EPs can participate in PQRS by reporting data via the following methods:
- To CMS via their Medicare Part B claims
- To a Qualified PQRS Registry
- To CMS via a qualified Electronic Health Record (EHR) product
- To a qualified PQRS data submission vendor
- To Certified Survey Vendors
- To Qualified Clinical Data Registries (QCDRs)
- Groups have the option of reporting data via the Group Practice Reporting Option (GPRO)
- Change in 2015: EPs in Critical Access Hospitals billing method II will be able to participate in PQRS using all reporting mechanisms, including claims.
New in 2015:
- Qualified Clinical Data Registries (QCDR) - the limit on the number of non-PQRS measured that a QCDR may submit on behalf of an EP has been increased to 30. An EP must report on at least 2 outcome measures (or, if less than 2, report on at least 1 outcome measure and at least 1 of the following measure types: patient safety, resource use, patient experience of care, or efficiency/appropriate use.)
- Qualified Registries now require an EP or group practice who treats at least 1 Medicare patient in a face-to-face encounter to report on at least 1 cross-cutting PQRS measure. In addition, the deadline for qualified registries to submit quality measures data, including, but not limited to, calculations and results, to March 31, 2016, for reporting periods ending in 2015.
- EHR - an EP's certified EHR technology does not need to be tested and certified to the most recent version of measures.
- GPRO - if a group practice does not have any Medicare patients for any of GPRO measures, the group practice will not meet the criteria for satisfactory reporting using the web interface (WI). Group practices of 25 or more must report on all measures in the WI and populate data fields for the first 248 consecutively ranked in the group's sample for each module or preventive care measure. If less than 248 patients, the group would report on 100% of assigned beneficiaries.
- Consumer Assessment of Healthcare Providers & Systems (CAHPS) for PQRS - group practices administering the CAHPS for PQRS will be required to contract with a CMS Certified Vendor and bear the cost of administering the CAHPS for PQRS. (CAHPS for PQRS is required for group practices of 100+ EPs.)
For more information on GPRO, visit: http://www.cms.gov/Medicare/Quality-Initiatives-Patient-Assessment-Instruments/PQRS/Group_Practice_Reporting_Option.html
For more information on reporting via Registry, visit: http://www.cms.gov/Medicare/Quality-Initiatives-Patient-Assessment-Instruments/PQRS/Registry-Reporting.html
For more information on the National Quality Strategy domains, visit: http://www.qualitymeasures.ahrq.gov/browse/nqf-endorsed.aspx
The International Spine Intervention Society provides this information for educational purposes only and always recommends that providers consult the CMS Web site for additional information. It is each provider's responsibility to know and to understand the requirements and consequences of each reporting program in which he or she participates.