Understand The PQRS Program

Understand the PQRS program and start reporting on the measures ASAP!

 

If you are not reporting PQRS measures successfully in 2013, your fees will be REDUCED in the future!

 CMS gave providers five years (2008-2012) to learn how to properly participate in the Physician Quality Reporting System (PQRS). They even paid a BONUS if you participated and did it right. The good news? The bonus will continue through 2014. The bad news? Starting in 2015 there will be a PENALTY put in place (a reduction to your fees) if you are not participating or not doing it right. The worse news? That penalty will be based on your performance in 2013!

 The Patient Protection and Affordable Care Act made participation in Medicare’s Physician Quality Reporting System (PQRS), formerly referred to as PQRI, mandatory beginning in 2015. Providers who are not satisfactorily participating in PQRS in the 2013 reporting period (January 1 – December 31, 2013) and beyond, will have their Medicare reimbursement decreased by 1.5% beginning in 2015. In 2016, the payment reduction will be 2%. Therefore, the 2012 reporting period is the last opportunity providers have to voluntarily participate in PQRS while incentives are still offered and Medicare reimbursement is not subject to penalty.

 

To date, our participation has been negligible (< 2%) and, of the doctors that participated, only 38% qualified for the incentive. Obviously, we need to start participating and learning how to do this RIGHT!

 

What is the Physician Quality Reporting System (PQRS)?

 

The Physician Quality Reporting System (PQRS) is a reporting program where eligible professionals (including doctors of chiropractic) report data on quality measures for covered Physician Fee Schedule services.

 

What is a Quality Measure?

 

Quality measures, generally, are rooted in evidence-based medicine. They can be ―guideline‖ measures (e.g., you get 12 visits for acute low back pain), ―process‖ measures (e.g., when a patient comes in with a cardiovascular episode and you gave them an aspirin), or ―outcome‖ measures (e.g., "X" condition was resolved). There are also other types of measures, such as ―structural‖, ―efficiency‖, or ―cost of care‖ measures. A few points that are important to keep in mind:

 

·        There is significant debate on the value of the different types of measures, with the community currently focusing mostly on ―process‖ measures. [Note: ―Guideline‖ measures have generally been discounted as a way to measure quality of care.] Certain groups are also paying close attention to ―structural‖ and ―cost of care‖ measures. The ultimate goal of all parties is to have effective outcomes measures.

·        There is also significant debate about whether certain measures simply demonstrate competency or actually will improve quality. For example, some measures deal with the documentation of care. Many in the healthcare community argue that documentation of care should be happening anyway, while others point out that it doesn’t happen 100% of the time, hence there’s room for improvement—a gap in care—with which a measure could help.

·        Measures are not specialty-specific; they are condition-specific

 For more information please contact our office 305-227-2383

 

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