Physician Quality Reporting System (PQRS)

First implemented as a voluntary program in 2007, the Physician Quality Reporting Initiative (PQRI) is now here to stay under its new title, the Physician Quality Reporting System (PQRS). Through PQRS, eligible physicians and other practitioners who satisfactorily report data on quality measures for covered services furnished during a reporting period will qualify for incentive payments.

In 2009, successful PQRI reporting resulted in an incentive of 2 percent of the total Medicare fee-for-service allowed charges and almost 120,000 professionals received payments. By 2010, eligible professionals had three options for reporting individual measures or measure groups: claims-based reporting, registry-based reporting, and the preferred method of EHR-based reporting.

Registry-based reporting is a significant improvement over claims-based reporting since it eliminates reporting discrepancies that arise from billing issues and clearinghouse errors. Albeit acceptable, neither claims-based nor registry-based PQRI reporting are intended to be long-term solutions to quality reporting. CMS states in the pre-amble of its Final Rule on Stage 1 Meaningful Use,

"... the HIT Policy Committee proposed the goal as, 'Report to patient registries for quality improvement, public reporting, etc.' We have modified this care goal, because we believe that patient registries are too narrow a reporting requirement to accomplish the goals of quality improvement and public reporting."

CMS goes on in the Final Rule to describe its goal as, "We envision a single reporting infrastructure for electronic submission in the future and will strive to align the EHR incentive program and PQRI as we develop the reporting framework for clinical quality measures to avoid redundant or duplicative reporting. Further, we also note that the Affordable Care Act requires that the Secretary develop a plan to integrate the EHR incentive program and PQRI by January 1, 2012." Thus, PQRS will be the vehicle for reporting CQMs, and EHR-based reporting the desired vehicle.

In 2011, CMS is providing a 1 percent incentive payment, and will provide 0.5 percent incentives for successfully reporting PQRS measures from 2012-2014. Those who do not satisfactorily submit quality data may face penalties beginning in 2015.

No sign up or pre-registration is required for participation in PQRS. For more information, visit https://www.cms.gov/PQRS/.