Beginning January 1, 2014, medical specialist societies will be permitted to select the quality measures for their specialty-specific physicians to report to the Physician Quality Reporting System (PQRS). Many medical specialist societies have protested the common quality measures because they believe they tend to favor primary care and family physicians over specialists. This new rule was enacted in the hopes of boosting participation in the PQRS.According to CMS, quality measures are “used to assign a quantity, based on a standard set by the developers, to the quality of care provided” by the physician or physician group. Measures are then reviewed and updated on a yearly basis based upon the measure developer’s input. CMS explains that the “types of measures vary by specialty and include care coordination, patient safety and engagement, clinical process/effectiveness and population/public health, as well as the efficient use of healthcare resources.” CMS suggests that certain factors be considered when determining measures for reporting, including clinical conditions commonly treated, types of care delivered frequently, settings where care is often delivered, and quality improvement goals for the year.
Historically, PQRS was established to shift from the traditional fee-for-service payment model to a pay-for-performance program with the idea that CMS should reimburse physicians for the quality of their health care services, and not for the quantity of their health care services. Currently, PQRS is shifting from providing participants with incentive payments (bonuses) to rendering payment adjustments (penalties) to those who do not participate. This year is the last year participants will receive incentive payments, which will amount to 0.5 percent of their total estimated Medicare Part B Physician Fee Schedule (PFS) allowed charges for covered professional services. Beginning in 2015, payment adjustments for not participating will be 1.5 percent based upon 2013 Medicare Part B charges. In 2016, the payment adjustment increases to 2.0 percent based upon 2014 Medicare Part B charges.
