Physician Quality Reporting System (PQRS)

What Is PQRS?

The Physician Quality Reporting System is one of several government reporting programs (including meaningful use) that utilizes incentives (through 2014) and payment adjustments (through 2018) to promote the reporting of Clinical Quality Measure (CQMs) data.

Effective 2017, under the proposed MACRA regulations, PQRS will cease to exist as an independent program, but PQRS-like quality reporting will continue to be a major component of Medicare’s value-based payment incentives.

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Effective April 2013, incentives are reduced by 2% due to sequestration.

PQRS-Eligible Professionals (EPs)

Medical professionals who provide services that are paid under the Medicare Part B Physician Fee Schedule (PFS) are eligible for PQRS incentive payments and/or payment adjustments. Note: PQRS eligibility differs from meaningful use eligibility.

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*Includes Advanced Practice Registered Nurse (APRN)

PQRS Reporting for 2016

Full calendar year reporting is required for PQRS. Most reporting methods require 9 CQMs covering at least 3 domains.

“Harmonized” Reporting Option for Providers Participating in MU and PQRS (and some other government programs)

Providers have the option to report once to simultaneously satisfy PQRS requirements and the CQM component of MU using Certified EHR Technology (CEHRT). Program harmonization offers EPs:

EHR (electronic) submission.
Up to 64 electronically specified CQMs (eCQMs)—EHR vendors choose and certify the CQMs they offer from this list.
Aligned requirements: report 9 measures over 3 domains.
Report once (at the end of the year) to avoid the 2018 PQRS payment adjustment and complete MU attestation to earn the MU incentive.

Other Reporting Methods

EPs who do not choose—or do not have access to—EHR reporting can select another reporting option, in which case they can choose from a larger set of individual measures (approximately 255 depending on reporting method) or a measures group.

Claims1
PQRS Registry (qualified registries are listed on CMS PQRS website)
Qualified Clinical Data Registry (QCDRs have not been authorized yet)
GPRO Web Interface2
CAHPS for PQRS CMS-Certified Survey Vendor

1Only available to EPs reporting as individuals. Not an option for group practices that self-nominate for the Group Practice Reporting Option (GPRO)
2Only available to GPROs with 25 or more EP.

 

Value-Based Payment Modifier Program (V-BPM)

What Is the Value-Based Payment Modifier?

CMS has been phasing in the Value-Based Payment Modifier (V-BPM) as a means of assessing group performance in terms of quality and cost relative to their peers.

The V-BPM has two components:

Part 1: Automatic 4% penalty in 2018 for not reporting PQRS in 2016 (in addition to the 2% PQRS penalty)

Part 2: Quality-Tiering – The 2018 VM will be based on 2016 performance according to the following charts:

 

Value-Based Modifier Payment Adjustment Amounts for 1-9 Providers

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*x = % adjustment factor to ensure budget neutrality

2018 Payment Adjustment Amounts for ≥10 Providers

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*x = % adjustment factor to ensure budget neutrality

 


 

CMS QualityNet Help Desk – 1-866-288-8912
eHealth Eligibility Tool
CMS Website on the PQRS Program
CMS Educational Resources Page
FAQs regarding PQRS on CMS Website (continually updated)
CMS Website on the Value-Based Modifier Program

Note: CMS is in the process of updating all the 2016 PQRS and V-BPM related materials. Continue to check their website for additional information on these programs.