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 TMA’s 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).
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.
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
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
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
here to learn more about Physician Compare.
Read more about Medicare
Value-Based Care in the April 2015 issue of Texas Medicine.
Payment AdjustmentsPhysician 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.Use this Medicare Payment Adjustment Calculator to calculate your estimated payment adjustments for nonparticipation.
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.
PQRS Feedback ReportsFor 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, CTPhone: (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 technical assistance about information in your QRUR, contact the CMS Physician Value Help Desk:Monday – Friday: 7 am – 7 pm, CTPhone: (888) 734-6433, press option 3; (TTY 1-888-734-6563)
On Sept. 9, CMS announced the release of 2014 PQRS Feedback Reports and QRURs. The deadline to appeal any errors is Dec. 16, 2015. Click here for more information.
Read more about Medicare quality reports in the July 2015 issue of Texas Medicine.
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.
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).
Refer to these portions of the TMA website:
Deadlines for Doctors Continuing Medical Education on Quality Improvement TopicsHITTMA Practice ConsultingPayment AdvocacyCancer Control and Prevention
Or Contact the TMA Knowledge Center:(800) firstname.lastname@example.orgAsk TMA
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