The Physician Quality Reporting
Initiative (PQRI) was first implemented as a voluntary program in 2007. The program is now considered to be permanent
and therefore the program name has been amended to the Physician Quality
Reporting System (PQRS). The program
provides incentive payments to eligible physicians and other practitioners who
satisfactorily report data on quality measures for covered services furnished
during a reporting period, which is typically one year. In 2010, participating
professionals reporting measures were eligible for an incentive payment equal
to 2.0 percent of the estimated total allowed charges for all covered
professional services furnished during the reporting period. In 2010, eligible
practitioners (EPs) could report individual measures or measure groups through
one of three reporting mechanisms: claims-based reporting, registry-based
reporting, and electronic health record (EHR)-based reporting. PQRS is applicable for Medicare Part B
patients only and not for Medicare HMO products or for other insurance
products.
CMS is providing a one percent
incentive payment in 2011 and 0.5 percent incentive payments in 2012 – 2014 for
successfully reporting PQRS measures. Penalties will begin in 2015 for those
who do not satisfactorily submit quality data. The major changes to the PQRS
program for 2011 are as follows:
- Reporting of
individual measures and measure groups - Eligible practitioners (EPs) participating in the program reporting
claims-based individual or measure groups must report at least three measures that
apply to the services furnished by the professional and report each measure for
at least 50 percent of the practitioner's Medicare Part B fee-for-service (FFS)
patients receiving services to which the measure applies. This is a reduction
from the current requirement of 80 percent. Eligible practitioners reporting
individual measures through qualified registries or electronic health records
(EHRs) must report at least three measures and report each measure for at least 80 percent
of the FFS patients receiving services where the measure applies. These
criteria also apply for reporting group measures through registries, but not
for EHR-based reporting.
- Reporting by a
Group Practice - CMS proposes to
continue to allow reporting by group practices as a whole and incentive
payments are provided to the group rather than the individual EP. CMS is
proposing to change the definition of a group practice to include any group
with two or more EPs. The smaller groups' participation in PQRI will be piloted
with the first 500 groups to sign up. Smaller group practices (with between 2
and 200 EPs) must report three to six individual measures and one or more measure
groups. For groups of more than 200 – all 26 of the current NQF-endorsed
quality measures for coronary artery disease, diabetes, heart failure and
preventive care services must be reported
- Proposed Quality Measures for CY 2011 - CMS proposes to include 198 measures individual
EPs can report in 2011. Measures are listed in the rule in four categories: 1)
claims-based and registry-based reporting measures; 2) registry-based reporting
measures only; 3) new individual measures, including several related to care
transitions from hospital to home/self care; 4) EHR-based reporting measures.
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