How to Select Which PQRS Measures to Report On A Case-By-Case Basis

Obaid Rahman / January 19, 2016

The EHR Physicians Quality reporting System or PQRS is a pay-to-report incentive program initiated by the CMS under the Electronic Health Records (EHR) Incentive programs. The program pays qualifying EPs or eligible professionals an incentive equivalent to 0.5% of their total estimated Medicare Part B PFS allowed charges for covered professional services furnished during that same reporting period.

Download an ENT’s Definitive Guide to the 2015 Physician Quality Reporting System (PQRS)

However, in order to successfully report measures related to your practice, you must first understand how to pick the measures that best fit your practice and also understand the conventions through which you will be reporting. Understanding how to select which PQRS measures to report on a case-by-case basis will therefore require following these steps:

Review the Measures List

To begin with, you’ll need to familiarize yourself with the various measures, domains, and reporting channels that are most likely to apply to your practice. This means that if you are an ENT, you’ll need to find all the measures that would likely apply to a majority of cases that you handle each year.

Remember you’ll be reporting measures for 50% or higher of the total patients you see so if you choose measures or domains that do not or infrequently apply to the cases you handle, you may be unable to meet the PQRS reporting threshold.

It’s also important to note that measures get reviewed on a year by year basis and also that measures may have different titles and descriptions across different EHR incentive programs. It’s therefore important to ensure you use the measures list specific to the program and year you are participating in. Practices participating in the GPRO program will find that there are a fixed list of measures on the GPRO Web Interface, all of which must be reported.

Important Factors to Consider

After familiarizing yourself with the measures, domains and reporting channels, it’s then imperative that you look at some of the important factors that will determine the measures you report and how you report them. According to the CMS website, these factors include:

  • Clinical conditions usually treated.
  • Types of care typically provided – e.g., preventive, chronic, acute.
  • Settings where care is usually delivered – e.g., office, emergency department (ED), surgical suite.
  • Quality improvement goals for 2015.
  • Other quality reporting programs in use or being considered by the National Quality Strategy, a prioritizing mechanism of 6 NQS domains under which various measures fall under.

Reviewing these factors will help you clarify further the measures you will need to report and also give you a better understanding of how to incorporate measures reporting into your practice’s workflow. After considering this, move to the final step, which is reviewing specifications.

Review Specifications

Undertake this step with an aim of understanding the exact steps and requirements required to report the measures you have chosen. These specifications are defined for the selected reporting option for each measure under consideration.

The aim of these specifications is to ensure you are able to review each measure’s denominator coding to determine which patients may be eligible for the selected PQRS measure or measures. For individual EPs, this may be for individual measures or for Measures Groups while GPRO reporting practices can only report individual measures.

When reviewed consecutively and consistently, these three steps will help you understand which measures to pick, how to apply them to each case you receive and how to report them effectively to avoid any penalties from the CMS. 

Download an ENT’s Definitive Guide to the 2015 Physician Quality Reporting System (PQRS)

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