Although the CMS' Physician Quality Reporting System — formerly the Physicians Quality Reporting Initiative — has been in existence for five years, confusion persists about this voluntary pay-for-performance program that pays an incentive to eligible physicians who comply with quality measures for services provided to Medicare fee-for-service patients. Here are my top eight misconceptions about the PQRS program.
1. Eligible professionals cannot participate and receive incentives from both PQRS and electronic health record meaningful use incentive programs in the same year. Wrong. PQRS and MU are distinctly different programs, and physicians can earn hefty incentives from both in 2011.
2. Practices need an electronic health record to participate in PQRS. They don’t. PQRS success requires data from as few as 30 Medicare patients. Required data can be entered from both paper charts and EHRs, so a paper-based practice or a group that's transitioning to an EHR can easily participate in the PQRS program and benefit from the financial incentives. However, when a paper-based practice chooses to submit its data to CMS through an approved registry, it's important to select one that offers the right tools — including easy-to-use, fill-in-the-blank templates.
3. PQRS reporting is too difficult and time-consuming. That was true when the program was launched in 2007; however, CMS quickly identified the problems, which included confusion about required quality data, burdensome and expensive data collection, and lower-than-expected incentives. CMS soon began to overhaul the program, which included offering a registry option to streamline data collection and reporting. In 2010, CMS eliminated the onerous requirement that data had to be collected during 30 consecutive patient visits — a very popular change. Unfortunately, some of the early negative perceptions about the program endure among non-participants who haven't experienced how the program has morphed from a frustrating drain on resources to a physician-friendly experience that promotes best practices that lead to higher quality care. In some cases it takes less than two hours to successfully complete PQRS-related activities.
Practices using the Covisint DocSite registry indicate that PQRS participation doesn't disrupt clinician workflow. Clerks or medical assistants identify suitable patients and provide the appropriate clinical data sheet to ensure that physicians ask the required questions during the patient encounter and complete the necessary documentation. The data collection takes a couple of minutes. An administrative staff member can upload the data for the 30 Medicare patients seen by each participating physician in about 20-25 minutes whenever it's convenient.
4. Multi-specialty practices must report on the same quality measures for every physician. False. Because the incentives are awarded based on an individual physician's performance, not the practice where he or she provides care, it's not mandatory for all physicians within a group to select the same quality measures group. Some multi-specialty groups may decide that all physicians will use the preventive care quality measures group while others may want to match various specialties to different quality measures groups. The approach can change from one year to the next.
5. CMS makes it tough for physicians to collect the incentive that they've earned. Quite the opposite, actually. Although there were problems early in the program, CMS has instituted a well publicized, transparent payment process that resolved those glitches. In 2009 and 2010 when eligible professionals could earn a bonus of 2 percent of their Medicare Part B Fee for Service Payments, almost 120,000 physicians and other eligible professionals in more than 12,600 practices received PQRS payments totaling more than $234 million. The bonuses both years averaged almost $2,000 per eligible professional and $18,525 per practice.
6. There's no reason for physicians to participate. Wrong. First, a physician or practice that fails to participate can easily leave a nice chunk of change on the table: For the 2011 calendar reporting year, physicians who participate successfully qualify for an incentive equal to 1.0 percent of their total estimated Medicare Part B Physician Fee Schedule allowed charges. In 2012 through 2014, the rate will be 0.5 percent. More importantly, starting in 2015, physicians who do not participate in PQRS will incur a 1.5 percent Medicare reimbursement cut and a 2 percent penalty starting in 2016.
7. Practices must submit data to CMS by December 31, 2011, to qualify for 2011 incentives. That is incorrect. While patients must be seen by Dec. 31, 2011, the deadline for CMS to receive data from physicians and other eligible professionals using the registry, EHR and group practice options is March 30, 2012. The Covisint DocSite registry will accept data until at least March 2, 2012, and possibly later. Other registries typically have earlier deadlines. Those using the claim reporting option only have until the end of February to submit their data to CMS.
8. All physicians in a practice must participate to quality for PQRS payments. Untrue. Since physicians qualify individually for PQRS incentives, there is no minimum or maximum level of participation required for PQRS participation.
John Haughton, MD, is chief medical information officer of Covisint, a Compuware company, which enables information ecosystems that quickly revolutionize organization by providing secure communication and collaboration between people and systems.
Most Practices Unhappy With Medicare's Physician Quality Reporting Initiative
1. Eligible professionals cannot participate and receive incentives from both PQRS and electronic health record meaningful use incentive programs in the same year. Wrong. PQRS and MU are distinctly different programs, and physicians can earn hefty incentives from both in 2011.
2. Practices need an electronic health record to participate in PQRS. They don’t. PQRS success requires data from as few as 30 Medicare patients. Required data can be entered from both paper charts and EHRs, so a paper-based practice or a group that's transitioning to an EHR can easily participate in the PQRS program and benefit from the financial incentives. However, when a paper-based practice chooses to submit its data to CMS through an approved registry, it's important to select one that offers the right tools — including easy-to-use, fill-in-the-blank templates.
3. PQRS reporting is too difficult and time-consuming. That was true when the program was launched in 2007; however, CMS quickly identified the problems, which included confusion about required quality data, burdensome and expensive data collection, and lower-than-expected incentives. CMS soon began to overhaul the program, which included offering a registry option to streamline data collection and reporting. In 2010, CMS eliminated the onerous requirement that data had to be collected during 30 consecutive patient visits — a very popular change. Unfortunately, some of the early negative perceptions about the program endure among non-participants who haven't experienced how the program has morphed from a frustrating drain on resources to a physician-friendly experience that promotes best practices that lead to higher quality care. In some cases it takes less than two hours to successfully complete PQRS-related activities.
Practices using the Covisint DocSite registry indicate that PQRS participation doesn't disrupt clinician workflow. Clerks or medical assistants identify suitable patients and provide the appropriate clinical data sheet to ensure that physicians ask the required questions during the patient encounter and complete the necessary documentation. The data collection takes a couple of minutes. An administrative staff member can upload the data for the 30 Medicare patients seen by each participating physician in about 20-25 minutes whenever it's convenient.
4. Multi-specialty practices must report on the same quality measures for every physician. False. Because the incentives are awarded based on an individual physician's performance, not the practice where he or she provides care, it's not mandatory for all physicians within a group to select the same quality measures group. Some multi-specialty groups may decide that all physicians will use the preventive care quality measures group while others may want to match various specialties to different quality measures groups. The approach can change from one year to the next.
5. CMS makes it tough for physicians to collect the incentive that they've earned. Quite the opposite, actually. Although there were problems early in the program, CMS has instituted a well publicized, transparent payment process that resolved those glitches. In 2009 and 2010 when eligible professionals could earn a bonus of 2 percent of their Medicare Part B Fee for Service Payments, almost 120,000 physicians and other eligible professionals in more than 12,600 practices received PQRS payments totaling more than $234 million. The bonuses both years averaged almost $2,000 per eligible professional and $18,525 per practice.
6. There's no reason for physicians to participate. Wrong. First, a physician or practice that fails to participate can easily leave a nice chunk of change on the table: For the 2011 calendar reporting year, physicians who participate successfully qualify for an incentive equal to 1.0 percent of their total estimated Medicare Part B Physician Fee Schedule allowed charges. In 2012 through 2014, the rate will be 0.5 percent. More importantly, starting in 2015, physicians who do not participate in PQRS will incur a 1.5 percent Medicare reimbursement cut and a 2 percent penalty starting in 2016.
7. Practices must submit data to CMS by December 31, 2011, to qualify for 2011 incentives. That is incorrect. While patients must be seen by Dec. 31, 2011, the deadline for CMS to receive data from physicians and other eligible professionals using the registry, EHR and group practice options is March 30, 2012. The Covisint DocSite registry will accept data until at least March 2, 2012, and possibly later. Other registries typically have earlier deadlines. Those using the claim reporting option only have until the end of February to submit their data to CMS.
8. All physicians in a practice must participate to quality for PQRS payments. Untrue. Since physicians qualify individually for PQRS incentives, there is no minimum or maximum level of participation required for PQRS participation.
John Haughton, MD, is chief medical information officer of Covisint, a Compuware company, which enables information ecosystems that quickly revolutionize organization by providing secure communication and collaboration between people and systems.
More Articles on Quality Reporting:
Physician Quality Reporting System: No New Anesthesiology Measures for 2011Most Practices Unhappy With Medicare's Physician Quality Reporting Initiative