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CMS To Combine Quality Reporting Programs

Janice Simmons, for HealthLeaders Media, June 29, 2010

Physicians who report quality measures to the Centers for Medicare and Medicaid Services (CMS) under the Physician Quality Reporting Initiative (PQRI) using electronic health records (EHRs) will soon be able to combine data with physicians who demonstrate "meaningful use" of those records under the HITECH Act. Under the new healthcare reform law, the deadline for combining the two programs is Jan. 1, 2012.

With PQRI, physicians participating in Medicare can receive incentives for reporting various quality measures -- a select number of which are being aimed at those who want to report using electronic health records. The PQRI first started in 2007.

Meaningful use measures that physicians could use for PQRI reporting through electronic health records include blood pressure measurement for hypertension, body mass index screening, and prevention care follow up, according to CMS.

As a result of healthcare reform, PQRI incentive payments are authorized through 2014. For 2011, the healthcare reform law states that providers may earn an incentive payment of 1% of the provider?s estimated total allowed charges for covered professional PFS services under Medicare Part B provided during the reporting period.

Meanwhile, providers who become "meaningful users" of EHRs, as laid down by the financial stimulus legislation in 2009, will be eligible for incentive payments as well.

The provision combining the two programs is included within a proposed rule about changes in Medicare physician payments for 2011.

In the proposed rule, CMS is soliciting comments on its approach to integrate measures of the two reporting programs. "Specifically, we encourage comments on how CMS plans to align the measures, and how the plan for integration will optimally improve quality of care for individuals and provide meaningful use of EHRs."

CMS also has proposed a number of key changes in 2011 for PQRI, including:

  • Adding 20 individual PQRI measures (including new measures for reporting through registries and electronic health records) and one new measures group on which individual providers may report;
  • Making 12 additional individual PQRI measures available for reporting through electronic health records systems (EHRs), in addition to the 10 measures already available for EHR reporting;
  • Reducing the reporting sample requirements for claims based reporting of individual measures from 80% to 50%, which could lessen the burden on providers to qualify for incentive payments; and
  • Creating a new group practice reporting option (GPRO) that would allow group practices with fewer than 200 providers to participate.

The proposed rule is expected to be published in the Federal Register on July 13. Comments will be accepted for 60 days after the date of filing.


Janice Simmons is a senior editor and Washington, DC, correspondent for HealthLeaders Media Online. She can be reached at jsimmons@healthleadersmedia.com.

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