Medicaid/Medicare Medicare P4P Physician Compensation Quality

PQRS in 2013

Some background:

Created in March 2007, the PQRI established a financial incentive for eligible healthcare professionals to participate in a voluntary quality reporting program. By reporting on a minimum of 3 measures on a specified group of patients, a physician can earn a bonus payment of 0.5% on all of their Medicare billing for 2012.

In 2011, CMS renamed the program the Physician Quality Reporting System (PQRS).

For 2012, there are 208 quality measures and 22 measures groups in the PQRS, which can be reported to CMS by physicians and other caregivers in hospitals or physician practices.

What is new for 2013? The CMS website has a full description of how each PQRS measure is calculated here.

In 2010, CMS created the group practice reporting option (GPRO) for the Physician Quality Reporting System (PQRS) to enable large groups to report quality measures as a single entity. CMS notes that “Group practices that satisfactorily report data on PQRS measures for a particular reporting period are eligible to earn a PQRS incentive payment equal to a specified percentage of the group practice’s total estimated Medicare Part B Physician Fee Schedule (PFS) allowed charges for covered professional services furnished during the reporting period.”

Physician quality measures also evaluate whether physicians are able to provide electronic prescriptions to patients.

The Electronic Prescribing (eRx) Incentive Program is a reporting program that uses a combination of incentive payments and payment adjustments to encourage electronic prescribing by eligible professionals. The program provides an incentive payment to practices with eligible professionals (identified on claims by their individual National Provider Identifier [NPI] and Tax Identification Number [TIN]) who successfully e-prescribe for covered Physician Fee Schedule (PFS) services furnished to Medicare Part B Fee-for-Service (FFS) beneficiaries (including Railroad Retirement Board and Medicare Secondary Payer). Beginning in 2012, the program also applies a payment adjustment to those eligible professionals who are not successful electronic prescribers on their Medicare Part B services. This website serves as the primary and authoritative source for all publicly available information and CMS-supported educational and implementation support materials for the eRx Incentive Program.

A final quality incentive Medicare use to evaluate physicians is to determine whether or not they use electronic health records (EHR). In fact, physicians can use EHRs to report their PQRS quality metrics. Not any EHR will work, however, as the EHR vendors need to be CMS-certified in order for the PQRS submission to proceed without problems.

Physicians that exceed quality benchmarks will receive higher reimbursement rates relative to those who do not meet established quality benchmarks.

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