Avoid payment reduction with proper PQRS reporting


By Joseph Lee, MD, PhD

Medicare’s Physician Quality Reporting System, known to most of us as PQRS, has been on my and my colleagues’ radars for the past several years. PQRS is the Medicare program that provides a financial incentive to those of us who report on best-practice quality measures for our Medicare patients. 

My colleagues and I have been successful in obtaining this incentive in the past, but we are reporting this year to not only earn a bonus of 0.5 percent of our Medicare charges, but to also avoid a potential 1.5 percent payment reduction from Medicare in 2015. The 2013 PQRS reporting year is the first in which, if we do not report at least one quality measure, we will be subject to a 1.5 percent payment reduction in 2015.

My practice has participated in PQRS since 2010, using the Academy’s Quality Reporting System (QRS) module. My colleagues and I each report our Medicare patients separately, under our individual NPIs. We have found it best to report the three melanoma measures, #137, #138, and #224, although, if you do not see a patient with melanoma, you could report biopsy measure #265. 

The 2013 PQRS reporting year is the first in which, if we do not report at least one quality measure, we will be subject to a 1.5 percent payment reduction in 2015. ​

Reporting these particular measures means we only report on our Medicare patients who had either a new occurrence or personal history of melanoma in 2013. Measure 137, Continuity of Care — Recall System, asks us whether we have a system in place to follow up with the patient within 12 months of the initial visit. 

Measure 138, Melanoma: Coordination of Care, which only applies to patients with a new occurrence of melanoma, measures whether we coordinated care with the referring primary care physician by sending him or her a melanoma treatment plan within one month of the diagnosis. You must have at least one new case of melanoma each year to report this measure. 

Finally, Measure 224, Overutilization of Imaging Studies in Melanoma, asks us to show that we did not order unnecessary imaging studies on stage 0 through IIC melanomas. The QRS module puts these measures in a questionnaire format where we simply answer “yes” or “no” about whether we performed the parts of the measure during the patient visit. 

Important 2013 PQRS dates:
  • Purchase your PQRS module by Dec. 13.
  • Report your measures by Jan. 17.

Our practice already performs the actions prescribed in the quality measures; therefore, answering these questions is fairly easy for us. We have our staff print out a blank questionnaire form that we fill out at the time of the visit. Later, we have other staff enter the same information into the online module.

Reporting the PQRS quality measures is not only vital in receiving a bonus incentive and avoiding a payment cut, but it is an excellent chance to show Medicare that we provide quality care for our patients. This is especially important with the recent launch of the Medicare Physician Compare website, which lists our practice information, along with whether we are currently involved in quality reporting. 

In the near future, the Physician Compare website will also include our PQRS measure performance rates. All of this information will be publicly available to our patients, allowing them to choose a dermatologist based on the PQRS measure benchmarks. I was especially pleased to discover that in the 2011 reporting year, the latest year for which we have data, dermatologists had a 95 percent PQRS incentive success rate when reporting through a registry. This rate was the second highest among all specialties that reported using a registry that year.

Quality reporting is something that I recommend for all of my colleagues. Setting up the QRS can take time, but once it's set up, quality reporting is easy to implement within your practice. Quality reporting is only going to continue to become more important if you are a Medicare provider. 

The AAD is now offering the QRS module for non-physician clinicians as well. Our physician assistant (PA) staff is a valuable part of our team, so it is great that they can now take advantage of the incentive and penalty avoidance opportunities. More information about how you and your colleagues can participate is available using the related resources links below. 

Joseph Lee, MD, PhD, is a board-certified dermatologist. He received his PhD, medical degree, and dermatology residency training from the State University of New York at Stony Brook. He is engaged in research at the National Institutes of Health, and has a broad background in skin cancer research and a special interest in surgery.

Email the Member to Member editor at members@aad.org.

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