The 2006 Tax Relief and Health Care Act (TRHCA) (P.L. 109-432) required the establishment of a physician quality reporting system, including an incentive payment for eligible professionals who satisfactorily report data on quality measures for covered services furnished to Medicare beneficiaries during the second half of 2007 (the 2007 reporting period). CMS named this program the Physician Quality Reporting Initiative (PQRI).

2007 PQRI

2007 PQRI concluded on December 31, 2007. The deadline for submission of 2007 PQRI quality data was February 29, 2008 on claims for dates of service July 1 through December 31, 2007. 

2008 PQRI:

The Medicare, Medicaid, and SCHIP Extension Act of 2007 (MMSEA) was enacted on December 29, 2007 (Pub. Law 110-173). MMSEA authorizes CMS to make PQRI incentive payments for satisfactorily reporting quality measures data in 2008. For 2008, eligible professionals who meet the criteria for satisfactory submission of quality measures data for services furnished during the reporting period, January 1, 2008 – December 31, 2008, will earn an incentive payment of 1.5 percent of their total allowed charges for Physician Fee Schedule (PFS) covered professional services furnished during that same period (the 2008 calendar year). This reporting period was established in the 2008 PFS Rule, as authorized by TRHCA.

MMSEA also provides professionals greater flexibility for participating in the PQRI for 2008, by authorizing CMS to establish alternative reporting criteria and alternative reporting periods for the reporting of measures groups and for the submission of data on PQRI quality measures through clinical data registries. CMS has posted a document that establishes the new alternative reporting criteria and periods: "2008 PQRI Establishment of Alternative Reporting Periods and Reporting Criteria." 

Note that physicians and eligible professionals still have the opportunity to begin participating in the 2008 program, and should review the document for more information about the dates for which reporting can occur.

Financial incentives earned for 2008 reporting will be paid in mid-2009 from the Federal Supplementary Medical Insurance (Part B) Trust Fund. The 1.5% financial incentive and its funding source for 2008 are the same as for 2007.

2008 PQRI consists of 119 quality measures, including 2 structural measures. One structural measure conveys whether a professional has and uses electronic health records and the other electronic prescribing. For further information on 2008 PQRI measures and detailed specifications, click on the Downloads link in the left-hand column on this page.

The Centers for Medicare & Medicaid Services has posted a letter to Medicare beneficiaries with important information about the Physician Quality Reporting Initiative (PQRI). The letter is from Medicare to the patient explaining what the program is, and the implications for the patient. Physicians may choose to provide a copy to their patients in support of their PQRI participation. 

Updated tools are available to assist professionals in 2008 PQRI reporting. To access these tools, click on the PQRI Tool Kit in Downloads link at left.