The Physician Quality Reporting System (PQRS) is a quality reporting program. PQRS encourages individual eligible professionals (EPs) and group practices to report information on the quality of care to Medicare. Eligible professionals (EPs) who participate in the program transmit data to the Center for Medicare and Medicaid Services (CMS) regarding selected quality measures. There is no requirement to participate in PQRS; however, negative payment adjustments based on non-participation began in 2015. Those who reported satisfactorily for the 2015 program year will avoid the 2017 PQRS negative payment adjustment.

In 2016, ASCO encourages oncologists to consider reporting to PQRS using a CMS-approved registry and the oncology measure group. ASCO's Quality Oncology Practice Initiative (QOPI®) has been deemed by CMS for standard registry and Qualified Clinical Data Registry (QCDR) reporting for 2016. 

Financial Incentives and Penalties

Physicians who do not participate in PQRS will be subject to a financial penalty, or "payment adjustment." Based on 2016 reporting, EPs can face a payment adjustment of -2.0% in 2018 if they do not satisfactorily report. This is on top of other penalties from the Value-Based Payment Modifier (VBM).

Eligibility

Eligible Professionals (EPs) for PQRS are those who provide services paid under or based on the Physician Fee Schedule (PFS). EPs include Medicare physicians, physician assistants, and nurse practitioners. A full list of EPs can be found on the CMS website. It should be noted that the definition of an EP has expanded in 2016.

Reporting Options and Requirements

Reporting mechanisms vary depending on whether the EP is reporting as an individual or a group. Click on the items below to find more information about each option.

Group Practice Reporting Options

ASCO's Quality Oncology Practice Initiative (QOPI®) has been deemed by CMS for standard registry and Qualified Clinical Data Registry (QCDR) reporting for 2016.

Oncology Measure Group Reporting Using an Approved Registry

ASCO encourages oncologists to report to PQRS using a CMS-approved registry that supports the oncology measure group.  ASCO's Quality Oncology Practice Initiative (QOPI®) has been deemed by CMS for standard registry and Qualified Clinical Data Registry (QCDR) reporting for 2016.  An approved list of registries for 2015 can be found on the CMS website. Within this list, look for registries designated as supporting "all measure groups" or specifically listing the oncology measure group.

For 2016, prospective qualified registries must submit a nomination containing their self-nomination, PQRS measures, and data validation plan by January 31, 2016.

The 2016 Oncology/Hematology Preferred Specialty Measure Set can be found on the CMS website.

Individual Reporting Mechanisms and Requirements

Claims

  • Report on at least 9 measures across 3 NQS domains for at least 50% of the EP’s Medicare Part B Fee-For-Service (FFS) patients.
  • EPs who see 1 Medicare patient in a face-to-face encounter must also report on 1 cross-cutting measure.

OR

  • EPs who submit quality data for only 1 to 8 PQRS measures for at least 50% of their patients or encounters eligible for each measure, OR who submit data for 9 or more PQRS measures across fewer than 3 domains for at least 50% of their patients or encounters eligible for each measure will be subject to Measure-Applicability Validation (MAV).
  • EPs who see 1 Medicare patient (face-to-face encounter), but do not report on 1 cross-cutting measure will be subject to MAV.(See the Analysis and Payment webpage for more information on MAV).

Qualified PQRS Registry

  • Report on at least 9 individual measures covering 3 National Quality Strategy (NQS) domains for at least 50% of the EP’s Medicare Part B FFS patients.
  • EPs who satisfactorily report for only 1 to 8 PQRS measures across 3 NQS domains for at least 50% of the EP’s Medicare Part B FFS patients OR who submit data for 9 or more PQRS measures across less than 3 domains for at least 50% of the EP’s Medicare Part B FFS patients eligible for each measure will be subject to Measure-Applicability Validation (MAV).

OR

  • Report at least 1 measures group on a 20-patient sample, a majority of which (at least 11 out of 20) must be Medicare Part B FFS patients.

Electronic Health Record

  • Report on at least 9 measures across at least 3 National Quality Strategy (NQS) domains
  • Use a direct EHR product that is Certified EHR Technology (CEHRT) or EHR data submission vendor that is CEHRT
  • If the EP’s CEHRT does not contain patient data for at least 9 measures across at least 3 domains, then the EP must report the measures for which there is Medicare patient data. An EP must report on at least 1 measure containing Medicare patient data.
  • Report on all payers.

Qualified Clinical Data Registry

  • Report at least 9 measures covering 3 National Quality Strategy (NQS) domains for at least 50% of the EP’s applicable patients seen during the 2015 participation period.
  • Report on at least 2 outcome measures. If the QCDR does not possess 2 outcome measures, then the QCDR must possess at least 1 outcome measure and 1 of the following other types of measure: 1 resource use, OR patient experience of care, OR efficiency appropriate use, OR patient safety measure.*
  • *EPs participating via QCDR should work with their selected QCDR to determine how to participate.

Group Practice Reporting Option Reporting Mechanisms and Requirements

Web Interface

For group size of 25-99 EPs:

  • Report on all measures included in the GPRO Web Interface; AND
  • Populate data fields for the first 248 consecutively ranked and assigned beneficiaries in the order in which they appear in the group’s sample for each module or preventive care measure.
  • If the pool of eligible assigned beneficiaries is less than 248, then report on 100 percent of assigned beneficiaries.
  • A PQRS group practice must report on at least 1 measure for which there is Medicare patient data.
  • In addition, the PQRS group practice choosing to take part in the PQRS GPRO Web Interface may additionally choose to participate in CAHPS for PQRS. If that election is made, the group practice must also report all CAHPS summary survey modules via a CMS-certified survey vendor (CAHPS for PQRS). CMS will not bear the cost of administering.

For group size of 100+ EPs:

  • Report on all measures included in the Web Interface; AND
  • Populate data fields for the first 248 consecutively ranked and assigned beneficiaries in the order in which they appear in the group’s sample for each module or preventive care measure.
  • If the pool of eligible assigned beneficiaries is less than 248, then report on 100 percent of assigned beneficiaries.
  • A PQRS group practice must report on at least 1 measure for which there is Medicare patient data.
  • In addition, the PQRS group practice choosing to take part in the PQRS GPRO Web Interface must also report all CAHPS summary survey modules via a CMS-certified survey vendor (CAHPS for PQRS). CMS will not bear the cost of administering.

Qualified PQRS Registry

  • Report on at least 9 measures covering 3 NQS domains for at least 50% of the group’s Medicare Part B FFS patients.
  • Group practices that submit quality data for only 1 to 8 PQRS measures covering 1-3 NQS domains for which there is Medicare patient data must report for at least 50% of the group practice’s Medicare Part B FFS patients seen during the reporting period to which the measure applies, OR that submit data for 9 or more PQRS measures across less than 3 domains for at least 50% of their patients or encounters eligible for each measure will be subject to MAV.
  • If 1 Medicare patient is seen face-to-face during the reporting period, the PQRS group practice must report on at least 1 cross-cutting measure.

Electronic Health Record

  • Register to report via EHR under Group Practice Reporting Option (GPRO) for PQRS 
  • Report on at least 9 measures across at least 3 National Quality Strategy (NQS) domains
  • Use a direct EHR product that is Certified EHR Technology (CEHRT) or EHR data submission vendor that is CEHRT
  • If the PQRS group practice’s CEHRT does not contain patient data for at least 9 measures across at least 3 domains, then the group practice must report the measures for which there is Medicare patient data.
  • A group practice must report on at least 1 measure containing Medicare patient data.
  • Report on all payers.

Consumer Assessment of Healthcare Providers and Systems (CAHPS)

  • CAHPS is required for groups of 100+ EPs.