Viewpoint

The PQRI Boondoggle

FROM THE CHIEF MEDICAL EDITOR
Larry E. Patterson, MD

In my continuing quest to be the Andy Rooney curmudgeon of ophthalmology, I'd like to mention a problem I'm having with Medicare. It turns out that many of you are, too.

Back in 2007, the Medicare PQRI program was started, with the aim of documenting our quality of care in return for a small bonus. The idea sounded fine; the implementation was another story. We had the option to voluntarily add certain codes to certain diagnoses that said, in essence, that we were doing really obvious things. This just sounded silly to me, so — like a number of you — I blew it off. But by the next year, 2008, it appeared this silliness was going to continue. It wasn't a great deal of work for us, but it did require putting a system in place to make it happen.

If we saw a glaucoma patient, we needed to add a code to each encounter that showed we looked at the optic nerve sometime in the last year. If my patient had macular degeneration, we coded that we had actually looked at and documented the condition of the macula. And there were similar codes for other conditions. Which led me to this inescapable conclusion: Duh. I mean, are there really that many ophthalmologists who don't look at the nerve of a glaucoma patient at least once a year? And who follows macular degeneration without actually examining the macula?

But we are talking about the government, the body which still has its eye on our entire health care system. So I followed the rules to the letter throughout 2008 and 2009. In 2009 I got an extra bonus opportunity through the e-prescribing system. Now, it actually cost me no small amount of money to invest in a system that would facilitate this, but it looked like I might make a small profit in the end.

OK, so what's my real beef? I have a relatively large practice, with seven doctors in five locations, and an above average Medicare population. Based on our estimates, my PQRI bonus for 2008 should have been in the $18,000 range. So far, we've received one check for… $200. That's it. About 99% of our bonus vanished into thin air. And there seems to be no easy way to figure out what to do. We've filed our complaints, but are still waiting for a reply. We have no idea if we did something incorrectly the last two years that might be disqualifying us for most of the bonus.

In a normal world, you'd have some place you could go to in order to determine if you are doing this correctly or not, during the actual participation. But our government and Medicare are not the normal world. Here you just do your best, and a year or so later find out whether or not you did it right. I read somewhere recently that about 50% of ophthalmologists were not getting paid for their efforts from the PQRI deal, so my story is unfortunately very common.

Did I mention that these same people are promising us limited-time bonus incentives if we make massive investments in electronic medical records?