The Centers for Medicare and Medicaid services (CMS) established an incentive program referred to as Physician Quality Reporting Initiative (PQRI) in 2007 for voluntary reporting of at least 3 of the 74 designated measures in at least 80% of eligible patient encounters. The Society of Hospital Medicine (SHM) has identified 11 measures that are pertinent to hospitalists. Implementation of this program in large hospitalist groups with multiple handoffs of patient care posed numerous operational issues. Evolution of diagnoses during the inpatient stay makes it difficult to identify the eligible patients and capture the information in real time. The incentives offered may not justify the opportunity cost of time devoted by the office staff and the hospitalists for capturing these later.


To describe a simple and efficient work flow designed by us to enable compliance with reporting these measures in real time.


We are a large hospitalist group with more than 25 full‐time equivalents of hospitalists working in a Solucient top 100 hospital. Our shifts are divided between admitting and rounding. The billing card made by the admitting hospitalist is used for subsequent handoffs. We examined the 74 designated measures including the 11 SHM recommended measures and decided to choose all 3 from a common group of diagnoses. Six measures involve ICD codes related to stroke/TIA. We chose the 4 most common. We created a separate billing card for billing for these patients. On the back of this card we added the questions related to the 4 measures (Fig. 1). The admitting hospitalist uses the PQRI billing card for any patient with suspected stroke or TIA and answers the first 2 questions (these measures require the billing encounter to be an admission or initial consult). The discharging hospitalist answers the last 2 questions (which require the encounter to be a discharge). The discharging hospitalist is also given the responsibility of identifying the final diagnoses. If the discharging hospitalist indicated that the patient had a stroke, then the billing company will include the quality codes for the first 2 measures for admitting hospitalist encounters and the last 2 measures for discharging hospitalist encounters. Instead, if it is indicated that the patient had a TIA, then the billing company will include only the quality codes for the measure “patient given antiplatelet therapy at discharge” for the discharging hospitalist encounter, as this is the only reportable measure for TIA.

Figure 1. Backside of billing card used for stroke/TIA patients.


As a result of this simple work flow, the group members embraced this program very well and enthusiastically look forward to continue this process through 2008. This process also helps us to upgrade our infrastructure to implement this on a larger scale, when the pay‐for‐performance initiatives become substantial. Currently, we are also collecting data to see if this reporting initiative results in performance improvement, which is the ultimate goal of the CMS.

Author Disclosure:

S. Kodali, none.