In early November, Dr. Nedza and her staff, Dr. Torcson, and SHM senior staff met via conference call to discuss the preliminary results of the 2007 PQRI and exchange thoughts on the program related to hospitalists. A concern for hospitalists was the intent for the PQRI to include performance measures for each of the 39 medical specialties recognized by CMS; hospitalists were lumped under general internal medicine. By working closely with CMS and the PCPI, SHM succeeded in achieving denominator specification changes for additional relevant measures to become available for hospitalist reporting through the 2007 PQRI.
Soon thereafter, the CMS Final Rule on Physician Payment was released, indicating that 10 of the 11 measures available for hospitalist reporting in the 2007 PQRI also were to be included for 2008. “Beta-blocker on Arrival for Acute Myocardial Infarction” was the one measure no longer part of the 2008 PQRI. One new measure available for hospitalist reporting in 2008 is measure No. 75, “Prevention of Ventilator-Associated Pneumonia—Head Elevation,” for which hospitalists can report using a critical care code.
The 2007 PQRI included the following measures on which hospitalists could report:
- No. 5: “Heart Failure: Angiotensin-Converting Enzyme (ACE) Inhibitor or Angiotensin Receptor Blocker (ARB) Therapy for Left Ventricular Systolic Dysfunction (LVSD)”;
- No. 6: “Oral Antiplatelet Therapy Prescribed for Patients with Coronary Artery Disease”;
- No. 7: “Beta-blocker Therapy for CAD Patients with Prior Myocardial Infarction”;
- No. 29: “Beta-blocker at Time of Arrival for Acute Myocardial Infarction”;
- No. 31: “Stroke and Stroke Rehabilitation: Deep Vein Thrombosis Prophylaxis”;
- No. 32: “Stroke and Stroke Rehabilitation: Discharged on Antiplatelet Therapy”;
- No. 33: “Stroke and Stroke Rehabilitation: Anticoagulant Therapy Prescribed for Atrial Fibrillation at Discharge”;
- No. 34: “Stroke and Stroke Rehabilitation: Tissue Plasminogen Activator Considered”;
- No. 35: “Stroke and Stroke Rehabilitation: Screening for Dysphagia”;
- No. 36: “Stroke and Stroke Rehabilitation: Consideration of Rehabilitation Services”; and
- No. 47: “Documentation of an Advanced Care Plan.”
After the final specifications for the 2008 PQRI were released, there was a proposal for denominator specification changes that would preclude inpatient reporting for many of the measures relevant and available to hospitalists in 2007. The PSC again worked closely with the PCPI and relevant professional organizations to preserve the measure specifications for the 2008 PQRI to allow inpatient and thus hospitalist reporting. This experience has further enhanced productive SHM relationships with the PCPI and CMS.
The PSC has an ongoing commitment to recommend SHM members for appointments to PCPI expert measure workgroups, depending on the topic. For example, SHM was recently asked to identify a member to join a newly forming asthma measures workgroup that will be looking to develop inpatient measures. SHM will be notified when a palliative care measures workgroup is being formed.
Senior staff and leadership will meet PCPI senior staff to discuss formation of an expert workgroup on care transitions measures. This work group will be co-chaired by SHM and the American College of Physicians (ACP) and include societies such as the Society of General Internal Medicine (SGIM), the American Geriatrics Society (AGS), and others engaged in the development of the transitions of care consensus document in summer 2007. The work group also will refer to the principles and standards that resulted from the ABIM Foundation’s Stepping Up to the Plate (SUTTP) Alliance as a resource in its development of measures.
Looking ahead to the 2009 PQRI, the PSC has requested measure specification changes to the following PQRI measures: