Medicare’s Physician Quality Reporting System (PQRS), previously known as the Physician Quality Reporting Initiative (PQRI), provides a financial incentive to physicians who volunteer to report on best-practice quality measures for the Medicare patients they treat.

Reporting quality performance measures assists AAD members in improving patient safety and quality in their clinical practice settings. The best-practice measures are meant to encourage practices to align their clinical operations with the quality measures the AAD establishes and that are approved by both the National Quality Forum (NQF) and the Centers for Medicare and Medicaid Services (CMS).

If participants successfully meet the criteria of the Physician Quality Reporting System and report all applicable measures for 2011, they receive a bonus of 1 percent of total allowed Medicare Part B CMS charges for that reporting period.

It is important to note that for the 2011 program year, dermatologists must successfully meet the measure for at least one patient per measure. For previous reporting periods, many AAD members asked if there were reporting minimums, which in the past there were none. However, for 2011, to receive an incentive payment from CMS, all participants must meet the measure for at least one patient per measure.

The health system reform law Congress passed in 2010 established a schedule for declining incentive payments through 2014. Beginning in 2015, physicians will be penalized for not reporting on quality measures.

However, the 2012 CMS Physician Fee Schedule states that “the reporting period for purposes of the 2015 payment adjustment […] be the 2013 calendar year, that is, Jan. 1, 2013 through Dec. 31, 2013.”  Therefore, an eligible professional will have to report for the 2013 reporting period to avoid the penalty in 2015. Check the AAD’s Health System Reform Resource Center for details about the quality reporting requirement.

Program participation

Dermatologists must use a CMS-approved registry to report on the three melanoma measures to the Physician Quality Reporting System. A registry is an electronic system that allows physician practices to enter quality information online. Although some other eligible professionals participating in the program are able to report via claims, dermatologists must submit through a qualified registry if they are reporting on the three melanoma measures (#137, #138 and #224).

A participant will receive his or her incentive payment only after the registry submits the data to CMS. The AAD has partnered with approved vendor NetHealth to offer Academy members a registry to report the melanoma measures. This module is exclusively for Physician Quality Reporting System submissions and only is open to AAD members.

Past performance

The 2009 PQRS and eRx Experience Report from CMS indicated more than 210,000 participants in the 2009 then-PQRI program, with about 120,000 eligible professionals earning incentive payments totaling almost $235 million. Individual eligible professionals earned an average incentive amount of $2,000.

More participants earned incentives using the registry reporting option, with about 90 percent of eligible professionals who reported with a registry earning incentives, compared to about 50 percent of participants who earned incentives for reporting via claims.

The report also compiled data by specialty using the primary specialty designated by each eligible professional in the National Plan and Provider Enumeration System (NPPES). In dermatology, 900 eligible professionals earned an average PQRI incentive of over $5,000. There were a total of 10,371 dermatology professionals eligible to participate in the program, with 2,106, or about 20 percent, reporting.  The successful participants represented about 9 percent of all eligible dermatology specialists. Nearly 34 percent of the dermatologists (638 of 1,879) who reported through claims-based reporting earned a PQRI incentive, while 93 percent (241 of 258) of those reporting via registry earned an incentive.

Eligible professionals earning a PQRI incentive, 2009

Measures for 2011

There are three confirmed measures that dermatologists can report on for the 2011 program year. Providers are eligible to earn an incentive of 1 percent of total allowed Part B charges to CMS for the chosen reporting period if all three measures are reported. The confirmed measures are as follows:

Melanoma: Continuity of Care Recall System (Measure #137): Percentage of patients, regardless of age, with a current diagnosis of melanoma or a history of melanoma whose information was entered at least once within a 12-month period into a recall system that includes:

• A target date for the next complete physical skin exam, AND
• A process to follow up with patients who either did not make an appointment within the specified timeframe or who missed a scheduled appointment.

Melanoma: Coordination of Care (Measure #138): Percentage of patient visits, regardless of patient age, with a new occurrence of melanoma who have a treatment plan documented in the chart that was communicated to the physician(s) providing continuing care within one month of diagnosis.

Overutilization of Imaging Studied in Stage 0-1A Melanoma (Measure #224): Percentage of patients with stage 0 or IA melanoma, without signs or symptoms, for whom no diagnostic imaging studies were ordered.

New Measure for 2012

There will be a new dermatology appropriate measure in 2012.

Biopsy Follow-Up (Measure #265): Percentage of patients whose biopsy results have been reviewed and communicated to the primary care/referring physician and patient by the performing physician.

To satisfy this measure, the biopsying physician must: review the biopsy results with the patient, communicate those results to the primary care/referring physician, track communication in a log, and document tracking process in the patient’s medical record. This measure applies to all patients undergoing a biopsy, regardless of diagnosis.