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

Physician Quality Reporting System (PQRS)

In 2017, the Centers for Medicare & Medicaid (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)
Promoting Interoperability, formerly known as Advancing Care Information (ACI) or the Electronic Health Record Incentive Payment Program
Cost, formerly known as the Physician Value-Based Payment Modifier (VM) program
Improvement Activities, a new category

These four components combine to form a MIPS Final Score that determines a MIPS eligible clinician’s Medicare Part B incentive payment.

For 2018, the MIPS final score is composed of Quality for 50 percent, Cost for 10 percent, Promoting Interoperability for 25 percent, and Improvement Activities for 15 percent. For more information on the MIPS program, please visit the ACS Quality Payment Program Resource Center.

The Centers for Medicare & Medicaid Services (CMS) continued the PQRS since its enactment in the Medicare Improvements for Patients and Providers Act of 2008 (MIPPA) until it was replaced by MIPS in 2017. PQRS was the first CMS national program to link the reporting of quality data to physician payment. Final payment adjustments for the PQRS will be applied in 2018 for data submitted in the 2016 performance year.

Physicians who did not participate in PQRS in 2016 were subject to a -2 percent payment adjustment in 2018. This reduction is the total penalty that resulted from payment adjustments for nonparticipation in PQRS and the effects on the VM, which, in part, hinged on PQRS participation.

Introduction to PQRS

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

Learn How You’re Performing

CMS distributed annual PQRS Payment Adjustment Feedback Reports which provided a physician or group practice with the determination of whether they met at least one of the criteria for avoiding a PQRS payment adjustment. The reports were 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 included 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 was subject to the payment adjustment. Learn more about PQRS Feedback Reports and how to obtain yours. The final PQRS feedback reports were distributed in 2016, and will reflect the 2018 payment adjustments. Reports can be accessed in the CMS Enterprise Portal with a CMS Enterprise Identity Management (EIDM) login.

During each year of the program, CMS published a PQRS Reporting Experience document that summarized the historical reporting experience of eligible professionals in the PQRS program. The most recent PQRS Reporting Experience document displays information through program year 2015 as well as preliminary PQRS data from the 2016 program year.

Individual Reporting Options

Surgeons participated 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. Surgeons who submitted PQRS data in 2016 will receive payment adjustments in the 2018 payment year.

Claims-Based Reporting Information

2016

Traditional Registry-Based Reporting Information

2016

QCDR-Based Reporting Information

2016

EHR Reporting Information

2016

Group Practice Reporting Option (GPRO) Information

Surgeons also had the option to participate collectively as groups through the group practice reporting option (GPRO). The methods available for the GPRO option included traditional registry, QCDR, EHR, web-interface, and the certified survey vendor reporting option. Groups who submitted PQRS data in 2016 will receive payment adjustments in the 2018 payment year.