This is the second in a series of PQRI informational resources for audiologists that were published in November by the AQC.
Beginning January 1, 2010 audiologists that bill Medicare Part B will have the opportunity to participate in the Medicare Physician Quality Reporting Initiative (PQRI) program. PQRI is a voluntary program designed to improve the quality of care to Medicare beneficiaries. Audiologists who participate in PQRI by reporting on approved quality measures are eligible for a 2% incentive payment after the yearly reporting period.
There are three measures that audiologists can report on for 2010. Each measure has a numerator, a denominator, and denominator exclusions.
- The numerator describes the action required by the measure for reporting and performance.
- A denominator describes all the eligible patients for a measure.
- Denominator exclusions are those patients that fit in the denominator but are not eligible for the measure for specific reasons.
Each audiology measure requires the audiologists to refer a patient to a physician after an audiologic evaluation finds a certain condition, unless the patient fits into an exclusion.
The Audiology Quality Consortium (AQC), a coalition of 10 audiology organizations, developed these measures based on the American Academy of Otolaryngology-Head and Neck Surgery (AAO-HNS) guidelines for “Red Flags–Warning of Ear Disease” and FDA regulations (21 C.F.R. § 801.420(c)(2)) requiring referral when there are signs of ear disease. AQC submitted eight “red flag” measures to the Centers for Medicare and Medicaid Services (CMS) for consideration and three were chosen for 2010. These measures, which came within a year of audiologists becoming eligible to participate in PQRI, will assist audiologists in documenting referral for warning signs. The three measures also directly benefit audiologists, rather than physicians who use audiology services.
The measures are as follows:
1. Referral for Otologic Evaluation for Patients with Congenital or Traumatic Deformity of the Ear
Description: Percentage of patients aged birth and older referred to a physician (preferably a physician with training in disorders of the ear) for an otologic evaluation subsequent to an audiologic evaluation after presenting with a visible congenital or traumatic deformity of the ear.
Numerator (action required): Patients referred to a physician (preferably a physician with training in disorders of the ear) for an otologic evaluation subsequent to an audiologic evaluation who present with visible congenital or traumatic deformity of the ear.
Denominator (eligible patients): Patients aged birth and older who present with visible congenital or traumatic deformity of the ear.
Denominator Exclusions: Patients not eligible for the “Referral for Otologic Evaluation for Patients with Congenital or Traumatic Deformity of the Ear” measure (e.g. Patients for whom an assessment of the visible congenital or traumatic deformity of the ear has been performed by a physician within the past 6 months; patients who are already under the care of a physician for congenital or traumatic deformity of the ear.)
2. Referral for Otologic Evaluation for Patients with a History of Active Drainage from the Ear within the Previous 90 Days
Description: Percentage of patients aged birth and older who have disease of the ear and mastoid processes referred to a physician (preferably a physician with training in disorders of the ear) for an otologic evaluation subsequent to an audiologic evaluation after presenting with a history of active drainage from the ear within the previous 90 days.
Numerator (action required): Patients referred to a physician (preferably a physician with training in disorders of the ear) for an otologic evaluation subsequent to an audiologic evaluation who present with a history of active drainage from the ear within the previous 90 days.
Denominator (eligible patients): Patients aged birth and older who have disease of the ear and mastoid processes who present with active drainage from the ear within the previous 90 days.
Denominator Exclusions: Patients not eligible for the “Referral for Otologic Evaluation for Patients with a History of Active Drainage” measure (e.g. Patients who are already under the care of a physician for active ear drainage.)
3. Referral for Otologic Evaluation for Patients with a History of Sudden or Rapidly Progressive Hearing Loss
Description: Percentage of patients aged birth and older referred to a physician (preferably a physician with training in disorders of the ear) for an otologic evaluation immediately following an audiologic evaluation that verifies and documents sudden or rapidly progressive hearing loss.
Numerator (action required): Patients referred to a physician (preferably a physician with training in disorders of the ear) for an otologic evaluation immediately following an audiologic evaluation that verifies and documents sudden or rapidly progressive hearing loss.
Denominator (eligible patients): Patients aged birth and older with verification and documentation of sudden or rapidly progressive hearing loss.
Denominator Exclusions: Patients not eligible for the “Referral for Otologic Evaluation for Sudden or Rapidly Progressive Hearing Loss” measure (e.g. patients who are under current care of a physician for sudden or rapidly progressive hearing loss.)
The full specifications for each measure can be found on the AQC website. CMS also provides general information on PQRI and measures in its PQRI Implementation Guide (.pdf download).
These measures are reported in the following ways:
- The measures are reportable via the CMS 1500 claim form.
- The audiologist would add Medicare directed codes to the claim form to report the measures to CMS.
- These codes are specific to both the numerator and denominator. The audiology measure codes will be released by CMS later in November.
- CMS requires that PQRI participants report on at least three measures, and on 80% patients seen that would fit into a measure. Therefore, an audiologist would need to report on 80% of the patients they see with the above three conditions.
The AQC will be providing more detailed information on reporting in the future.
Further information, including frequently asked questions, is available on the AQC website.