What is PQRI and Why is it Important


PQRI stands for Physician Quality Reporting Initiative, although the program is now called the Physician Quality Reporting System, or PQRS. This program has been in place since 2006, and is hosted by the Centers for Medicare and Medicaid (CMS).

Essentially, the program dictates that qualified physicians can report on their Medicare patients. If done correctly and to the standards set by CMS, the physician could receive a payment incentive. Standards have been updated each year since the program’s inception, and can be found on the CMS website. There you can also find more information on the program, including implementation and education materials.

History of PQRI

PQRI was implemented in 2006. It was born from the Tax Relief and Health Care Act of 2006 under the Bush administration. The program offered a 1.5 percent payment incentive for physicians that used the reporting program to standard for Medicare Part B covered healthcare procedures and visits.

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How to use PQRI

PQRI is a simple program on the surface, but complicated when you get into the reporting standards. Gather all of the available information from the CMS website first, including educational materials, reporting standards, and implementation advice.

By far, the two easiest ways to report are via the claims or electronic health record products. In addition, these two methods will help you ensure that you are reporting to the quality standards set forth by CMS. This is going to be even more important moving forward.

Changes to PQRI

With the Affordable Healthcare Act came changes to PQRI. Some of these changes have yet to take place. Largely, the changes are in the standards for reporting. However, there are some other changes that make participation extremely important.

The first changes you will notice are in the incentives. The incentive will only be .5 percent for years 2012 through 2014. Starting in 2015, there will be a penalty for not participating in quality reporting. However, it is important not to wait until 2015 to participate.

One of the things that has physicians and physician advocacy groups upset about the new legislation is that penalties in 2015 will be based in part on 2013 participation. This means that if you do not participate in 2013, you will be penalized in 2015, even if you participate in that year. Therefore, it is best to start participating now, so that you can be certain you have achieved the learning curve before 2013.

In short, the program that was initially voluntary is now going to be mandatory, hence the name change. It is important to stay abreast of future changes to this program.

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