Changes ahead for quality reporting, e-prescribing programs

By Bernie Monegain
09:11 AM

Key changes to physician quality reporting and e-prescribing incentives are being proposed by the Centers for Medicare and Medicaid.

The proposed changes add reporting measures and a way for reporting by group practice rather than individual physician, as well as provisions for EHR-based reporting. For e-prescribing, CMS aims to simplify the reporting measures.

The Physician Quality Reporting Initiative (PQRI), first implemented in 2007, is a voluntary program that provides incentives for reporting data on certain quality measures for services provided under Medicare Part B.

For calendar year 2010, participants may earn an incentive payment of 2 percent of the estimated total allowed charges for Medicare Part B covered professional services provided during the reporting period.

CMS is offering additional reporting options and reporting periods. Some options require data on quality measures to be submitted by Dec. 31, 2010.

However, participants who submit data through registries will not be required to submit data on quality measures until 2011.

Key changes in the MPFS final rule with comment period for calendar year 2010 will:

  • Add 30 individual PQRI measures and six measures groups on which individual eligible professionals may report.
  • Implement provisions of the Medicare Improvement for Patients and Providers Act of 2008 (MIPPA) that will enable group practices to qualify for a 2010 PQRI incentive payment based on a determination at the group practice level, rather than at the individual practitioner level.
  • Add a reporting mechanism to promote the adoption and use of EHRs and provide both eligible professionals and CMS with experience on EHR-based quality reporting. Under the rule, CMS will begin accepting data from qualified EHR products on 10 individual PQRI measures. In 2010, CMS will, for the first time, allow physicians to count their submission of EHR-based measures toward their eligibility for a PQRI incentive payment. Specifically, the final rule provides that physicians who satisfactorily report data on at least three of the 10 EHR-based individual PQRI measures are eligible for an incentive payment. In previous years, EHR-based measure submission has been on a voluntary or "pilot" basis and has not counted toward an EP's eligibility for an incentive payment.

The new rule adds a six-month reporting period, which begins July 1, 2010, for claims-based reporting of individual measures. In prior years, the six-month reporting period was available only for measures group reporting or for registry-based reporting.

Following distribution of 2010 incentive payments, CMS will post on its Web site the names of eligible professionals and group practices that satisfactorily report quality measures.

E-prescribing incentive program

Beginning in 2012, CMS will impose penalties on physicians who aren't prescribing electronically. The reporting period for the e-prescribing incentive program for 2010 will be the entire calendar year, and incentives will be paid based on the covered professional services furnished by an eligible professional during the reporting year.

Key changes for the calendar year 2010 under the final rule will simplify the reporting requirements for the electronic prescribing measure by:

  • Streamlining in what manner and how often a physician must report e-prescribing information to CMS. For 2010, the rule requires them to report an e-prescribing code only when a patient visit results in an electronic prescription being placed. The final rule also provides that a physician will need to report this code at least 25 times during the reporting period to be considered a successful electronic prescriber. In 2009, CMS required physicians to report one of several e-prescribing codes, based on different scenarios that characterize the presence or absence of an electronic prescription during a patient visit, and to report these codes at least 50 percent of the time.
  • Providing more choices for reporting electronic prescribing measures. For 2010, in addition to the current claims-based reporting mechanism, physicians will be allowed to report the e-prescribing measure through qualified registries or through a qualified EHR product. Only registries and EHR products that qualify for the 2010 PQRI and have the capability to report the e-prescribing measure will be qualified for submitting data on the e-prescribing measure for 2010.
  • Broaden eligibility for the e-prescribing incentive by including professional services furnished in skilled nursing facilities, domiciliary care or the home-care setting as part of the list of services for which the electronic prescribing measure is reportable.
  • Implement a MIPPA provision that enables group practices to qualify for a 2010 e-prescribing incentive payment based on a determination at the group practice level, rather than at the individual eligible professional level, that the group practice is a successful electronic prescriber.

Following distribution of 2010 incentive payments, CMS will post on its Web site the names of individual physicians and group practices that are successful e-prescribers for the 2010 program.

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