Meaningful Use and PQRS- Know More!

The voluntary program Physician Quality Reporting System (PQRS) is meant to pay eligible professionals (EPs). This includes physicians under Medicare as well as a few select therapists and service providers who extend their services to beneficiaries under Medicare.

However, there does exist a bit of confusion with medical practices on whether the requirements of PQRS are fulfilled if attested to Meaningful Use. Most practice managers believe that once they attest to using Clinical Quality Measures (CQM) with Meaningful Use the requirements for PQRS are more than fulfilled. This is not true at all.

One is different from the other

PQRS and Meaningful Use are quite different from each other as each goes by sets of rules and regulations of their own. Both these incentive programs have CMS administering them and have no alignment to each other whatsoever. There are several EHR vendors who have recognized the administrative burden created by these separate entities and have adjusted themselves in accommodating the reports for both these programs.

The mad scramble to make sense of it all

With 2015 gone, there is a mad scramble by providers who are trying to make some sense out of the modifications done to Meaningful Use, though they were finalized in October 2015 itself. Notifications of penalty adjustments were sent out in November 2015 and Eligible Professionals who had earlier opted out of Meaningful Use are now busy reconsidering further participation.

With program penalty adjustments looming most providers are intent on meeting the revised objectives of CMS. There is a silver lining though; the MU program now has only 10 simplified objectives to report on as compared to 20 complex objectives earlier. This has eased the workflow to a considerable extent allowing the providers to get accustomed to participation in the MU program.

Know what category of data vendor you are

The first type or category of approved EHR vendors is the one that extracts data directly from EHR, also known as Qualified Direct EHR product. CMS has released a list of EHR vendors that clearly spells out the types of data vendors. The list can be viewed on the CMS website. A word of caution though, approvals from CMS for EHR depend on the version.

Hence, you need to be using an EHR that figures on the list while the one you have been using until now could be an older version that is not approved. In order to take advantage of dual reporting, it is better to upgrade to the new version at the earliest.

Specific Clinical Quality Measures

PQRS has limitations when it comes to reporting as it can report 51 specific Clinical Quality Measures. Hence it is important that any three of these measures match the specialty in Meaningful Use reporting. Moreover, the PQRS and NQS measure names and numbers need not be necessarily the same, hence care needs to be exercised while looking at the CQM list. As it is the current misalignment between PQRS and Meaningful Use programs there is a lot of confusion for providers.

CMS on its part has taken this into account and is working on making the alignment tolerable through its pilot program that was started in 2012. As more streamlining is required it is better to check and be sure that the requirements for Meaningful Use and PQRS are met. Although PQRS was an incentive in 2015, going forward it may turn out to be non-productive if the penalties are greater than the incentives, thus defeating the very purpose.

In case you are one of the Eligible Professionals seeing Medicare and Medicaid patients with incentive payments that are yet to be collected, you could be in the penalty phase already. You need to take advantage of the modified Meaningful Use program requirements in order to avoid dual reporting penalty payments.