American College of Physicians: Internal Medicine — Doctors for Adults ®

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Tool simplifies quality measure reporting

From the January ACP Internist, copyright © 2013 by the American College of Physicians

The Physician Quality Reporting System (PQRS) can offer a good return on investment. While it is a voluntary program, starting this year there will be penalties for not participating.

Incentive payments, equal to 0.5% of allowed charges for services covered by the Medicare Physician Fee Schedule, ended after 2012. Now, clinicians who do not report PQRS measures in 2013 will incur a 1.5% deduction from their 2015 Medicare reimbursements. The negative adjustment will increase to 2% for future years.

Practices have several options to report quality measures. It may seem intimidating at first, but it is possible to spend a little time up front deciding the reporting method and the measures that are most applicable to a practice.

There are two principal decisions to make: what reporting method to use and whether to report individual measures or measures groups.

Claims-based reporting. To use claims-based reporting, clinicians can choose three or more measures. For instance, common measures for internal medicine relate to diabetes or congestive heart failure management or preventive care. Clinicians who choose this option will bill using specific codes for 12 months:

  • Individual measures. Clinicians must report on at least three measures and report at least 50% of applicable Medicare fee-for-service patients.
  • Measures groups. Clinicians must report on at least 30 patients during the 12-month period or, if fewer than 30 but more than 15, then at least 50%.

EHR-based reporting. To report directly from an EHR, the EHR must be PQRS-qualified. (Clinicians can ask their vendors if they qualify or check online.) Physicians who are participating in the 2012 Medicare EHR Incentive Program may satisfy the meaningful use objective to report clinical quality measures to CMS by reporting them through the PQRS-Medicare EHR Incentive Pilot, which uses specific 2012 Physician Quality Reporting EHR measure specifications.

Registry-based reporting. With this option, clinicians satisfactorily report on at least 80% of eligible encounters or report on a 30-patient sample (if reporting measures groups). Unlike the other options, which are tied to claim submittals, this option can be done retroactively. Additionally, the fact that only 30 patients are needed to qualify is very appealing.

ACP offers a registry tool, the PQRIWizard, that allows physicians to participate using the 30-patient measures group option. The process requires identifying patients who meet the criteria (such as using the practice management system), pulling the charts and then inputting data regarding the measures group. With well-organized charts, this process can take as little as two hours.

More details on each of these options, as well as how to access the PQRIWizard, are online.

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