Physician Quality Reporting System
What You Need to Know for 2015
Since 2007, the Physician Quality Reporting System (PQRS)
has been a voluntary federal program, offering Medicare
incentive payments to those who report quality measure
data to the Centers for Medicare and Medicaid Services
(CMS). However, the Affordable Care Act requires that
CMS phase out incentive payments and instead apply
penalties by 2015 to physicians who fail to satisfy PQRS
reporting requirements. As a result, physicians who do
not satisfy the program’s requirements in 2015 will be
subject to a 2.0% penalty in 2016.*
PQRS measure data also will be used to calculate a
separate performance-based payment adjustment known
as the Value- Based Payment Modifier.
Given the payment implications of these new policies, it is
critical that HRS members understand PQRS and its
reporting requirements.
Upcoming PQRS Incentives and Penalties
Action
Satisfy PQRS
reporting criteria
Take no action/fail
to satisfy PQRS
reporting criteria
Reporting
Year
Affected
Payment
Year
Payment
Adjustment
2015
2017
0%
2015
2017
-2%
Reporting into the PQRS will become
mandatory beginning in 2015
*Payment adjustments are applied to total allowed charges for covered Medicare
Part B Physician Fee Schedule services provided during the reporting period.
How to Get Started
1. Review the PQRS reporting criteria to determine which reporting option is best for you.
Eligible professionals can choose from multiple reporting options to satisfy PQRS reporting requirements, including:
 Reporting as an individual physician or as a group practice under the Group Practice Reporting Option (GPRO)
 Reporting individual measures or measures groups (i.e., sets of clinically relevant measures reported together)1
 Reporting via claims, qualified registry, electronic health record (EHR), or qualified clinical data registry (QCDR)
1
CMS removed the Cardiovascular Prevention Measures Group for 2015.
continued
Heart Rhythm Society | 1400 K St. NW, Suite 500 | Washington, DC 20005 | 202-464-3400 | Fax: 202-464-3401 | www.HRSonline.org | [email protected]
Reporting requirements differ depending on the reporting
method selected and certain requirements have changed
for 2015. To avoid the 2017 penalty, if reporting individual
measures via claims or a qualified registry as an individual
physician, you must submit data on nine PQRS measures,
one of which is from a list of “cross-cutting” measures, for
at least 50% of applicable Medicare Part B patients.
For those opting to use the Group Practice Reporting
Option, CMS defines “group practice” as those with 2
or more eligible professionals, identified by individual
National Provider Identifiers (NPIs), who reassign their
billing rights to a single Tax Identification Number
(TIN). All individual physicians under a TIN that reports
satisfactorily as a group will be considered satisfactory
PQRS reporters even if the individual does not have
measure data reported on their individual services.
When selecting a reporting method, choose the one that is
most relevant and meaningful to your patient population,
but also the least burdensome to your practice. Since
certain measures can only be reported via certain methods,
confirm that there are sufficient measures applicable to your
practice and are available via that reporting method.
More information about PQRS reporting options is
available at www.cms.gov/Medicare/QualityInitiatives-Patient-Assessment-Instruments/pqrs/
2. Select your measures
Listed below are select 2015 PQRS measures that may be
relevant to your practice. A complete list of measures,
including more detailed specifications, is available at
www.cms.gov/Medicare/Quality-Initiatives- PatientAssessment-Instruments/PQRS/MeasuresCodes.html.
An eligible professional cannot participate in PQRS
both as an individual and as part of a group practice.
PQRS
#
Measure Title
Domain
PQRS Reporting
Mechanisms
Individual Measures
348
392
ICD Complications Rate
NEW for 2015 Cardiac Tamponade and/or Pericardiocentesis Following
Atrial Fibrillation Ablation
Patient Safety
Registry
Patient Safety
Registry
NEW for 2015 Infection within 180 Days of Cardiac Implantable Electronic Patient Safety
Device (CIED)
Implantation,
Replacement,
orAnticoagulation
Revision
AF
and Atrial Flutter:
Chronic
Therapy
Effective Clinical Care
Registry
Patient Safety
Claims, Registry
23
Perioperative Care: Selection of Prophylactic Antibiotic – 1st OR 2nd
Generation
Cephalosporin
Perioperative Care: Venous Thromboembolism (VTE) Prophylaxis
Patient Safety
Claims, Registry
118
CAD: ACE Inhibitor or ARB- Therapy -- Diabetes or LVEF < 40%
Effective Clinical Care
Registry
145
Radiology: Exposure Time Reported for Procedures Using Fluoroscopy
Patient Safety
Claims, Registry
226
47
Preventive Care and Screening: Tobacco Use: Screening and Cessation
+
Intervention
Advance
Care
Plan+
46
Medication Reconciliation+
Community/Population Claims, Registry, EHR
Health
Communication/Care
Claims, Registry
Coordination
Patient
safety
Claims, Registry
393
326
21
+Cross-cutting
Claims, Registry
measure
continued
Heart Rhythm Society | 1400 K St. NW, Suite 500 | Washington, DC 20005 | 202-464-3400 | Fax: 202-464-3401 | www.HRSonline.org | [email protected]
The Society recognizes the limited number of performance
measures to capture electrophysiologists’ highly
specialized care. Efforts continue to develop and test more
appropriate measures for inclusion in federal reporting
programs and to ensure the availability of meaningful
measures for electrophysiologists.
For more information, visit our website
at www. HRSonline.org/Policy, and
select Quality/Outcomes Reporting in
the left navigation bar. If you have
questions, please email Policy@
HRSonline.org.
3. Regis ter and Start R e p o r t i n g
Updated November 2014
There is no registration for individuals seeking to participate
in the 2015 PQRS. If using the claims-based reporting
option, start reporting the Quality-Data Codes (QDCs)
listed in the measure specifications you have selected on
applicable Medicare Part B claims. If using a third party
entity to submit your measure data to CMS,
such as a qualified registry or EHR vendor, confirm with
the entity if it has its own set of registration and
reporting deadlines.
Group practices choosing to take part in the PQRS
GPRO for the 2015 reporting year must register online
by September 30, 2015. For more information on the
GPRO, including how to register, please visit www.cms.
gov/Medicare/Quality-Initiatives-Patient-AssessmentInstruments/PQRS/Group_Practice_Reporting_Option.
html.
.
Heart Rhythm Society | 1400 K St. NW, Suite 500 | Washington, DC 20005 | 202-464-3400 | Fax: 202-464-3401 | www.HRSonline.org | [email protected]