• The CMS Physician Quality Reporting System (PQRS) program

    • TMA Offers Member Discounts for PQRS Reporting

      Participation in the Physician Quality Reporting System (PQRS) does not have to be complicated or require complex coding systems and expensive manual processes. TMA endorses two qualified registries for PQRS: PQRSwizard, and Covisint PQRS. Each provides a simple and cost-effective way for eligible professionals to collect and report quality measures data under the PQRS program.  

      PQRSwizard and Covisint PQRS are easy to use and competitively priced with TMAs discounted rate: $199 for PQRSwizard, and $195 for Covisint PQRS (use discount code TMAPQRS15). The tools enable you to participate in the PQRS program without modifying your billing processes.

      Learn about PQRS and how it relates to the Value-Based Payment Modifier (VBM) program from the TMA Education Center and earn 1 AMA PRA Category 1 Credits™ (enduring) and 1 ETHICS credit.

      Find more on PQRS and VBM from the Centers for Medicare & Medicaid Services (CMS).

  • You are in a unique position to improve medical care in our nation.

    TMA has developed tools to assist you. Please see the menu to the left for available resources on clinical effectiveness, patient experience, performance improvement programs, and related topics.

  • What are the different CMS physician quality programs?

    • Medicare value-based care

      There are three main quality programs physicians report their data to and a fourth under which Medicare uses that data to issue public "report cards" on physician quality. 

      Physician Quality Reporting System (PQRS) 
      PQRS is a reporting program that uses payment adjustments to promote reporting of quality data by physicians and other EPs that provide care to Medicare Part B fee-for-service beneficiaries. Under the PQRS program, physicians must document and report on the care they provide through a set of clinical quality measures on an annual basis. Depending on the size of a group practice and reporting mechanism, practices also must report on patient experience and satisfaction using Consumer Assessment of Healthcare Providers and Systems (CAHPS) surveys. According to CMS, the program's intent is to provide physicians with the opportunity to assess the quality of care they provide to their patients through PQRS feedback reports. Click here to learn more about PQRS. 

      Value-Based Payment Modifier (VBM)
      The goal of CMS is to move toward physician payment based on value rather than volume. The VBM is based on participation in PQRS. Under this program, CMS adjusts physician payments based on their performance in PQRS and on cost performance derived from claims data. Depending on how physicians stack up against their peers, CMS will increase, decrease, or keep payments the same. This program provides feedback to physicians through quality and resource use reports (QRURs), so physicians may assess the quality and efficiency of their medical care to their patients. Click here to learn more about the VBM.

      Electronic Health Record (EHR) Incentive Program 
      This program is commonly referred to as the meaningful use (MU) program. MU requires physicians to demonstrate that they are using certified EHRs to improve quality, safety, and efficiency in their practices. Compliance criteria increase over time over three stages that focus on data capture and sharing (Stage 1); advanced clinical processes (Stage 2); and improved outcomes (Stage 3). CMS provides physicians with the option to streamline their reporting efforts and report quality data only once for PQRS, VBM, and MU. Click here to learn more about how to report once for Medicare’s quality reporting programs. Visit the TMA Meaningful Use Program Resource Center to learn about MU requirements.

      Physician Compare 
      CMS launched the Physician Compare website in 2010. Physician Compare first contained mainly demographic information about participating Medicare physicians and other health care organizations and professionals. CMS now collects quality-of-care performance scores from PQRS, MU and other programs, and publishes those scores on Physician Compare. According to CMS, the intent of displaying those scores is to help patients make informed decisions and to create incentives for physicians to maximize performance. Click here to learn more about Physician Compare. 

      Payment Adjustments
      Physician solo practitioners and physician groups of all sizes will be subject to payment adjustments in 2017 based on quality and cost performance in 2015. Failure to report data on quality measures to Medicare for the 2015 PQRS program year will result in an automatic 2-percent pay cut under PQRS, plus another automatic 2-percent to 4-percent pay cut under the VBM; and failure to participate in MU in 2015 will result in an additional automatic 3-percent pay cut, all in 2017. 

      Read more about Medicare Value-Based Care in the April 2015 issue of Texas Medicine.  

  • How do I participate in PQRS?

    • How to get started


      According to CMS, the following steps include:

      Step 1: Determine your eligibility
      Step 2: Determine whether you want to participate in PQRS as an individual EP or as part of a group practice
      Step 3: Choose your reporting mechanism
      Step 4: Choose which quality measures to report
      Step 5: Review PQRS payment adjustment information
      Step 6: Review the PQRS timeline

      Watch this CMS video presentation for an overview of PQRS and to learn how your participation in PQRS in 2015 will determine how the VBM will be applied to physicians' payment in 2017.

      For CME credit, learn about PQRS and how it relates to the VBM from the TMA Education Center and earn 1 AMA PRA Category 1 Credit™ (enduring) and 1 ETHICS credit.

      View this table for reporting mechanisms and to see how PQRS reporting in 2015 affects the PQRS and VBM payment adjustments in 2017. 

      For step-by-step instructions on how to get started with PQRS, visit the CMS website.

  • When are the PQRS deadlines?

  • How do I get my quality reports?

    • PQRS Feedback Reports and QRURs
       

      PQRS Feedback Reports
      For information on PQRS feedback reports and step-by-step guidance on how to request one, click here.
      For technical assistance, contact the CMS QualityNet Help Desk:
      Monday - Friday: 7 am - 7 pm, CT
      Phone: (866) 288-8912 (TTY 1-877-715-6222)
      Email: Qnetsupport@hcqis.org


      Quality and Resource Use Reports (QRURs)
      The Value-Based Payment Modifier is based on PQRS data and cost performance. For information on QRURs and step-by-step guidance on how to request one, click here.  For questions related to an IACS account and accessing your QRUR, contact the CMS Quality Net Help Desk.
      For technical assistance about information in your QRUR, contact the CMS Physician Value Help Desk:
      Monday – Friday: 7 am – 7 pm, CT
      Phone: (888) 734-6433, press option 3; (TTY 1-888-734-6563)

      Read more about Medicare quality reports in the July 2015 issue of Texas Medicine.

  • Where can I get consulting services?

    • Where can I get help?


      For free consulting services on Medicare's quality reporting programs, turn to the TMF Quality Innovation Network Quality Improvement Organization (QIN-QIO), an offshoot of the TMF Health Quality Institute. Under contract with Medicare, TMF has created several educational networks you can join.

      The TMF QIN-QIO provides technical assistance to eligible physicians and physician groups, health care providers, inpatient/outpatient hospital departments, acute care and critical access hospitals, rural hospitals and clinics, inpatient psychiatric facilities, ambulatory surgery centers, and prospective payment system-exempt cancer hospitals.

      Create a free website account and join their network(s) to learn more about how you and members of your practice or hospital can benefit. 


      Read more about TMF Health Quality Institute in the October 2014 issue of Texas Medicine.

  • What other resources should I be aware of?

    • Resources

      CMS is the authoritative source for PQRS information and has educational resources available online to assist physicians with PQRS participation.

      Stay informed about the latest PQRS news by subscribing to the PQRS listserv and visit www.cms.gov/PQRS for the most up-to-date information.

      For questions about PQRS, contact the CMS QualityNet Help Desk, Monday through Friday, 7 am to 7 pm CT by phone, (866) 288-8912, or email.  

      For questions about the VBM, contact the CMS Physician Value Help Desk, Monday through Friday, 7 am to 7 pm CT by phone, (888) 734-6433 (press 3). 

       

  • Get the latest news on PQRS.

    • PQRS and the Value Modifier: How to Interpret Your Quality Report, Improve Performance
      The TMF Quality Innovation Network Quality Improvement Organization will host more webinars on Quality and Resource Use Reports (QRURs). These open forums are free and will provide you with information to help you interpret your QRUR and improve your performance.
    • PQRS and the Value Modifier: How to Get and Understand Your Quality Report
      The TMF Health Quality Innovation Network Quality Improvement Organization is hosting an open forum on Quality and Resource Use Reports (QRURs) on Tuesday, July 21, from 12:30 pm to 1:30 pm CDT. This open forum is free and will provide you with information on how to access and better understand your QRUR.
    • Report Quality Data in 2015 to Avoid Penalties in 2017
      Medicare’s Value-Based Payment Modifier is no longer just for large practices. In 2017, all physician practices will become subject to differential payment from Medicare based upon quality of care. Group practices: Deadline is June 30, 2015, for one participation option in the Physician Quality Reporting System.
    • Start the PQRS GPRO Registration Process Now
      The Physician Value-Physician Quality Reporting System (PV-PQRS) registration system is open through June 30. This registration applies to group practices with two or more eligible professionals interested in participating in the 2015 PQRS program year under the group practice reporting option (GPRO).
    • Another Medicare Audit, This Time Voluntary
      The Centers for Medicare & Medicaid Services’ latest audit is underway. CMS calls the process Primary Source Verification, and it’s directed at the Physician Quality Reporting System and Electronic Prescribing Incentive Program.
  • Whom do I contact if I have more questions?