White Paper: How The New PQRI Will Affect Emergency Department Provider Documentation

The Physician Quality Reporting Initiative (PQRI) program instituted by the Centers for Medicaid and Medicare Services (CMS) has received changes for the 2008 calendar year. The PQRI program replaces the Physician Voluntary Reporting Program (PVRP) and involves all emergency care providers (i.e., physician assistants and nurse practitioners), not just physicians. CMS began collecting the PQRI data on July 1, 2007. Data reporting utilizes the CMS coding and billing infrastructure through the use of CPT Category II codes or in some instances G-codes.

Revisions have been made to both The T System® paper templates and The T SystemEV®, our electronic ED information system, to make it easier for providers to document and coders to capture all relevant PQRI data. Currently, PQRI incorporates 119 quality measures into the program. These measures are endorsed by the various quality improvement organizations, including the American Quality Alliance (AQA), National Quality Forum (NQF) and National Committee for Quality Assurance (NCQA). Eight of these measures relate directly to the practice of emergency medicine and were developed with input from ACEP and other emergency medicine professional organizations. The eight emergency medicine-related PQRI measures are:

• Aspirin on arrival for AMI
• ECG performed for non-traumatic chest pain
• ECG performed for syncope
• Vital signs for CAP
• Assessment of oxygen saturation for CAP
• Assessment of mental status for CAP
• Appropriate empiric antibiotic for CAP
• t-PA considered for ischemic stroke