There are many acronyms the federal government uses, and we've heard of some of the big ones such as HIPPA and EMTALA. However, not many of us have heard of PQRS (Physician Quality Reporting System).
"PQRS is a reporting program that uses a combination of incentive payments and negative payment adjustments (read penalties) to promote reporting of quality information by eligible professionals (EPs). This applies only to Medicare patients for now. Beginning in 2015, psychologist and other eligible professionals participating in the program are expected to report on quality measures. The program will also apply a negative payment adjustment to EPs who do not satisfactorily report data on quality measures for covered professional services." Although PQRS is a standalone program, it touches on other CMS programs that require quality reporting, such as the e-Prescribing (eRx) Incentive Program, the EHR Incentive Program, the Medicare Shared Savings Program, and the Value-Based Payment Modifier.
CMS has retired 50 measures from the PQRS program in 2015, including the following 4 out of the 7 measures from the 2014 emergency care cluster:
On January 19, 2015, CMS released the 2015 Measure Applicability Validation (MAV) process, and they identified the following Claims-Based MAV for Emergency Care.
Measure #54 - 12 Lead Electrocardiogram Performed for Non-Traumatic Chest Pain
Measure #254 - Ultrasound Determination of Pregnancy Location for Pregnant Patients with Abdominal Pain
Measure #255 - Rh Immunoglobulin (Rhogam) for Rh-Negative Pregnant Women at Risk of Fetal Blood Exposure
Measure #317 - Preventive Care & Screening: Screening for High Blood Pressure and Follow-up Documentation
Other PQRS Measures potentially relevant to emergency physicians in 2015, are listed below:
Measure #76 - Prevention of CRBSI: Central Venous Catheter (CVC) Insertion Protocol
Measure #91 - Acute Otitis Externa (AOE): Topical Therapy
Measure #93 - Acute Otitis Externa (AOE): Systemic Antimicrobial Therapy - Avoidance in Inappropriate Use
Measure #187 - Stroke and Stroke Rehabilitation: Thrombolytic therapy (tPA)
Measure #326 - Atrial Fibrillation and Atrial Flutter: Chronic Anticoagulation Therapy
An eligible provider can still satisfy PQRS and avoid the penalty by reporting on less than 9 measures, but would be subject to the MAV process to determine whether he/she reported on as many measures as are applicable, and will also determine if they could have reported on any cross cutting measures. It should be noted that 99% of emergency providers will not have any Medicare patients that fall into measures #91, #93, #254, and #255 above, so it is highly unlikely that those measures would be counted toward the nine measure goal for most providers. Emergency physicians should also beware of reporting on any measures outside of their cluster (with the exception of #76 and #317) as reporting additional measures may trigger additional clusters as noted in the list above.
For more information on PQRS and the Value Modifier please visit www.acep.org/quality/pqrs.
These measures are tied into the physician's NPI. Eventually, it is speculated that Medicare will pay physicians at different rates depending on their performance and participation in the program.
In summary, the PQRS is a program implemented by CMS to make sure we are giving quality standard care and at reasonable cost. This program was enacted in 2007. It allowed physicians to recover an additional 2% on their Medicare reimbursement. There is a change in the program to implement a 1.5% withholding (AKA penalty) in 2015, and it goes to 2.0% withholding in 2016, if not participating. It benefits the group to participate in terms of financial reimbursements and benefits the patient in terms of making sure they get quality care as put forth by CMS and in comparison to other physicians. Bottom line is CMS wants to make sure we follow their guidelines and either will reward or penalize based on compliance. The best thing we can do is be aware of the measures and document, document, document.
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