What Are the Different CMS Physician Quality Programs?

Physician Quality Reporting System
PQRS encourages physicians and other eligible professionals to annually report data on clinical quality measures associated with the care they give to Medicare Part B fee-for-service patients. Depending on the size of a group practice and the reporting mechanism it uses, practices also must report on patient experience and satisfaction using Consumer Assessment of Healthcare Providers and Systems surveys. The program’s intent is to give physicians the opportunity to assess, through PQRS feedback reports, the quality of care they provide to their patients.

Value-Based Payment Modifier Program
CMS is moving toward physician payment based on value rather than volume. The VM program is based on participation in PQRS. Under this program, CMS adjusts physicians’ 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.  

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 practice. CMS provides physicians the option to streamline participation by reporting quality data only once for the PQRS, VM, and MU programs. Learn more about this option in this CMS guide. Visit the TMA Meaningful Use Program Resource Center to learn about MU requirements.

Physician Compare
CMS collects quality-of-care performance scores from PQRS and publishes them on the Physician Compare website. This website, which is open to the public, reports information about physicians and other health care professionals who take part in Medicare and satisfactorily participate in CMS quality programs. CMS states the purpose of displaying performance scores is to help patients make informed decisions about their health care and to create incentives for physicians to maximize performance. For more information, visit the CMS Physician Compare website.  


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Last Updated On

May 13, 2016

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