A new tool helps docs winnow measures

November 23, 2007

Many physicians didn't participate in CMS' Physician Quality Reporting Initiative because Medicare's bonus didn't justify the costs involved. But a new service might help physicians get onboard if CMS extends the program next year.

Many physicians didn't participate in CMS' Physician Quality Reporting Initiative (PQRI) because Medicare's 1.5 percent bonus didn't justify the administrative costs involved. But a new service being piloted by the Medical Society of New Jersey (MSNJ) might help physicians get onboard if CMS extends the program next year, and it could also aid doctors in using their own billing data to keep track of their chronic disease patients.

The medical society's Alpha Project, funded by nearly $900,000 in foundation money, is designed to help New Jersey practices do disease management and improve patient care. As part of this project, MSNJ contracted with Thomson Medstat, which analyzes claims data for big corporations, and STI, a vendor of practice management systems. For the past few months, MSNJ has been piloting the Alpha Project with half a dozen New Jersey practices, and it's about to add 30 more to the test.

Here's how the service works: Practice staffers enter regular billing codes plus the CPT II codes for the PQRI program into their practice management system. Then they send an extract of their billing data for either Medicare patients or all adult patients to a secure web portal. Thomson analyzes the data, compares it with its claims database, and provides three graphical reports to the practice.

The first report profiles the practice's and each doctor's patient population. It shows the top five chronic diseases treated by the physicians, breaks down the visits by E&M code to show the intensity of visits, and compares that data to regional practice norms in a doctor's specialty. It also provides subreports on each major payer grouping—Medicare, Medicaid, commercial, and self-pay.

This provides a global view of the practice that can help physicians determine which conditions they should target if they want to qualify for PQRI or private pay-for-performance (P4P) incentives. A second report goes further, recommending specific PQRI measures that physicians should consider reporting data on to qualify for the CMS bonus. A third report, which is run after three months' worth of data has been submitted, shows which CPT II codes have been used and whether they meet the 80 percent thresholds required by the Medicare program.

Barbara Moorer of the MSNJ says that this approach relieves physicians of part of the administrative load of reporting data to CMS.

Good practice management systems can generate the same kind of reports that Thomson does, admits Susan Salkowitz, a consultant to MSNJ. But she notes that Thomson is providing comparative data that most practices don't have. Also, she says, many practices are too busy to figure out how to run the reports.

MSNJ and Thomson are now discussing how the system might be used to build disease registries for participating practices.