What You Need to Know About PQRS Participation in 2012

The Physician Quality Reporting System (PQRS) has seen significant expansion and improvement since its launch in 2007. However, while participation has grown, the majority of physicians in the Medicare program have not taken advantage of this program.  With PQRS transitioning starting in 2013 from bonuses to penalties, those who have resisted may wish to examine their options for reporting.

A successful participant in PQRS has been one who submitted information on quality measures at a significant volume to satisfy CMS regardless of the level of performance.  Since 2007, successful participants have received a bonus payment of as much as 2 percent of Medicare allowed charges. Beginning this year through 2014, qualifying participants will receive a bonus payment of 0.5 percent. However, while there may be some provisions for physicians who do not have appropriate measures to report, the vast majority of cardiologists will likely be subject to a penalty starting in 2015. To make things more confusing, CMS will assess the penalty similar to the e-prescribing penalty, meaning penalties will be based on participation prior to the year in question. For example, physicians who do not participate in PQRS in 2013 will be subject to the 2015 penalty.

Fortunately, participation in PQRS has been eased considerably. The original claims-based method is still available but for most cardiologists, this is not the best option for two reasons. First, because participating via claims means interpreting the performance measures standards and appending codes onto claims, it is easy to make a mistake.  Second, many of the measures based on ACC/AHA performance measures have been deleted from claims submission because they are too complex.

Two options may be better for cardiologists. First, physicians who use electronic medical records can take advantage of the data already recorded to report without much additional work.  While there is an opportunity for direct EHR reporting, very few EHRs have successfully reported.  Another option, is reporting through the ACC’s PINNACLE Registry, which extracts data from most popular EHRs to make reports.  This registry calculates many more performance measures than needed for PQRS and can be a valuable quality improvement tool.

For practices not participating in the PINNACLE Registry or not using EHRs, another option is to report data through an online data repository.  While there are a number available, ACC has worked with CECity to offer the PQRIWizard to members. This tool allows submissions of measures groups, in which a group of related performance measures are reported on patients with a single condition such as coronary artery disease.  With this method, providers need only report on 30 Medicare patients and do not have to do so at the time that claims are submitted. 

Methods that allow for reporting through electronic means have greatly increased the success rate. The ACC is strongly encouraging members to take advantage of these electronic opportunities in 2012, not only to avoid future penalties, but take advantage of the incentive payments offered over the next three years.

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