PQRS and Your Practice
Physician Quality Reporting System
- Pay-for-reporting, not pay-for-performance
- Multiple ways to participate/report
- Registry participation is the most promising path for small- and medium-sized practices
- PQRS is not a substitute for local quality improvement efforts
- Penalties began in 2015 and will continue through 2018 for those who did not successfully report two years earlier (e.g. -2.0% in 2017 and 2018 if no successful reporting in 2015 and 2016, respectively).
- PQRS outcomes are partially used to calculate the value-based payment modifier
- In 2019 and beyond, PQRS will be replaced by the merit-based incentive payment system (MIPS)
PQRS Reporting Options
Individual eligible professionals (EPs) may report information on individual PQRS quality measures or group measures using the following mechanisms:
- Medicare Part B claims-based reporting (CPT II or G codes)
- CMS-approved registry (PQRSwizard (aafp.pqrswizard.com) is one option)
- Certified electronic health record technology (CEHRT) product
- CEHRT via data submission vendor
- Qualified clinical data registry (QCDR)
Group practices should register to report as a group. EPs within a group must report as individuals if the practice did not register. Group practices may report PQRS quality measures using the following mechanisms:
- CMS-approved registry (PQRSwizard (aafp.pqrswizard.com) is one option)
- Web interface (for groups of 25+ EPs only)
- Certified electronic health record technology (CEHRT) product
- CEHRT via data submission vendor
- Consumer Assessment of Healthcare Providers and Systems (CAHPS) for PQRS via CMS-certified survey vendor (for group practices of 2+ EPs) to supplement PQRS group practice reporting
Qualified Registries
A list of CMS qualified registries (www.cms.gov) is available on the CMS web site.
The American Medical Association also maintains an inventory of national clinical registries (www.ama-assn.org).