PQRS By The Numbers - 2016

2016: PQRS 2016 By the Numbers

CMS has released the Physician Quality Reporting System (PQRS) specifications for the 2016 reporting period and as previous years indicate, they are full of changes. Since inception, PQRS has greatly changed the coding and documentation landscape for Eligible Professionals (EP) and Group Practices. Reporting on quality measures has become a way of life for the practicing physician. Whether the reporting is being executed through a registry, allowed for most all standard measures and measure groups, or by individual physicians utilizing claims-based reporting, the additional time and monetary importance is not inconsequential. Physicians are being asked to do more and more each year so it’s vitally important for them to have an intuitive and robust system for collecting the data. Of course, that’s always been the challenge. PQRS kicked off programming with 74 measures, rose to a measure high of 402 in 2015 and has retired a great many of those measures over the years. Here is a representation of how far CMS has brought the PQRS system and some of the highlights for this coming year:

2016 Highlights

  • New Measure High – #439
  • New Measures – 37
  • Retired Measures – 9 (3 are Claims-Based)
  • Measures Changing from Claims-Based to Registry Only – only 5 this year
  • Total Available Measures – 198
  • Total Available Claims-Based Measures – 79

As always, medical professionals should consider several factors when selecting measures for the coming year. Here are the ones most commonly recommended guidelines by CMS:

  • Physicians’ most commonly treated clinical conditions
  • Types of clinical care provided - acute, preventive, chronic
  • Care delivery area for most treatments
  • Quality improvement goals for the coming year
  • Overlay with other quality programs that will be reported on in the coming year

Additionally, there is no requirement for physicians to change measures year after year, but each EP or Group Practice should strongly consider on reporting 9 different measures across 3 of the National Quality Strategy domains during the reporting period in order to reach required reporting minimums. Each measure must also be reported 50% of the time for the EP’s Medicare Part B patient visits. Returning for 2016, EPs must continue to report on Cross-Cut Measures when at least one Medicare patient is treated in a face-to-face encounter. A minimum of one cross-cutting measure is required to satisfactorily report in the 2016 PQRS.  The face-to-face encounter would include outpatient visits, surgical procedures and most general office visits. Meeting PQRS goals in 2016 (as in 2015) will enable the EP or Group Practice to avoid the stated CMS payment adjustments. Qualified revenue cycle management companies, like eMDs, will help physicians properly select and report measures for 2016 by considering many factors – specialty, level of care, location and quality goals for the coming year. The last piece of the reporting puzzle is being sure to include PQRS data on the minimum number of Medicare insured patient visits, which depending on the reporting method, can be as high as 50%. eMDs has prepared a resource page for physicians detailing the 2016 PQRS updates. Click here to view the page.


Join Our Newsletter

Get Updates Direct to Your Inbox. Gain access to a rich library of articles, white papers, webinars, podcasts and more. Register today to receive eMDs Insights newsletter.

Specialty *
State *