PQRS and eRx participation rose substantially in 2012

Participation in the government’s Physician Quality Reporting System (PQRS) incentive payment program went up 36 percent from the previous year in 2012, and participation in the Electronic Prescribing (eRx) Incentive Program went up 22 percent.

For those who favor moving to a Medicare payment system that rewards meeting quality metrics and uses more electronic transfers of care information, these are encouraging results. However, it should be noted that only the eRx program uses penalties (payment adjustments) so far to punish participating providers who do not meet the target for electronic prescription transfers. For the PQRS quality measures, it is a strict bonus program up until next year. That meant participating providers only stood to gain and had nothing to lose by not reporting and meeting the program’s defined quality metrics.

According to a report released Thursday by the Centers for Medicare and Medicaid Services, in 2012, nearly half a million (435,931) eligible professionals participated as individuals and as part of group practices in PQRS, through at least one reporting method. That was 115,509 more than participated in 2011 and represents about a third of all the professionals who were eligible to participate in 2012. According to CMS, the participating eligible professionals earned a combined total of $167,815,193 in PQRS incentive payments

In addition, the participation rate was highest among those providers who saw the most Medicare beneficiaries. More than half of eligible professionals who saw in excess of 200 Medicare beneficiaries per year participated.

For the eRx program, which has a payment adjustment penalty, 344,676 eligible professionals participated in 2012. This represents approximately 44 percent of the 778,904 professionals who were eligible to participate that year. Total incentive payments handed out in that program were $335,331,216. Next year is the last year of the eRx incentive program, which means the push is on for CMS to get as many of the approximately 56 percent of eligible professionals who were not participating in the eRx program yet to adopt electronic prescribing by the end of 2015.

One factor that really seemed to help increase participation in the PQRS, CMS noted, was aligning quality measurement across programs. Many eligible providers participate in other quality incentive programs, such as pay for performance (P4P), and they were more likely to participate in PQRS when they didn’t have to collect a completely new set of quality measures for the PQRS program and could instead use some of the data they already had gathered for other incentive programs to earn PQRS incentive payments.

“Aligning measures across quality programs focuses providers on the most important measures for patients and makes it easier to participate in programs like PQRS, which are designed to emphasize quality for Medicare beneficiaries,” noted Patrick Conway, M.D., deputy administrator for innovation and quality and chief medical officer at CMS in a press release announcing the report.

Download the full report as a zip file here.