Fact Sheets

CMS REPORTS RESULTS OF 2009 MEDICARE PHYSICIAN QUALITY REPORTING SYSTEM AND EPRESCRIBING INCENTIVE PROGRAM

Data Show Gains in Reporting Quality Measures and in Program Participation Rates

Overview

The Centers for Medicare & Medicaid Services (CMS) today announced the results for the 2009 Physician Quality Reporting System (formerly Physician Quality Reporting Initiative or PQRI) and the 2009 ePrescribing Incentive Program. 

In 2009, more than 210,000 physicians and other eligible professionals participated in the Physician Quality Reporting System and more than 92,000 participated in the ePrescribing Incentive Program. Of those participating, nearly 120,000 eligible professionals earned an incentive payment through the Physician Quality Reporting System, totaling almost $235 million. In addition, over 48,000 eligible professionals who were successful electronic prescribers earned an incentive payment through the ePrescribing Incentive Program, totaling over $148 million. The average incentive amount for individual professionals who satisfactorily reported was nearly $2,000 for the Physician Quality Reporting System and over $3,000 for successful electronic prescribers under the ePrescribing Incentive Program.

Background

The Tax Relief and Health Care Act of 2006 and the Medicare Improvements for Patients and Providers Act of 2008 authorized the creation of the Physician Quality Reporting System and the ePrescribing Incentive Program, respectively. Both programs allow physicians and other eligible professionals to earn incentive payments for reporting quality-related information about the services they provide to Medicare beneficiaries and also for reporting data on use of a qualified electronic prescribing system. The Physician Quality Reporting System began in 2007, and the ePrescribing Incentive Program was launched in 2009.

Much of the data reported under the Physician Quality Reporting System represents clinical performance measures (for example, percent of age-appropriate women receiving mammograms to screen for breast cancer), that were developed by leading physician and health care quality organizations such as the American Medical Association and the National Committee for Quality Assurance.

Physicians and other eligible professionals who satisfactorily reported data on these quality measures under the Physician Quality Reporting System in 2009 earned an incentive payment equaling 2 percent of their total estimated allowed charges under Medicare Part B for covered professional services. Similarly, under the ePrescribing Incentive Program, successful electronic prescribers earned a separate incentive payment equaling 2 percent of their allowed charges for covered professional services for 2009.

Gains in Health Quality Reporting May Signal Clinical Improvements

The most commonly reported measures under the Physician Quality Reporting System suggest an ongoing commitment by America’s health professionals to provide preventive services to as many patients as possible. The most frequently reported measures included:

• Reports that professionals had performed electrocardiograms in the emergency department to help diagnose patients with chest pain for a potential heart attack.

• Reports that professionals had adopted or used electronic health records to help organize and manage care for patients.

• Reports that professionals worked with patients with diabetes to control blood sugar in the long-term, in order to avoid or lessen potential complications of the disease.

In 2009, a number of measures showed improvements from their 2007 rates. For instance:

• The percent of professionals who reported that they had communicated with patients with diabetes about potentially damaging eye-related complications of the disease jumped from 52 percent in 2007 to 93 percent in 2009.

• The percent of professionals who reported that   patients with left-ventricular systolic dysfunction (a specific form of heart failure) received recommended beta-blocker drugs jumped from 64 percent in 2007 to 95 percent in 2009.

• The percent of professionals who reported   that care teams effectively stopped post-surgical antibiotics (to prevent overmedication and the formation of potentially drug-resistant “superbugs”) jumped from 54 percent to 95 percent.

Increases in Participation Rates and Frequency of Successful Reporting

Similar to previous program years, in 2009, CMS sought to encourage participation and enhance aspects of the Physician Quality Reporting System. Examples include the addition of 52 individual measures and four measures groups for the 2009 Physician Quality Reporting program year.

Also, under the Physician Quality Reporting System, the option to use registries to submit data on behalf of eligible professionals was implemented in the 2008 program year, and in 2009 the number of CMS-qualified registries continued to grow, with 74 registries submitting data for approximately 15 percent of participating eligible professionals. Moreover, eligible professionals participating through a registry were very likely to earn an incentive.  In fact, approximately 90 percent of professionals submitting individual measures through a registry earned an incentive.

Increases in Numbers of Health Professionals Who Choose to Participate

Since the Physician Quality Reporting System began in 2007, CMS has continued to add additional quality measures to the program—bringing the total menu of measures from which professionals could choose to report from 74 to 194. The increase in the number of measures signals CMS’ commitment to ensuring that as many types of eligible professionals and specialty groups as possible are able to report quality data through the System.

CMS also strives to make the Physician Quality Reporting System measures as universally applicable to a broad range of specialties.  Examples of the types of eligible professionals who participate in quality reporting include radiologists, anesthesiologists, ophthalmologists, nurse practitioners, physician assistants, family practitioners, and orthopedic surgeons. Through the most popular form of collecting data (that is, Medicare Part B claims), emergency medical physicians had the highest rate of satisfactory reporting in 2009— nearly 31,000 reported on at least one quality measure and 79 percent of those received an incentive payment.

More specific details about the nature of participation in CMS’ Physician Quality Reporting System and ePrescribing Incentive Program are available in the report, 2009 Reporting Experience, available for download on the CMS website at http://www.cms.gov/PQRS.

The Future of the Physician Quality Reporting System and the ePrescribing Incentive Program

Congress extended the Physician Quality Reporting System in 2008 and authorized incentive payments through 2010.  Additional legislation extended incentive payments for the Physician Quality Reporting System through 2014. Beginning in 2015, eligible professionals who do not report data to CMS satisfactorily under the System will receive a payment adjustment.

The 2009 and 2010 Physician Quality Reporting System included positive changes to ease the reporting of quality measures, and the 2011 Physician Quality Reporting System has enhancements that will make it even easier for physicians and other eligible health care professionals to participate.  For instance, beginning in 2011, eligible professionals reporting through the claims method will find the reporting rate criterion reduced from 80 percent to 50 percent. A Maintenance of Certification Program also was created in 2011 to allow eligible professionals the opportunity to earn an additional 0.5 percent incentive to their Physician Quality Reporting incentive for meeting specialty certification criteria. 

More information about the Physician Quality Reporting System, including how eligible professionals can participate and the criteria to qualify for an incentive payment, is available at http://www.cms.gov/PQRS.

For the ePrescribing Incentive Program, data reporting on the electronic prescribing quality measure during the first six months of 2011 will be used to determine which eligible professionals and group practices are exempt from the upcoming legislatively mandated 2012 ePrescribing Payment Adjustment. More information on how to participate in the ePrescribing Incentive program as well more information about the 2012 ePrescribing Payment Adjustment can be found at http://www.cms.gov/ERXincentive/.

The full 2009 PQRS and ePrescribing Experience Report is also available on CMS’ website at http://www.cms.gov/PQRS.

A press release on the 2009 Physician Quality Reporting System and ePrescribing Incentive Program results may be viewed at http://www.cms.hhs.gov/apps/media/press_releases.asp.

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