical area (http://www.acr.org/SecondaryMainMenuCategories/quality_safety/RadSafety.aspx), and information on relative radiation levels now provided in ACR’s Appropriateness Criteria (http://www.acr.org/SecondaryMainMenuCategories/quality_safety/app_criteria/RRLInformation.aspx).
Two Stroke Imaging Measures Already Reportable Under PQRI
There are currently two measures for diagnostic radiologists included in the 2007 PQRI measure list – “Measure #10” and “Measure #11”, which relate to imaging for stroke. With a slight modification, these will remain as the two most likely reportable measures for radiologists in the 2008 program. Measure #10, CT/MRI Reporting will be modified in 2008 to include additional ICD9 diagnoses codes that are signs or symptoms of stroke. This will facilitate reporting additional cases in which there is not a definitive diagnosis of stroke, but a strong likelihood exists yet cannot be coded on a claim form as such.
ACR Help for Members: Getting Ready for Reporting the New Radiology Performance Measures and 2008 PQRI Reporting
In the coming year, the ACR will make the new measures available to radiologists, conduct pilot testing and provide educational resources for implementation of the measures in radiology practices and pursue endorsement of the measures by the National Quality Forum. In this way, radiologists will be well prepared to begin reporting on the measures if they are deferred for PQRI inclusion in 2009, should the bonus program continue to be funded by Congress.
Over the next month, the ACR Web site will provide updated information on the mechanics of reporting radiology measures for 2008, the format and timing of 2007 feedback reports and bonus distribution, as well as legislative decisions on continuation of the PQRI financial incentives. Please visit the CMS website at http://www.cms.hhs.gov/PQRI/ for detailed information on the program.
Questions regarding the CMS program can be sent to P4Pquestions@acr.org.