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PQRS for the Other Guys

December 17, 2013
by Gabriel Perna
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A new caveat to the CMS’ PQRS program makes life easier for physician specialists
Arthur Lerner, M.D.

Earlier this year, the Centers for Medicare and Medicaid Services (CMS) finalized a rule that would make earning Physician Quality Reporting System (PQRS) incentives easier for specialists. The rule will go into effect in 2014.

The PQRS was enacted in 2007 as a temporary initiative and then was made permanent in 2008. Physicians who are eligible and volunteer can earn incentives, depending on whether they meet predetermined clinical quality measures and participate. Starting in 2015, those who don’t participate will receive a 1.5 percent penalty from CMS.

The revised rule allows medical associations and societies for physician specialties and sub-specialties to create a qualified clinical data registry that defines quality measures for that particular specialty. If providers in those specialties can meet those measures, they qualify for PQRS incentives and can avoid payment adjustments.

Arthur Lerner, M.D., principal at the Palm City, Fla.-based Technology Education Consulting in Healthcare and the past president of the American Society of Breast Surgeons, spoke with HCI and says with this change, the quality measures of PQRS no longer cater to only primary care physicians.  Previously, he says, this lack of dimension was holding the program back.

“PQRS participation, I think it is fair to say, was not where they hoped it would be,” Dr. Lerner says. In 2011, according to a report, 26,515 medical practices with 266,521 eligible professionals (EPs) participated in PQRS. While this was a jump up of 37 percent from 2010, it was still only 27 percent of EPs who were eligible.

“The quality measures were heavily weighted and based on primary care patients, not on specialty and sub-specialty [care]. When we built the registry for the American Society of Breast Surgeons, there weren’t any quality measures pertinent to the practice of breast surgery,” Lerner added.

With the creation of these clinical data registries, that will no longer be the case. The registries allow for medical boards, societies, etc. that don’t already have a registry participating with PQRS to apply and form one. Organizations can create the registries to integrate with the provider’s electronic health record (EHR) or they can create ones that don’t need an EHR for access.

Naturally, there are pre-requirements to get these registries approved by CMS. The registry must have 50 participating members and must meet the criterion that’s been put in place for reporting electronically (to protect data from security threats).

“It’s a rather lengthy and tedious process an organization representing physicians must go through,” Dr. Lerner said. These data registries, he adds, are for specialty organizations that are not hospital-based. “Organizations that don’t have reporting databases, or have one but it’s not set up to report to PQRS, these organizations on behalf of their physicians will have an opportunity to do this.”

Groups like American Society for Breast Surgeons took on this initiative before the new rule was put into place. It took the registry of patient information it had in place, which Lerner says was for data collection, and adapted it for the PQRS’ measures. It will now change that registry to comply with the new rule. Other groups, Lerner says, that have not done that will have to start from scratch.

The data registries are not cheap and take time to develop, Lerner says. Thus, organizations representing specialty and sub-specialty physicians who are starting from scratch have to understand the value of doing something like this. But that’s not the only thing that it will take to create a successful data registry for PQRS reporting. 

“There has to be a champion, there has to be someone who says, ‘I will work hard to get this done,’” Lerner says. “That champion can be a physician, an administrator. You need enthusiasm and insight at the leadership level to move forward.”

Lerner said he is optimistic that this new opportunity will bring more specialist and sub-specialist PQRS participants. “We’re hoping for the snowball effect where people will say, ‘It’s working for plastic surgeons, the breast surgeons, we can make it work for us,’” he says.