By Daniel H. Green, MD, FACOG
The Physician Quality Reporting System (PQRS), run by the Centers for Medicare & Medicaid Services (CMS), encourages the reporting of quality information. PQRS gives participating eligible professionals the opportunity to assess the quality of care they are providing to their patients, helping to ensure that patients get the right care at the right time.
Through 2014, the program provides an incentive payment to individual eligible professionals and group practices that satisfactorily report data on quality measures for covered professional services during the applicable reporting period. Negative payment adjustments will begin in 2015 and are based on a prior year's reporting period.
By reporting PQRS quality measures, eligible professionals can also quantify how often they are meeting a particular quality metric. The PQRS program gives participating eligible professionals summary information on their reporting rates and clinical performance, and it allows professionals to compare their performance on a given measure with their peers. Participating in the program means health care professionals have an opportunity to assess the quality of care they are providing to their patients.
About the Measures
The quality measures adopted under PQRS are developed by provider associations, quality groups, and CMS. The measures are used to quantify, based on standards set by the developers, the quality of care provided by individual eligible professionals or group practices. Measures generally are reviewed and updated each year based on input from the developers.
The types of measures vary by specialty and include care coordination, patient safety and engagement, clinical process and effectiveness, population and public health, and the efficient use of healthcare resources. Eligible professionals and group practices choose the measures they wish to report to CMS. The measure reporting requirements are determined by the reporting method chosen.
How to Participate
To participate in the PQRS program, individual eligible professionals may choose to report quality data to CMS through one of several reporting methods, including Medicare Part B claims, a qualified PQRS registry, a qualified electronic health record (EHR) product, or a qualified PQRS data submission vendor.
Group practices may participate through the group practice reporting option, and they can participate via a web interface or a qualified PQRS registry, depending on the size of the practice.
Incentive Payments and Payment Adjustments
For the 2013 and 2014 reporting periods, eligible professionals or group practices that satisfactorily submit PQRS quality measures data for the year will earn an incentive payment equal to 0.5 percent of the total estimated Medicare Part B Physician Fee Schedule (PFS) allowed charges for covered professional services.
Eligible professionals and group practices who have failed to satisfactorily report data on quality measures based on their 2013 participation will be subject to a 1.5 percent payment adjustment to their Medicare PFS allowed charges for services provided in 2015. Eligible providers who do not report measures in 2014 will receive a 2.0 percent payment adjustment to their Medicare PFS allowed charges in 2016.
Feedback reports will be available in the fall of the year following the reporting period to eligible professionals and group practices that reported PQRS quality measures data (e.g., 2013 feedback reports will be available in the fall of 2014).
Eligible professionals who have questions about or need assistance with PQRS reporting are encouraged to contact the QualityNet Help Desk.
Phone: 1-866-288-8912 • TTY: 1-877-715-6222
Additional information and resources are available on the CMS PQRS website at www.cms.gov/PQRS.