PQRS 2015
Written by Editor   
Wednesday, December 31, 2014 04:24 PM

The Patient Protection and Affordable Care Act (PPACA) mandated that non-participation or unsuccessful/unsatisfactory reporting in Medicare’s Physician Quality Reporting System (PQRS), formerly referred to as PQRI, will result in negative payment adjustments to Medicare reimbursement beginning in 2015.

In the 2012 Medicare Physician Fee Schedule Final Rule, the Centers for Medicare and Medicaid Services (CMS) ruled that providers who did not successfully/satisfactorily participate in PQRS by the 2013 reporting period will have their Medicare reimbursement decreased by 1.5 percent beginning on January 1, 2015. Non-participation or unsuccessful/unsatisfactory reporting during the 2014 performance period will result in a 2% reduction in a provider's 2016 Medicare reimbursement, and further non-participation or unsuccessful/unsatisfactory reporting this year (Jan. 1 -  Dec. 31, 2015) will affect a provider's 2017 Medicare reimbursement by applying a payment reduction of 2%.

If you have never participated in PQRS, you may not know where to begin. For those doctors of chiropractic who are continuing their participation in PQRS in 2015, please be advised that significant updates and revisions have been made to the PQRS Measures applicable to chiropractic practices. 

For the 2015 reporting period (January 1 – December 31, 2015), DCs have two (2) PQRS Measures that they are able to report. Getting Started with PQRS 2015—A Guidebook for Doctors of Chiropractic - The ACA has developed the PQRS Guidebook specifically with the chiropractic practice in mind. We have researched all of the 2015 regulations and measure specifications, identified the information that DCs need to know, and compiled that information into this succinct and efficient resource to assist with the proper implementation of PQRS reporting in your office.

“Quality” is an increasing concern for healthcare policymakers in Washington, DC. The word dovetails into various areas such as pay-for-performance and health IT. Although this issue and its related areas have been percolating for almost a dozen years (and there is some experience in private pay on the issues), with the development of actual quality measures and the continuing significant reimbursement reform challenges, this is all now on the front-burner where public programs (and specifically, Medicare) are concerned. The Tax Relief and Healthcare Act of 2006 linked reimbursement to reporting on quality measures for the first time; CMS’ Physician Quality Reporting System (PQRS), is the program associated with this.

Quality measures, generally, are rooted in evidence-based medicine. They can be “guideline” measures (e.g., you get 12 visits for acute low back pain), “process” measures (e.g., when a patient comes in with a cardiovascular episode and you gave them an aspirin), or “outcome” measures (e.g., "X" condition was resolved). There are also other types of measures, such as “structural,” “efficiency,” or “cost of care” measures.

Measures are not specialty-specific, and there is significant debate on the value of the different types of measures, with the community currently focusing mostly on “process” measures. Certain groups are also paying close attention to “structural” and “cost of care” measures. The ultimate goal of all parties is to have effective outcomes measures.

There is also significant debate about whether certain measures simply demonstrate competency or actually will improve quality. For example, some measures deal with the documentation of care. Many in the community argue that documentation of care should be happening anyway, while others point out that it doesn’t happen 100% of the time, hence there’s room for improvement—a gap in care—with which a measure could help.

Source: http://www.acatoday.org/content_css.cfm?CID=2296