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Knowledge is power, the saying goes, and access to more information about the quality of care that we provide to patients will help improve the way we deliver healthcare in this country. To that end, the U.S. government established the Physician Quality Reporting System (PQRS) for the Centers for Medicare and Medicaid Services, or CMS. The PQRS was designed to help eligible providers provide a higher standard of care to each patient they treat, as well as to quantify their ability to meet various quality metrics.

Chances are that as a busy physician, your schedule has already been packed with all the normal duties of your practice, leaving you with little time to research into PQRS. Doctors in need of useful information to run their practice better can subscribe to this blog to stay updated on industry best practices and trends.

Keep in mind that the PQRS has been combined into the Merit-based Incentive Payment System or MIPS, but doctors will want to know more about the basics of PQRS as it relates to quality control and how the U.S. government motivates eligible doctors to participate.

With that said, here are answers to six of the most frequently asked questions that we hear about PQRS.

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1. What’s the Purpose of PQRS?

Our government established the Physician Quality Reporting System because it recognized the importance of measuring the quality of healthcare services that we deliver in order to make any kinds of improvements.

Patients benefit because of lowered costs, to be sure. Members of the public were also able to look at the performance scores of different medical organizations, so they could better determine if they wanted to get treatment at your facility or at one of your competitors.

The government wanted a process where it could collect healthcare data and encourage organizations to boost quality, with online information paving the way.

2. Is PQRS a Stand-alone Program?

Remember that PQRS is no longer a stand-alone program, as it was actually rolled into the Merit-based Incentive Payment System (MIPS) under the new Quality Payment Program in 2017.

3. Why Is it Important to Report PQRS Data?

Instead of keeping patient details to yourself, for only your staff to examine and manipulate the data in analytics, you can provide useful information to the healthcare industry by reporting it to the PQRS database. Patients use this valuable information to make decisions about where to spend their healthcare dollars—should it be at your practice or the one located down the street?

When you participate in reporting quality metrics, it means that there will be a system behind that in your office to do cost-saving tasks, such as screening patients for high blood pressure, obesity and diabetes so you can begin a treatment program for these ailments and reduce the number of associated complications. Likewise, you will have a protocol that has you encouraging all senior members of your patient pool to come in for a flu shot (and perhaps a vaccination for a condition like shingles).

4. What Are the Benefits of Participating?

One benefit of participating is that doctors will have a sense of fulfilling their civic duty, by making this vital health information available to researchers. The more information they provide that makes its way into the public scoring of each practice, the more chances they have of new patients finding and then selecting them for service.

While CMS no longer provides financial incentives in the form of payment, the PQRS system still benefits you because participants will no longer see a penalty of 2% decrease in reimbursement.

5. Who Can Participate?

Doctors who provide services to be reimbursed through CMS were deemed eligible to participate. To begin, you must use a certified Electronic Health Record or EHR application when you report patient data. It’s best to go with an EHR that has a simple and clear user interface, so your staff will spend more time on inputing patient data rather than contending with a clunky menu system.

If you do not currently have an EHR in place, now is the time to deploy this software, which saves significant time and effort for your staff.

You can participate in two ways. The first option is to participate as a Group Practice. Doing so requires you to use a web interface if you have 25 or more providers in your group. You also have to include CAHPS for PQRS Survey if your group has 100 or more eligible providers. It is optional if you have fewer.

The requirement for a web interface is waived if you are using option 2, to participate as an Individual Provider. Each individual provider is exempt from CAHPS as well.


6. Are There Incentives or Penalties?

First, you should know that the government made it voluntary to participate in the PQRS. But to encourage participation, the CMS initially provided incentives, with financial reimbursement to those who did provide reports.

After the initial period of monetary motivation, the CMS stopped offering reimbursements and instead went with a penalty approach, where doctors would see a reduction of 2% in Medicare Physician Fees. So, it would be in your best interest to participate, since doing so will have a clear effect on your bottom line.

Now that you have become more acquainted with the PQRS and how the philosophy of establishing and meeting quality metrics motivates all parties to improve the way they deliver healthcare, you will most certainly want to stay on top of healthcare industry developments. An easy way to remain informed on emerging medical topics is to click here to subscribe to the blog.


Key Takeaway

  • The U.S. government established the Physician Quality Reporting System (PQRS) for the Centers for Medicare and Medicaid Services in an effort to improve the quality of care.
  • Controlling costs and emphasizing quality of care over quantity of care is a central aspect to reporting quality, such as through the PQRS.
  • The goals of quality control through PQRS have been integrated into the government’s newer Merit-based Incentive Payment System or MIPS.
  • Reporting data and keeping track of it enables doctors to compare how well they are doing in quality. The information also helps public health researchers with access to aggregated information on patient treatment and outcomes across the country.
  • If you participate by providing information in a quality information sharing system, you can be eligible to receive financial reimbursement from the government.
  • A focus on quality of care over quantity of care is driving the expansion of systems such as the PQRS, with an eye toward bringing down healthcare costs while improving outcomes for all patients.


About Christina Rosario

Christina Rosario is the Director of Sales and Marketing at Advanced Data Systems Corporation, a leading provider of healthcare IT solutions for medical practices and billing companies. When she's not helping ADS clients boost productivity and profitability, she can be found browsing travel websites, shopping in NYC, and spending time with her family.