Physician Quality Reporting System (PQRS)

Introduction and History

In 2007, the Centers for Medicare and Medicaid Services (CMS) established the Physician Quality Reporting Initiative (PQRI) as required by the 2006 Tax Relief and Health Care Act (TRHCA). The 2007 PQRI was a pay-for-reporting program that included claims-based reporting of data on 74 individual quality measures. The program allowed eligible professionals (EPs) to report at least three applicable measures in at least 80% of the cases from July 1, 2007 through December 31, 2007. Those who met the criteria for submitting quality data were eligible to earn a lump-sum incentive payment equivalent to 1.5% of their total estimated allowable charges for Medicare Part B Physician Fee Schedule (PFS).

The Medicare, Medicaid, and SCHIP Extension Act of 2007 (MMSEA) extended the incentive payment for 2008 and 2009 PQRI and authorized CMS to establish alternative reporting criteria and alternative reporting periods for the reporting of measures groups and for the submission of data on PQRI quality measures through clinical data registries furnished in calendar-year 2008. Alternative reporting criteria are applicable to the reporting of measures groups, whether submitted via claims or Registry reporting.

The Medicare Improvements for Patients and Providers Act of 2008 (MIPPA) made the PQRI program permanent, with incentive payments authorized through 2010. The Act mandated additional changes for the 2009 PQRI reporting year including the removal of the electronic prescribing measure (measure #125) and incentive payments were increased to 2.0%. The electronic prescribing measure became a stand-alone initiative with the potential for an additional 2.0% incentive payment for participation. (For more information on e-prescribing, see the E-Prescribing Information Center on this web site.)

In 2009, there were 153 individual quality measures and 7 measure groups for reporting under the program.

For 2010, CMS finalized 119 of the 2009 PQRI measures with 26 of these measures reportable only through registry-based submission, and added 30 new individual measures along with 6 new measure groups. In total, there were 175 individual measures and 13 measure groups. CMS finalized physician group practice submission of quality data as a group in 2010. A “physician group” is defined as a group of at least 200 eligible professionals that have reassigned their billing rights to the tax identification number (TIN). This definition was finalized based on CMS’ experience with the Physician Group Practice Demonstration. In 2010, CMS was also required by law to post on its web site, in an easily understandable format, a list of the names of the eligible professionals who satisfactorily submitted data on quality measures under PQRI in 2009.

As a result of the recently enacted health-reform legislation, the Affordable Care Act (ACA), the PQRI acronym was changed to Physician Quality Reporting System (PQRS). In 2011, EPs may earn an incentive payment of 1.0 % for successfully reporting PQRS measures. There are 190 individual measures (including 5 new measures for claims and registry reporting, 11 new registry-only measures, and 4 new measures for EHR-based reporting only) and 14 measure groups. EPs who satisfactorily report Physician Quality Reporting System measures can qualify to earn an additional 0.5 % incentive payment by, more frequently than is required to qualify for or maintain board certification status, participating in a maintenance of certification program and successfully completing a qualified maintenance of certification program practice assessment.

The American Academy of Orthopaedic Surgeons has been instrumental in assisting CMS with the development of orthopaedic-related tools for this program, and we continue to be involved in ongoing discussions with CMS on the program’s development. If you have questions, you can send an email to PQRI@aaos.org and we will respond as quickly as possible.