The Physician Quality Reporting System

You may have heard of the new pay for performance model, wherein providers are paid based on their quality measures, adjusted based on their performance or the Physician Quality Reporting System (PQRS) Model. The fee for service model has resulted in overbilling, bringing in patients too often, and other issues. Additionally, the pay for service model typically didn't help prevent illness or manage populations effectively. So there has been a push to move to a quality based payment model.

The Physician Quality Reporting System (PQRS) and other value based payment approaches are often misunderstood, thus providers can be confused about whether to participate in them. However not participating in them can lead to penalties such as reductions in Medicare reimbursements (up to 9%), as well as potentially missing out on money from the various incentive programs aimed to promote these new models. Additionally, as quality metrics are posted online such as the Physician Compare program, not working on optimizing these quality results may result in reputation issues, being kicked out of groups that use averages to get their incentives, etc. Thus physicians are being forced to learn more about these reporting systems, incentive programs, etc. to avoid penalties, and not miss out on their incentives.

Reporting is done via the electronic record, registries, using claim data, AHRQ's Consumer Assessment of Healthcare Providers and Systems (CAHPS) program etc.

To discuss how PQRS reporting will affect your reimbursements, or to work on improving your population quality reporting reach out to us and lets discuss your unique situation. We can help you maximize your incentive programs, PQRS, and other value based payment programs - Click here to get started!!