The Physician Quality Reporting System (PQRS)

The Physician Quality Reporting System (PQRS) is a result of the Tax Relief and Health Care Act of 2006, which authorized a financial incentive for eligible professionals to participate in a voluntary reporting program.

2011 PQRS —There’s still time to report

Although the year has nearly ended, there is still time to submit Medicare quality data via the AGA Digestive Health Outcomes Registry® (AGA Registry) for the hepatitis C measures group. Health-care providers who treat Medicare Part B (fee-for-service) patients are eligible for a 1 percent bonus of their total estimated Medicare Part B physician fee schedule allowed charges for covered professional services furnished during that same reporting period by participating in the 2011 PQRS.

You can still report on the hepatitis C measures group for your patients with chronic hepatitis C even if you only saw eight Medicare patients with chronic hepatitis C.

Deadline extended: Join the AGA Registry by Feb. 17, 2012, and submit your data by Feb. 29, 2012. Read more.

2012 PQRS

Eligible professionals who satisfactorily report in the 2012 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 [or, in the case of a group practice participating in the group practice report option (GPRO), the group practice] during the applicable reporting period. The Patient Protection and Affordable Care Act authorizes incentive payments through 2014 and requires a penalty, beginning in 2015, for eligible professionals who do not satisfactorily report.  

CMS now defines a “group practice” to include groups with 25 or more eligible professionals. CMS is working to develop the GPRO so that it may be viable reporting option for group practices smaller than 25 eligible professionals in future program years.

CMS will also provide an additional 0.5 percent maintenance of certification (MOC) program incentive payment for 2011 through 2014 for those who:

  • Satisfactorily submit data, without regard to method, on quality measures under physician quality reporting, for a 12-month reporting period either as an individual physician or as a member of a selected group practice.

AND

  • More frequently than is required to qualify for or maintain board certification:
    • Participate in a MOC program.
    • Successfully complete a qualified MOC program practice assessment.

CMS is providing more flexibility to entities sponsoring MOC programs to define what an eligible professional is required to do so “more frequently” for purposes of the PQRS MOC program incentive.

2012 PQRS Measures

CMS finalized the 2012 PQRS core measure set, including 211 individual measures and 23 measures groups for claims and/or registry-based reporting. The 2012 PQRS program includes the IBD measures group developed by the AGA. The IBD measures group is a subset of the AGA adult IBD measures, which focus on transitioning patients to corticosteroid-sparing therapy and preventive care. The final CMS rules allow reporting of the IBD measures group only through a CMS qualified registry, not via claims.

Individual 2012 PQRS measures related to gastroenterology include:

  • 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.

PQRS measures groups available for 2012 related to gastroenterology include:

Hepatitis C (chronic)

  • Measure 83: Confirmation of HCV viremia
  • Measure 84: RNA testing before initiating treatment
  • Measure 85: HCV genotype prior to treatment
  • Measure 86: HCV antiviral treatment prescribed
  • Measure 87: HCV RNA testing at week 12
  • Measure 89:  HCV counseling risk of alcohol consumption
  • Measure 90: contraception counseling prior to HCV therapy
  • Measure 183: hepatitis A vaccination in HCV patients
  • Measure 184: hepatitis B vaccination in HCV patients

The hepatitis C measures, both as individual measures and a measures group, will continue to be available for reporting in the 2012 PQRS. It is allowable to report almost all of the hepatitis C measures via claims or a qualified registry. However, keep in mind that that these measures apply to chronic hepatitis, not acute hepatitis, diagnostic codes.

IBD 

  • Measure 269: asessment of IBD activity and severity
  • Measure 270: IBD corticosteroid-sparing therapy
  • Measure 271: corticosteroid related iatrogenic injury – bone loss assessment  
  • Measure 272: influenza immunization
  • Measure 273: pneumococcal immunization
  • Measure 274: testing for latent TB before anti-TNF therapy
  • Measure 275: assessment of HBV status before initiating anti-TNF therapy
  • Measure 226: tobacco use screening and cessation intervention

Preventive care

  • Measure 110: preventive care and screening: influenza immunization
  • Measure 111: preventive care and screening: pneumonia vaccination for patients 65 years and older
  • Measure 113: preventive care and screening: colorectal cancer screening
  • Measure 128: preventive care and screening: body mass index (BMI) screening and follow-up
  • Measure 173: preventive care and screening: unhealthy alcohol use – screening

Review the reporting options available for GI-related measures.

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 2012 PQRS measure list and implementation guide as well as documents with detailed reporting specification and instructions for each measure and reporting method.

Individual Physician Quality Reporting Measures

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

PQRS Measures Groups

Once you have selected a measures group(s) to report, carefully review the following documents:

Registry Reporting 

CMS has shown that professionals who participate through a registry were more likely to earn incentive payments and higher incentive payments due to the lack of submission errors and missing data common in claims?based reporting. The AGA Registry is qualified for CMS quality reporting. It provides participating providers with a streamlined way to meet CMS reporting requirements for the hepatitis C measures group and potentially qualify for increased reimbursement for Medicare Part B encounters.

PQRS Feedback Reports 

The most recent aggregate information available regarding PQRS reporting results is for the 2009 PQRS reporting year; review the details for 2009 reporting experience including trends, 2007 — 2010. Historically, participating providers have had to wait about nine months after the end of the reporting year to receive any feedback or results of their PQRS participation. However, CMS will provide interim feedback reports for eligible professionals reporting individual measures and measures groups through the claims-based reporting mechanism for 2012 and beyond. Eligible professionals who would like to submit a request for an informal review are required to do so via a web-based tool, the communication support page. Information on the communication support page, including the link to the page, will be available at http://www.cms.gov/PQRS.

Participation

Step 1

Determine if you are eligible to participate. Not all entities are considered eligible because they are reimbursed by Medicare under other fee schedule methods than the Medicare physician fee schedule. Review a list of professionals who are eligible and able to participate in PQRS under downloads of the “how to get started” section of the PQRS website.

Step 2

  • Determine which PQRS reporting option(s) best fits your practice (claims-based or registry-based reporting of either individual measures or measures groups).
  • Determine the PQRS reporting period (12 months or six months where applicable) which varies with the reporting option selected.
  • For 2012 and beyond, CMS finalized the proposal to specify a 12 month reporting period (Jan. 1 through Dec. 31 of the respective program year) for the satisfactory reporting of PQRS quality measures for claims, registry and EHR?based reporting.
  • For reporting measures groups via registry, the six month reporting period (July 1 through Dec. 31 of the respective program year) is also an option.

Step 3

Review the 2012 PQRS Measures List and Implementation Guide, available under "downloads" in the measures code section of the PQRS website and determine which PQRS measures apply to your practice. At a minimum, the following factors should be considered when selecting measures for reporting:

  • Clinical conditions usually treated.
  • Types of care typically provided — e.g., preventive, chronic, acute.
  • Settings where care is usually delivered — e.g., office, ED, surgical suite.
  • Practice quality improvement goals for 2012.

The implementation guide also indicates the reporting options/methods available for each measure. Refer to the decision trees in the implementation guide to determine the requirements for reporting via the various reporting methods. For example, if you are reporting individual measures by claims and report less than three applicable measures, CMS will apply  a measure-applicability validation process  (i.e. audit)when determining incentive eligibility.

Review the CMS 2012 physician quality reporting participation decision tree.

Getting Help

CMS has provided the following resources to answer inquiries regarding PQRS and the electronic prescribing (eRx) incentive program, incentive payments, feedback reports, and IACS registration.

QualityNet Help Desk – 7 a.m. – 7 p.m. CT

  • General CMS PQRS and eRx incentive program information
  • Portal password issues
  • Feedback report availability and access
  • PQRI-IACS registration questions
  • PQRI-IACS login issues

Phone: 1-866-288-8912
TTY: 1-877-715-6222
Email: Qnetsupport@sdps.org

A/B MAC and Carrier Provider Contact Centers

  • Remittance advice
  • Incentive payments
  • Adjustments made to incentive payments due to sanctions/overpayments
  • NPI-level feedback reports

Obtain a list of provider contact centers at the provider call center toll-free numbers directory.

FAQ

Frequently asked questions regarding PQRS are available on the overview page of the PQRS website by scrolling to the “related links inside CMS” section of this page and clicking on the Physician Quality Reporting System FAQ link.

Additional educational products are available on the PQRS website in the educational resources section.

 

Updated December 2011