Some emergency physicians may perceive hospital quality-improvement initiatives as endeavors that were conceived primarily by academic types and committees and that have relatively little effect on how the emergency department operates on a day-to-day basis. That may have been the case a few years ago, but things are changing—and fast.

Several performance-reporting and incentive programs, some in place and others in development, will affect the emergency department in the year ahead, either directly or by a trickle-down effect of hospital performance-improvement pressures. For now, the dominant one is the Physician Quality Reporting Initiative (PQRI).

PQRI Program Will Expand

The 3-year-old program created by the Centers for Medicare and Medicaid Services has begun to pay out as promised, and payments to emergency physicians this year and next are expected to increase substantially from the average $1,000 bonus for 2008 reporting, said Dr. Michael Granovsky, course director of ACEP’s National Coding and Reimbursement Conference.

“Statistically, all other things remaining equal, we should expect that payments will be larger for 2009 and 2010 because we now have 12 months at 2%,” he said, up from the 1.5% bonus structure in place in 2008. If emergency physicians maintain consistent reporting rates, he added, they can expect a bonus of roughly $1,300.

It’s not just rising incentive payments—which may not even cover the investment in systems required to report—that will drive increased participation in PQRI, Dr. Granovsky predicts. Rather, it’s the growing perception that measuring performance confers benefits for the community and fosters pride on the part of hospitals.

Since PQRI’s launch in 2007, emergency medicine has emerged as a stellar performer among the specialties in reporting rates. On the community-acquired pneumonia (CAP) measures in 2008, emergency physicians tallied a 97% reporting success rate on antibiotic administration and assessment of mental status in pneumonia, and 96% on vital signs. Emergency physicians also performed well on three other emergency medicine measures: aspirin administration for myocardial infarction, ECG for chest pain, and ECG for syncope.

One reason ACEP members might not be fully in tune with developments in the PQRI program is that incentive funds flow through the hospital or corporate entity that employs them, not directly to emergency physicians. Also, because ED billing companies handle most of the measure-performance reporting activities, emergency physicians might be unaware that a bonus payment is tied to the government initiative.