Physicians Quality Reporting System: Definition and how it works

In 2007 the Physician Quality Reporting Initiative was formed.  This program was designed to voluntarily allow eligible physicians and practitioners to report on quality measure data and receive incentives for doing so.  This program provided the groundwork for what is now known as the Physician Quality Reporting System.  This program, also known as PQRS, was amended to become a permanent program, in which it still is today.  The basis for this program is that eligible practitioners are allowed to report on quality measures from the traditional fee for service for Medicare Part B patients.  The reporting is available through three different avenues for eligible practitioners.  These are electronic health records, claims based reporting, and registry-based reporting.

A reporting registry must meet CMS qualifications in order to be an acceptable data center.  It is here that eligible practitioners must report on fifty percent of measures to receive the incentive bonus. The reporting registry takes the data from the eligible practitioners and transfers it directly to the CMS, almost acting as a middle man between the physician group and the government.

For eligible practitioners that use electronic health records currently in their practices, they may submit the data directly to the CMS.  Again to receive the incentives, the group must report on fifty percent of the Medicare part B patients.  This holds true for the claims based approach as well.  These percentages were adjusted in 2011 from a former threshold of eighty percent.

The Affordable Healthcare Act was a catalyst for much of the change in the PQRS system, including the change in the amount of measures that had to be reported in order to receive incentives.  One of the largest changes was the penalty that will be enacted in the year 2015.  In 2010, eligible practitioners were able to receive a 2.0% incentive on the measures that they reported.  Obamacare extended the incentive period until 2014, at 0.5% a year.  However, starting in 2015, eligible practitioners will be penalized 1.5% for poor data reporting and this will increase to 2.0% in 2016.  Some more changes that took place were to the percentage of measures that were required to be reported on. Also, the CMS was able to change the definition of a group receiving incentives to two or more eligible practitioners, and these groups will be able to report and receive incentives.  Another change to PQRS was the addition to over 198 quality measures that eligible practitioners can chose from to report data on. Eligible practitioners are only required to report on at least three quality measures.

It is important to understand that being registered in a PQRS program is totally voluntary.  The question remains as to what the goal of the program is? The answer is very simple. The CMS wants to improve quality of care and at the same time decrease cost.  This goal is similar in all new healthcare measures.
An example of a successful PQRS eligible practitioner comes in the form of Gates Hospitalists group. This group is composed of seven physicians in Liberty, Missouri.  For several years the group failed to receive incentives in the PQRS.  However, after changing the reporting system from a claims based to registry, the group has received incentives for the past two years.  “It’s a much easier and reliable way to ensure a physician’s performance on PQRS measures are accurately provided directly to CMS. Registries get an instant confirmation of receipt, so there is no doubt that the PQRS data has reached the CMS,” said Dr. Steven Liu in an April 2013 article.  Dr. Liu is the provider of the registry for the Gates group.  He speculated on why some reporting methods are better fits for certain practitioners and how the registry approach helped the Gates group receive incentives after many years of failure.

The PQRS program can be a great tool for physician groups to receive extra income from incentives that can go to improving their practices.  Since it is performance based, it is also beneficial because it will prompt better care for less money.  Hopefully, the program will be an important step in improving the United States’ healthcare system overall.

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