CY 2014 Physician
Quality Reporting System
(PQRS) 101
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Table of Contents
CY 2014 Physician Quality Reporting System (PQRS) 101
Step 1: Understand PQRS and how it impacts you
A. When was PQRS first established and implemented?
B. What is PQRS?
C. How does CMS calculate and distribute incentive payments?
D. When and how does CMS calculate and apply payment adjustments?
E. Where can I access useful resources to aid my understanding of PQRS in CY 2014?
Step 2: Determine whether or not you are eligible for/exempt from participating in PQRS
A. Do I bill Medicare Part B?
B. Do I bill exclusively using Place of Service (POS) 81?
C. Am I participating in a Medicare Shared Savings Program?
Step 3: If you are eligible to participate in PQRS, determine whether or not you are required to participate
based on whether or not you have applicable measures
A. Where can I access the list of measures available for reporting in CY 2014 in order to determine whether
or not they are applicable to my practice?
B. How do I know if I have an applicable PQRS measure?
C. What if I have no applicable PQRS measures?
D. If I have only one applicable measure, am I still required to participate in PQRS?
Step 4: If you have applicable PQRS measure(s), understand the program’s registration
and reporting requirements
A. When and where do I register to participate in CY 2014 PQRS?
B. What are the reporting requirements in CY 2014 for avoiding application of a -2 percent payment adjustment
on my Medicare Part B allowed charges in CY 2016?
C. What are the reporting requirements in CY 2014 for earning the payment incentive amounting in 0.5 percent
of my Medicare Part B allowed charges that year?
D. What if the number of required measures exceeds the number of measures applicable to my practice?
Step 5: Assess your reporting options
A. Do I want to report as a group or individually?
B. Where can I obtain information on all reporting options available in CY 2014?
C. For CY 2014, what key changes related to specific reporting options and/or measures should I be aware of
and how will these changes impact me as a pathologist?
Step 6: Select the reporting option that is best for you and your practice
A. As a pathologist, am I limited to any particular reporting options?
B. As a pathologist, when would selecting the group reporting option benefit me?
Step 7: Understand how your PQRS participation impacts the application and direction (+/-) of an additional
value modifier on Medicare Part B payment amounts under the Value-based Payment Modifier
(VBM) Program
A.
B.
C.
D.
What is the Value-Based Payment Modifier (VBM) Program?
How does PQRS relate to the VBM program?
What is “quality tiering” under the VBM program?
What are some important changes in the VBM program for CY 2014?
Step 8: Review your PQRS and VBM performance and identify areas for improvement
A.
B.
C.
D.
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What is the Physician Feedback Program?
Where can I access analyses of the findings from the QRURs distributed over the years?
Where can I go to access a summary of my performance results?
Will my performance be made public and, if so, will I have the opportunity to review it first?
CY 2014 Physician Quality Reporting System (PQRS) 101
Step 1: Understand PQRS and how it impacts you
A. When was PQRS first established and implemented? In 2006, the Tax Relief and Health Care Act authorized
the establishment of a physician quality reporting system by the Centers for Medicare and Medicaid Services
(CMS).CMS began program implementation in 2007, initially referring to the program as the Physician Quality
Reporting Initiative (PQRI).
B. What is PQRS? In 2011, CMS renamed PQRI the Physician Quality Reporting System (PQRS). CMS describes
PQRS as “a quality reporting program that provides incentive payments and payment adjustments to eligible
professionals and group practices based on whether or not they satisfactorily report data on quality measures for
covered professional services furnished during a specified reporting period.”
C. How does CMS calculate and distribute incentive payments? Each year, incentive payments are calculated
according to a specified percent of the total estimated Medicare Part B allowed charges for all covered
professional services furnished by an eligible professional (EP) or group practice during the applicable reporting
period. In CY 2014, incentive payment amounts are valued at 0.5 percent. This is the last performance year for
which incentive payments will be rewarded.
D. When and how does CMS calculate and apply payment adjustments? In accordance with the Affordable
Care Act (ACA), CMS will begin enforcing payment adjustments in CY 2015 based on PQRS participation in CY
2013. The PQRS payment adjustment applies to all of the EP’s Medicare Part B covered professional services.
Accordingly, EPs subject to a payment adjustment in 2015 will be paid 1.5 percent less than the amount specified
for each service under the Medicare Physician Fee Schedule (PFS). The payment adjustment amount then
increases to -2 percent for CY 2016 (based on failure to successfully participate in PQRS in CY 2014) and each
subsequent year.
E. Where can I access useful resources to aid my understanding of PQRS in CY 2014?
•
CMS “2014 Physician Quality Reporting System (PQRS):Implementation Guide”
•
CMS“2014 Physician Quality Reporting System (PQRS) Measures List”
•
PQRS GPRO 2014 Requirements
•
CY 2014 Medicare Physician Fee Schedule Final Rule- CMS Website
•
CMS Fact Sheet: Changes for Calendar Year 2014 Physician Quality Programs and the Value-Based
Payment Modifier
•
CMS PQRS Website
•
PQRS FAQ Web Page
•
MLN Connects National Provider Call Presentation on the CY 2014 PFS Final Rule
•
MLN Connects National Provider Call Presentation on the VBM Program in CY 2014
•
CMS VBM Program Website
•
CMS QualityNet Help Desk: 866-288-8912 (TTY 877-715-6222); qnetsupport@sdps.org
•
Provider Contact Center Directory
Step 2: Determine whether or not you are eligible for/exempt from participating in PQRS
A. Do I bill Medicare Part B? If you do not submit claims for Medicare Part B Fee-for-Service (FFS) beneficiaries,
then you are not eligible to participate in PQRS, nor will you be assessed under the Value-based Payment
Modifier (VBM) program.
B. Do I bill exclusively using Place of Service (POS) 81? If you bill exclusively under POS 81 (the independent
laboratory setting) you are not eligible to participate in PQRS, nor will you be assessed under the Value-based
Payment Modifier (VBM) program.
C. Am I participating in a Medicare Shared Savings Program? ACO participants in the Medicare Shared Savings
Program may automatically receive PQRS credit via their ACO participation if their ACO reports quality metrics on
behalf of the EPs within the ACO-participant Tax Identification Number(s) (TINs).
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CY 2014 Physician Quality Reporting System (PQRS) 101
Step 3: If you are eligible to participate in PQRS, determine whether or not you are required to participate based
on whether or not you have applicable measures
A. Where can I access the list of measures available for reporting in CY 2014 in order to determine whether
or not they are applicable to my practice? All measures available for PQRS reporting in CY 2014 are available
here. Note that there are only five pathology-specific PQRS measures available in CY 2014.
B. How do I know if I have an applicable PQRS measure? A PQRS measure applies to an EP’s practice when
the combination of ICD-9 and CPT codes denoted in the measure’s denominator appear on a claim form for a
service billed by the EP during the reporting period. Multiple applicable procedure codes billed on one claim will
only be counted once in the denominator for the measure. This means that only one quality data code (QDC)
will need to be reported on the claim.
C. What if I have no applicable PQRS measures? Though not explicitly stated in the CY 2014 PFS Final Rule, an
EP will not be subject to a negative payment adjustment if the EP truly has zero applicable measures. However,
the EP will also not qualify for an incentive payment nor will the EP be assessed under the Value-based Payment
Modifier (VBM) program. CMS will verify that the EP has zero applicable PQRS measures through the Measures
Applicability Valuation (MAV) Process.
D. If I have only one applicable measure, am I still required to participate in PQRS? Yes. If you do not
participate and CMS discovers that you failed to report on an applicable measure, you will be subject to a
negative payment adjustment.
Step 4: If you have applicable PQRS measure(s), understand the program’s registration
and reporting requirements
A. When and where do I register to participate in CY 2014 PQRS? Individual EPs do not have to register
to participate in PQRS. Instead, if the EP bills under Medicare Part B, they are automatically included in
PQRS. However, EPs that intend to participate in PQRS as a group (as defined by tax identification number)
must register as a group via the Physician Value-Physician Quality Reporting System (PV-PQRS) portal. It is
important to note that the person registering the group must first register for an Individuals Authorized Access
for CMS Computer Services ( IACS account) before they can access the PV-PQRS portal on the group’s behalf.
The deadline for group registration, or self-nomination, is September 30thof the CY reporting period.
B. What are the reporting requirements in CY 2014 for avoiding application of a -2 percent payment
adjustment on my Medicare Part B allowed charges in CY 2016? In the CY 2014 Medicare Physician Fee
Schedule (PFS) Final Rule, CMS increased the number of measures required to be reported on for avoidance
of a negative payment adjustment from one to three and specified that the three measures must cover at least
one of the six National Quality Strategy (NQS) domains.
C. What are the reporting requirements in CY 2014 for earning the payment incentive amounting in 0.5
percent of my Medicare Part B allowed charges that year? CMS increased the number of measures
required to earn an incentive payment from three measures in CY 2013 to nine measures, covering at least
three NQS domains, in CY 2014. (Important Notice: CY 2014 is the last year incentive payments will be
awarded)
D. What if the number of required measures exceeds the number of measures applicable to my practice?
CMS will allow an EP to report on as many PQRS measures as are applicable to the EP’s practice. As such, an
EP can earn an incentive payment in CY 2014 even if they only have one applicable PQRS measure as long as
they successfully report on that measure. An EP is considered to have “successfully reported” on a measure if
the EP reports on that measure for at least 50 percent of his/her Medicare Part B FFS patient population seen
during the reporting period.
EPs that report on less than three measures covering one NQS domain to avoid a negative payment
adjustment will be subject to CMS’s Measures Applicability Valuation (MAV) Process. Similarly, EPs that report
on less than nine measures covering less than three NQS domains to achieve an incentive payment will also
be subject to the MAV process. Through this process, CMS will determine whether or not the EP could have
reported on more applicable measures than they did.
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CY 2014 Physician Quality Reporting System (PQRS) 101
Step 5: Assess your reporting options
A. Do I want to report as a group or individually? EPs have the option to report individually, as indicated by
their National Provider Identification (NPI) number or as a group, as indicated by their NPI/Tax Identification
Number (TIN) combination. If a group or providers report unsuccessfully in CY 2014, the payment adjustment
will be applied to each individual EP’s allowed Medicare Part B charges even if an EP leaves the group/TIN
prior to the payment adjustment year in CY 2016.
The benefit to group reporting is that EPs with few or no measures applicable to their practice and/or EPs
that face difficulty successfully reporting on applicable measures may still possibly avoid a negative payment
adjustment and qualify for an incentive payment. As such, once EPs within the same tax identification number
(TIN) register for PQRS as a group, CMS assesses adherence to PQRS requirements at the group-level, rather
than the individual-level. This may be an attractive option for pathologists practicing in multi-specialty physician
practices with specialists that have more applicable PQRS measures.
It is important to note that the reporting mechanisms available to EPs differ based on whether or not the EP
elects to participate in PQRS individually or as a group. Additionally, measures available for reporting may differ
within each reporting option.
B. Where can I obtain information on all reporting options available in CY 2014? ASCP has put together a
CY 2014 PQRS Reporting Options Chart that:
• Lists each reporting option available in CY 2014;
• Specifies whether or not the reporting option is available for individual and/or group reporting;
• Outlines the reporting requirements for each reporting option;
• Provides information regarding the submission timing and process for each reporting option;
• Includes additional relevant information regarding the reporting option for CY 2014;
• Explains the attractiveness of each reporting option to pathologists; and
•
Provides useful resources to aid implementation of each reporting option
C. For CY 2014, what key changes related to specific reporting options and/or measures should I be aware
of and how will these changes impact me as a pathologist?
CMS urges reporting via registry and EHR-based reporting in CY 2014: For CY 2014, CMS is
adding 57 new individual measures and 2 measures groups to fill existing measure gaps and they will
be retiring a number of claims-based measures to encourage reporting via registry and EHR-based
reporting mechanisms. As such, the CY 2014 PQRS measures set will contain a total of 287 measures
and 25 measures groups. It is discouraging to the pathology community that CMS did not approve the
three additional pathology-specific measures proposed for inclusion in the CY2014 PQRS measures
set by the College of American Pathologists. It is also discouraging that CMS is moving away from the
claims-based reporting option, which remains the most widely used option for pathologists. However,
thankfully CMS is not eliminating the claims-based reporting option for any pathology-specific measures
in CY 2014.
Measures groups will only be available for reporting via registry in CY 2014: EPs have the option
to report on individual measures or measures groups. A measures group is defined as “a subset of four
or more PQRS measures that have a particular clinical condition or focus in common.” For measures
groups, EPs must report at least one measures group, AND report each measures group for at least
20 patients, a majority of which much be Medicare Part B patients. However, for CY 2014, CMS has
eliminated the option to report measures groups via claims and is only allowing reporting on measures
groups through registry reporting. This will not impact pathologists, since there are no pathologyspecific measures groups.
The administrative claims-based reporting option will no longer be available in CY 2014 for
avoidance of a CY 2016 payment adjustment: The administrative claims-based reporting option was
made available only in 2013 for avoidance of a 2015 payment adjustment. Through this option, CMS
used claims data to evaluate performance on 14 quality measures and 3 outcome measures for both
individual EPs and groups of EPs. CMS assigned patients using a two-step primary care attribution
methodology. This reporting option was the least administratively burdensome option and also costfree. As such, many provider groups urged CMS to maintain this option for 2014, but CMS went against
these recommendations in the Final Rule.
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CY 2014 Physician Quality Reporting System (PQRS) 101
CMS introduces “satisfactory participation” individual reporting option via a Qualified Clinical
Data Registry (QCRD) in CY 2014:The American Taxpayer Relief Act of 2012 allows EPs to be
treated as satisfactorily submitting data on quality measures for covered professional services if the
EP satisfactorily participates in a qualified clinical data registry (QCDR). CMS defines a QCDR for the
purposes of PQRS as a “CMS-approved entity (such as a registry, certification board, collaborative,
etc.) that collects medical and/or clinical data for the purpose of patient and disease tracking to foster
improvement in the quality of care furnished to patients.”
In order to qualify as a QCDR for a given year, an entity must already be in existence with at least 50
participants as of January 1st the year prior. The QCDR must also have the ability to submit measures
data to CMS and must possess a method to benchmark the quality of care measures an EP provides
with that of other EP performing the same or similar functions.
The QCDR is intended to offer EPs more flexibility when reporting quality. This option does not
require reporting on PQRS measures, nor does it require that measures are reported solely for
Medicare Part B FFS patients. EPs will be able to report up to 20 non-PQRS measures for a
broader patient population, including non-Medicare patients. However, CMS does specify that all
newly developed measures must fall into one or more of the following categories: CG-CAHPS; NQF
endorsed measures; current PQRS measures; measures used by boards or specialty societies; and
measures used in regional quality collaboratives.
Regardless of the flexibility offered to EPs through this option, EPs are still required to report on at
least nine measures, covering at least three NQS domains, in order to qualify for an incentive payment.
CMS further specifies that one of these measures must be an outcome measure. Additionally, EPs
must report on at least three measures, covering at least one NQS domain, in order to avoid the
PQRS payment adjustment. Nonetheless, CMS will not be able to verify firsthand that EPs met these
specified requirements for CY 2014 and are instead relying on QCDRs to verify this for them. Though
QCDRs must eventually be able to submit all quality measures to CMS, they are not required to do so
for CY 2014 because CMS may not yet have the capacity to receive information on newly customized
QCDR measures. As such, for the CY 2014 reporting period only, the QCDR must simply provide CMS
with a list of EPs (with TIN/NPI info) that participated in and reported quality data to the QCDR, in order
to determine satisfactory participation for the 2014 PQRS incentive and 2016 Payment Adjustment.
Nonetheless, if an EP does not
This reporting option is not to be confused with the existing registry reporting option, which will also
remain available for 2014 reporting. QCDRs will need to meet enhanced requirements when compared
with the requirements for the existing certified registries.
CMS introduces the Certified Survey Vendor reporting mechanism for groups of 25+ EPs in
CY 2014:A group of25+ EPs may report patient experience of care survey measures, known as the
Clinician and Group Consumer Assessment of Healthcare Providers and Systems(CG CAHPS) survey
measures, in conjunction with other PQRS reporting mechanisms for achievement of CY 2014 incentive
and avoidance of the CY 2016 payment adjustment. Specifically, the EP must report all 12 CG CAHPS
survey measures via a CMS-certified survey vendor AND report at least six measures covering at least
two of the NQS domains using a qualified registry, direct EHR product, EHR data submission vendor, or
GPRO web interface.
Unfortunately, CMS will not bear the cost of administering the CG-CAHPS Survey for groups of less
than 100 EPs under this reporting option. Moreover, because CMS assigns beneficiaries to a group
based on the provision of primary care services, this survey is not an appropriate option for groups of
physicians that do not provide primary care services. Hence, this does not appear to be a viable option
for a pathologist unless the pathologist works within a group practice with primary care physicians.
Step 6: Select the reporting option that is best for you and your practice
A. As a pathologist, am I limited to any particular reporting options? Pathologists, by default, are essentially
limited to the claims-based reporting option or the registry reporting option. The other mechanisms are not
yet able to support reporting of pathology-specific measures. For claim based reporting, you must report the
PQRS codes at the time of billing. PQRS cannot be reported retrospectively. However, if the CY reporting
period comes to a close and you have failed to provide appropriate measures documentation on your eligible
claims throughout the CY, you can still participate in PQRS via a registry. Registry reporting offers the
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CY 2014 Physician Quality Reporting System (PQRS) 101
ability to retrospectively report PQRS measures following the close of the CY reporting period. Currently, 31
out of the 70 certified registries approved for CY 2013 have the ability to report on at least one pathologyspecific PQRS measure. In fact, 22 of these 33 registries have the capability to report on ALL five available
pathology-specific PQRS measures. Also, 22 of these 33 registries offer group reporting in addition to
individual reporting of measures.
B. As a pathologist, when would selecting the group reporting option benefit me? If you are a pathologist
in practice with other non-pathologist physicians that have more applicable PQRS measures available to them,
you may want to encourage your group practice to participate as a group. This is especially recommended if
you have minimal or no measures applicable to you/would be unable to successfully participate in PQRS as
an individual. If your group practice successfully reports PQRS as a group, you will avoid a negative payment
adjustment and even qualify for an incentive payment in PQRS for CY 2014.
Step 7: Understand how your PQRS participation impacts the application and direction (+/-) of an additional
value modifier on Medicare Part B payment amounts under the Value-based Payment Modifier
(VBM) Program
A. What is the Value-Based Payment Modifier (VBM) Program? The ACA mandated that, by 2015, CMS begin
applying a value modifier under the PFS to facilitate upward and downward payment adjustments to physicians
based on both the cost and quality of the care that they provide to their patient population covered under
Medicare FFS.
B. How does PQRS relate to the VBM program? Groups of EPs (and beginning in 2017, individual EPs) that
fail to successfully report PQRS measures will be subject to an additional negative payment adjustment on
Medicare Part B covered services under the VBM program, in addition to the negative payment adjustment
under the PQRS. Performance on PQRS measures also contributes to a quality composite score calculated
under the VBM program, which can result in an additional positive, negative, or neutral payment adjustment as
directed via CMS’ quality-tiering approach.
C. What is “quality tiering” under the VBM program? Under CMS’s quality-tiering approach, each group of EPs
receives two composite scores, one on cost and one on quality.
The group’s quality composite score is calculated based on the group’s performance on PQRS
measures as well as their performance on three additional outcome measures, including: all cause
readmission; a composite of acute prevention quality indicators (bacterial pneumonia, urinary tract
infection, dehydration); and a composite of chronic prevention quality indicators (COPD, heart failure,
diabetes).
The group’s cost composite score is calculated based on: total per capita cost (Medicare Parts A and
B); total per capita cost for beneficiaries with four chronic conditions ( COPD, heart failure, coronary
artery disease, and diabetes); and, new in CY 2014, a Medicare Spending Per Beneficiary (MSPB)
measure.
Each score is based on the group’s standardized performance in that category, which is assessed via the
distance of the group’s score from the national mean score. Group cost measures are then adjusted for
specialty provider composition of the group. CMS then identifies statistically significant outliers and assigns
them to their respective quality and cost tiers. Accordingly, CMS applies upward, downward
(maximum -2 percent),and neutral payment adjustments.
Quality/Cost Performance
Low Cost
Average Cost
High Cost
High Quality
+2x*
+1x*
+0%
Average Quality
+1x*
+0%
-1%
Low Quality
+0%
-1%
-2%
Important Notes:(“x”) = upward payment adjustment factor determined after the performance period has ended based
on the aggregate amount of downward payment adjustments; (*)= additional upward payment adjustment of +1.0x available
to groups treating high-risk beneficiaries; average beneficiary risk score must be in the top 25 percent of all beneficiary risk scores.
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CY 2014 Physician Quality Reporting System (PQRS) 101
D. What are some important changes in the VBM program for CY 2014?
Groups of 10-99 EPs are subject to the VBM for the first time. In the CY 2014 PFS Final Rule, CMS
lowered the group size threshold for application of the VBM. The VBM was previously only applied to
groups of 100+ EPs but now it will also be applied to groups of 10-99 EPs. In 2017, CMS is statutorily
required to apply the VBM to all EPs. This means that individual EPs, not just groups of EPs, will be
subject to the VBM.
There is more payment at risk under the VBM program in CY 2014. CMS is increasing the
maximum downward adjustment under the value-based payment modifier from 1.0 percent in CY 2015
to 2.0 percent for CY 2016. In CY 2014, failure to participate in PQRS (as a group or even as an individual) does not
automatically translate to application of a negative payment adjustment under the VBM
program. An EP that fails to successfully report under PQRS as an individual or a group, may still avoid
a negative payment adjustment under the VBM program if at least 50 percent of the EPs under his/her
same tax identification number (TIN) successfully report under PQRS as individuals. This gives way to
the following surprising hypothetical scenarios, among others:
• Dr. Smith fails to successfully participate in PQRS, and is thus subject to the PQRS payment
adjustment. However, because 50 percent of the EPs within the Dr. Smith’s TIN successfully
individually participated in PQRS, Dr. Smith is exempt from the automatic additional -2 percent
payment adjustment under the VBM program. Dr. Smith may even qualify for a positive value
modifier, dependent on the cost and quality composite scores achieved collectively by EPs
within his/her TIN.
• Dr. Kline successfully participates in PQRS as an individual and earns a PQRS incentive
payment. However, because Dr. Kline does not participate in PQRS as a group AND less than
50 percent of the EPs within Dr. Kline’s TIN do not individually participate in PQRS, Dr. Kline is
subject to a -2 percent payment adjustment under the VBM program.
Quality-tiering becomes mandatory: Quality-tiering was previously optional in CY 2013 and now it is
mandatory for the CY 2014 performance year. Groups of 100+ EPs that successfully meet the reporting
criteria for the PQRS incentive payment will be subject to an upward, downward (maximum -2 percent),
or neutral (0 percent) payment adjustment under the VBM program based on mandatory quality-tiering.
Groups of 10+ EPs will also be subject to the VBM program’s mandatory quality-tiering in CY 2014, but
will be protected from a potential downward adjustment since it is their first year subject to the VBM.
There is an additional cost measure assessed in the CY 2014 performance year: For the CY
2014 performance year, CMS introduces an additional cost measure, entitled the “Medicare Spending
Per Beneficiary (MSPB) measure.”This composite cost measure includes all Medicare Part A and Part
B payments during an MSPB episode, spanning from three days prior to a hospital admission to 30
days post-discharge. CMS initially proposed to attribute an MSPB episode to a group of physicians if
any EP in the group bills a Medicare Part B claim during that patient’s hospital admission. However,
CMS finalized an attribution methodology based on the plurality of services provided during the MSPB
episode.
Refines the Cost Measure Benchmarking Methodology to Account for Specialty Mix: CMS
examined the distribution of the cost composite scores among all groups of physicians and solo
practitioners to determine whether comparisons at the group level are appropriate. CMS found that its
current peer grouping methodology could have varied impacts on different physician specialties and
therefore will be enforcing specialty type adjustments when comparing physician group performance
accordingly.
Step 8: Review your PQRS and VBM performance and identify areas for improvement
A. What is the Physician Feedback Program? The Physician Feedback program authorizes CMS to develop
and distribute Quality Resource Use Reports (QRURs) that provide comparative data on quality and resource
use (cost) to physicians and groups of physicians furnishing services to Medicare Part B beneficiaries. The goal
is to help physicians identify areas for improvement in quality and efficiency prior to implementation of the VBM
program. For this reason, though the first performance year of the VBM program wasn’t until CY 2013, CMS
has been increasingly making physician groups aware of their performance on VBM quality and cost measures
via distribution of QRURs since CY 2011.
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CY 2014 Physician Quality Reporting System (PQRS) 101
B. Where can I access analyses of the findings from the QRURs distributed over the years?
CY 2010 QRURs: Distributed in September 2011 to 35 physician groups consisting of 200+ EPs that elected to
participate in the CY 2010 PQRS Group Practice Reporting Option (GPRO).
CY 2011 QRURs: Distributed in December 2012 to 54 large physician groups that participated in the CY 2011
PQRS via the GPRO web-interface. That same year, CMS also distributed individual QRURs to nearly 100,000
individual physicians affiliated with group practices of 25+ EPs.
Supplemental CY 2011 QRURs: Distributed in June 2013, aiming to demonstrate episode-based costs for the
54 large group practices that received CY 2011 QRURs. The QRURs illustrated the CMS episode grouper
prototype and its classification system, using the following three categories: chronic, acute, and procedural.
The 2011 supplemental QRURs include episode-based costs for five clinical conditions: pneumonia, acute
myocardial infarction (AMI), coronary artery disease, percutaneous coronary intervention (PCI), and coronary
artery bypass graft (CABG). CMS notes that they will continue to experiment with various attribution
methodologies and risk adjustment approaches in effort to improve the development of episode groupers in
future years.
CY 2012 QRURs: Distributed in September 2013 to groups of 25+ EPs. In addition to containing quality and
cost data, these reports gave physicians a preview of how they would fare under the VBM program. In fact, the
QRURs provided physician groups of 100+ EPs with quality-tiering information on 2012 data in an effort to help
aid their decision to elect quality-tiering in the CY 2013 performance year.
CY 2013 QRURs: Anticipated for release in Summer of CY 2014.
C. Where can I go to access a summary of my performance results? Authorized representatives of physician
groups can access the Quality Resource Use Reports (QRURs) and individual Eligible Professional (IEP) PQRS
Performance Reports at https://portal.cms.gov using an Individuals Authorized Access to the CMS Computer
Services (IACS) IACS account. Authorized representatives of groups must sign up for a new IACS account or
modify an existing account at https://applications.cms.hhs.gov. Physician groups can also contact the Physician
Value Help Desk for assistance accessing their reports at: Phone: 1 (888) 734-6433, press option 3; (TTY
1-888-734-6563); Email: pvhelpdesk@cms.hhs.gov.
D. Will my performance be made public and, if so, will I have the opportunity to review it first? Beginning
in CY 2014, CMS will make publically available certain physician performance data on the Physician Compare
Website. CMS will provide a 30-day preview period prior to publication of quality data on Physician Compare
so that group practices and ACOs can view their data as it will appear on Physician Compare before
it is publicly reported.
For CY 2014,CMS has committed to making publically available on the Physician Compare website
performance on the Diabetes Mellitus (DM) and Coronary Artery Disease (CAD) PQRS Group Practice
Reporting Option (GPRO) measures collected via the GPRO web-interface for a minimum sample size of
20 patients. Also beginning in CY 2014, CMS begins publically reporting Clinician and Group Consumer
Assessment of Healthcare Providers and Systems (CG-CAHPS) data for group practices of 100+ EPs
reporting data in 2013 under the GPRO, and for ACOs participating in the Shared Savings Program.
As indicated in the CY 2014 PFS Final Rule, CMS intends to expand the list of physician performance
information that will be publically available on the Physician Compare website in CY 2015. CMS plans
to post performance on all measures collected through the GPRO web-interface for groups of all sizes
participating in PQRS in the CY 2014. CMS also intends to make available performance on GPRO
measures reported via registry or EHR as well as individual measures reported via registry, EHR, or claims
if they are also measures that can be reported via the GPRO web-interface. Additionally, CMS will make
publically available data for any group practice that voluntarily chooses to report CG-CAHPS, regardless
of group size. In CY 2015, CMS also plans to publically report on individual Cardiovascular Prevention
measures in support of the Million Hearts Initiative.
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