Prepare for this year's significant changes to PQRI reporting

Now in its fourth year, the Medicare Physician Quality Reporting Initiative continues to adjust its parameters. ACP's Running a Practice section offers resources to stay atop the ebb and flow.

The Medicare Physician Quality Reporting Initiative (PQRI) is going into its fourth year, and like each previous year, there are changes and adjustments to the program parameters. This column highlights the significant changes.

Q: How many different ways are there to participate in PQRI?

A: For the 2010 PQRI, there are 175 individual measures, 13 measures groups, and four reporting options: claims-based reporting, registry-based reporting, electronic health record (EHR)-based reporting, and the new group practice reporting option (GPRO). Each option has different benefits and advantages for physicians. CMS officials note that providers who used registry-based reporting have had the highest rates of success in past years.


The CMS E-Prescribing (E-Rx) program is a similar incentive program, but has its own requirements and parameters .

Q: Our practice will be trying PQRI for the first time this year. Are there places to learn more about PQRI?

A: The College has a number of articles on the 2010 PQRI program. In addition, CMS offers a number of venues for learning about PQRI: National Provider Calls and Open Door Forums (conference calls) and fact sheets and program summaries available from the CMS Web site. Also, please check your Medicare administrative contractor's or carrier's Web site; they may be offering their own conference calls on PQRI as part of their outreach to physicians. To find out when CMS-sponsored calls are scheduled, go online or subscribe to the listservs of the National Institutes of Health.

Q: Do I need to register to participate? How do I get started?

A: There is no registration or sign-up for an individual physician to get involved in PQRI. Once you decide to participate, you will need to choose among the available quality measures and the accompanying reporting options.

An individual physician can choose to report his or her quality measure information on individual PQRI quality measures or measures groups via three mechanisms:

  1. 1. by submitting Medicare Part B claims to CMS,
  2. 2. by using a qualified PQRI registry or
  3. 3. by using a qualified EHR product.

Q: Tell me more about the EHR reporting option.

A: PQRI for 2010 adds the EHR-based reporting mechanism to promote the adoption and use of EHRs and to provide both physicians and CMS with experience on EHR-based quality reporting. CMS will begin accepting data from qualified EHR products on 10 individual PQRI measures.

In 2010, CMS will count physicians' submission of EHR-based measures toward their eligibility for a PQRI incentive payment. Physicians must successfully report data on at least three of the 10 EHR-based individual PQRI measures to receive an incentive payment. In previous years, EHR-based measure submission was on a voluntary or “pilot” basis and was not counted toward a physician's eligibility for an incentive payment.

Q: Tell me more about the new group practice reporting option.

A: For the group practice reporting option, there is an “up front” process. The group must comply with certain eligibility requirements, submit a self-nomination letter to CMS, and then be selected to participate in the 2010 PQRI GPRO. Success will be determined according to whether a group practice satisfactorily submits PQRI quality measures data; each of the selected group practices is required to report 26 quality measures.

For 2010, there are several reporting periods. For some quality measures, the reporting period is six months; for others, the reporting period is 12 months. The applicable reporting period for each measure is stated in specifications manuals:

Q: Can I get double incentive payments if I participate as an individual physician and as part of my group practice?

A: It's possible, under the right circumstances. The program rules state that although a physician can participate both as an individual and as part of a medical group practice, the incentive payment for successful reporting will be based on the physician's association with a Tax Identification Number (TIN).

For tracking purposes, once a group practice (identified by its TIN) is selected to participate in the GPRO, this is the only method of PQRI reporting available to the group and all individuals who bill Medicare under the group's TIN.

If the physician is participating as a member of a group practice in PQRI and is participating separately from that group practice with a separate TIN, that physician potentially could be eligible for two separate incentive payments, one for each TIN, assuming that all qualifying criteria for success are met.

Q: We participated in PQRI last year, and earned an incentive payment. Can we use the same reporting measures this year?

A: Yes, if the measures are still applicable. Be sure to check the measure specifications and release notes (updates) for 2010; they may have been modified since 2009. Be sure to use the most up-to-date information. The 2010 individual measures changes are documented in the yearly PQRI Release Notes , found on ACP's Web site. The release notes for the 2010 measures groups changes are online. If a measure you used in the past is no longer in the program, you will need to choose another appropriate reporting measure.