Updated August 27, 2014
The Physician Quality Reporting System (PQRS) program is a voluntary reporting program that rewards physicians who successfully report data on quality measures to the Centers for Medicare and Medicaid Services (CMS). Physicians who do not participate in the program going forward are at risk for penalties applied to their Medicare Part B reimbursement.
The College of American Pathologists (CAP) and its Council on Government and Professional Affairs have dedicated considerable resources to enable pathologists to successfully participate in the program.
The CAP’s measure development efforts have focused on ensuring that members can benefit from public and private pay-for-performance programs.
Currently, five CAP-developed pathology measures exist in the 2014 PQRS. The CAP developed three additional measures in 2012 and currently, they are under consideration by CMS for inclusion in the 2015 PQRS. The CAP is committed to the continued development and maintenance of these measures for the benefit of CAP members.
Overview and Pathology Measures included in the 2014 PQRS (PDF, 424 K)
How to Participate in PQRS
Pathologists have several options for participating in PQRS. Your options depend on how you bill, the size of your practice, and whether your practice’s members want to report individually or as a group.
The New CAP PQRS/VBM online tool Helps You Find the Right Answer
Participating in PQRS has been voluntary, but now it is becoming mandatory if one wants to avoid Medicare payment penalties in the future. Pathologists are at risk of having Medicare payments reduced when CMS determines that they could have participated in PQRS and did not. For some pathologists, performance on PQRS measures in 2014 will be the factor deciding whether their Medicare Part B payments will have a negative PQRS and VBM adjustment in 2016.
While the CMS has said that the penalties will not apply for pathologists who have no applicable PQRS measures, the CMS plans to review claims to check that none of the measures applied. Eligible physicians face a 2% penalty in 2016 for not successfully reporting PQRS measures in 2014. PQRS also is a factor in the VBM, which also could penalize eligible physicians by an additional 2% in 2016 following the 2014 PQRS reporting year.
The CAP advocates on behalf of pathologists regarding their options for PQRS reporting. While the CAP has created eight PQRS measures for pathologists, five of these measures are in the current PQRS program. CMS continues to raise the bar. In 2014, most specialties must report on a minimum of nine measures. But the CMS has assured the CAP—in writing—that pathologists who have fewer than nine measures will only need to report on applicable measures, and pathologists with no applicable measures will not face PQRS penalties in either 2015 or 2016.
The CAP has created a number of resources to help pathologists navigate the rules for PQRS, understand their options for reporting, and successfully report measures.
CAP Today Articles
Centers for Medicaid and Medicare Services (CMS)
Federal Registry Resources