The Centers for Medicare & Medicaid (CMS) has announced that as of Jan. 1, 2008, chiropractors are eligible to participate in reporting for the Physician Quality Reporting Initiative (PQRI).
The PQRI is a voluntary financial-incentive program in which physicians who successfully report quality measures on their Medicare/Medicaid claims from Jan. 1, 2008 to Dec. 31, 2008 may receive a bonus payment between 1.5 percent and 2 percent of charges for Medicare services.
According to CMS, "The Tax Relief and Health Care Act of 2006 ... establishes specific requirements for measures for eligible professionals to use to submit data on the quality of covered professional services furnished during 2008, and requires CMS to address a mechanism for registry-based submission of quality data within the reporting system." In 2008, the program will include 119 quality measures, including two that are applicable to chiropractic.
Chiropractors will be allowed to report quality measures in the areas of "pain assessment prior to initiation of patient treatment" and "adoption/use of health-information technology." While physicians are not required to register prior to participation in PQRI, they must be enrolled in Medicare and have a National Provider Identifier (NPI).
Quality measures can include outcomes (e.g., "percentage of patients where low back pain was resolved with the use of chiropractic"), processes (e.g., "percentage of patients who received orthotics for posture problems") or guidelines (e.g., "percentage of patients who resolved neck pain with 12 visits"). For comparison, the 2007 list of measures is available online.
CMS hopes to use these captured data about quality of care to formulate a set of "best practices" provided to Medicare/Medicaid recipients. More detailed information about the 2008 PQRI can be found here. A list of frequently asked questions (FAQs) is available online. Letters to Medicare patients also have been posted on the CMS Web site, detailing what the program will mean for them. The inclusion of chiropractors in this program is even more significant in light of the recent demonstration project that expanded access to chiropractic for seniors on Medicare.
American Chiropractic Association President, Glenn Manceaux, DC, encouraged chiropractors to become involved in the program: "The inclusion of quality measures applicable to chiropractic care in the 2008 PQRI affords our profession an opportunity to strengthen its involvement in the promotion of quality patient care. The ACA urges doctors of chiropractic to participate in the PQRI. Proper documentation will be the lynchpin for full chiropractic parity in Medicare. With the profession eagerly awaiting analysis of the Medicare chiropractic demonstration project, I urge chiropractic offices to become fully acclimated in reporting quality measures."
In anticipation of being included in the 2008 program, the ACA set up its own performance quality-measurement group early in 2007. This group was formed to address quality-measures development, endorsement and implementation issues specific to chiropractic care. The group has been successful in providing chiropractors an opportunity to report on quality measures specific to the chiropractic manipulative treatment (CMT) codes recognized by Medicare. The ACA believes that this has provided excellent training for inclusion into the PQRI program.