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 Levy⁴

¹University of Minnesota: Minneapolis, Minnesota
²Healthcore, Incorporated: Wilmington, Delaware
³Simmons College: Boston, Massachusetts
⁴Independent Consultant

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, physician, payment, value, PQRS, attribution

doi: http://dx.doi.org/10.5600/mmrr.004.02.a04

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