Health Policy Basics: Physician Quality Reporting System

Abstract

The U.S. health care system is in the midst of transforming from a fee-for-service system to a value-based system that delivers high-quality and cost-effective care. Quality reporting programs and increasing transparency of performance are meant to encourage physicians and hospitals to invest in improving the delivery of care. In 2006, the Centers for Medicare & Medicaid Services implemented the Physician Quality Reporting System (PQRS). The PQRS is an incentive and penalty payment program for eligible professionals who report data on quality measures for covered professional services furnished to Medicare beneficiaries. The program gives eligible professionals the opportunity to assess the quality of care they are providing to their patients and compare their performance on a given measure with that of their peers. This article discusses the history of PQRS, the 2014 PQRS, and how it affects other quality programs.

Quality Indicators for the Management of Barrett’s Esophagus, Dysplasia, and Esophageal Adenocarcinoma: International Consensus Recommendations from the American Gastroenterological Association Symposium

“…The Centers for Medicare and Medicaid Services are increasingly encouraging physicians to document quality measures by participating in voluntary reporting programs, such as the Physician Quality Reporting System, which provides incentives to physicians who report data on quality measures. 12 Failure to participate in these programs can result in annual payment cuts. Physician reimbursement rates will be increasingly based on outcome measures performance as determined by the Centers for Medicare and Medicaid Services.…”

“…The Centers for Medicare and Medicaid Services and private payers will increasingly demand documentation of quality measures through participation in voluntary reporting programs, such as the Physician Quality Reporting System to receive payment incentives and at some point in the future reimbursement will likely be contingent on adherence to validated quality indicators, once they are defined. 12 …”

Value-Based Payment Reform and the Medicare Access and Children’s Health Insurance Program Reauthorization Act of 2015: A Primer for Plastic Surgeons

“…4 The physician quality reporting system was initially developed in 2006 under the Tax Relief and Healthcare Act, as a voluntary “pay-for-reporting” program to encourage providers to report quality measures to CMS. 18 However, over time through various additional legislature, participation in the PQRS has become mandatory among eligible providers to avoid negative payment penalties. 18 …”

“…18 However, over time through various additional legislature, participation in the PQRS has become mandatory among eligible providers to avoid negative payment penalties. 18 …”

An electronic interface to routinize outcomes assessment and streamline clinic workflow

“…Although physicians are typically adept at managing clinical dilemmas, we are increasingly challenged by ancillary responsibilities related to medical documentation, billing requirements, and programs evaluating meaningful use and participation in the Physician Quality Reporting System. [1][2][3][4][5][6] Although items tracked by these programs have been selected for specific reasons, they do not always reflect the metrics that are most vital to us in daily practice. Nonetheless, many practitioners possess an innate desire to track outcomes relevant to their patients, particularly those with immediate clinical applicability.…”