PQRS Basics
- PQRS reporting is a voluntary reporting program implemented by the Center for Medicare and Medicaid Services (CMS).
- PQRS was known as the Physician Quality Reporting Initiative (PQRI) prior to 2010.
- The program currently provides incentive payments to eligible professionals who satisfactorily report data on quality measures for covered Physician Fee Schedule (PFS) services furnished to Medicare Part B Fee-for-Service beneficiaries.
- There is no registration or sign-up required to participate. Simple submit quality measure data and meet the criteria for satisfactorily reporting to become eligible for an incentive payment.
Incentive payments and penalty adjustment Eligible professionals who satisfactorily report data of quality measures will qualify for an incentive payment equal to 0.5% of their total Medicare Part B PFS charges during the 2012 reporting period.
Beginning in 2015, CMS will adopt a payment adjustment (penalty) as part of the PQRS program. Eligible professionals who do not satisfactorily submit PQRS quality measure data will be applied a 1.5% payment adjustment. The adjustment (98.5% of the fee schedule amount that would otherwise apply to such services) applies to covered professional services furnished by the eligible professional during 2015 or any subsequent year. The payment adjustment rises to 2% in 2016.
To avoid the 2015 payment adjustment, an eligible professional must satisfactorily report PQRS quality measure data during the 2013 reporting period (January 1, 2013 – December 21, 2013).
PQRS in 2012 There are three reporting methods available to eligible professionals to participate in PQRS:
- Claims based reporting during your regular process of submitting Medicare Part B claims to CMS
- Registry based reporting - Via a qualified PQRS registry, such as the PQRIWizard
- Electronic Health Record (EHR) reporting - Via a qualified EHR product
Reporting requirements:
The reporting requirements differ for each of the outlined reporting methods. Requirements also differ depending on whether eligible professionals report on individual measures or on measures groups.
Claims based reporting
| Individual Measures Reporting Criteria |
Reporting Period |
- Report at least 3 PQRS individual measures
- For at least 50% of applicable patients for each measure
Measures with a 0% performance rate will be considered in analysis but will not be considered satisfactorily reported for incentive eligibility.
|
January 1, 2012 - December 31, 2012 |
| Measures Group Reporting Criteria |
Reporting Criteria |
- Report one measures group
- For 50% of applicable patients for each measure
Measures groups containing a measure with a 0% performance rate will not be counted.
|
January 1, 2012 - December 31, 2012 |
- Report one measures group
- For 30 unique Medicare Part B FFS patients
Measures groups containing a measure with a 0% performance rate will not be counted.
|
January 1, 2012 - December 31, 2012 |
Registry based reporting
| Individual Measures Reporting Criteria |
Reporting Period |
- Report at least 3 PQRS individual measures
- For at least 80% of applicable patients for each measure.
Measures with a 0% performance rate will not be counted.
|
January 1, 2012 - December 31, 2012 |
| Measures Groups Reporting Criteria |
Reporting Period |
- Report one measures group
- For 30 unique Medicare Part B FFS patients Measures groups containing a measure with a 0% performance rate will not be counted.
|
January 1, 2012 - December 31, 2012 |
- Report one measures group
- For 80% of applicable patients (with a minimum of 15 patients during the reporting period)
Measures groups containing a measure with a 0% performance rate will not be counted.
|
January 1, 2012 - December 31, 2012 |
- Report one measures group
- For 80% of applicable patients (with a minimum of 8 patients during the reporting period)
Measures groups containing a measure with a 0% performance rate will not be counted.
|
July 1, 2012 - December 31, 2012 |
Electronic Health Record (EHR) based reporting:
| Reporting Criteria |
Reporting Period |
- Report at least 3 PQRS individual measures
- For at least 80% of applicable patients for each measure.
Measures with a 0% performance rate will not be counted.
|
January 1, 2012 - December 31, 2012 |
- Report on ALL 3 Medicare EHR Incentive Program CORE measures. If the denominator for one or more of the core measures is 0, report on up to 3 Medicare EHR Incentive Program alternative core measures.
- Report on 3 (of 38) additional measures available for the Medicare HER Incentive Program.
|
January 1, 2012 - December 31, 2012 |
2012 Physician Quality Reporting Individual Measures The 2012 PQRS includes 210 individual quality measures. 28 new measures for claims and registry based reporting were included for 2012. 9 measures from the 2011 program were retired for 2012.
A selection of the full measure set is highlighted below. The table references the measure most applicable to an otolaryngology practice. The 2012 measure specification manual, which includes all 210 measures, is available here.
Measure #
|
Measure Title and Description |
Reporting Options/Methods |
20
|
Perioperative Care: Timing of Antibiotic Prophylaxis – Ordering Physician |
Claims, Registry |
21
|
Perioperative Care: Selection of Prophylactic Antibiotic – First OR Second Generation Cephalosporin |
Claims, Registry |
22
|
Perioperative Care: Discontinuation of Prophylactic Antibiotics (Non-Cardiac Procedures) |
Claims, Registry |
23
|
Perioperative Care: Venous Thromboembolism (VTE) Prophylaxis (When Indicated in ALL Patients) |
Claims, Registry |
30
|
Perioperative Care: Timely Administration of Prophylactic Parenteral Antibiotics |
Claims, Registry |
46
|
Medication Reconciliation: Reconciliation After Discharge from an Inpatient Facility |
Claims, Registry |
| 47 |
Advance Care Plan
|
Claims, Registry, EHR |
53
|
Asthma: Pharmacologic Therapy for Persistent Asthma |
Claims, Registry, EHR |
64
|
Asthma: Assessment of Asthma Control
|
Claims, Registry, EHR |
| 66 |
Appropriate Testing for Children with Pharyngitis
|
Claims, Registry, EHR |
91
|
Acute Otitis Externa (AOE): Topical Therapy
|
Claims, Registry |
| 92 |
Acute Otitis Externa (AOE): Pain Assessment |
Claims, Registry |
93
|
Acute Otitis Externa (AOE): Systemic Antimicrobial Therapy – Avoidance of Inappropriate Use
|
Claims, Registry |
110
|
Preventive Care and Screening: Influenza Immunization |
Claims, Registry, EHR |
111
|
Preventive Care and Screening: Pneumonia Vaccination for Patients 65 Years and Older
|
Claims, Registry, EHR |
124
|
Health Information Technology (HIT): Adoption/Use of Electronic Health Records (EHR)
|
Claims, Registry |
128
|
Preventive Care and Screening: Body Mass Index (BMI) Screening and Follow-Up
|
Claims, Registry, EHR |
130
|
Documentation of Current Medications in the Medical Record
|
Claims, Registry |
| 131 |
Pain Assessment and Follow-Up |
Claims, Registry |
143
|
Oncology: Medical and Radiation – Pain Intensity Quantified
|
Registry |
144
|
Oncology: Medical and Radiation – Plan of Care for Pain
|
Registry |
154
|
Falls: Risk Assessment
|
Claims, Registry |
155
|
Falls: Plan of Care
|
Claims, Registry |
| 173 |
Preventative Care and Screening: Unhealthy Alcohol Use - Screening |
Claims, Registry, EHR |
| 182 |
Functional Outcome Assessment |
Claims, Registry |
193
|
Perioperative Temperature Management |
Claims, Registry |
226
|
Preventive Care and Screening: Tobacco Use: Screening and Cessation Intervention
|
Claims, Registry, EHR |
231
|
Asthma: Tobacco Use Screening - Ambulatory Care Setting
|
Claims, Registry |
| 232 |
Asthma: Tobacco Use Intervention - Ambulatory Care Setting
|
Claims, Registry |
| 244 |
Hypertension: Blood Pressure Management |
Registry |
| 317 |
Preventative Care and Screening: Screening for High Blood Pressure |
Claims, Registry, EHR |
2012 Physician Quality Reporting Measures Groups Measures groups are a subset of four or more Physician Quality Reporting measures that have a particular clinical condition or focus in common. PQRS includes 22 measures groups for 2012, three of which are potentially applicable to a practicing otolaryngologist. Measures groups containing a measure with a 0% performance rate will not be counted as satisfactorily reporting the measures group.
Perioperative Care Measures Group (Claims and Registry Reporting) Measure 20. Perioperative Care: Timing of Antibiotic Prophylaxis - Ordering Physician
Measure 21. Perioperative Care: Selection of Prophylactic Antibiotic - First OR Second Generation Cephalosporin
Measure 22. Perioperative Care: Discontinuation of Prophylactic Antibiotics (Non-Cardiac Procedures)
Measure 23. Perioperative Care: Venous Thromboembolism (VTE) Prophylaxis (When Indicated in ALL Patients)
Asthma Measures Group (Claims and Registry Reporting) Measure 53. Asthma: Pharmacologic Therapy
Measure 64. Asthma: Asthma Assessment
Measure 231. Asthma: Tobacco Use: Screening - Ambulatory Care Setting
Measure 232. Asthma: Tobacco Use: Intervention - Ambulatory Care Setting
Sleep Apnea Measures Group (Registry Reporting ONLY) Measure 276. Sleep apnea: Assessment of Sleep Symptoms
Measure 277. Sleep apnea: Severity Assessment at Initial Diagnosis
Measure 278. Sleep Apnea: Positive Prescribed
Measure 279. Sleep Apnea: Assessment of Adherence to Positive Airway Pressure Therapy
|
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