2008 Diabetes Physician Quality Reporting Module Introduction

You have elected to participate in the Physician Quality Reporting Initiative (PQRI) using the PQRI Diabetes Module that the American Board of Family Medicine (ABFM) developed specifically for this purpose. Completion of this module will allow you to qualify for an incentive payment based on your successful reporting of data on five diabetes quality measures.

The Medicare, Medicaid, and SCHIP Extension Act of 2007 (MMSEA), enacted on December 29, 2007, authorized the Center for Medicare and Medicaid Services (CMS) to make PQRI incentive payments to physicians for satisfactory reporting of quality measures data in 2008. It also established alternative reporting periods and criteria for the reporting of measure groups and of PQRI quality measures through a clinical data registry.

CMS has granted approval to the ABFM to submit PQRI data to CMS on behalf of its Diplomates using the ABFM Performance in Practice Registry. You may use the PQRI Diabetes Module to collect and submit data to the Registry on a set of 30 or 15 consecutive, separate and distinct patients with either type 1 or type 2 diabetes mellitus. These patients must be between 18 and 75 years of age, and at least 2 patients must be covered by Medicare Part B Insurance (although you may collect data from patients covered by Medicare Advantage Programs, these patients will not satisfy this requirement). A patient may be counted only once during the reporting period for a single provider as the data submitted must be for 15 or 30 consecutive, separate and distinct patients. If you are in a group and a patient is seen for management of their diabetes on several occasions by multiple providers within the group, each provider may include the patient in their respective count.

In 2008, physicians who meet the criteria for satisfactory submission of quality measures data for 30 consecutive, separate and distinct patients during the reporting period January 1–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 reporting period. Alternatively, physicians who meet the criteria for satisfactory submission of quality measures data for 15 consecutive, separate and distinct patients will earn an incentive payment of 1.5 percent of their total allowed charges for PFS covered professional services furnished during the reporting period July 1–December 31, 2008. CMS approved financial incentives earned for 2008 reporting are scheduled to be paid in mid-2009 from the Federal Supplementary Medical Insurance (Part B) Trust Fund.

The ABFM PQRI Diabetes Module is easy to use. However, prior to beginning the module you must complete an online attestation form giving the ABFM permission to transmit your data to CMS. At the end of this document we request both your National Physician Identifier (NPI) number and your Taxpayer Identification Number (TIN). Please make sure to provide your individual NPI number and the TIN that you use to receive Medicare reimbursement (this may be an individual TIN or the TIN that has been assigned to your medical group or corporation). It is important that you supply the correct information because CMS will use both numbers to process your incentive payment. Incorrect numbers may result in a delay of reimbursement.

To begin collecting data for the module, download the printable data collection templates and record data from either 30 or 15 consecutive, separate and distinct patients between 18 and 75 years of age who have a diagnosis of type 1 or type 2 diabetes mellitus at the time of their visit. You can do this prospectively, filling in information from patients that you see for the remainder of calendar year 2008; or if you have an electronic health record system, you can use records for any 30 or 15 consecutive, separate and distinct patients (by date of visit) seen during the corresponding reporting period for calendar year 2008 and complete the data templates by retrospective chart audit. It is important to remember that regardless of the method you use to collect data, the patients must have been seen consecutively by date of visit. Do not exclude from your data collection any diabetic patient that was seen by you between the date of service of the first patient and the date of service of the last patient. After you have collected data on the requisite number of patients, login to the ABFM Website and enter the data from the templates. The data may be submitted to us as soon as it is collected, but it must be received no later than January 10, 2009.

Be certain to save the data collection templates! Approximately 3% of the registry’s participants will be randomly selected for audit, so it is important that you maintain the templates that you have completed. Because you will be sending the ABFM de-identified data, these templates provide the only link between the data you send to us and the patients you have seen, which must be verified if you are selected for audit.

We will forward your data to CMS early in 2009. If you currently are participating in Maintenance of Certification for Family Physicians (MC-FP), you may elect to continue completing the diabetes module to receive Part IV credit for your current stage (if you have not already completed a Performance in Practice Module [PPM] or an approved alternative Part IV activity).

To continue the Diabetes PQRI Module for MC-FP credit, proceed to the quality improvement “wizard” and select one quality indicator to use to develop a quality improvement (QI) plan. The wizard also will help you develop and submit the QI plan. Implement the plan in your practice, and in approximately one week, we will send you an email reminder to collect data using the same methods described above to determine the impact of your QI plan on the care that you deliver to your patients.

When completing the 2008 PQRI Diabetes Module for MC-FP Part IV credit, you can opt to wait until 2009 to collect your post–QI intervention data; and then use the 2009 PQRI Diabetes Module to collect data on either 30 or 15 consecutive, separate and distinct patients and qualify for the 2009 incentive payment. We will automatically incorporate this data into the 2008 PQRI Diabetes Module, if you have elected to continue this module for MC-FP credit, thereby ensuring that you receive appropriate Part IV credit.

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