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. 2014 Jun 25;4(2):doi: 10.5600/mmrr.004.02.a04.
doi: 10.5600/mmrr.004.02.a04. eCollection 2014.

Medicare's Physician Quality Reporting System (PQRS): quality measurement and beneficiary attribution

Bryan Dowd  1 , Chia-hsuan Li  2 , Tami Swenson  1 , Robert Coulam  3 , Jesse Levy  4
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Medicare's Physician Quality Reporting System (PQRS): quality measurement and beneficiary attribution

Bryan Dowd et al. Medicare Medicaid Res Rev. .

Abstract

Purpose: To explore two issues that are relevant to inclusion of PQRS reporting in a value-based payment system: (1) what are the characteristics of PQRS reports and the providers who file them; and (2) could PQRS provide active attribution information to supplement existing attribution algorithms?

Design and methods: Using data from five states for the years 2008 (the first full year of the program) and 2009, we examined the number and type of providers who reported PQRS measures and the types of measures that were reported. We then compared the PQRS reporting provider to the provider who supplied the plurality of the beneficiary's non-hospital evaluation and management (NH-E&M) visits.

Results: Although PQRS-reporting providers provide only 17 percent of the beneficiary's NH-E&M visits on average in 2009, the provider who provided the plurality of visits supplied only 50 percent of such visits, on average.

Implications: PQRS reporting alone cannot solve the attribution problem that is inherent in traditional fee-for-service Medicare, but as PQRS participation increases, it could help improve both attribution and information regarding the quality of health care services delivered to Medicare beneficiaries.

Keywords: Medicare; PQRS; attribution; payment; physician; value.

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Figures

Exhibit 1.
Exhibit 1.. A PQRS Claims-Based Report
See this image and copyright information in PMC

References

    1. Centers for Medicare & Medicaid Services. Quality Reporting Initiative: 2007 reporting experience. 2008 Retrieved from https://www.cms.gov/Medicare/Quality-Initiatives-Patient-Assessment-Inst....
    1. Centers for Medicare & Medicaid Services. PGP fact sheet. 2009 Retrieved from http://www.cms.gov/Medicare/Demonstration-Projects/DemoProjectsEvalRpts/.... - PubMed
    1. Centers for Medicare & Medicaid Services. 2010 http://www.cms.gov/Medicare/Medicare-Fee-for-Service-Payment/PhysicianFe... - PubMed
    1. Centers for Medicare & Medicaid Services. Medicare EHR Incentive Program, Physician Quality Reporting System and e-Prescribing Comparison. 2011 Retrieved from https://www.cms.gov/Outreach-and-Education/Medicare-Learning-Network-MLN....
    1. Centers for Medicare & Medicaid Services. Physician Quality Reporting System. 2012a Retrieved from http://www.cms.gov/Medicare/Quality-Initiatives-Patient-Assessment-Instr...

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