CMS REPORTS RESULTS OF 2010 MEDICARE PHYSICIAN QUALITY REPORTING SYSTEM AND ELECTRONIC PRESCRIBING (ERX) INCENTIVE PROGRAM

Overview

The Centers for Medicare & Medicaid Services’ (CMS) results for the 2010 Physician Quality Reporting System and the 2010 Electronic Prescribing (eRx) Incentive Program show significant gains in participation and incentives paid to eligible health care professionals. The report, 2010 Physician Quality Reporting System and eRx Experience Report, identifies key areas in which physician-level quality measures point toward future measurable results in improved quality of care delivered to Medicare beneficiaries. The full report can be found at http://www.cms.gov/PQRS.

In 2010, 268,968 eligible professionals participated as individuals and part of group practices in the Physician Quality Reporting System program through all reporting methods, compared to 210,559 in 2009 and 153,839 in 2008. This represents approximately 26 percent of the 1,017,664 professionals eligible to participate.  Among those participants, 193,666 (72 percent) were incentive eligible, compared to 57.3 percent in 2009 and 55.5 percent in 2008. Physician Quality Reporting System incentive payments in 2010 totaled $391,635,495, of which $364,254,804 was earned by individual eligible professionals (compared to $236,696,432 earned by individual professionals in 2009 and $95,080,976 earned by individual professionals in 2008).

Under the 2010 eRx Incentive Program, 696,663 professionals were eligible to participate, of whom 130,953 (18.8 percent) participated, compared to 89,752 (13.4 percent) in the 2009. Of those eligible professionals who submitted data on the eRx measures in 2010, 82,950 (63.3 percent) were incentive eligible, compared to 48,354 (53.9 percent) in 2009. eRx incentive payments in 2010 totaled $270,895,540, compared to $148,007,816 in 2009.

In line with results from the 2009 eRx incentive program, in 2010, physician specialties with the highest participation rate were cardiology (35.4 percent), ophthalmology (33.8 percent), and rheumatology (31.7 percent). Non-physician specialties totaled 10.2 percent of participants and, similar to 2009 results, the highest participation levels among the non-physicians were nurse practitioners and physician assistants.

The Physician Quality Reporting System and the eRx Incentive Program, combined, paid $662,531,035 in incentives in 2010 across all participation options, a 72-percent increase from 2009 ($384,704,248). The average incentive amount for individual professionals who satisfactorily reported was nearly $2,000 in the Physician Quality Reporting System for 2010 and more than $3,000 for successful electronic prescribers in the eRx Incentive Program.

While Physician Quality Reporting and the eRx Incentive Program were designed to promote reporting of quality data, this information can be useful for future evaluations of the quality of care furnished to Medicare beneficiaries. The 2010 eRx Incentive Program revealed that more than 130,000 eligible professionals and 27,000 practices implemented and used qualified electronic prescribing systems. Each patient who received electronic prescriptions has the potential to reap the demonstrated benefits of electronic prescribing such as improving prescription accuracy and reducing preventable adverse drug interactions.

Background

The Tax Relief and Health Care Act of 2006 and the Medicare Improvements for Patients and Providers Act of 2008 authorized the creation of the Physician Quality Reporting System and the (eRx) Incentive Program, respectively. Both programs allow physicians and other eligible professionals to earn incentive payments for reporting data on quality measures for covered professional services eligible professionals furnish to Medicare beneficiaries. Under the eRx Incentive Program, eligible professionals report data on the electronic quality measure regarding the professional’s use of a qualified electronic prescribing system. The Physician Quality Reporting System began in 2007, and the eRx Incentive Program was launched in 2009.

Much of the data reported through the Physician Quality Reporting System represents clinical performance measures (for example, percent of age-appropriate women receiving mammograms to screen for breast cancer), which were developed by leading physician and health care quality organizations such as the American Medical Association and the National Committee for Quality Assurance.

Physicians and other eligible health care professionals who satisfactorily reported data on these quality measures through the Physician Quality Reporting System in 2010 earned an incentive payment equaling 2 percent of CMS’ estimate of the eligible professional’s allowed charges under Medicare Part B for covered professional services furnished during the reporting period. Similarly, through the 2010 eRx Incentive Program, successful electronic prescribers earned a separate incentive payment equaling 2 percent of CMS’ estimate of the eligible professional’s allowed charges for covered professional services furnished by the eligible professional during the reporting period.

Gains in health quality reporting may signal clinical improvements

The most frequently reported measures included:

• Performance of electrocardiograms in the emergency department to help diagnose patients with chest pain for a potential heart attack.

• Adoption or use of electronic health records to help organize and manage care for patients.

• Administration of timely and appropriate antibiotics for patients undergoing surgery to reduce the risk of infection before the procedure begins.

In 2010, the performance rates for a number of measures showed improvements from their 2007 performance rates. For instance, the percent of professionals who reported:

• that they tested patients who had a stroke for difficulty swallowing before the patients took in foods, fluids, or medication by mouth (a potential choking hazard in some patients) jumped from 46.5 percent in 2007 to 87.3 percent   in 2010.
• that they had tested patients with diabetes for potentially damaging eye-related complications of the disease, and then communicated those results to the patient’s diabetes doctor, jumped from 69.9 in 2007 to 93.3 in 2010.
• that patients diagnosed with chronic obstructive pulmonary disease received appropriate prescriptions for drugs to help with breathing (bronchodilators) jumped from 78.4 percent in 2007 to 99.3 percent in 2010.
• that care teams effectively stopped post-surgical antibiotics in cardiac patients (to prevent overmedication and the formation of potentially drug-resistant “superbugs”) jumped from 81.6 percent t to 99.6 percent.

Increases in participation rates and frequency of successful reporting

Similar to previous program years, in 2010, CMS sought to encourage participation and enhance aspects of the Physician Quality Reporting System. Examples include the addition of 22 individual measures and six measures groups for the Physician Quality Reporting System in 2010.

Also, under the Physician Quality Reporting System, the option to use registries to submit data on behalf of eligible professionals was implemented in the 2008 program year, and in 2010 the number of CMS-qualified registries continued to grow, with 89 registries submitting data for over 56,000 eligible professionals. Approximately 90 percent of professionals submitting individual measures through a registry earned an incentive.
 

Increases in numbers of health professionals who choose to participate

Since the Physician Quality Reporting System began in 2007, CMS has added additional quality measures—bringing the total menu of measures from which eligible professionals could choose to report from 74 to 175. The increase in the number of measures shows CMS’ commitment to ensuring that as many types of eligible health professionals and specialty groups as possible are able to report quality data.

CMS also strives to make the Physician Quality Reporting System measures as universally applicable to a broad range of specialties.  Examples of the types of eligible professionals who participate in quality reporting include radiologists, anesthesiologists, ophthalmologists, nurse practitioners, physician assistants, family practitioners, and orthopedic surgeons. Through the most popular form of collecting data (that is, Medicare Part B claims), emergency medical physicians had the highest rate of satisfactory reporting in 2010— nearly 65 percent reported on at least one quality measure and 85.6 percent of those received an incentive payment.

The future of the Physician Quality Reporting System and the eRx Incentive Program

Congress extended the Physician Quality Reporting System in 2008 and authorized incentive payments through 2010.  Additional legislation extended incentive payments for the Physician Quality Reporting System through 2014. Beginning in 2015, eligible professionals who do not report data to CMS satisfactorily under the Physician Quality Reporting System will receive a downward payment adjustment of 1.5 percent.  In 2016 and subsequent years, this payment reduction will increase to 2.0 percent.

The Physician Quality Reporting System in 2010 and 2011 included changes in an effort to eliminate unnecessary burden and facilitate quality reporting. For instance, beginning in 2011, eligible professionals reporting through the claims method found the reporting rate criterion changed from 80 percent to 50 percent. An additional incentive also was authorized in 2011 to help eligible professionals earn an additional 0.5 percent incentive for reporting measures through the Physician Quality Reporting System and meeting certain requirements related to participating in a Maintenance of Certification Program.   In 2012, the EHR Data Submission Vendor reporting mechanism was added to the Physician Quality Reporting System to enable greater participation by physicians and other eligible health care professionals.  

More information about the Physician Quality Reporting System, including how eligible professionals can participate and the criteria for reporting to qualify for an incentive payment, is available at http://www.cms.gov/PQRS.

For the eRx Incentive Program, data reporting on the electronic prescribing quality measure during the first six months of 2011 was used to determine which eligible professionals and group practices are exempt from the legislatively mandated 2012 eRx payment reduction of 1 percent.   

More information on how to participate in the eRx Incentive Program as well as more information about the 2012 eRx payment adjustment can be found at http://www.cms.gov/ERXincentive/.

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