Best Care at Lowest Cost:
The US health care system has become expensive and complex to continue business as usual. Inefficiencies, overabundance of data, and economic and quality barriers hinder progress in improving health and threaten economic stability.
Physician Quality Reporting System (PQRS), undertaken by CMS (Centres for Medicare & Medicaid Services), has triggered enhanced patient documentation and care. The strategic goal of the PQRS is to collect meaningful data that can help lead to improved patient care. The program uses a series of measures—138 for 2013—developed by leading physician organizations to evaluate the level of care being provided by doctors.
PQRS has stimulated quality reporting and improvement in the value of services provided by physicians’ and groups of physicians’ services to Medicare (national social insurance program) beneficiaries. PQRS, a pay-for-reporting program, blends incentive payments for improved performance of physicians, along with deductions for below-par performance.
According to David Harlow, Principal of The Harlow Group, a health care law and consulting firm in Boston, PQRS is a way to keep track of a set of measures that the Medicare program has deemed important.
PQRS will help to put the health system on the right course to achieve continuous improvement and better quality care at affordable cost. Collection of abundant patient data enables capturing of entire picture of the care provided to the beneficiary. Such data help evaluate EP quality performance under the Value-based Payment Modifier (VPM). The first step to improving quality is beginning to measure and report on the quality of care that is currently being provided.
Chronological milestones :
- 2006: Establishment of PQRS (formerly the Physician Quality Reporting Initiative, or PQRI) by the Medicare Improvements and Extension Act of 2006 (MIEA-TRHCA) and codified in the Social Security Act.
- 2007: Launching of PQRS in the US.
- 2013 and 2014: Collection of this information is voluntary and only applies to EPs or group practice (GP) who want to participate in PQRS.
- 2015 and 2016 : Collection of this information applies to all EPs and group practices.
Objective of PQRS :
The data on PQRS quality measures collected from EPs or group practices will be used by CMS to:
- Determine whether an EP or GP meets the criteria for satisfactory reporting of quality measures data for the 2013 and 2014 PQRS incentives and the 2015 and 2016 PQRS penal deductions for non-satisfactory reporting.
- To calculate and make incentive payments to EPs and GP in for the 2013 and 2014 PQRS incentives.
- Publicly post the names of eligible professionals and GP who satisfactorily report PQRS quality measures data on the CMS Physician Compare Web site.
Many of the physicians groups who received these reports noted that they found the reports informative and also suggested ways to improve the reports to facilitate care coordination and quality improvement. These suggestions will be incorporated in the Quality and Resource Use Reports (QRUR) reports in September 2013 to all groups of physicians with 25 or more EPs.
PQRS benefits galore with deductions :
- An incentive payment through 2014 for individual eligible professionals (EP) who satisfactorily report data on quality measures for covered professional services furnished to Medicare Part B fee-for-service beneficiaries during applicable reporting period.
- EPs are identified on claims by their individual National Provider Identifiers [NPI] and Tax Identification Numbers [TIN]).
- Group practices (GPs) (with groups of EPs) that satisfactorily report data on PQRS measures for a particular reporting period are also eligible to earn a PQRS incentive.
- PQRS incentive payment equal to a specified % of the group practice’s total estimated Medicare Part B Physician Fee Schedule (PFS) is allowed during the reporting period.
- GPs may self-nominate or register to participate in GPRO via Web Interface or registry reporting system
- Names of EPs who satisfactorily submit quality data for PQRS, as required by the Affordable Care Act (ACA) are uploaded to the Physician Compare website.
- On the flip side, beginning in 2015, EPs who do who do not satisfactorily report data will face penal deductions.
Evolution of PQRS, besides rewarding and penalizing clinicians for their patient care performances, will also enhance the credibility of physicians and trust of patients. PQRS is all set to revolutionise healthcare. In the near future, private insurance companies could also be within the gamut of PQRS.
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