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Physician Quality Reporting System

Resources from SHM

Quick PQRS Reference Card for Hospitalists

Sorting Out the Acronyms: 2014 PQRS and VBPM

Report Quality Measures in the PQRS Wizard
(Under the PQRS Tab)

The Physician Quality Reporting System (PQRS) is a CMS-mandated reporting system to be used by providers and group practices to capture quality information on selected measures. Using the federal rulemaking process, the Centers for Medicare and Medicaid Services (CMS) updates the program and its quality measures every year in the Physician Fee Schedule.

Eligible professionals (EPs) who successfully report quality measures receive an incentive payment for participation through 2014. Beginning in 2015, eligible professionals who do not successfully report to PQRS will face a 1.5 percent penalty in their covered professional services.

     PQRS Reporting Year    Potential Incentive Payments

     Penalties for Not Reporting

     2014

     0.5% of 2014 Part B fees

     2.0% of 2016 Part B fees

     2015

     N/A

     2.0% of 2014 Part B fees


Quality Measures

EPs have the option to report on quality measures that reflect their practice patterns and patient population. There are more than 250 physician-level performance measures available for selection and a number of reporting methodologies. The Society of Hospital Medicine (SHM) has identified a number of measures that many hospitalists may be able to report, including:

     PQRS Number and Measure Title      NQS Domain

    
     Reporting Methodology

     1: Diabetes: Hemoglobin A1c Control

     Effective Clinical Care

     1, 2, 3, 4, 5, 6

     2: Diabetes: LDL-C Control

     Effective Clinical Care

     1, 2, 3, 6

     5: Heart Failure: ACE/ARB for LVSD

     Effective Clinical Care

     2, 3, 6

     8: Heart Failure: B-blocker for LVSD

     Effective Clinical Care

     2, 3, 4, 6

     24: Osteoperosis: Comm. Post-Fracture

     Comm., Care Coordination

     1, 2

     31: Stroke: VTE Prophylaxis

     Effective Clinical Care

     1, 2

     32: Stroke: DC on Antithrombotic Therapy

     Effective Clinical Care

     1, 2

     33: Stroke: Anticoagulation for AFib

     Effective Clinical Care

     2

     35: Stroke: Screening for Dysphagia

     Effective Clinical Care

     1, 2

     36: Stroke: Rehabilitation Services

     Effective Clinical Care

     1, 2

     40: Osteoperosis Mgmt. Post-Fracture      Effective Clinical Care
     1, 2
     47: Advance Care Plan
     Comm., Care Coordination
     1, 2
     56: CAP: Vital Signs
     Effective Clinical Care
     1, 2
     59: CAP: Empiric Antibiotics      Effective Clinical Care
     1, 2
     76: Prevention of CRBSI: CVC Insertion
     Patient Safety
     1, 2
     117: Diabetes: Eye Exam      Effective Clinical Care
     1, 2, 3, 6
     119: Diabetes: Attention for Nephropathy      Effective Clinical Care      1, 2, 3, 6
     130: Document Current Medications      Patient Safety      1, 2, 3, 6
     163: Diabetes: Foot Exam      Effective Clinical Care      1, 2, 3, 6
     187: Stroke: Thrombolytic Therapy      Effective Clinical Care
     2
     228: Heart Failure: LVF Testing      Effective Clinical Care
     2

Reporting Methodology:
  1. Claims
  2. Registry
  3. EHR
  4. Group Practice Reporting Option (GPRO)
  5. ACO {only for ACO Participants}
  6. Measures Groups

Background

The Tax Relief and Health Care Act of 2006 created the Physician Quality Reporting System, with subsequent continuations in the Medicare, Medicaid, and SCHIP Extension Act of 2007, the Medicare Improvements for Patients and Providers Act (MIPPA) of 2008 and the Affordable Care Act (ACA) of 2010. MIPPA granted permanency to the program; the ACA extended PQRS incentive payments to 2014 and established penalties for 2015.

Report Measures Via the PQRS Wizard Registry

SHM has secured a significant discount for SHM members to report PQRS through the PQRSwizard. It is a fast, convenient and cost-effective online tool to help collect and report quality measure data to CMS.

The PQRSwizard is powered by the CECity Registry®, a CMS-qualified registry for PQRS reporting.

Learn more | Get started in PQRS