When the Physician Quality Reporting System (PQRS) started in the second half of 2007 as the Physician Quality Reporting Initiative (PQRI), it was among the first tactics the Centers for Medicare and Medicaid Services (CMS) employed to become an active purchaser of health care value. Initially, there were limited opportunities for participation and those who did participate had a very small chance of being successful. There has been a significant expansion and improvement in the system since that time. 76.1 percent of 15,571 eligible cardiologists participated in PQRS in 2014, an increase over the 2013 participation rate of 67.9 percent. Participation in the program is currently required to avoid a negative payment adjustment.

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Starting with the 2015 participation year, the PQRS program implemented a negative payment adjustment for physicians who did not report data for services provided in 2013. The program assesses a penalty two years after the reporting year in question. Those who do not successfully report in 2016 will see the 2 percent penalty applied on 2018 payments.

PQRS data submitted in 2016 will also be used to calculate the 2018 Value-Based Payment Modifier for all physician solo practitioners and physicians in group practices of two or more eligible professionals. 2018 will be the final year of payment adjustments under PQRS since Merit-Based Incentive Payment System (MIPS) penalties will start in 2019. Physicians who successfully participate in 2016 will be listed on the public Physician Compare website. Therefore, it is vital that physicians who are eligible for PQRS actually participate in the program in 2016.

The ACC offers the following information to provide members with an understanding of 2016 PQRS participation options and requirements:

  1. Incentives and Penalties
  2. Reporting Options: Individual or Group
  3. Measure Options: ACC-Developed, Evidence-Based Measures Available in PQRS
  4. New Minimum Reporting Requirements
  5. Reporting as an Individual:
    • Reporting Methods: Self-Reported Claims, Qualified Registry, Certified EHR Vendor, Qualified Clinical Data Registry
    • Measure Types: Individual Measures or Measures Groups
    • Reporting Requirements per Method
    • ACC-Sponsored Reporting Mechanisms and Measures Reported
    • Other Reporting Mechanisms
  6. Reporting as a Group (Group Practice Reporting Option):
    • Reporting Methods: Qualified Registry, Certified EHR Vendor, CMS Web Interface
    • Reporting Requirements per Method
    • GPRO Registration Process
    • CMS Web Interface Measures

For complete and current PQRS information, visit the CMS PQRS Website. If you have questions or comments, please email us.