The initials “PQRI” float around in emergency department management articles, ACEP News, Scientific Assembly, and many other venues. Most physicians know the letters are related to Centers for Medicare and Medicaid Services reimbursement, and some know there are quality measurements to meet. But what exactly do the initials stand for? And why should you as a practicing physician care?

By staying ahead of the game, emergency physicians can capture extra revenue and avoid future reductions in pay.

What is PQRI?

PQRI stands for the Physician Quality Reporting Initiative. Congress started this program through a provision of the Tax Relief and Health Care Act of 2006. Since being implemented in mid-2007, the program pays physicians a small bonus for reporting on quality measures related to their specialty. The program currently is voluntary.

Why is it important (other than some extra cash in my pocket)?

There is extra payment for participation, although the amount can be small and is based on how many Medicare patients emergency physicians see. The bonus is up to 2% of your total Medicare-allowed charges for all Medicare patients. Billing companies estimate the bonus to be around $1,500 per emergency physician annually.

The importance of the program lies in a fundamental shift in CMS’s perspective on how the agency pays for services. Instead of rewarding volumes of services with payment, PQRI is a small step toward financial rewards for efficient and high-quality care. It is anticipated that in the future the bonus will turn into a requirement for full Medicare payment, the same way physicians caring for have been affected by the Core Measures and Present on Admission initiatives.

An additional important aspect of the PQRI program is the manner in which CMS sought physician input. Unlike other initiatives (such as the hospital Core Measures), CMS turned to physicians and asked for their input, guidance, and buy in. The majority of the PQRI measures were developed by the American Medical Association’s Physician Consortium for Performance Improvement (PCPI). ACEP is a standing PCPI member and actively participates. There are also vetting groups, such as the National Quality Forum, with which ACEP participates as well.

The change in approach was directed by federal statute, but was a change welcomed by physicians and ultimately their patients. (Everyone ready to stop measuring beta blockers in 24 hours and antibiotics for pneumonia within 4 hours?)