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The Financial Professional's Guide to Healthcare Reform by Gregory Anderson, Mark Dietrich

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Chapter 13

Other Provisions

Physician Quality Reporting System

The Tax Relief and Health Care Act,1 enacted on December 20, 2006, required the Centers for Medicare and Medicaid Services (CMS) to implement a physician quality reporting system in 2007, which CMS named the Physician Quality Reporting Initiative (PQRI). PQRI was a voluntary pay-for-reporting program that provided an incentive payment to professionals, such as physicians, mid-level providers, and therapists2 who satisfactorily reported data on quality measures for covered professional services. The financial incentive for eligible professionals under PQRI as adopted in 2007 was 1.5 percent of total allowed charges under the Medicare physician fee schedule (MPFS). The PQRI was extended and further enhanced as a result of the Medicare, Medicaid, and SCHIP Extension Act,3 enacted on December 29, 2007. The Medicare Improvements for Patients and Providers Act,4 enacted on July 15, 2008, made the PQRI permanent, but only authorized incentive payments through 2010 and increased the incentive rate to 2.0 percent. Whereas in the past, CMS only had the authority to continue the PQRI incentive payments for a specified period of time, CMS believes the changes authorized by the Affordable Care Act (ACA) lend permanency to the PQRI. To reflect this transition from the PQRI being a temporary initiative to a permanent quality-reporting program, CMS now refers to the PQRI as the Physician Quality Reporting System (PQRS) and will be ...

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