The PQRS Basics
CMS states the Physician Quality Reporting System (PQRS) “has been using incentive payments, and will begin to use payment adjustments in 2015, to encourage eligible health care professionals (EPs) to report on specific quality measures.” Fundamentally, the purpose of PQRS is for EP’s to be able to quantify how often they meet a certain quality metric. Take into account, much like the Meaningful Use program, there are a number of objectives and steps to meet.
For example, if you are an EP participating in the PQRS program there are five different reporting methods.
- Medicare Part B claims
- Qualified Registry
- Direct Electronic Health Record
- CERHT via Data Submission Vendor
- Qualified Clinical Data Registry
As if these options aren't confusing enough, there is a note that states, “The PQRS program requirements and measure specifications for the current program year may be different from the PQRS requirements and measure specifications for a prior year. EPs are responsible for ensuring that they are using the PQRS documents for the correct program year.”
Another example is for group practices to report on PQRS quality measures under a different set of methods:
- Qualified PQRS Registry
- Web Interface
- Direct EHR
- CEHRT via Data Submission Vendor
- Qualified Clinical Data Registry
Is your head spinning yet? There’s more…
The AMA’s Distaste for Regulatory Soup
Just a few days ago the American Medical Association (AMA) stated they are “appalled by news from the CMS.” The reason for their discerning outlook is due to the fact that more than 50 percent of eligible professionals will face Meaningful Use Penalties in 2015. When looking at a number of more than 257,000, one can see why this report is less than desirable. The question is, “why is Meaningful Use so difficult to achieve?” Are the objectives truly that difficult, or has it met its match with physician resistance? After all, as the saying goes, “culture eats strategy for lunch.” The AMA thinks otherwise.
According to the AMA’s statement, “the Meaningful Use program was intended to increase physician use of technology to help improve care and efficiency. Unfortunately, the strict set of one-size fits all requirements are failing physicians and their patients.” However, the dilemma is not founded in the complexity of MU objectives, but in this disconnect of overlapping Medicare incentive programs. To put it simply, there is too much going on at one time! Eligible physician’s primary focus is to provide quality care for their patients. This focus is affected because of stringent obstinate guidelines that are too complex for even the staff in charge of implementing them to understand. Ultimately, this muddled web of confusion that we’ve woven could potentially “pose a risk to the stability of the Medicare program.” This is a concern that the AMA delivered to Marilyn Tavenner of CMS back in October 2014. The AMA requested CMS to unify the requirements of these regulatory programs and reverse the cumulative effect of the 13 percent worth of penalties that will occur by the end of the decade.
Disregarding the Value-Based Payment Modifier (VBM) the overlap in allotted time periods combined with the quality measures and objectives from PQRS and MU alone have created a web of confusion that is puzzling for anyone to understand. Although, physician’s have a choice to participate and gain these incentives they are also penalized for trying to follow the confusing guidelines of these programs. Ultimately, from a long-term perspective, these changes may be great. However, this isn't as simple as the switch from analog to digital cable. What are your thoughts? Are we trying to change too much too fast?