What is the EHR PQRS Incentive Program?

dr_EHR / January 18, 2016

The Physician Quality Reporting System or PQRS incentive program is a program that falls under the wider Medicare and Medicaid Electronic Health Care Record (EHR) incentive programs. Previously known as the Physician Quality Reporting Initiative or PQRI, the program was conceived as a far-reaching incentive program targeted at eligible professionals, hospitals and critical access hospitals (CAHs) to reward them for the adoption, implementation, upgrading or demonstration of meaningful use of certified EHR technology.

The PQRS incentive program has its origins in the 2006 Tax Relief and Health Care Act (TRHCA) that occasioned the setting up of an incentive program to reward eligible professionals for the consistent and diligent reporting of quality measures drawn from 74 individual quality measures drafted at the time.

Drafted by the Centers for Medicare and Medicaid Services, the program did its maiden cruise from July 1, 2007 through December 31, 2007, requiring eligible professionals or EPs to report at least three quality measures from the pool of measures supplied for a cumulative 80% of all the cases they handled. EPs that successfully reported quality measures during this initial run were rewarded with a pay-to-report incentive of 1.5% of the total estimated allowable charges as reflected in the Medicare Part B Physician Fee Schedule (PFS).

The PQRI incentive program, having gained traction during this trial run, was revived through the Medicare, Medicaid, and SCHIP Extension Act of 2007 (MMSEA) for years 2008 and 2009. During this period, the CMS was charged with adding some modifications to how the initiative worked. Some of the main changes the initiative underwent included the establishment of alternative reporting criteria and alternative reporting periods for reporting of various measures groups, the establishment of clinical data registries through which reporting could be done, as well as the defining the applicability of alternative reporting criteria whether through the registry or via claims.

The PQRI program finally found permanency through the Medicare Improvements for Patients and Providers Act of 2008 (MIPPA) and this brought with it the authorization of incentive payments, now raised to 2%, through 2010. Electronic prescribing measure was also spun off during this reincarnation of the program with the possibility of this measure becoming a stand-alone incentive program in itself with a reward of another 2% over and above the PQRI incentive.

Through 2009 and 2010, the program had an increase and diversification of quality measures, the development of additional measures groups, the finalization and implementation of group reporting as well as it becoming mandatory for the CMS to publish on its website a list of eligible professionals who have successfully participated in the program.

The PQRI finally became the PQRS program owing to the enactment of the Affordable Care Act (ACA), which came with a further addition of measures and measures groups, including measures for claims and registry reporting, registry-only measures, and measures for EHR-based reporting only.

In 2015, the quality measure list has grown to include 254 individual measures that fall under a number of measures groups. In addition, the number of ways an EP can do their reporting has grown to five while the number of ways groups can report has also grown to a total of five channels as well. Also in 2015, the CMS introduced a negative payments adjustment to penalize EPs that did not satisfactorily report data on quality measures applicable to their specialty or practice. This negative adjustment is currently pegged at 1.5% of the total estimated amount they are eligible for under the Medicare Physician Fee Schedule (PFS) and is set to rise to 2% in 2016.