Medicare paid $92 million for 2008 quality bonuses

Washington -- More than 85,000 physicians and other health professionals shared more than $92 million worth of bonuses from the 2008 run of the Medicare Physician Quality Reporting Initiative. But another roughly 70,000 doctors who participated did not see a single dime from the effort.

The PQRI, operating for its first full year in 2008 after its six-month launch in 2007, gave physicians the chance to earn up to a 1.5% bonus on all their Medicare fees for the year by reporting quality information to the government. If the Centers for Medicare & Medicaid Services determined that a doctor had included enough quality measures on his or her claims forms for a sufficient percentage of patients to which the measures applied, that physician would qualify for a lump-sum payout.

CMS was looking to increase physician participation in the PQRI after its initial year, and the agency was able to convince more than 150,000 doctors to take part. Federal officials hope to attract enough participants to the pay-for-reporting effort that it can develop into a robust pay-for-performance and quality improvement element for Medicare somewhere down the line.

"We are not surprised that more eligible professionals participated and qualified for higher payments under the PQRI in 2008," said Barry M. Straube, MD, the CMS chief medical officer and director of the agency's Office of Clinical Standards & Quality. "For the 2008 program year, CMS made a concerted effort to include as many provider types and as many medical specialties as possible in our menu of PQRI quality measures to assure that we were capturing the full spectrum of the health care services that Medicare beneficiaries receive. We also worked with national stakeholder groups to make improvements in the program from 2007 to 2008 and to promote education and outreach efforts to support eligible professionals in participation."

Charlene Frizerra, acting CMS chief, said the administration is pleased with the 2008 results. "More health professionals have successfully reported data, and the substantial growth in the national total for PQRI incentive payments demonstrates that Medicare can align payment with quality incentives."

Participants who qualified for a bonus received an average of about $1,000 for their reporting efforts. The highest payment to a single physician exceeded $98,000.

Physician practices in Florida and Illinois secured the highest pay-for-reporting bonuses for 2008, with doctors in those states receiving more than $7.5 million and more than $6 million, respectively.

The agency and Congress made additional enhancements to encourage more physicians to participate in 2009. They raised the number of available quality measures to 153 and increased the potential bonus to 2% of all Medicare payments for the year. The program is set to run through 2010 unless Congress extends it.

But CMS also has had to work hard to assuage physicians who were confident that they accurately reported enough quality measures in 2007 but still were denied a bonus.

Surveys by the American Medical Association and the Medical Group Management Assn. found widespread complaints about the process practices used to access information about their bonuses and receive quality feedback reports from the government. Some physicians said they were reconsidering whether to spend the time and resources needed to file the additional quality measure claims codes if they were not going to receive any payments for the extra work.

Some of the complaints from doctors who said they had been inappropriately denied a 2007 bonus prompted CMS to re-run some of the suspect data that had led to the denials.

The second look resulted in an additional 3,900 physicians receiving bonus payments in November 2009 that averaged more than $860 per doctor.

Physicians who received a 2008 bonus can access confidential feedback reports that will show them how well they did on the quality measures when compared with other doctors who submitted the same measures. CMS said it redesigned the reports since last year in response to suggestions from physician organizations and others.

Participants can access their reports online or by contacting their Medicare contractors.