To participate in the 2011 Physician Quality Reporting System, individual eligible professionals may choose to report information on individual Physician Quality Reporting measures or measures groups to:
(1) CMS on their Medicare Part B Claims,
(2) a qualified Physician Quality Reporting Registry*, or
(3) CMS via a qualified electronic health record (EHR) product.
CMS has posted comprehensive information regarding the 2011 Physician Quality Reporting System on their website. Additional information can be found in the 2011 PQRS Implementation Guide.
Individual eligible professionals who meet the criteria for satisfactory submission of Physician Quality Reporting quality measures data via one of the reporting mechanisms above for services furnished during a 2011 reporting period will qualify to earn an incentive payment equal to 1.0% of their total estimated Medicare Part B Physician Fee Schedule (PFS) allowed charges for covered professional services furnished during that same reporting period.
New Group Practice Option
A group practice may also potentially qualify to earn Physician Quality Reporting incentive payment equal to 1.0% of the group practice's total estimated Medicare Part B PFS allowed charges for covered professional services furnished during a 2011 Physician Quality Reporting System reporting period based on the group practice meeting the criteria for satisfactory reporting specified by CMS. Visit the "Group Practice Reporting Option" section of the CMS website to learn more about this reporting option. This section will also provide instructions on how a group practice can sign up to participate in either GPRO I or GPRO II.
Ophthalmology Measures for 2011
CMS released the physician quality reporting system (PQRS) measures for 2011, retaining 9 (of 10) ophthalmology measures from the 2010 PQRS program, shown below.
Measure 12: Primary Open-Angle Glaucoma (POAG): Optic Nerve Evaluation
Measure 14: Age-Related Macular Degeneration (AMD): Dilated Macular Examination
Measure 18: Diabetic Retinopathy: Documentation of Presence or Absence of Macular Edema and Level of Severity of Retinopathy
Measure 19: Diabetic Retinopathy: Communication with the Physician Managing Ongoing Diabetes Care
Measure 117: Diabetes Mellitus: Dilated Eye Exam in Diabetic Patient
Measure 140: Age-Related Macular Degeneration (AMD): Counseling on Antioxidant Supplement
Measure 141: Primary Open-Angle Glaucoma (POAG): Reduction of Intraocular Pressure (IOP) by 15% OR Documentation of a Plan of Care
CMS will retained two quality measures from the 2010 PQRI program that were developed by the ophthalmology community in conjunction with the AMA’s Physician Consortium for Performance Improvement (PCPI). These measures will be available under the registry* reporting option (see below).
Measure 191 Cataracts: 20/40 or Better Visual Acuity Within 90 days Following Cataract Surgery (REGISTRY REPORTING ONLY*)
Measure 192 Cataracts: Complications Within 30 Days Following Cataract Surgery Requiring Additional Surgical Procedures (REGISTRY REPORTING ONLY*)
Reporting Periods
12 months - January 1, 2011 - December 31, 2011
6 months - July 1, 2011 - December 31, 2011 (claims and registry-based reporting only*)
Important To Note
Reporting Threshold for Claims Based Reporting – now 50%; down from 80% in 2010. (*Registry based reporting threshold is still 80%*)
Maintenance of Certification Program Incentive - Beginning in 2011 through 2014, an additional incentive payment of 0.5% can be earned if a provider who successfully participates in the PQRS also provides data on quality measures through a Maintenance of Certification Program (certain requirements and criteria must be met). Stay tuned for additional infomration from ASCRS regarding the MOC program from ophthalmologists.
New Group Practice Option - A group practice may also potentially qualify to earn Physician Quality Reporting incentive payment equal to 1.0% of the group practice's total estimated Medicare Part B PFS allowed charges for covered professional services furnished during a 2011 Physician Quality Reporting System reporting period based on the group practice meeting the criteria for satisfactory reporting specified by CMS. Visit the "Group Practice Reporting Option" section of the CMS website to learn more about this reporting option. This section will also provide instructions on how a group practice can sign up to participate in either GPRO I or GPRO II.
Payments
Eligible professionals who satisfactorily report quality-measures data for services furnished during a Physician Quality Reporting System reporting period are eligible to earn an incentive payment equal to a percentage of the eligible professional's estimated total allowed charges for covered Medicare Part B Physician Fee Schedule (PFS) services provided during the reporting period.
Below are the authorized incentive payment amounts for each program year:
• 2010 Physician Quality Reporting System 2.0%.
The Affordable Care Act authorized incentive payment through 2014;
• 2011 Physician Quality Reporting System 1%
• 2012 Physician Quality Reporting System 0.5%
• 2013 Physician Quality Reporting System 0.5%
• 2014 Physician Quality Reporting System 0.5%
Payments adjustments for the (penalties) for not participating in the PQRS program would begin in 2015.
*Information about reporting via registry is outlined below under "Registry Reporting: Ophthalmic Patient Outcomes Database."
