PQRS (Physician Quality Reporting System) is a “reporting program that uses a combination of incentive payments and payment adjustments to promote reporting of quality information by eligible professionals (EPs).” 1

The program provides an incentive payment to practices with EPs (identified on claims by their individual National Provider Identifier [NPI] and Tax Identification Number [TIN]). EPs satisfactorily report data on quality measures for covered Physician Fee Schedule (PFS) services furnished to Medicare Part B Fee-for-Service (FFS) beneficiaries (including Railroad Retirement Board and Medicare Secondary Payer).

It is a program that was created in 2006 Tax Relief and Health Care Act (TRHCA). At first, it was known as Physician Quality Reporting Initiative (PQRI) and offered 1.5% bonus payment for successful reporting on quality measures. In 2008, Medicare Improvement for Patient and Provider Act made the program permanent, and in 2010 the Affordable Care Act ensured that individuals who would not adhere to PQRS would face negative adjustments starting in 2015.

CMS defines PQRS as a reporting program that uses a combination of incentive payments and payment adjustments to promote reporting of quality information by eligible professionals (EPs).  The program provides incentive payment to practices with EPs (identified on claims by their individual National Provider Identifier [NPI] and Tax Identification Number [TIN]). EPs satisfactorily report data on quality measures for covered Physician Fee Schedule (PFS) services furnished to Medicare Part B Fee-for-Service (FFS) beneficiaries (including Railroad Retirement Board and Medicare Secondary Payer).

The goal of PQRS program is to collect data that can help lead to improved patient care. By reporting PQRS quality measures, EP (Eligible Providers) can quantify how often they are meeting a particular metric. They can then use this data to compare their performance with their peers. PQRS measures consist of a numerator and a denominator. The numerator describes the clinical action required by the measure for reporting and performance, according to CMS. PQRS denominator describes the eligible cases for each measures such as the eligible patient population associate with a measure’s numerator. Currently there are 259 measures in PQRS.

PQRS should not be confused with EHR incentive program “Meaningful Use”. The EHR incentive program was created under the American Recover and Reinvestment Act of 2009, which provides incentive payments to EPs, Hospitals, and Critical Access Hospitals for the “meaningful use” of certified EHR technology. Since Meaningful Use is a separate program than PQRS, attesting to Meaningful Use does not mean successful participation in PQRS or vice versa.

As per CMS, CQMs (Clinical Quality Measures) are tools that help us measure and track the quality of healthcare services provided by EPs, eligible hospitals (EHs) and critical access hospitals (CAHs) within our health care system. These measures use a wide variety of data that are associated with a provider’s ability to deliver high-quality care or relate to long term goals for health care quality. In 2014, EP are required to report on 9 of 64 approved CQM’s, where else EHs and CAHs must report on 16 of 29 CQMs. CQMs must be selected from at least 3 of the 6 key healthcare policy domain such as Patient and Family engagement, Patient Safety, Care Coordination, Population and Public Health, Efficient use of healthcare resources, Clinical Processes/effectiveness. Furthermore, in 2014, all EP’s beyond their first year of Meaningful Use will be required to report their CQM data electronically from their 2014 certified EHR system.

Though both programs, PQRS and EHR incentive program “Meaningful Use”, are administered by CMS, reporting for both programs is slightly different.  In order to use the EHR to report PQRS data, the EHR has to be ” Qualified” by CMS i.e. tested, vetted and approved by CMS. Therefore, an EHR may be certified for Meaningful Use but may not be approved to participate in PQRS.

 

 

SOURCE:

“Physician Quality Reporting System.” – Centers for Medicare & Medicaid Services. N.p., n.d. Web. 2 Mar. 2014. <http://www.cms.gov/Medicare/Quality-Initiatives-Patient-Assessment-Instruments/pqrs/index.html>.