As the end of 2012 draws near, eligible professionals who have not already begun reporting PQRS measures will soon decide whether or not they will begin in 2013. As you know, the Physician Quality Reporting System (PQRS) was launched in 2006 (originally named the Physician Quality Reporting Initiative or PQRI) in order to provide a financial incentive to eligible professionals for voluntarily reporting data on designated quality measures with regard to Medicare patients. For 2012, eligible professionals who satisfactorily report on at least three (3) measures could receive an incentive payment of 0.5% of their total estimated allowed charges for Medicare Part B Physician Fee Schedule (PFS) covered services provided during the reporting period. The same incentive payment will be available to eligible professionals (which includes physicians, physician assistants, and nurse practitioners, among others) for 2013 and 2014.
While the program is technically voluntary, eligible professionals who do not satisfactorily report PQRS measures will experience a negative payment adjustment, which is based upon the professional’s total Medicare charges during the reporting period, beginning in 2015. It is important to note that the negative payment adjustment of 1.5% for 2015 will be based upon the measures reported during 2013; in other words, to avoid experiencing any “penalty” adjustments, eligible professionals must begin reporting PQRS measures in 2013. See chart below.
From an emergency provider standpoint, there are 16 measures out of over 300 measures that apply to the emergency department setting:
#28 – Aspirin at Arrival for Acute Myocardial Infarction (AMI)
#31 – Deep Vein Thrombosis (DVT) Prophylaxis for Ischemic Stroke or Intracranial Hemorrhage
#54 -12-Lead Electrocardiogram (ECG) Performed for Non-Traumatic Chest Pain
#55 -12-Lead Electrocardiogram (ECG) Performed for Syncope
#56 – Community-Acquired Pneumonia (CAP): Vital Signs
#57 – Community-Acquired Pneumonia (CAP): Assessment of Oxygen Saturation
#58 – Community-Acquired Pneumonia (CAP): Assessment of Mental Status
#59 – Community-Acquired Pneumonia (CAP): Empiric Antibiotic
#76 – Central Venous Catheter (CVC) Insertion Protocol
#91 – Acute Otitis Externa (AOE): Topical Therapy
#92 – Acute Otitis Externa (AOE): Pain Assessment
#93 – Acute Otitis Externa (AOE): Systemic Antimicrobial Therapy – Avoidance of Inappropriate Use
#252 – Anticoagulation for Acute Pulmonary Embolus Patients
#253 – Pregnancy Test for Female Abdominal Pain Patients
#254 – Ultrasound Determination of Pregnancy Location for Pregnant Patients with Abdominal Pain
#255 – Rh Immunoglobulin (Rhogam) for Rh-Negative Pregnant Women at Risk of Fetal Blood Exposure
Eligible ED-based professionals should report on at least three (3) measures during the reporting period (typically January 1 – December 31 for ED-based professionals) in order to receive the incentive payment. While there are several ways in which to submit PQRS measures to CMS, the two main methods for ED-based professionals are claims-based submissions and registry-based submissions. Regardless of the method used, the most important aspect of PQRS measurement is ensuring that the required data elements for each measure are properly included in the medical record; conversely, it is equally as important to document the patient, medical, or health system reasons why a particular measure was not met for a specific patient in order to still get credit for the measure (ex: aspirin not given on arrival due to patient refusal or aspirin allergy). For claims-based submissions, coding professionals can assign a designated code and modifier in order to report the measure to CMS based on the information in the medical record.
Specially trained medical scribes can help physicians document PQRS measures. As an advanced training topic, scribes can learn the data elements necessary to include in the medical record in order to get credit for a particular PQRS measure. Scribes can prompt physicians to include additional, necessary information, such as providing the medical or patient reason for not meeting a certain measure. While the eligible professional is ultimately responsible for all information entered into the record, it is invaluable to have a scribe trained in recognizing the type of patient encounters for which the physician will be able to report on the quality of care provided.
For more information on scribe training innovations as provided by PhysAssist Scribes, please click here.
- Brittany Baine, J.D.
PQRS Incentive Payments or Payment Adjustments by Calendar Year
2011: 1.0% incentive payment
2012: 0.5% incentive payment
2013: 0.5% incentive payment
2014: 0.5.% incentive payment
2015: -1.5% payment adjustment
2016 and beyond: -2.0% payment adjustment
Information on PQRS can be found on the CMS website, found here.
ACEP FAQ on PQRS and Emergency Medicine can be found here.