A couple of weeks ago, I talked about offsetting the decrease in payment from the Medicare 2009 Physician Payment Schedule by participating in the PQRI (in the future through the IC3 quality improvement program affiliated with NCDR). Ganpat Thakker, M.D., F.A.C.C., governor of the ACC West Virginia chapter, commented on the post: “Most of us who reported PQRI measures for 2007 did not get [an] incentive payment. CMS did not have necessary setup, and there is no appeal option. I am almost positive that we will not receive any reward for 2008 either.” The reality is that CMS lacks the capacities to run PQRI effectively -- it is a crude beginning of a quality monitoring and incentive program. A few of our larger practices got some actual reward from PQRI, but not many.

My message to all of you exasperated physicians on this topic is: Think of PQRI as an awkward baby step in the potentially good direction of substantially increasing payment for improved quality and risk-adjusted outcomes. I emphasize potentially. We are advocating to Congress and the payers for real "value" and quality-improvement reward programs with significant incentives (at least 7 – 10 percent payment increase). We are further working on Congress and insurers to appreciate the value in using our NCDR systems and the new IC3 quality improvement program to members and primary care practices to collect and populate CV performance data. If we, as the profession, are not engaged in designing and helping to implement quality improvement and reporting programs, they won’t work.

The ACC applauds all of you who made the effort to participate in the PQRI, realizing full well that it was as frustrating for most of you as the Blagojavich Senate seat selection process has been for the people of Illinois. But, since quality reporting is coming for certain, at least those of you who tried to participate are getting ready for the inevitable, and a future program that will hopefully offer real value to patients and doctors.

Please join the conversation on the topic of quality reporting and tell us what you think. Don’t use any four letter words though -- please -- if you’re a PQRI participant. We’re going to make it better.