Started in 2007 with the creation of the Physician Quality Reporting Initiative (PQRI), quality reporting has evolved over the past few years, and will continue to evolve as a result of the Affordable Care Act (ACA). Made permanent in 2008 under the Medicare Improvements for Patients & Providers Act (MIPPA) and subsequently renamed the Physician Quality Reporting System (PQRS) in 2011, PQRS affords physicians the opportunity to earn incentives in addition to Meaningful Use funds. At present, providers can participate in PQRS through one of three ways—claims-based reporting, registry-based reporting or the preferred method, EHR-based reporting.
For 2013, there are 210 PQRS measures for claims-based and/or registry-based reporting, and 51 measures for EHR-based reporting, including all 44 Meaningful Use Clinical Quality Measures (CQMs). CMS wants providers to report using their EHR, not through claims or registry. Claims-based and Registry-based reporting is limited to providing only little bits of data. Whereas, EHR-based reporting delivers a specialized Continuity-of-Care-Document (CCD), painting the full picture on an individual patient and why medical decisions were made to perform or not perform a certain clinical event.
Under the ACA, CMS must begin applying a value-based modifier to the Medicare fee-for-service reimbursement based upon performance measured under PQRS. The modifier will be a composite of both the cost and quality of care delivered by a provider –and will be publicly posted on the "Physician Compare" website, now online. Like the penalties for failure to meeting Stage 3 meaningful use deadline, the trigger date for the value-based modifier is 2015 for certain specialists defined by the Secretary of Health and Human Services, and 2017 for all providers. The strongest positioning a provider can have as the U.S. transitions into this new reimbursement model and public transparency on performance is to provide more than a single data point. For this reason, providers must seek to move to EHR-based PQRS reporting.