Tuesday, 08 March 2016 20:36

Developing an Effective PQRS Quality Measures Reporting Strategy for 2016

Written by Gloria Johnston, MBA, RN, RHIT, CCS-P


It’s time for providers to consider a Physician Quality Reporting System (PQRS) quality measures reporting strategy for 2016 PQRS and Value-Based Modifier (VBM) programs in order to avoid heavy penalties in 2018.

Developing an effective strategy for reporting PQRS quality measures is imperative. The same PQRS measures reported to satisfy PQRS reporting are also a required component of the VBM program. Penalties for not successfully reporting PQRS measures in 2016 are significant: 4 percent for practices with fewer than 10 eligible professionals (EPs) and 6 percent for practices with 10 or more EPs for the PQRS and VBM programs combined. Practices can avoid these penalties by implementing an effective PQRS quality measures reporting strategy. Strategies for minimizing costs and optimizing quality performance are important components of the VBM program and will be discussed in future articles.

Figure 1: 2018 Payment Impacts for 2016 PQRS and VBM Program Performance

* Includes practices comprised of only non-physician practitioners 

Step 1: Understand Your Financial Exposure

The first step in developing an effective strategy is to understand the financial impact of failing to successfully report PQRS quality measures. 

The primary consideration is if the practice will report PQRS quality measures as a group or as individual EPs. If reporting as a group, at least 50 percent of EPs within the group must report PQRS measures to avoid the automatic 2-percent penalty under the PQRS program Under the group reporting option, if the group as a whole is unsuccessful in their reporting, the PQRS penalty is applied to all participating providers – even those that were successful PQRS reporters. For the individual EP reporting approach, only those providers that were not successful reporters are penalized under the PQRS program.

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Last modified on Wednesday, 09 March 2016 12:51