PROCRITline.com - Medicare's Physician Quality Reporting Initiative (PQRI) Continues for 2010

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Please see full Prescribing Information, including Boxed WARNINGS, for PROCRIT^® (Epoetin alfa)

Please see full Prescribing Information, including Boxed WARNINGS, for LEUSTATIN^® (cladribine)

Reimbursement Overview

Oncology Diagnosis Codes

Nephrology Diagnosis Codes

Surgery Diagnosis Codes

Virology Diagnosis Codes

RESOURCES

Medicare's Physician Quality Reporting Initiative (PQRI)

PQRI Continues for 2010¹

Medicare providers who participate in the Physician Quality Reporting Initiative (PQRI) in 2010 will be eligible for incentive payment of up to 2 percent of their Medicare physician fee schedule charges . The incentive payment is calculated based on a physician's estimated total Medicare Part B allowable charges for claims submitted within 2 months of the end of the reporting period.

For 2010, there are two reporting periods: One runs the full year from January 1, 2010, to December 31, 2010. The second runs for the last 6 months from July 1, 2010, to December 31, 2010.

For 2010, there are 125 individual measures and 8 additional measures groups to report on. Among the 2010 quality measures that your practice may be interested in:

Individual Measures for Nephrology

Myelodysplastic Syndrome (MDS): Documentation of Iron Stores in Patients Receiving Erythropoietin Therapy (Measure 68)

End-Stage Renal Disease (ESRD):Influenza Immunization in Patients with ESRD (Measure 79)

Hemodialysis Vascular Access Decision-Making by Surgeon to Maximize Placement of Autogenous Arteriovenous (AV) Fistula (Measure 172)

CKD Measures Group

CKD: Laboratory Testing (Calcium, Phosphorus, Intact Parathyroid Hormone (iPTH) and Lipid Profile) (Measure 121)

CKD: Blood Pressure Management (Measure 122)

CKD: Plan of Care: Elevated Hemoglobin for Patients Receiving Erythropoiesis-Stimulating Agents (ESAs) (Measure 123)

CKD: Influenza Immunization (Measure 135)

CKD: Referral for Arteriovenous (AV) Fistula (Measure 153)

Individual Measures for Oncology

Multiple Myeloma: Treatment with Bisphosphonates (Measure 69)

Chronic Lymphocytic Leukemia (CLL): Baseline Flow Cytometry (Measure 70)

Breast Cancer: Hormonal Therapy for Stage 1C-111C Estrogen Receptor/Progesterone Receptor (ER/PR) Positive Breast Cancer (Measure 71)

Colon Cancer: Chemotherapy for Stage III Colon Cancer Patients (Measure 72)

Breast Cancer Resection Pathology Reporting:pT Category (Primary Tumor) and pN Category (Regional Lymph Nodes) with Histologic Grade (Measure 99)

Colorectal Cancer Resection Pathology Reporting: pT Category (Primary Tumor) and pN Category (Regional Lymph Nodes) with Histologic Grace (Measure 100)

Prostate Cancer: Avoidance of Overuse of Bone Scan for Staging Low-Risk Prostate Cancer Patients (Measure 102)

Prostate Cancer: Adjuvant Hormonal Therapy for High-Risk Prostate Cancer Patients (Measure 104)

Prostate Cancer: Three-Dimensional (3D) Radiotherapy (Measure 105)

Oncology: Medical and Radiation - Pain Intensity Quantified (Measure 143)

Oncology: Medical and Radiation - Plan of Care for Pain (Measure 144)

Radiology: Exposure Time Reported for Procedures Using Fluoroscopy (Measure 145)

Oncology: Radiation Dose Limits to Normal Tissues (Measure 156)

Thoracic Surgery: Recording of Clinical Stage for Lung Cancer and Esophageal Cancer Resection (Measure 157)

Oncology: Cancer Stage Documented (Measure TBD²)

For more information on PQRI, including detailed guidance on methods and metrics for successful participation, please visit www.cms.gov/pqri/. You may also contact your regional or national professional society for additional information on PQRI-related information specific to your specialty.

¹Federal Register, Vol. 74 No. 226, November 25, 2009, Rules and Regulations.

²Measure is new for 2010.

Important Safety Information for PROCRIT^® (Epoetin alfa)

WARNINGS: INCREASED MORTALITY, SERIOUS CARDIOVASCULAR EVENTS, THROMBOEMBOLIC EVENTS, STROKE and INCREASED RISK OF TUMOR PROGRESSION OR RECURRENCE

Chronic Renal Failure:

In clinical studies, patients experienced greater risks for death, serious cardiovascular events, and stroke when administered erythropoiesis-stimulating agents (ESAs) to target hemoglobin levels of 13 g/dL and above.

Individualize dosing to achieve and maintain hemoglobin levels within the range of 10 to 12 g/dL.

Cancer:

ESAs shortened overall survival and/or increased the risk of tumor progression or recurrence in some clinical studies in patients with breast, non-small cell lung, head and neck, lymphoid, and cervical cancers (see WARNINGS: Table 1).

To decrease these risks, as well as the risk of serious cardio- and thrombovascular events, use the lowest dose needed to avoid red blood cell transfusion.

Because of these risks, prescribers and hospitals must enroll in and comply with the ESA APPRISE Oncology Program to prescribe and/or dispense PROCRIT^® to patients with cancer. To enroll in the ESA APPRISE Oncology Program, visit www.esa-apprise.com or call 1-866-284-8089 for further assistance.

Use ESAs only for treatment of anemia due to concomitant myelosuppressive chemotherapy.

ESAs are not indicated for patients receiving myelosuppressive therapy when the anticipated outcome is cure.

Discontinue following the completion of a chemotherapy course.

Perisurgery: PROCRIT^® (Epoetin alfa) increased the rate of deep venous thromboses in patients not receiving prophylactic anticoagulation. Consider deep venous thrombosis prophylaxis.

(See WARNINGS: Increased Mortality, Serious Cardiovascular Events, Thromboembolic Events, and Stroke, WARNINGS: Increased Mortality and/or Increased Risk of Tumor Progression or Recurrence, INDICATIONS AND USAGE, and DOSAGE AND ADMINISTRATION.)

Please see full Prescribing Information, including Boxed WARNINGS for PROCRIT^® (Epoetin alfa)

Medication Guide for PROCRIT^®
Please read the Medication Guide for PROCRIT^® and discuss with your doctor.

Patient Instructions for Use
Instructions if you or your caregiver has been trained to give PROCRIT^® injections at home.

Boxed WARNINGS: LEUSTATIN^® (cladribine) Injection

LEUSTATIN (cladribine) Injection should be administered under the supervision of a qualified physician experienced in the use of antineoplastic therapy. Suppression of bone marrow function should be anticipated. This is usually reversible and appears to be dose dependent. Serious neurological toxicity (including irreversible paraparesis and quadraparesis) has been reported in patients who received LEUSTATIN Injection by continuous infusion at high doses (4 to 9 times the recommended dose for Hairy Cell Leukemia). Neurologic toxicity appears to demonstrate a dose relationship; however, severe neurological toxicity has been reported rarely following treatment with standard cladribine dosing regimens.

Acute nephrotoxicity has been observed with high doses of LEUSTATIN (4 to 9 times the recommended dose for Hairy Cell Leukemia), especially when given concomitantly with other nephrotoxic agents/therapies.

Please see full Prescribing Information, including Boxed WARNINGS for LEUSTATIN^® (cladribine)