There’s a lot of confusion and frustration in the healthcare industry right now about the government quality programs, where they overlap (and where they don’t), and how to report the correct information.
A (Brief) History
The Physician Quality Reporting System (PQRS) has been around since 2007. Traditionally providers voluntarily reported at least three measures by including level II CPT codes on their Medicare Part B claims, and they received an incentive payment from CMS.
Clinical Quality Measures (CQMs) were introduced in 2011 as part of the EHR Incentive Program, better known as meaningful use. This program required providers to manually enter a calculated percentage for six to nine measures to receive an incentive as part of meaningful use.
A Confluence of Program Changes
Recently, the Centers for Medicare and Medicaid Services (CMS) initiated plans to align the PQRS and the CQM measures to make reporting easier for providers. At the same time, CMS is laying the groundwork to discontinue the claims-based PQRS reporting that providers have become accustomed to. CMS’ goal is for providers to electronically submit a file that contains all of their yearly quality data to satisfy the requirements for both PQRS and CQMs. You may have heard of this file referred to as QRDA.
Additionally, CMS currently requires a full year of quality reporting under both programs in 2015.
All of these changes are happening just as the programs transition from paying providers incentives for participating, to subjecting providers to penalties for not participating.
Staying Afloat
Amidst the tidal wave of changes, many brave providers have tried to embrace the new electronic submission—without success. CMS is rejectin