American College Of Surgeons - Inspiring Quality: Highest Standards, Better Outcomes

Physician Quality Reporting System

The Centers for Medicare & Medicaid Services (CMS) has continued the Physician Quality Reporting System (PQRS) since its enactment in the Medicare Improvements for Patients and Providers Act of 2008 (MIPPA). PQRS was the first CMS national program to link the reporting of quality data to physician payment. There are no longer incentive payments being offered for those eligible professionals who successfully participate and the program has now moved into a penalty-only phase. Regulations for the PQRS program are updated annually in the Medicare Physician Fee Schedule (MPFS) rule.

Physicians who do not participate in PQRS in 2016 may be subject to a -6 percent payment adjustment in 2018. This reduction is the total penalty resulting from payment adjustments for nonparticipation in PQRS and the effects on the value-based payment modifier (VM), which, in part, hinges on PQRS participation.

Introduction to PQRS

2016 Surgeon’s Guide to Understanding the Physician Quality Reporting System
2015 Surgeon’s Guide to Understanding the Physician Quality Reporting System
2014 Surgeon’s Guide to Understanding the Physician Quality Reporting System

Bulletin Articles about PQRS

PQRS reporting in 2016 and what the College is doing to help
Benefits of PQRS Participation and what the College is doing on your behalf
What surgeons should know about... PQRS reporting in 2014

PQRS Eligibility Criteria

Definition of Eligible Provider

CMS PQRS Implementation Guide

2016
2015
2014

PQRS Measure List

2016
2015
2014

Learn How You’re Performing

CMS distributes annual PQRS Payment Adjustment Feedback Reports which provides a physicians or group practice with the determination of whether they met at least one of the criteria for avoiding a PQRS payment adjustment. The reports are distributed at the TIN-level, with individual-level reporting (by NPI) for each EP who submitted under that TIN for services furnished during the reporting periods. Reports include high-level information on number of valid measures reported, whether or not they met criteria to avoid the PQRS payment adjustment and whether or not the provider will be subject to the payment adjustment. Learn more about PQRS Feedback Reports and how to obtain yours.

Every year, CMS also publishes a PQRS Reporting Experience document that summarizes the historical reporting experience of eligible professionals in the PQRS program. The most recent PQRs experience report displays information through program year 2014.

Individual Reporting Options

Surgeons can participate individually in the PQRS program through one of four methods: claims-based reporting, traditional registry-based reporting, qualified clinical data registry (QCDR)-based reporting, or electronic health records (EHR)-based reporting.

Claims-Based Reporting Information

2016 | 2015 | 2014

Traditional Registry-Based Reporting Information

2016 | 2015 | 2014

QCDR-Based Reporting Information

2016 | 2015

EHR Reporting Information

2016 | 2015

Group Practice Reporting Option (GPRO) Information

Surgeons can also participate as collectively as groups through the group practice reporting option (GPRO). The methods available for the GPRO option include traditional registry, QCDR, EHR, web-interface, and the certified survey vendor reporting option.

Web Interface (25+ Group Only)

2016 | 2015

Traditional Registry

2016 | 2015

QCDR-Based Reporting Information

2016

Certified Survey Vendor

2016 | 2015

EHR

2016 | 2015

Federal Regulations

PQRS-Related Final Rules

2016 MPFS Final Rule
2015 MPFS Final Rule
2014 MPFS Final Rule

ACS Comment Letters

2016 ACS Comment Letter to MPFS Final Rule
2015 ACS Comment Letter to MPFS Final Rule
2014 ACS Comment Letter to MPFS Final Rule

Additional Resources

CMS PQRS Experience Reports

2013 PQRS Experience Report
2011 PQRS Experience Report
2010 PQRS Experience Report

CMS QualityNet
CMS QualityNet Help Desk: 1-866-288-8912
E-mail: qnetsupport@sdps.org

For further information, please contact Molly Peltzman at mpeltzman@facs.org.