The Physician Quality Reporting System (PQRS)

The Physician Quality Reporting System (PQRS) has been using incentive payments, and will begin to use payment adjustments in 2015, to encourage eligible health care professionals (EPs) to report on specific quality measures. 

2014 PQRS Measures

Reporting Deadlines: the deadline to submit data for 2014 PQRS is Feb. 27, 2015. To submit quality data via the AGA Digestive Health Recognition Program™ (DHRP) the deadline is Feb. 26, 2015.

Incentives

Eligible professionals who satisfactorily report in the 2014 PQRS program can qualify for an incentive equal to 0.5 percent of the total estimated part B allowed charges for all covered professional services furnished by the eligible professional during the applicable reporting period. In the case of a group practice participating in the group practice report option (GPRO), the group may also potentially qualify to earn PQRS incentive payments equal to 0.5 percent of the group practice's total estimated Medicare Part B PFS allowed charges for covered professional services furnished during a 2014 PQRS reporting period based on the group practice meeting the criteria for satisfactory reporting specified by CMS.

Penalties

Upcoming CMS Penalties for Non-participation in Quality Programs:

Year

eRx

EMR

PQRS

Total Penalty

2014

-2.0%

No penalty

No penalty

-2.0%

2015

No penalty

-1.0%

-1.5%

-2.5%

2016

No penalty

-2.0%

-2.0%

-4.0%

2017

No penalty

-3.0%

-2.0%

-5.0%

EPs who do not satisfactorily report data on quality measures for covered professional services during the 2014 PQRS program year will be subject to a 2% payment adjustment to their Medicare PFS amount for services provided in 2016.

To participate in the 2014 PQRS program, individual EPs may choose to report quality information through one of the following methods:

  • Medicare Part B claims
  • Qualified PQRS Registry
  • Direct Electronic Health Records (EHR) using Certified EHR Technology (CEHRT)
  • CEHRT via Data Submission Vendor
  • Qualified clinical data registry (QCDR)

Reporting Periods

Regarding adjustments, both the 6- and 12-month reporting periods occurring 2 years prior to the 2015 and 2016 PQRS payment will impact adjustments (e.g., Jan. 1, 2014–Dec. 31, 2014 or July 1, 2014–Dec. 31, 2014 for the 2016 adjustment). For 2017 and beyond, CMS finalized a 12-month reporting period for payment adjustments, eliminating the 6-month reporting period.

Definition of Group

CMS has changed its definition of group practice from 25 or more to 2 or more. The revised definition is a single Tax Identification Number (TIN) with 2 or more eligible professionals, as identified by their individual National Provider Identifier (NPI), who have reassigned their Medicare billing rights to the TIN. This will allow more practices to participate in the PQRS Group Practice Reporting Option (GPRO).  

Group practices participating through the Group Practice Reporting Option (GPRO) in the 2014 PQRS program year can participate through one of the following methods:

  • Qualified PQRS registry
  • Web interface (for groups of 25+ only)
  • Direct EHR using CEHRT
  • CEHRT via Data Submission Vendor
  • CG CAHPS CMS - certified survey vendor (for groups of 25+ only)

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2014 PQRS Measures

CMS offers 12 PQRS reporting options, The six-month reporting option is only available for reporting measures groups via registries. 

Individual 2014 PQRS measures related to colorectal cancer (CRC) screening and surveillance include: 

  • Measure 320: Endoscopy and Polyp Surveillance. Appropriate Follow-Up Interval for Normal Colonoscopy in Average Risk Patients. Percentage of patients aged 50 years and older receiving a screening colonoscopy without biopsy or polypectomy who had a recommended follow-up interval of at least 10 years for repeat colonoscopy documented in their colonoscopy report.
  • Measure 185: endoscopy & polyp surveillance: colonoscopy interval for patients with a history of adenomatous polyps — avoidance of inappropriate use. Percentage of patients aged 18 years and older receiving a surveillance colonoscopy with a history of colonic polyp(s) in a previous colonoscopy, who had a follow-up interval of three or more years since their last colonoscopy documented in the colonoscopy report.
  • Measure 128: preventive care and screening: body mass index (BMI) screening and follow-up. Percentage of patients aged 18 years and older with a calculated BMI in the past six months or during the current visit documented in the medical record AND if the most recent BMI is outside of normal parameters, a follow-up plan is documented.
    • Normal Parameters: Age 65 years and older BMI ≥ 23 and < 30; Age 18-64 years BMI ≥ 18.5 and < 25.
  • Measure 226: preventive care and screening: tobacco use: screening and cessation intervention. Percentage of patients aged 18 years and older who were screened for tobacco use one or more times within 24 months AND who received cessation counseling intervention if identified as a tobacco user.
  • Measure 343: screening colonoscopy adenoma detection rate. Percentage of patients age 50 years or older with at least one adenoma or other colorectal cancer precursor or colorectal cancer detected during screening colonoscopy.

Hepatitis C Measures are also available to be reported as individual measures. These are PQRS measures 83, 84, 85,  87, and 183. 

Reporting Measure Groups

The minimum patient count for reporting measures groups has been lowered from 30 to 20 for individuals reporting measures groups via claims and registry for the 2013 and 2014 PQRS incentives.

Reporting instructions and specifications for 25 measures groups, including those related to gastroenterology, can be found in the 2014 PQRS Measure Groups Specifications, Release Notes, Getting Started with 2014 PQRS Measures Groups, 2014 Quality-Data Code Categories, and 2014 PQRS Measures Groups Single Source Code Master

The Hepatitis C (chronic) Measures Group is comprised of the following measures:

  • Measure 84: RNA testing before initiating treatment
  • Measure 85: HCV genotype prior to treatment
  • Measure 87: HCV RNA testing at week 12 of treatment
  • Measure 183: hepatitis A vaccination in patients with HCV

The hepatitis C measures group may be reported via claims or registry.

The Inflammatory Bowel Disease (IBD) Measures Group is comprised of the following measures: 

  • Measure 269: Inflammatory Bowel Disease (IBD): Type, Anatomic Location and Activity All Documented
  • Measure 270: Inflammatory Bowel Disease (IBD): Preventive Care: Corticosteroid Sparing Therapy
  • Measure 271: Inflammatory Bowel Disease (IBD): Preventive Care: Corticosteroid Related Iatrogenic Injury – Bone Loss Assessment
  • Measure 272: Inflammatory Bowel Disease (IBD): Preventive Care: Influenza Immunization
  • Measure 273: Inflammatory Bowel Disease (IBD): Preventive Care: Pneumococcal Immunization
  • Measure 274: Inflammatory Bowel Disease (IBD): Testing for Latent Tuberculosis (TB) Before Initiating Anti-TNF (Tumor Necrosis Factor)Therapy
  • Measure 275: Inflammatory Bowel Disease (IBD): Assessment of Hepatitis B Virus (HBV) Status Before Initiating Anti-TNF (Tumor Necrosis Factor) Therapy
  • Measure 226: Preventive Care and Screening: Tobacco Use: Screening and Cessation Intervention

The IBD measures can only be reported as a group via the registry reporting mechanism.

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PQRS Measure Specification

PQRS measure specification are updated and posted prior to the beginning of each program year; therefore, eligible professionals need to use the specification for the current/applicable year for which they are reporting. It is most prudent to access those materials directly from the CMS PQRS Web page to be sure you are using the most current versions. 

In the measures codes section you will find the 2014 PQRS measure list and implementation guide as well as documents with detailed reporting specification and instructions for each measure and reporting method. 

The 2014 Physician Quality Reporting System (PQRS): Implementation Guide – Claims-Based Reporting for Incentive provides an overview of the reporting system including decision trees to help your practice understand how of the various reporting options might be applied to your specific circumstances.  

2014 PQRS Measures Group Specifications

Once you have selected the measures (at least three), carefully review the following documents:

2014 PQRS Measure Groups Specifications

 

Participation and Getting Help

See the CMS website for step by step guidance on how to get started on reporting individual measures and measures groups for 2014 PQRS.

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