Medicare Physician Quality Reporting System

Get started with PQRS

 The following are frequently asked questions about the Medicare Physician Quality Reporting System (PQRS). 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).

Q: What is the Physician Quality Reporting System?

A: The Physician Quality Reporting System (PQRS), formerly known as PQRI, is a program developed by the Centers for Medicare and Medicaid Services (CMS) to provide a financial incentive bonus to physicians who report on best-practice quality measures for the Medicare patients they treat.

Q: How much will my incentive payment be?

A: If a participant successfully meets all criteria of the PQRS program, he or she will receive a bonus of 0.5 percent of total allowed Medicare Part B charges to CMS for the calendar year.

Q: Is there a penalty associated with PQRS?

A: Yes, if one does not report at least one measure for one patient in 2013, then he or she will be assessed a 1.5 percent payment reduction in 2015.

Q: How many measures do I have to report to earn an incentive?

A: Providers must report a minimum of three measures to earn the incentive. There is no advantage to reporting more than three.

Q: How many measures do I have to meet if I am reporting to earn an incentive?

A: You do not have to meet every measure, however:

  • You must have greater than a 0 percent performance rate for all reported measures.
  • Not every reported patient needs to meet all three measures.
  • Each of the quality measures must have at least one eligible instance.

Q: How many measures do I have to report to avoid the 1.5 percent payment reduction in 2015?

A: The first payment reduction will occur in 2015, and will be based on your participation in 2013. To avoid this first payment reduction, you have to report — at a minimum — at least one measure, one time. This can be done either through a registry or via claims (keep in mind that the dermatology-appropriate measures can only be reported via registry). Reporting one measure, one time will only exempt you from the payment reduction; you still need to report three measures to be eligible for the incentive.

Q: The dermatologist I work for told me I need to submit his or her PQRS information through a registry. What does that mean?

A: A registry is an electronic system that is built by an outside company (vendor) that allows practice staff to enter quality information online. All vendors have to be registered with CMS on a qualified list  to report PQRS data.

Q: I participated in this program in the past using my claims forms; am I able to do that this year?

A: If you choose to report the dermatology-appropriate measures #137, #138, #224, and/or #265, then you must report via a registry. CMS determined that these measures can only be answered through an electronic registry in 2013. However, there are other PQRS measures that you may be able to report via claims.

Q: If I participated in PQRS and did not earn an incentive, can I appeal to CMS?

A: CMS allows participants to request an informal appeal via the QualityNet Help Desk so your PQRS data can be reviewed to determine if a mistake was made. You can contact the QualityNet Help Desk at (866) 288-8912 (TTY (877) 715-6222) or at http://qnetsupport@sdps.org. They are available Monday through Friday from 7 a.m. to 7 p.m. CT.

Q: How will the health care reform law affect PQRS?

A: The Patient Protection and Affordable Care Act will continue to offer incentives for participation through 2014. However, an eligible professional will have to report on at least one measure for one patient for the 2013 reporting period to avoid the penalty in 2015.

 

Year  Incentive or Penalty  Percentage 
 2011  Incentive  + 1 percent
 2012  Incentive  + 0.5 percent
 2013  Incentive  + 0.5 percent
 2014  Incentive  + 0.5 percent
 2015  Penalty  - 1.5 percent
 2016+  Penalty  - 2 percent

Q: How have physicians performed in the past?

2011 PQRS performance — All MD/DO participants and dermatology MD/DO participants

Population

Reporting
method

Number
participating
Number
earning
incentive
Percent
earning
incentive
Mean
incentive
earned
Median
incentive
earned

ALL MD/DO

Individual
measures:
claims
162,557 125,300 77.1
percent

$1,259.14

$686.08

Individual
measures:
registry

41,587 37,544 90.3
percent

Measures
group:
claims

3,758 2,518 67.0
percent
Measures
group:
registry
11,392 10,565 92.7
percent

Dermatology

Individual
measures:
claims
675 457 67.7
percent

$3881.27

$2,543.14

Individual
measures:
registry
1,834 1,739 94.8
percent
Measures
group:
claims
1 1 100
percent
Measures
group:
registry
19 17 89
percent

 

2010 PQRS performance — All MD/DO participants and dermatology MD/DO participants

Population

Reporting
method

Number
participating
Number
earning
incentive
Percent
earning
incentive
Mean
incentive
earned
Median
incentive
earned

ALL MD/DO

Individual
measures:
claims
145,047 89,198 61.5
percent

$2,519.87

$1,364.14

Individual
measures:
registry

32,532 28,961 89.0
percent

Measures
group:
claims

3,487 1,950 55.9
percent
Measures
group:
registry
15,006 14,305 95.3
percent

Dermatology

Individual
measures:
claims
 538  318  59.1
percent

$7,462.06

$4,910.12

Individual
measures:
registry
 1,311  1,194  91.1
 percent
Measures
group:
claims
12  5  41.7
 percent
Measures
group:
registry
 48  46  95.8
 percent

 2009 PQRS performance — All MD/DO participants and dermatology MD/DO participants

Population

Reporting
method

Number
participating
Number
earning
incentive
Percent
earning
incentive
Mean
incentive
earned
Median
incentive
earned

ALL MD/DO

Individual
measures:
claims
145,047 89,198 61.5
percent

$2,519.87

$1,364.14

Individual
measures:
registry

32,532 28,961 89.0
percent

Measures
group:
claims

3,487 1,950 55.9
percent
Measures
group:
registry
15,006 14,305 95.3
percent

Dermatology

Individual
measures:
claims
538 318 59.1
percent

$7,462.06

$4,910.12

Individual
measures:
registry
1,311 1,194 91.1
percent
Measures
group:
claims
12 5 41.7
percent
Measures
group:
registry
48 46 95.8
percent

 

2011 PQRS performance  (all reporting methods) -- Other specialities by comparison

Specialty   Number
participating
Number
earning
incentive 
Percent
earning
incentive 
Mean
incentive
earned 
Median
incentive
earned
 
 Dermatology  2,310  2,075  89.8
percent
 $3,881.27  $2,543.14
 Rheumatology  1,530  1,177  76.9
percent
 $1,673.40  $1,172.71
 Urology  3,432  2,484  72.4
percent
 $2,221.65  $1,956.92
 Internal
medicine
 26,403  20,621  78.1
percent
 $1,116.48  $778.74
 Opthalmology  8,828  7,011  79.4
percent
 $3,797.63  $3,009.49

2010 PQRS performance (all reporting methods) -- Other specialities by comparison

Specialty Number
participating
Number
earning
incentive
Percent
earning
incentive
Mean
incentive
earned
Median
incentive
earned
Dermatology  1,725  1,451  84.1
percent
$7,462.06 $4,910.12
Rheumatology  1,386  994  71.7
percent
$3,515.70 $2,640.73
Urology  2,888  1,752  60.7
percent
$4,583.05 $3,912.59
Internal
medicine
 22,715  15,844  69.8
percent
$2,226.27 $1,537.27
Opthalmology 8,144  5,216  64.0
percent
$7,750.95 $6,182.11

 

 

 2009 PQRS performance (all reporting methods) -- Other specialities by comparison

Specialty Number
participating
Number
earning
incentive
Percent
earning
incentive
Mean
incentive
earned
Median
incentive
earned
Dermatology  2,106  900  42.7
percent
$5,277.39 $3,347.23
Rheumatology  1,156  682  59.0
percent
$3,104.01 $2,004.23
Urology  2,182 1,041  47.7
percent
$4,351.65 $3,879.67
Internal
medicine
 19,217  11,277  58.7
percent
$1,935.21 $1,333.49
Opthalmology  7,387  3,695  50.0
percent
$7,266.00 $5,847.13

 Source: 2011 reporting experience, including trends (2008-2012): Physician Quality Reporting System and electronic prescribing (eRx) incentive program. March. 26, 2013.