Physician Quality Reporting System (PQRS) Quality Measure: The Elder Maltreatment Screen and Follow-Up Plan

Elder Abuse ◽  
2017 ◽  
pp. 247-293
Author(s):  
Tara L. McMullen ◽  
Kimberly Schwartz ◽  
Sophia Autrey ◽  
Jane Lucas ◽  
Gary Rezek ◽  
...  
2016 ◽  
Vol 17 (2) ◽  
pp. 229-237 ◽  
Author(s):  
Jennifer Wiler ◽  
Michael Granovsky ◽  
Stephen Cantrill ◽  
Richard Newell ◽  
Arjun Venkatesh ◽  
...  

2016 ◽  
Vol 73 (5) ◽  
pp. 774-779 ◽  
Author(s):  
Avni P. Finn ◽  
Sheila Borboli-Gerogiannis ◽  
Stacey Brauner ◽  
Han-Ying Peggy Chang ◽  
Sherleen Chen ◽  
...  

2019 ◽  
Vol 152 (Supplement_1) ◽  
pp. S141-S141
Author(s):  
Li Ge ◽  
Xinliang Liu

Abstract Objectives Public reporting of quality metrics has become increasingly important for pathologists to demonstrate excellence of care and to secure value-based payments from both public and private payers. This study evaluated the participation and performance of pathologists in the Medicare Physician Quality Reporting System (PQRS). Methods This study conducted a retrospective review of the Physician Compare data files from 2016. Specifically, pathologists enrolled in the Physician Compare Initiative were identified and merged with quality data using uniquely assigned National Provider Identifiers. Descriptive statistics and multiple logistic regression were performed using Stata (version 12.1) statistical software (StataCorp, College Station, TX). Results Among the 11,637 pathologists identified in the Physician Compare Initiative, 8,408 pathologists (73.3%) participated in the PQRS. Regression analysis indicated that female gender, foreign medical graduate (FMG), and a larger number of employees in the affiliated organization were associated with a lower likelihood of participating in the PQRS. To protect patient privacy, the Centers for Medicare and Medicaid Services (CMS) only released the quality metrics of 353 pathologists, which were computed based on 20 or more Medicare beneficiaries. The three most commonly reported quality metrics included PQRS#249 Barrett’s Esophagus, PQRS#395 Lung Cancer Reporting (Biopsy/Cytology Specimens), and PQRS#397 Melanoma Reporting. The mean performance rates for the three most common metrics were 98.8% (SD 8.3%), 96.8% (SD 11.9%), and 97.4% (SD 6.9%), respectively. Conclusion A majority of pathologists participated in the Medicare PQRS program in 2016. The performance rates of public available quality metrics remained at high levels with significant variations in some metrics. Future research should examine the quality performance of pathologists as they transition from the PQRS to the Merit-based Incentive Payment System (MIPS) under the Quality Payment Program.


2011 ◽  
Vol 32 (11) ◽  
pp. 2000-2001 ◽  
Author(s):  
N. Anumula ◽  
P.C. Sanelli

2016 ◽  
Vol 1;19 (1;1) ◽  
pp. E15-E32
Author(s):  
Laxmaiah Manchikanti

Basing their rationale on multiple publications from Institute of Medicine (IOM), specifically Crossing the Quality Chasm, policy makers have focused on a broad range of issues, including assessment of the influence of medical practice organization structures on quality performance and development of quality measures. The 2006 Tax Relief and Health Care Act established the Physician Quality Reporting System (PQRS), to enable eligible professionals to report health care quality and health outcome information that cannot be obtained from standard Medicare claims. However, the Patient Protection and Affordable Care Act (ACA) of 2010 required the Centers for Medicare and Medicaid Services (CMS) to incorporate a combination of cost and quality into the payment systems for health care as a precursor to value-based payments. The final change to PQRS pending initiation after 2018, is based on the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA) which has incorporated alternative payment models and merit-based payment systems. Recent publication of quality performance scores by CMS has been less than optimal. When voluntary participation began in July 2007, providers were paid a bonus for reporting quality measures from 2008 through 2014, ranging from 0.5% to 2% of the Medicare Part B allowed charges furnished during the reporting period. Starting in 2015, penalties started for nonparticipation. Eligible professionals and group practices that failed to satisfactorily report data on quality measures during 2014 are subject to a 2% reduction in Medicare fee-for-service amounts for services furnished by the eligible professional or group practice during 2016. The CMS proposed rule for 2016 physician payments contained a number of provisions with proposed updates to the PQRS and Physician Value-Based Payment Modifier among other changes. The proposed rule is the first release since MACRA repealed the sustainable growth rate formula. CMS proposed to continue many existing policies regarding PQRS from 2015 to 2016. In addition, 2016 will be the year that is utilized to determine the 2018 PQRS payment adjustment. However, after 2018 the PQRS payment adjustment will be transitioned to the Merit-Based Incentive Payment System (MIPS), as required by MACRA. Overall, there will be over 280 measures in the 2016 PQRS. Readers might be surprised to find out that despite the cost intensity including time requirements personnel, the negative payment adjustments, are only the tip of the iceberg of cost. Indeed, all of the above may only be one-third or one-fourth of the cost to completely implement the PQRS system. Thus far, data across all specialties shows participation to be around 50%. In addition, penalties for lack of reporting of PQRS measures stands to be controversial to the Supreme Court ruling that unfunded mandates must not be permitted and also lack of significant relationships with improvement in quality in the overall analysis in multiple publications. Key words: Value-based modifier, Medicare Access and CHIP Reauthorization Act of 2015 (MACRA), alternative payment models (APMs), merit based payment systems, negative payments, bonuses


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