This aphorism may well apply to ADS (Advanced Data Systems) in the context of its announcement, in late June, that its medical practice automation applications were ready to support a new Medicare (CMS) reporting initiative. This six-month trial program, PQRI (Physicians Quality Reporting Initiative), rewards practices that provide Medicare with additional information when submitting claims. Medicare began accepting PQRI-compliant claims on July 1, and the program is scheduled to run until the end of the year. "It's 98 percent likely that something extremely similar if not identical to PQRI will be approved for 2008," says Stephanie Davidson, the owner of Health Informatics Consulting, a Belle Mead, NJ company that advises medical practices on electronic health records (EHR).
PQRI, is, in a nutshell, a set of 74 diagnosis and procedure measures that translate into five-digit codes that practices can add to Medicare claims. The measures are designed to provide more detail about a patient's history, the type and severity of current condition(s), and treatment plan. A visit to the Medicare Web site, along with scores of seminars and even a 275-page commercially-produced guide to PQRI, makes the new reporting experiment appear to be complicated and onerous.
But for Maywood, NJ-based ADS, which produces the popular medical practice management software package MedicsElite, and also MedicsDocAssistant, an electronic medical records package, the task of making its software "PQRI compliant" was a relatively simple one. "It just so happens that we've always had additional fields to use (in our software), so we didn't have to change it -- except for adding one space in one field," says ADS Director of Marketing Marc E. Klar. "As a result, there are going to be hundreds of thousands of PQRI claims submitted by our clients during this trial time period."
That should be good news for many practices, says ADS Executive Vice President George Grodentzik, who is also a senior product developer. With Medicare promising up to 1.5 percent extra back to practices that submit claims that are PQRI compliant, practices who have the required information readily available in their current systems will reap some small, but relatively easy, rewards for using the system. Other practices, especially ones that have few Medicare patients or small management staffs, may find that the work needed to comply won't pay off in the short term, says Grodentzik.
"How much work PQRI requires depends on the practice's specialty, and on how they keep their records already," he said. It also depends on diligence. The PQRI filing period began July 1, and only practices that file their first PQRI-compliant claims by Sept. 1 will be eligible for the "bonus." In addition, practices have to file PQRI codes on at least 80 percent of their Medicare claims to be eligible for cash back.
Only a handful of the 500+ EHR vendors who produce similar software packages are PQRI compliant, says Davidson, which is primarily a result of how the program has been rolled out. "PQRI came up pretty quickly," she says. "Medicare announced it at the beginning of 2007, but they didn't provide much information until shortly before it was implemented." A similar Medicare reporting program, PVRP, had been in place before PQRI, but there was "very little participation," says Davidson, in large part because there was no reimbursement involved.
For ADS, says Grodentzik, making their systems PQRI compliant required little more than adapting a single numerical field in its software to accommodate the five-digit PQRI codes. "There was very little modification in the software," he emphasizes, saying that the small change could help some of ADS's clients to reap a small financial reward, depending on how their reporting systems are already set up. But he adds that even if there's little financial incentive, practices that hop on the PQRI bandwagon early will likely reap rewards later.
Davidson says that while "PQRI isn't terribly important to too many practices" right now, "because the bonus (from Medicare) isn't that large, and it involves some paperwork," Health Informatics Consulting is encouraging practices to participate if the extra paperwork isn't too onerous. This is partly because she expects the program to someday become mandatory, and eventually expects Medicare to require PQRI codes not just in claims, but in EHR reports. Most practices don't use electronic health records, but Medicare can use the EHR information to both streamline its system, and gather more information about practices, patients, and health care in general. And, says Davidson, this style of rollout is nothing new for Medicare. "They've done similar things with hospitals, starting programs that are voluntary and then making them mandatory."
Meanwhile, Davidson says, ADS has been "way out in front" of the hundreds of other vendors providing health care management software. "That's partly because ADS is a smaller company, which enables them to be faster on their feet than some of the larger companies," she says. "They don't have the layers of bureaucracy." But all of ADS's competitors are talking about PQRI, says Davidson, and are probably all working in it as well. But ADS's head start provided a nice, if small, bonus to its customers.
