American College of Surgeons Advocacy Regulatory Issues Physician Quality Reporting System (PQRS)

Physician Quality Reporting System (PQRS)

MAV Process

Starting in 2017, Centers for Medicare & Medicaid Services (CMS) merged its previous physician quality programs into the Merit-based Incentive Payment System (MIPS). MIPS includes four components: Quality, formerly known as the Physician Quality Reporting System (PQRS); Advancing Care Information (ACI), formerly known as Electronic Health Record Incentive Payment Program, or Meaningful Use; Cost, formerly known as the Physician Value-Based Payment Modifier (VM) program; and Improvement Activities, a new category. These four components combine to form a MIPS Final Score which determines a MIPS eligible clinician’s Medicare Part B incentive payment for the payment year. For 2017, Quality accounts for 60 percent of the MIPS final composite score, and ACI and IA account for 25 and 15 percent, respectively. Due to ongoing development, the Cost component has a weight of zero. For more information on the MIPS program, please visit the ACS Quality Payment Program Resource Center.

The Centers for Medicare & Medicaid Services (CMS) has continued the 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 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

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

Traditional Registry-Based Reporting Information

2016 | 2015

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.