Physician Quality Reporting System
CMS launched the Medicare Physician Voluntary Reporting Program as an initial step to introduce quality reporting and advance measurement in EP practices. Incentives for reporting of quality measures was implemented in 2007 as the Physician Quality Reporting Initiative, which is currently known as Physician Quality Reporting System (PQRS). For Meaningful Use requirements, CQMs can be reported through PQRS.
PQRS uses negative payment adjustments to promote quality reporting by EPs and group practices.
Who qualifies to participate?
Eligible Professionals (EPs): Physicians, practitioners, and therapists providing covered professional services paid under or base on the Medicare Physician Fee Schedule (MPFS).
Also, eligible to participate are EPs in PQRS group practices, Accountable Care Organizations (ACOs) reporting PQRS via the GPRO Web Interface, and Comprehensive Primary Care (CPC) practices.
The National Quality Strategy (NQS)
In 2016, EPs or PQRS group practices must report on 9 or more measures covering at least 3 NQS domains and cross-cutting measures for EPs with billable face-to-face encounters must satisfy reporting or participation to avoid the 2018 PQRS negative payment adjustment when reporting individual measures.
The NQS Domains & 2016 Cross-Cutting Measures (if applicable):
1. Patient Safety
- Documentation of Current Medications in the Medical Record
- Falls: Risk Assessment
- Falls: Screening for Fall Risk
2. Effective Clinical Care
- Diabetes: Hemoglobin A1c Poor Control
- Breast Cancer Screening
- Controlling High Blood Pressure
- One-Time Screening for Hepatitis C Virus (HCV) for Patients at Risk
3. Person and Caregiver-Centered Experience and Outcomes
- CAHPS for PQRS Clinician/Group Survey
4. Community/Population Health
- Preventive Care and Screening: Influenza Immunization
- Pneumonia Vaccination Status for Older Adults
- Preventive Care and Screening: Body Mass Index (BMI) Screening and Follow-Up Plan
- Preventive Care and Screening: Screening for Clinical Depression and Follow-Up Plan
- Preventive Care and Screening: Tobacco Use: Screening and Cessation Intervention
- Childhood Immunization Status
- Preventive Care and Screening: Screening for High Blood Pressure and Follow-Up Documented
- Tobacco Use and Help with Quitting Among Adolescents
- Preventive Care and Screening: Unhealthy Alcohol Use: Screening & Brief Counseling
5. Communication and Care Coordination
- Medication Reconciliation Post Discharge
- Care Plan
- Pain Assessment and Follow-Up
- Falls: Plan of Care
- Functional Outcome Assessment
- Closing the Referral Loop: Receipt of Specialist Report
6. Efficiency and Cost Reduction
Reporting PQRS Measures
To determine which reporting mechanism to use, first you must determine your group size. PQRS defines a group practice as a single Taxpayer Identification Number (TIN) with 2 or more individual EPs.
Individual EP Reporting Mechanisms:
- EHR direct product that is Certified Electronic Health Record Technology (CEHRT)
- EHR data submission vendor (DSV) that is CEHRT
- Qualified PQRS Registry
- Qualified Clinical Data Registry (QCDR)
- Medicare Part B claims submitted to CMS
PQRS Group Practice Reporting Mechanisms*:
- EHR direct product that is CEHRT (2+ providers)
- EHR DSV that is CEHRT (2+ providers)
- Qualified PQRS Registry (2+ providers)
- QCDR (2+ providers)
- GPRO Web Interface (25+ providers)
- CAHPS for PQRS using CMS-certified survey vendor (2+ providers)
- - CAHPS is supplemental to other reporting mechanisms (Required for groups of 100+ providers)
* Group practices must register for the GPRO and select reporting mechanism by June 30, 2016.
EPs who do not meet the criteria for satisfactory reporting or participating for 2016 PQRS will be subject to the CY 2018 negative payment adjustment.
How the Merit-Based Incentive Payment System (MIPS) Impacts PQRS in CY 2017
The Merit-Based Incentive Payment System (MIPS) will streamline how Medicare measures value and quality of care by doctors and other clinicians by streamlining three independent programs: Physician Quality Reporting Program (PQRS), Medicare EHR Incentive Program – Meaningful Use (MU), and Value-Based Payment Modifier Program.
MIPS will sunset PQRS payment adjustments for Eligible Professionals (EPs) at the end of CY 2018.
In the place of PQRS, MIPS will require EPs to meet the performance category requirements for Quality. The Quality category would replace PQRS and would account for 50% of an EP’s total performance score.
MIPS would reduce the number of quality reporting measure from 9 to 6, eliminate the domain requirement, and remove all-or-nothing. With MIPS, EPs will be required to have 1 measure that is cross-cutting and for EPs that are patient facing, 1 measure must be an outcome measure or a high quality measure. For example, Patient Experience is a high quality measure, so it is recommended that you implement Patient Satisfaction Surveys in your practice.
The other performance categories and percentage of total score include: Advancing Care Information (ACI) (25%), Clinical Practice Improvement Activities (15%), and Cost (10%).
The first performance year is CY 2017 with Medicare payment adjustments beginning in CY 2019.
Read More About the Merit-Based Incentive Payment System (MIPS)
