Physician Quality Reporting System (PQRS) 2012

 
PQRS in 2012

There are three reporting methods available to eligible professionals to participate in PQRS:

  1. Claims based reporting during your regular process of submitting Medicare Part B claims to CMS
  2. Registry based reporting - Via a qualified PQRS registry, such as the PQRIWizard 
  3. Electronic Health Record (EHR) reporting - Via a qualified EHR product

Reporting requirements:
The reporting requirements differ for each of the outlined reporting methods. Requirements also differ depending on whether eligible professionals report on individual measures or on measures groups.

 
Claims based reporting

Individual Measures Reporting Criteria Reporting Period
  1. Report at least 3 PQRS individual measures
  2. For at least 50% of applicable patients for each measure
    Measures with a 0% performance rate will be considered in analysis but will not be considered satisfactorily reported for incentive eligibility.
 January 1, 2012 - December 31, 2012


Measures Group Reporting Criteria Reporting Criteria
  1. Report one measures group
  2. For 50% of applicable patients for each measure
    Measures groups containing a measure with a 0% performance rate will not be counted.
January 1, 2012 - December 31, 2012
 
  1. Report one measures group
  2. For 30 unique Medicare Part B FFS patients 
    Measures groups containing a measure with a 0% performance rate will not be counted.
January 1, 2012 - December 31, 2012


 
Registry based reporting

Individual Measures Reporting Criteria Reporting Period
  1. Report at least 3 PQRS individual measures
  2. For at least 80% of applicable patients for each measure.
    Measures with a 0% performance rate will not be counted.
January 1, 2012 - December 31, 2012

Measures Groups Reporting Criteria Reporting Period
  1. Report one measures group
  2. For 30 unique Medicare Part B FFS patients Measures groups containing a measure with a 0% performance rate will not be counted.
 January 1, 2012 - December 31, 2012
  1. Report one measures group
  2. For 80% of applicable patients (with a minimum of 15 patients during the reporting period)
    Measures groups containing a measure with a 0% performance rate will not be counted.
 January 1, 2012 - December 31, 2012
  1. Report one measures group
  2. For 80% of applicable patients (with a minimum of 8 patients during the reporting period)
    Measures groups containing a measure with a 0% performance rate will not be counted.
 July 1, 2012 - December 31, 2012

 
Electronic Health Record (EHR) based reporting:

Reporting Criteria Reporting Period
  1. Report at least 3 PQRS individual measures
  2. For at least 80% of applicable patients for each measure.
    Measures with a 0% performance rate will not be counted.
January 1, 2012 - December 31, 2012
  1. Report on ALL 3 Medicare EHR Incentive Program CORE measures. If the denominator for one or more of the core measures is 0, report on up to 3 Medicare EHR Incentive Program alternative core measures.
  2. Report on 3 (of 38) additional measures available for the Medicare HER Incentive Program.
January 1, 2012 - December 31, 2012


 
2012 Physician Quality Reporting Individual Measures

The 2012 PQRS includes 210 individual quality measures. 28 new measures for claims and registry based reporting were included for 2012. 9 measures from the 2011 program were retired for 2012.

A selection of the full measure set is highlighted below. The table references the measures most applicable to an otolaryngology practice. View the 2012 measure specification manual which includes all 210 measures.


Measure Title and Description
Reporting Options/Methods
Measure #20: Perioperative Care: Timing of Antibiotic Prophylaxis – Ordering Physician Claims, Registry
Measure #21: Perioperative Care: Selection of Prophylactic Antibiotic – First OR Second Generation Cephalosporin Claims, Registry
Measure #22: Perioperative Care: Discontinuation of Prophylactic Antibiotics (Non-Cardiac Procedures) Claims, Registry
Measure #23: Perioperative Care: Venous Thromboembolism (VTE) Prophylaxis (When Indicated in ALL Patients) Claims, Registry
Measure #30: Perioperative Care: Timely Administration of Prophylactic Parenteral Antibiotics Claims, Registry
Measure #46: Medication Reconciliation: Reconciliation After Discharge from an Inpatient Facility Claims, Registry
Measure #47: Advance Care Plan Claims, Registry, EHR
Measure #53: Asthma: Pharmacologic Therapy for Persistent Asthma Claims, Registry, EHR
Measure #64: Asthma: Assessment of Asthma Control Claims, Registry, EHR
Measure #66: Appropriate Testing for Children with Pharyngitis Claims, Registry, EHR
Measure #91: Acute Otitis Externa (AOE): Topical Therapy Claims, Registry
Measure #92: Acute Otitis Externa (AOE): Pain Assessment Claims, Registry
Measure #93: Acute Otitis Externa (AOE): Systemic Antimicrobial Therapy – Avoidance of Inappropriate Use Claims, Registry
Measure #110: Preventive Care and Screening: Influenza Immunization Claims, Registry, EHR
Measure #111: Preventive Care and Screening: Pneumonia Vaccination for Patients 65 Years and Older Claims, Registry, EHR
Measure #124: Health Information Technology (HIT): Adoption/Use of Electronic Health Records (EHR) Claims, Registry
Measure #128: Preventive Care and Screening: Body Mass Index (BMI) Screening and Follow-Up Claims, Registry, EHR
Measure #130: Documentation of Current Medications in the Medical Record Claims, Registry
Measure #131: Pain Assessment and Follow-Up Claims, Registry
Measure #143: Oncology: Medical and Radiation – Pain Intensity Quantified  Registry
Measure #144: Oncology: Medical and Radiation – Plan of Care for Pain Registry
Measure #154: Falls: Risk Assessment Claims, Registry
Measure #155: Falls: Plan of Care Claims, Registry
Measure #173: Preventative Care and Screening: Unhealthy Alcohol Use - Screening Claims, Registry, EHR
Measure #182: Functional Outcome Assessment Claims, Registry
Measure #193: Perioperative Temperature Management Claims, Registry
Measure #226: Preventive Care and Screening: Tobacco Use: Screening and Cessation Intervention Claims, Registry, EHR
Measure #231: Asthma: Tobacco Use Screening - Ambulatory Care Setting Claims, Registry
Measure #232: Asthma: Tobacco Use Intervention - Ambulatory Care Setting Claims, Registry
Measure #244: Hypertension: Blood Pressure Management Registry
Measure #317: Preventative Care and Screening: Screening for High Blood Pressure Claims, Registry, EHR
 
2012 Physician Quality Reporting Measures Groups
Measures groups are a subset of four or more Physician Quality Reporting measures that have a particular clinical condition or focus in common. PQRS includes 22 measures groups for 2012, three of which are potentially applicable to a practicing otolaryngologist. Measures groups containing a measure with a 0% performance rate will not be counted as satisfactorily reporting the measures group.
 
Perioperative Care Measures Group (Claims and Registry Reporting)
Measure 20. Perioperative Care: Timing of Antibiotic Prophylaxis - Ordering Physician
Measure 21. Perioperative Care: Selection of Prophylactic Antibiotic - First OR Second Generation Cephalosporin
Measure 22. Perioperative Care: Discontinuation of Prophylactic Antibiotics (Non-Cardiac Procedures)
Measure 23. Perioperative Care: Venous Thromboembolism (VTE) Prophylaxis (When Indicated in ALL Patients)
 
Asthma Measures Group (Claims and Registry Reporting)
Measure 53. Asthma: Pharmacologic Therapy
Measure 64. Asthma: Asthma Assessment
Measure 231. Asthma: Tobacco Use: Screening - Ambulatory Care Setting
Measure 232. Asthma: Tobacco Use: Intervention - Ambulatory Care Setting
 
Sleep Apnea Measures Group (Registry Reporting ONLY)
Measure 276. Sleep apnea: Assessment of Sleep Symptoms
Measure 277. Sleep apnea: Severity Assessment at Initial Diagnosis
Measure 278. Sleep Apnea: Positive Prescribed
Measure 279. Sleep Apnea: Assessment of Adherence to Positive Airway Pressure Therapy