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Physician Quality Reporting System

The Physician Quality Reporting System provides an incentive payment for eligible professionals who satisfactorily report data on quality measures for covered professional services furnished to Medicare beneficiaries. For each program year, CMS implements Physician Quality Reporting through an annual rulemaking process published in the Federal Register.

To participate in the 2012 Physician Quality Reporting, individual eligible professionals may choose to report information on individual Physician Quality Reporting quality measures or measures groups: to CMS on their Medicare Part B claims, to a qualified Physician Quality Reporting registry or to CMS via a qualified electronic health record (EHR) product. Individual eligible professionals who meet the criteria for satisfactory submission of Physician Quality Reporting quality measures data via one of the reporting mechanisms above for services furnished during a 2012 reporting period will qualify to earn a Physician Quality Reporting incentive payment equal. For 2012, there are no radiation oncology measure groups.  


 

Background on 2012 PQRS Measures and Reporting 

Eligible professionals may choose to report PQRS measures on fee-for-service Medicare beneficiaries to CMS through their Part B claims, a qualified registry or via a qualified electronic health record (EHR) product. Important information about the 2012 PQRS information is below.  

2012 Reporting Period – The reporting period for claims-based, registry-based, and electronic health record (EHR)-based reporting for individual measures is from January 1, 2012 to December 31, 2012.

Criteria for successfully reporting – The threshold for successfully reporting varies by reporting method.  

  • Claims-based – 50 percent of applicable Part B patients
  • Registry-based – 80 percent of applicable Part B patients
  • EHR-based – 80 percent of applicable Part B patients

Incentive Payments - A 0.5 percent incentive payment has been established for program years 2012 through 2014. A penalty will be implemented after 2014 for those who do not satisfactorily report.

Maintenance of Certification Program - Eligible professionals may qualify for an additional 0.5 percent incentive beginning in 2011 if they satisfactorily report data on the Physician Quality Reporting System and participate in a Maintenance of Certification Program.

PQRS Bonus and Penalty Schedule 

 

Successful PQRS + No MOC 

Successful PQRS + MOC 


 

 

 

2012 

0.5 percent

1.0 percent

2013 

0.5 percent

1.0 percent

2014 

0.5 percent

1.0 percent

2015 

-1.5 percent

2016 

-2.0 percent


 

 

2012 Radiation Oncology Measures  

The 2012 PQRS program includes the following measures that may be of interest to radiation oncologists:

  • Measure 71 - Breast Cancer: Hormonal Therapy for Stage IC-IIIC Estrogen Receptor/Progesterone Receptor (ER/PR) Positive Breast Cancer
  • Measure 102 - Prostate Cancer: Avoidance of Overuse of Bone Scan for Staging Low-risk Prostate Cancer Patient
  • Measure 104 - Prostate Cancer: Adjuvant Hormonal Therapy for High-risk Prostate Cancer Patients 
  • Measure 105 - Prostate Cancer: Three Dimensional (3-D) Radiotherapy
  • Measure 143 - Oncology: Pain Intensity Quantified (registry only)
  • Measure 144 - Oncology: Plan of Care for Pain (registry only)
  • Measure 156 - Oncology: Radiation Dose Limits to Normal Tissues
  • Measure 194 - Cancer Stage Documented

For more information, including the 2012 PQRS measure list, measure specification document, and other information about the program, visit CMS’ website or email Sheila Madhani.

Content last updated 4/5/2012
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