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CMS sends out first PQRI payments

September 2008

Published in the September 2008 issue of Today’s Hospitalist

THE CENTERS FOR MEDICARE AND MEDICAID SERVICES (CMS) this summer sent out its first bonus payments to physicians who successfully reported quality information to the CMS via the Physician Quality Reporting Initiative (PQRI) in 2007.

Physicians should have received their bonus payments in August. Bonus payments to physicians for PQRI reporting in 2007 totaled more than $36 million. According to the CMS, the average incentive amount paid to individual physicians was $600, while the largest payment to a physician group weighed in at more than $200,000.

The PQRI initiative, which took effect July 2007, allowed physicians to collect a bonus of 1.5% of their total allowed Medicare charges in return for reporting data on performance measures. Hospitalists who continue to participate in the program this year are able to submit quality data on 11 clinical measures. To qualify for the bonus, physicians must report on at least three of the measures that pertain to their specialty.

While more than 109,000 professionals participated in the PQRI program for 2007, payments were made to fewer than 57,000 physicians and other providers. For more information on the 2008 PQRI program, see “Time to sign up for pay for reporting” in the July 2008 issue of Today’s Hospitalist online.

Study: Suspect AMI in patients with severe CAP

AFTER FINDING HIGH RATES OF ACUTE MYOCARDIAL INFARCTION (AMI) among patients with severe community-acquired pneumonia (CAP), researchers are urging physicians to maintain a “high index of suspicion of AMI” for CAP patients on admission.

A recent retrospective study at one VA hospital found that 15% of patients who had severe CAP on admission also had AMI, while another 15% of patients who experienced clinical failure during hospitalization for CAP also had AMI. For CAP patients experiencing clinical failure, study authors urged physicians to rule out AMI as part of their work-up.

That work-up is particularly important because elderly patients experiencing AMI often don’t have typical chest pain but instead present with changes in mental status or with difficulties breathing. That makes it harder to recognize a cardiac event associated with CAP at the time of admission.

The study was published in the July 15 issue of Clinical Infectious Diseases. Authors noted that the study was limited in that it looked at patients at only one site. They also noted that their findings apply only to elderly patients.

Proposed code set would support PFP, quality improvement

THE DEPARTMENT OF HEALTH AND HUMAN SERVICES (HHS) last month proposed replacing the current diagnostic and inpatient procedure code set with a more advanced set that’s already being used in other countries.

If adopted, the proposal would replace the current ICD-9 diagnosis and procedure codes with ICD-10, which is used throughout the rest of the industrialized world. The ICD-9 set is almost 30 years old and, with only 17,000 codes possible, may soon run out of possible code combinations.

The ICD-10 code set, by comparison, would allow for more than 155,000 combinations. According to HHS officials, adoption of the more complex coding system would help facilitate quality reporting and pay-for-performance initiatives as well as bio-surveillance.

As proposed, the new code set would take effect October 2011. The comment period for the proposed rule ends Oct. 21. More information is available from the HHS online newsroom.

Staying anonymous online?

A STUDY THAT LOOKED AT ONLINE BLOGS posted by physicians and nurses found that more than half of those blogs offered enough information to identify their authors. The study concluded that many of the blogs might allow patients to recognize their own cases and potentially lead to a breach of patient privacy.

The study, which was published online by the Journal of General Internal Medicine, looked at more than 270 medical blogs posted during 2006. The authors found that in blogs that described patient interactions, more than 16% of those blogs included enough details for patients to identify either themselves or their physician.

Some blogs also featured what the authors called “unprofessional tone or content,” which included negative comments about the medical profession or patients.

The authors also noted that nearly one-third of all medical bloggers have been approached to endorse products “and that more than half of those physicians or nurses have written some form of endorsement in their blogs without labeling such posts as advertising.

The authors urged professional medical organizations to address standards for blog content and tone. They also pointed out that a forum for self-expression may reduce provider isolation and help retention in rural areas.

Pediatric hospitalizations for skin infections on the rise
In 2006, more than 34,000 children age 4 and younger were hospitalized with skin infections, a 150% increase over the number of those hospitalizations in 2000.

According to the Agency for Healthcare Research and Quality, hospitalizations for skin infections among youths age 15 to 17 also were on the rise. The most common sites for skin infections among children were the legs, face and buttocks. Reasons for the increase are unclear but may be linked to increasing antibiotic resistance.

In 2006, skin infections became the 8th leading cause of pediatric hospitalization, up from 17th in 2000.

Where to go for hospitalist CME

Looking for hospitalist-specific continuing medical education? Here’s a line-up of some courses available this fall:

4th Annual Midwestern Hospital Medicine Conference
Sept. 25-27, Chicago
Hosted by Northwestern Memorial Hospital
Information: www.cme.northwestern.edu/conferences

Hospitalist Mini-College
Oct. 20-22, San Francisco
Hosted by the University of California, San Francisco (precourse to Management of the Hospitalized Patient, below)
Information: www.cme.ucsf.edu/cme/Index.aspx

Management of the Hospitalized Patient
Oct. 23-25, San Francisco
Hosted by the University of California, San Francisco
Information: www.cme.ucsf.edu/cme/Index.aspx

SHM’s One-Day University
Nov. 5-6, Baltimore
Hosted by the Society of Hospital Medicine
Information: www.hospitalmedicine.org (click on Events)

Update in Hospital Medicine
Nov. 12-15, Tucson, Ariz.
Hosted by the Mayo Foundation for Medical Education and Research
Information: www.mayo.edu/cme/sct-courses.html

Hospitalist Procedures
Nov. 7-8, Charlotte, N.C.
Hosted by National Procedures Institute
Information: www.npinstitute.com/Course.asp?pid=26

Johns Hopkins Consultative Medicine Essentials
Hosted by Johns Hopkins University School of Medicine
Information: www.jhcme.com/site/index.cfm