Quality Reporting Programs

Explore the basics on some of the Federal quality reporting programs. For more information or questions, please contact ACR staff at programs@rheumatology.org.

Physician Quality Reporting System (PQRS)

PQRS is a quality reporting program that rewards eligible professionals (EPs) for satisfactorily reporting data on quality measures for services furnished to Medicare Part B beneficiaries.

How to avoid the payment adjustment by using RISE:

  • RISE is a Qualified Clinical Data Registry (QCDR) and participation in RISE according to CMS requirements will help you avoid the PQRS payment adjustment
  • Learn more about RISE
  • EPs who successfully report for PQRS using RISE will also satisfy the registry reporting requirement in Meaningful Use,however, they will still be required to meet the other MU objectives through the CMS registration and attestation system

How to avoid the payment adjustment by using the RCR:

  • Sign up for the RCR by emailing rcr@rheumatology.org
  • Users must report on a minimum of 20 patients, a majority (at least 11 out of 20) of which must be Medicare Part B patients
  • The reporting period is 12 months; patients include those seen by the EP within the 2016 year
  • Users will report on the RA measures group, which includes 8 measures, view the measures group
  • The deadline to finish reporting is December 31, 2016 and data will be submitted on March 31, 2017

View the PQRS Timeline 2015-2017

EHR Incentive Programs - (Meaningful Use)

For the 2016 program year, providers must demonstrate meaningful use of Electronic Health Record (EHR) systems by meeting specific criteria. All providers are required to attest to a single set of objectives and measures. This replaces the previous structure of previous stages that required attestation to a core and menu set of objectives.

Eligible professionals report the following ten objectives:

  1. Protect Electronic Protected Health Information
  2. Clinical Decision Support
  3. Computerized Provider Order Entry
  4. Electronic Prescribing (eRx)
  5. Health Information Exchange
  6. Patient-Specific Education Resources
  7. Medication Reconciliation
  8. Patient Electronic Access
  9. Secure Electronic Messaging
  10. Public Health Reporting

The EHR reporting period must be completed within January 1 – December 31 of the 2016 calendar year. For all returning participants, the reporting period will be the full calendar year from January 1, 2016 - December 31, 2016. For eligible professionals who have not successfully demonstrated meaningful use in a prior year, the reporting period will be any continuous 90-day period.

All providers must attest to objectives and measures using EHR technology certified to the 2014 Edition. All providers may attest to objectives and measures using EHR technology certified to the 2015 Edition, or a combination of the two (if the 2015 Edition is available).

Value-Based Modifier (VBM)

The Value Based Modifier (VBM) program provides comparative performance information to physicians to help improve the quality of medical care. Physicians are paid based on the quality of care furnished compared to the cost of care. The VBM is being phased in slowly and will affect all physicians beginning in 2017 based on 2015 performance. The VBM’s quality measurement component is aligned with the reporting requirements under PQRS.

Learn more about the value-based modifier on the CMS website.

Contact CMS QualityNet Help Desk at 1-866-288-8912 or qnetsupport@hcqis.org.

MACRA

Keep in mind that, beginning in 2017, the Medicare Access and CHIP Reauthorization Act (MACRA) will be in effect. The MACRA will combine existing quality reporting programs into one new system and allow providers to choose from two payment paths, including the Merit-Based Incentive Payment System (MIPS) and Alternative Payment Models (APMs).

MIPS is a new program that combines the Physician Quality Reporting System (PQRS), Meaningful Use (MU), and the Value Based Modifier (VBM) into one single program in which eligible professionals will be measured on quality, resource use, clinical practice improvement, and meaningful use of certified EHR technology.

APMs include payment models that incentivize providers on quality, outcomes, and cost containment. Accountable Care Organizations (ACOs), Patient Centered Medical Homes, and bundled payment models are some examples of APMs.

Please visit the MACRA page for more information.