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Due to some recent confusion from members and consultants over the number of measures an individual anesthesiologist must submit in 2010 in order to be a successful participant in the Physicians Quality Reporting Initiative (PQRI), ASA is providing this additional clarification. ASA posted information on the ASA website on December 15, 2009, regarding the new Measure 193 and the Measure Applicability Validation (MAV) process that now applies to anesthesiologists.
PQRI is a voluntary program by which eligible participants self-select the measures that apply to their respective practice. If an eligible participant (EP) begins reporting on a particular PQRI measure, CMS will assume that such measure applies to the EP and will require submission of the measure for at least 80 percent of the patients or encounters eligible for the measure in order to deem the EP successful. CMS does not require an EP to submit three measures. However, if an EP submits fewer than three measures, the MAV process will determine whether he/she should have submitted quality data codes (QDCs) for additional measures.
For anesthesiologists, CMS has identified two anesthesia clusters as part of the MAV process. The clusters are part of the clinical relation test, which assumes that if one measure is applicable to a practice the other measure in the cluster is also applicable and should be reported. The anesthesia clusters are as follows:
Anesthesia Cluster 1:
Measure 30 (Timely Administration of Antibiotics)
Measure 76 (Prevention of Catheter-Related Bloodstream Infections (CRBSI): Central Venous Catheter (CVC) Insertion Protocol)
Anesthesia Cluster 2:
Measure 76 (Prevention of Catheter-Related Bloodstream Infections (CRBSI): Central Venous Catheter (CVC) Insertion Protocol)
Measure 193 (Perioperative Temperature Management)
For those subject to the MAV process there is also a second step, the minimum threshold test, whereby CMS only requires submission of an additional measure if the EP treated a sufficient number of Medicare patients with a condition applicable to that measure within the reporting period. In other words, if an anesthesiologist submitted QDCs for Measure 30, CMS look to see whether QDCs were also reported for Measure 76. If not, CMS would further look to determine whether the anesthesiologist treated at least 15 Medicare patients during 2010 (or 8 patients if reporting the alternative reporting period of July 1- December 31, 2010) who had a condition to which Measure 76 would apply. If so, the anesthesiologist would be deemed to not have successfully participated in PQRI.
To reiterate, CMS has stated that an EP who submits QDCs for Measure 30 must also report Measure 76. Those who submit QDCs for Measure 193 must also report Measure 76. However, there is no requirement within the MAV process for submission of all three measures, though an EP is permitted to submit all three measures if they apply to his/her practice. Keep in mind that if an anesthesiologist determines that Measure 76 is the only measure that applies to his/her practice and submits QDCs for only that measure, the MAV process will not apply and he/she can successfully participate in PQRI with only the one measure.
Common reporting scenarios for PQRI 2010 include:
1. Measures 30 and 76 (Cluster 1)
2. Measures 76 and 193 (Cluster 2)
3. Measure 76 only
4. Measures 30, 76 and 193
5. Other measures the EP deems applicable to his/her practice plus any combination above
For more information from CMS on the Measure Applicability Validation process, please visit this link:
http://www.cms.hhs.gov/PQRI/25_AnalysisAndPayment.asp#TopOfPage
