PQRS

Physician Quality Reporting System

The Physician Quality Reporting System (PQRS) is a reporting program that allows individual and group providers to assess the quality of care they provide to Medicare patients. As of January 1st, 2017 however, PQRS will be incorporated under a new Merit-Based Incentive Payment System (MIPS), mandated by the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA). More specifically, PQRS will be replaced by the “Quality” category in the MIPS model.

The new Quality category will still have over 300 different measure options for providers to report on when filing for Medicare reimbursement, thereby allowing the Center for Medicare and Medicaid Services (CMS) to continue calculating population-based measures. However, the primary difference between the Quality category under MIPS and PQRS is that MIPS is a pay-for-performance program as opposed to PQRS’ pay-for-reporting format. As such, MIPS only requires providers to report on six measures (including one measure focused on outcomes) instead of the nine traditionally required by PQRS. Furthermore, clinicians can earn bonus points for reporting high-priority measures or by using end-to-end electronic reporting through certified Electronic Health Records technology.

The new MIPS Quality category thus shifts reimbursement focus away from rewarding reporting to rewarding performance. The aim of this newly updated version of PQRS is to reduce workload for independent physicians while still retaining the same, familiar measures. Finally, independent physicians should take advantage of EHR technologies and other bonus point opportunities to maximize not only their reimbursement percentages, but also the quality of their patients’ care.