What Does a PQRS Really Measure?

Posted on October 26, 2012 by Dr. David Edward Marcinko MBA MEd CMP™

And, What Does a PQRSMeasure Group Look Like?

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[By Staff Reporters]

At a basic level, a Physician Quality Reporting System [PQRS] is a program that pays medical providers for reporting outcomes on quality outcomes metrics for Medicare Part B patients.

Primary care and specialty care providers of all kinds can participate by selecting outcomes measures that are pertinent to their fields. There is something for most every specialty, even pathology and radiology.

For example, you may choose from a menu of outcome measures and pick those measures you want, or you can report on a predetermined group of measures that focus on a specific condition or situation, such as diabetes or perioperative care.

The CMS Document

According to the 655 page 2012 Physician Quality Reporting System Measure Specifications Manual for Claims and Registry Reporting of Individual Measures produced by CMS, here are some high-level descriptions of individual measures.

Assessment

Conclusion

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9 Responses

  1. Mira, on October 26, 2012 at 5:37 PM said:

    Patient Satisfaction

    The New Rules of Engagement is an essay by Holly Korda PhD.

    Patient satisfaction has garnered new attention as an indicator of provider performance and an important dimension of value-based health care under the Affordable Care Act (ACA).

    http://thehealthcareblog.com/blog/2012/10/26/patient-satisfaction-the-new-rules-of-engagement/

    Defined in any number of ways, it is often publicly reported to help patients choose among health care providers.

    Mira

    Like

  2. Hope Rachel Hetico RN MHA, on October 28, 2012 at 1:35 PM said:

    Is customer satisfaction in healthcare a gateway to corruption?

    Customer satisfaction is quite the rage these days. Many stores and restaurants, many professional offices, hand out surveys, or ask customers to log onto their survey site on the Internet.

    http://www.kevinmd.com/blog/2012/10/customer-satisfaction-healthcare-gateway-corruption.html

    As a reward, one may win everything from a free sandwich to an iPad. But, is this a good idea for our healthcare quality initiatives?

    Hope Rachel Hetico RN MHA
    [Managing Editor]

    Like

  3. Ann Miller RN MHA, on July 9, 2013 at 11:01 PM said:

    Proposed Payment Schedule Includes Harmonization of Reporting Measures

    Healthcare providers have long decried the cacophony of reporting requirements under various CMS programs and have asked for harmonization of the rules.

    Now, the 652-page proposed rule encompassing changes to the Medicare Physician Payment Schedule, released Monday, may have providers who report clinical quality measures more often singing from the same hymnal in 2014.

    For calendar year 2014, physicians and other “eligible professionals” under the EHR incentive program will have the option to use qualified clinical data registries, as defined by the Physician Quality Reporting System, to meet their meaningful-use incentive payment requirements for clinical quality reporting in 2014, according to a CMS summary of the rule changes.

    To qualify for EHR incentive payments, however, providers still have to use a federally certified EHR and report to the registry those quality measures required by that program.

    Source: Joseph Conn, Modern Healthcare [7/9/13]

    Like

  4. Sheila, on October 6, 2013 at 3:54 PM said:

    A PQRS Video

    http://www.youtube.com/watch?v=vldx0Ezjts4#t=16

    The choice: QRS or cats?

    Sheila

    Like

  5. Ann Miller RN MHA, on June 6, 2014 at 8:33 PM said:

    3 reasons to kill PQRS and eRx audits

    Not everyone is happy with CMS’ proposed intent to conduct audits of physicians who collect incentive payments under the Medicare Physician Quality Reporting System and ePrescribing (eRx) programs.

    http://www.medicalpracticeinsider.com/news/3-reasons-why-pqrs-erx-audits-are-bad-idea

    Here is why?

    Ann Miller RN MHA

    Like

  6. D. Kellus Pruitt DDS, on June 7, 2014 at 8:14 PM said:

    What’s the NPI number really for?

    Should physicians be paid for healing Medicare/Medicaid patients or for participating in a game of gotcha with CMS – which neither doctors or patients can win?

    “3 reasons to kill PQRS, eRx audits,” by Madelyn Kearns – Associate Editor, Medical Practice Insider, June 03, 2014.

    http://www.medicalpracticeinsider.com/news/3-reasons-why-pqrs-erx-audits-are-bad-idea

    The American Medical Association explains: “Physicians already are facing numerous obstacles, outside of their control, that limit their chance of success in these programs. By adding an audit process, which spans over four years, CMS is creating yet another barrier to successful participation.”

    Physician Quality Reporting System (PQRS) is based on physicians’ National Provider Identifier numbers. I bet whoever talked you into volunteering for the permanent 10-digit identifier did not explain that your application serves as a consent to abide by government quality control (cost control) efforts. Were you?

    D. Kellus Pruitt DDS

    Like

  7. Crowely, on September 15, 2014 at 9:02 PM said:

    Financial penalties nearing for physician incentive programs

    Physicians not participating in meaningful use, PQRS should prepare for financial hits

    http://medicaleconomics.modernmedicine.com/medical-economics/news/financial-penalties-nearing-physician-incentive-programs

    Crowely

    Like

  8. Ann Miller RN MHA, on November 10, 2015 at 11:57 AM said:

    Medicare Extends Deadline to Appeal Two Penalties

    The Centers for Medicare & Medicaid Services (CMS) has extended the deadlines for physicians and group practices facing two different Medicare penalties in 2016 to request an informal review if they believe the government made a mistake. The penalties, which whittle down reimbursement, are levied under Medicare’s Physician Quality Reporting System (PQRS) and the Value Based Payment Modifier (VBM) program. The original deadline for an informal review of both penalties had been November 9. Now it is November 23.

    In PQRS, Medicare penalizes physicians for unsatisfactory reporting of clinical quality data. The penalty in 2016, based on performance in 2014, will lower fee-for-service payments by 2%. Physicians, medical groups, and accountable care organizations can learn if they are due for a pay cut by obtaining a PQRS feedback report for 2014. The CMS website explains how to obtain the report. Requests for an informal review can only be made online through the Quality Reporting Communication Support Page of CMS. CMS promises a decision, which is final, within 90 days.

    Source: Robert Lowes, Medscape News [11/6/15]

    Like

  9. Brick, on June 21, 2017 at 10:13 AM said:

    Half a Million Clinicians Face 2% Medicare Penalty This Year

    Roughly 500,000 clinicians will see their fee-for-service Medicare payments trimmed by 2% this year because they didn’t meet the requirements of the Physician Quality Reporting System (PQRS) in 2015, the government announced earlier this month. For a substantial number of these clinicians, the impact of the revenue cut will be minor. In a report on PQRS performance in 2015, the Centers for Medicare & Medicaid Services (CMS) said that almost 230,000 clinicians being penalized had $10,000 or less in Medicare allowed charges that year.

    A 2% pay cut based on the same level of charges in 2017 will top out at $200. However, another 64,200 clinicians subject to the 2% penalty this year had Medicare charges in 2015 that exceeded $100,000. If they bill Medicare for just as much in 2017, they will forfeit more than $2,000. The last year for PQRS penalties is 2018, when physicians will suffer the consequences for botched or skipped reporting in 2016. In 2019, a new Medicare reimbursement scheme called the Quality Payment Program (QPP) will apportion bonuses and penalties on the basis of performance in 2017.

    Source: Robert Lowes, Medscape [6/20/17]

    Like

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