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The Physician Quality Reporting Initiative (PQRI) is a program designed by the Center for Medicare and Medicaid Services (CMS) to improve the quality of reporting in the healthcare industry. The program is now considered to be permanent and therefore the program name has been amended to the Physician Quality Reporting System (PQRS). PQRS reporting is based on individual measures which are associated to a specific patient group by diagnosis, ailment, age, or clinical action taken by the reporting therapist. All Medicare Part B FFS (fee for service) patients are eligible, but must meet inclusion criteria for each measure.

There are 2 methods of reporting your clinical data to CMS:  Claims-based and Registry.  Choosing your reporting method is very important in reaching your 1% incentive goal.  What is the difference between the 2 methods?  What are the Pros and Cons of each?  Let’s explore:

Claims-based Reporting
With claims-based reporting, measures are tied to clinical practice reported on claims with CPT codes that link to measures. Data submission is the responsibility of the eligible professional or group practice themselves or your billing company may offer this service for an extra fee.

To qualify for your 0.5% incentive, you must report on at least 3 measures and report on 50% of eligible patients (this is a reduction from the 80% requirement of 2010).

Advantages of claims-based reporting

  1. You are in control of your own data from completion to submission
  2. Self auditing process developed to your clinic’s specific needs
  3. Cheaper – no added cost
  4. Only 50% reporting requirement
  5. OK for smaller practice or if Medicare is a small portion of your payer mix

Disadvantages of claims-based reporting:

  1. Must have someone in the clinic who will own this project: complete audits, know all the ins/outs of PQRS, keep record of the % completed
  2. Auditing process can be tedious and potentially a productivity loss for an employee
  3. You must complete and submit the proper forms in proper format for the eligible patients
  4. Workload could be significant if large % of your patients are Medicare or part of a large clinic
  5. No internal automated check/balance system completed by the billing company: submits only what you give them

Registry-based Reporting
With registry-based reporting, the eligible professional or group practice submits the data electronically to the registry, who then captures and stores the measure related data. The registry is then responsible for submitting the individual measure or measures group information to CMS on behalf of eligible professionals.  Registries provide CMS with calculated reporting and performance rates at the end of the reporting period.  Registries must pass stringent reporting method criteria annually and be qualified to participate. WebPT is one of only two certified EMR registries available in the PT industry.

Check out the most current list of Qualified Registries for 2010 PQRI Reporting is available at the CMS website. (The 2011 list has not been updated on the CMS website yet).

To qualify for your 0.5% incentive, you must report on at least 3 measures and report on 80% of eligible patients.

Advantages of registry-based reporting:

  1. Form creation and submission is done for you
  2. No need for auditing due to the EMR enforcing measure criteria and selecting eligible patients
  3. Staff productivity maintained
  4. Higher potential for meeting the reporting criteria and receiving your 0.5% incentive bonus
  5. Using a PT specific EMR registry gives you added insight and assistance with choosing most appropriate measures
  6. Measures are updated automatically each year as information is provided by CMS.

Disadvantages of registry-based reporting: 

  1. There is a cost involved; but if using WebPT it is nominal and definitely provides an ROI when staff time, paper/office supplies, and decreased stress levels are calculated
  2. 80% reporting requirement, but with the EMR in place, 100% data collection should be the expectation.
  3. Data collection enforcement with all eligible patients – no choice but to report on each patient

The 1% incentive may not seem like much of a bonus if you have to spend staff time and effort to get the proper codes into billing, complete audits to ensure your clinic is meeting its minimum criteria, and manually submitting claims to CMS. Although there is a cost associated with using a registry, the savings on staff time and maintaining productivity alone will be worth it.  

It also makes sense to choose a PT specific registry, like WebPT, which gives you the tools and outlines the measures in a way that streamlines to your workflow.  To me, registry reporting just makes more sense – leave the technical automated reporting method to the experts and let me use my clinical expertise to provide valuable feedback on how PTs impact patients’ lives daily.

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Heidi Jannenga PT

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