The Physician Quality Reporting Initiative (PQRI) was established by Congress in 2006 to improve quality reporting in healthcare. It provides incentives for eligible professionals to satisfactorily report data on quality measures for their Medicare patients. Professionals can report either through claims-based reporting using CPT codes or registry-based reporting which involves submitting data to a registry. While the program aims to encourage adoption of electronic health records, participation is currently voluntary though incentives are in place.

1. Presented by
Michal S. Klein

2. • In 2006 the Tax Relief and Health Care Act (TRHCA) was
passed by Congress.
• Required establishing a physician quality reporting
system.
• This program was named the Physician Quality Reporting
Initiative (PQRI) by CMS (Center for Medicare and
Medicaid Services).
• The Physician Quality Reporting Initiative (PQRI) is a
program designed by CMS to improve the quality of
reporting in the healthcare industry.

3. • Includes an incentive payment for EPs (Eligible
Professionals) to encourage them to satisfactorily report
data on quality measures for their Medicare patients.
• Program is voluntary for EPs, it is meant to encourage use
of a certified EHR software program.
• PQRS also encourages submission of valuable data for
analysis which can be used to improve health care for
patients.

4. • In 2011, the program name was changed to Physician
Quality Reporting System (PQRS).
• The first reporting period started with the second half of
2007 (July 1-December 31).
• EPs have been able to report for either a whole calendar
year (January 1-December 31) or for half a calendar year
(July 1-December 31).
• A new change in 2012 says an EP can only report with the
6-month reporting option when reporting measures
groups via a registry.
• EPs report on individual measures or a measures group.

5. • Claims Reporting vs. Registry Reporting
• Claims-based reporting uses special CPT codes submitted
on the claim that link to quality measures.
• Data submission is responsibility of the EP or group
practice, or the billing company might provide service for
a fee.
• Registry reporting involves the EP or group practice
submitting data to a registry who collects data and
submits it to CMS on their behalf.

6. Claims-based reporting:
 Advantage is:
 You are in control of your own data from completion to
submission.
 Cheaper- No added cost.
 Only 50% submission is necessary.
 Disadvantage is:
 A designated person in charge is needed to:
• Complete audits.
• Know all the ins/outs of PQRS.
• Keep record of the % completed.

7. Registry reporting:
 Advantage is:
 Someone stores and submits the data for you.
 No internal audits are necessary.
 Disadvantage is:
 There is a nominal fee for registry. But ROI in staff time
saved, office supplies and decreased stress levels are worth
it.
 80% reporting is necessary, but with EMR in place there
should be 100% data collection.

8. • The incentive started out as a 2% bonus of total allowed
Medicare Part B Fee-For-Service (FFS) charges for
reporting on a minimum of 3 Quality Measures or 1 of 14
Measure Groups.
• For 2011 reporting, PQRS provides a 1% bonus.
• PQRS bonuses are based upon minimally reporting on 1
measure group or 3 individual measures. The threshold
for successful PQRS participation is reporting on at least
30 eligible patient encounters for Measure Group
reporting or on 80% of all eligible Medicare Part B FFS
patients.

9. • PQRS is voluntary for EPs, but Section 111 of the
Medicare Improvements for Patients and Providers Act of
2008 (MIPPA) further modified PQRI adding new
mandatory reporting requirements for group health plan
(GHP) arrangements and for Liability Insurance (including
Self-Insurance), No-Fault Insurance, and Worker’s
Compensation.
• Who must report: "an entity serving as an insurer or third
party administrator for a group health plan…and, in the
case of a group health plan that is self-insured and self-
administered, a plan administrator or fiduciary."

10. • CMS views Quality Reporting as a key determinant of
evidence-based medicine, supporting the transition from
fee-for-service to fee-for-value reimbursements by 2015.
• Incentives encourage EPs and group practices to adopt an
EHR software program and to report their patient’s data
to CMS for analysis.
• Interconnected with MU (Meaningful Use). Smoking
status and quality measures requirement in MU core set
are satisfied with PQRS.
• In the future hopefully data submission will be second
nature so that it can be used to study different health
conditions and behavior trends to improve health care for
all.

11. • https://www.cms.gov/PQRS/
• https://www.cms.gov/MandatoryInsRep/
• https://www.cms.gov/PQRS/Downloads/2012WhatsNew
PQRS_Final508_1-23-2012.pdf
• http://www.ehealthmadeeasy.com/d7.htm
• http://www.webpt.com/blog/post/registry-vs-claims-
based-reporting-pqrs-pqri
• http://www.mdinteractive.cc/2011-pqri-reporting-
options