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Physician Quality Reporting Initiative

Measuring the performance of health care providers and organizations and effectively communicating information about performance are considered the essential tools needed to improve the quality of the health care system. Despite enormous expenditures and startling breakthroughs in biomedical research and technology, the U.S. health care system does not consistently deliver safe and effective care. In November 2001, then U.S. Department of Health and Human Services Secretary Tommy Thompson announced the Centers for Medicare & Medicaid Services (CMS) Quality Initiative, a commitment to ensure high quality health care through published consumer information on the performance of health care providers coupled with health care quality improvement support through Medicare’s Quality Improvement Organizations (QIOs). The quality initiative was launched nationally in 2002 as the Nursing Home Quality Initiative. It was then expanded in 2003 with the Home Health Quality Initiative and the National Voluntary Hospital Quality Reporting Initiative and, in 2004, with the Physician Focused Quality Initiative.

The first seven years of CMS’s quality initiative have been a time of both enormous progress and major change. The hospital quality initiative has evolved from a surveillance program in which the performance of a few common processes of care were reported to CMS to one in which the outcomes of care, including mortality, are publicly available for most of the nation’s hospitals. Started in 2006 as the Physician Voluntary Reporting Program (PVRP) with a “starter-set” of just 16 measures, the Physician Quality Reporting Initiative (PQRI) has grown to its current 153 measures and now offers opportunities for almost all physicians to participate in the program. The pace and magnitude of change promise to accelerate over the next five years as CMS works to improve the effectiveness of performance measurement and public reporting in order to improve the quality and outcomes of health care for Medicare beneficiaries.    

Mathematica has assumed a leading role in developing provider measures and assessing PQRI’s success. Together with the National Committee for Quality Assurance (NCQA) and the American Medical Association (AMA), Mathematica was the prime contractor on several projects to create 54 of the 153 indicators currently used in PQRI. These measures apply to clinical specialties that previously could not participate in PQRI, including eye care, geriatrics, and emergency medicine, or conditions for which there were no measures, including osteoporosis, perioperative care, stroke and stroke rehabilitation, skin cancer, gastroesophageal reflux disease (GERD), palliative care, wound care, and rheumatoid arthritis. We also have worked with CMS to assess the feasibility of new measures for addressing racial and ethnic disparities in health care quality, outcomes, care coordination, and efficiency.

Mathematica holds contracts with CMS and the National Quality Forum to develop, evaluate, test, and implement new quality measures in the future. In particular, we continue our work with CMS to implement public reporting of hospital quality indicators.