How PQRS ties reimbursements to outcomes

July 10, 2013

Medicare’s Physician Quality Reporting System (PQRS) currently offers .5% incentive to participate this year (1% with Maintenance of Certification); penalties will start in 2015 as a result of the Affordable Care Act.

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Your reimbursements will be tied to outcomes in the near future. Medicare’s Physician Quality Reporting System (PQRS) currently offers .5% incentive to participate this year (1% with Maintenance of Certification); penalties will start in 2015 as a result of the Affordable Care Act (ACA).

The overall goal of the PQRS, according to CMS, is to collect meaningful data that can help lead to improved patient care. The program uses a series of measures-138 for 2013-developed by leading physician organizations to evaluate the level of care being provided by doctors. Measures consist of a denominator and numerator. PQRS denominators describe the eligible cases for each measure, such as the eligible patient population associated with a measure’s numerator. The numerator describes the clinical action required by the measure for reporting and performance, according to CMS.

To qualify, a practice simply must meet CMS’ criteria for satisfactory reporting for a particular reporting period. Groups, however, must self-nominate to submit data as a group rather than individually, CMS notes.

The quality measures for 2013 PQRS address areas such as preventive care, chronic- and acute-care management, procedure-related care, and care coordination. Review the 2013 PQRS Measures List (go to www.cms.gov/Medicare/Quality-Initiatives-Patient-Assessment- Instruments/PQRS/MeasuresCodes.html) for detailed guidance. CMS recommends considering typical clinical conditions treated, types of care provided, the setting the care, and quality improvement goals for 2013 when selecting measures to report.

When it comes to reporting, you can choose from several options, including reporting via paper claims or registry (each with multiple reporting options), reporting through an electronic health record (EHR) system, or reporting through the group practice reporting option.