Physician Quality Reporting (PQRI) sounds good, doesn’t it? After all, delivering “quality” is what it’s all about, right? Maybe. Maybe the government’s efforts are really designed to improve the quality of the practice of medicine in the US. Unfortunately, PQRI has fallen short of its reported goal by a long shot.
PQRI is time consuming. PQRI is expensive. I think PQRI has more potential to do harm than it does to do good. At first glance, there are several hundred PQRI codes (measurements) that can be reported. Items to be reported to Medicare include diabetic care, depression, stroke, ocular disorders, heart disease, smoking status, alcohol consumption, lung disease, liver disease, and a vast assortment of other medical illnesses and treatments. In researching this topic I was not surprised to find that there were only 8 preventative medicine codes out of over 250 codes in my computer’s data base. So much for the government’s professed interest in preventative medicine.
In order to qualify for my Medicare bonus bucks and meet meaningful use criteria, each and every day I click on at least 4 PQRI codes that pertain to my patient’s illness code. Medicare’s data banks record who is naughty and who is nice, whose diabetes is controlled and who is not, who is depressed, who drinks too much, etc. So far, I have not received any quality feedback nor have I seen any literature that accumulating quality data is beneficial.
Actually, sending data is beneficial. It helps pay the bills. Medicare’s reimbursement for services rendered is poor. There are times when seeing Medicare patients actually costs me money. Without Medicare’s paltry bonus bucks, Medicare is a losing concern.
While reporting PQRI codes is voluntary, it’s not. Bonus bucks and payment for meaningful use are mandatory sources of income that help keep a family physician’s doors open. Unfortunately, PQRI will become mandatory in the future. As the command structure of the EMR improves, the practice of medicine will change in ways no one could ever imagine.
Stewart Segal is a family physician who blogs at Livewellthy.org.
