Reporting of Physician Quality Reporting System Measures Groups

60.2 – Reporting of Physician Quality Reporting System Measures Groups (Rev. 10, Issued: 07-27-12, Effective: 10-29-12, Implementation: 10-29-12) For the 2008 Physician Quality Reporting System, CMS established 4 measures groups to address the following clinical topics: (1) Diabetes Mellitus, 18 (2) Chronic Kidney Disease (CKD), (3) Preventive Care, and (4) End Stage Renal Disease (ESRD). For the 2009 Physician Quality Reporting System, CMS removed the ESRD measures group, but added 4 additional measures for a total of 7 measures groups. The 2009 Physician Quality Reporting System measures groups address the following clinical topics: (1) Diabetes Mellitus, (2) CKD, (3) Preventive Care, (4) Coronary Artery Bypass Graft (CABG) Surgery, (5) Rheumatoid Arthritis, (6) Perioperative Care, and (7) Back Pain. For the 2010 Physician Quality Reporting System, CMS retained all of the 2009 Physician Quality Reporting System measures groups and added 6 new measures groups for a total of 13 measures groups. The 2010 Physician Quality Reporting System measures groups address the following clinical topics: (1) Diabetes Mellitus, (2) CKD, (3) Preventive Care, (4) CABG Surgery, (5) Rheumatoid Arthritis, (6) Perioperative Care, (7) Back Pain, (8) Coronary Artery Disease (CAD), (9) Heart Failure, (10) Hepatitis C, (11) Ischemic Vascular Disease (IVD), (12) Human Immunodeficiency Virus (HIV)/Acquired Immune Deficiency Syndrome (AIDS), and (13) Community-Acquired Pneumonia (CAP). For the 2011 Physician Quality Reporting System, CMS retained all of the 2010 Physician Quality Reporting System measures groups and added 1 new measures group, for a total of 14 measures groups. The 2011 Physician Quality Reporting System measures groups address the following clinical topics: (1) Diabetes Mellitus, (2) CKD, (3) Preventive Care, (4) CABG Surgery, (5) Rheumatoid Arthritis, (6) Perioperative Care, 19 (7) Back Pain, (8) Coronary Artery Disease (CAD), (9) Heart Failure, (10) Hepatitis C, (11) Ischemic Vascular Disease (IVD), (12) Human Immunodeficiency Virus (HIV)/Acquired Immune Deficiency Syndrome (AIDS), and (13) Community-Acquired Pneumonia (CAP). (14) Asthma For the 2012 Physician Quality Reporting System, CMS retained all of the 2011 Physician Quality Reporting System measures groups and added 8 new measures groups, for a total of 22 measures groups. The 2012 Physician Quality Reporting System measures groups address the following clinical topics: (1) Diabetes Mellitus, (2) CKD, (3) Preventive Care, (4) CABG Surgery, (5) Rheumatoid Arthritis, (6) Perioperative Care, (7) Back Pain, (8) Coronary Artery Disease (CAD), (9) Heart Failure, (10) Hepatitis C, (11) Ischemic Vascular Disease (IVD), (12) Human Immunodeficiency Virus (HIV)/Acquired Immune Deficiency Syndrome (AIDS), (13) Community-Acquired Pneumonia (CAP), (14) Asthma, (15) COPD, (16) IBD, (17) Sleep Apnea, (18) Dementia, (19) Parkinson’s, (20) Elevated Blood Pressure, (21) Cardiovascular Prevention, and (22) Cataracts. In addition, all measures contained in the following 2012 Physician Quality Reporting System measures groups are also reportable as individual measures: (1) Diabetes Mellitus, (2) CKD, (3) Preventive Care, (4) CABG Surgery, (5) Rheumatoid Arthritis, (6) Perioperative Care, 20 (7) Coronary Artery Disease (CAD), (8) Heart Failure, (9) Hepatitis C, (10) Ischemic Vascular Disease (IVD), (11) Human Immunodeficiency Virus (HIV)/Acquired Immune Deficiency Syndrome (AIDS), (12) Community-Acquired Pneumonia (CAP), (13) Asthma, (14) COPD, and (15) Cardiovascular Prevention. In addition, data on the CABG, CAD, Heart Failure, HIV/AIDS, IBD, Sleep Apnea, Dementia, Parkinson’s, Elevated Blood Pressure, and Cataracts measures groups may only be reported through a qualified registry and may not be reported through claims-based reporting (see §50 above). Measures groups specifications are different from the specifications for individually reported measures (if any measures in a measures group may be reported individually) that form the group. Therefore, the specifications, including the list of measures selected for inclusion in each of the Physician Quality Reporting System measures groups, and reporting instructions for the Physician Quality Reporting System measures groups are provided separately from the specifications for the individual Physician Quality Reporting System measures. The specifications manual for measures groups can be found on the CMS Physician Quality Reporting System website at http://www.cms.hhs.gov/PQRS. Measures group specifications for the current or upcoming program year can be found on the Measures Codes page of the CMS PQRS website. Measures group specifications for prior program years are archived to the appropriate Physician Quality Reporting System Program page of the CMS Physician Quality Reporting System website. To initiate claims-based reporting of measures groups, it is necessary that the eligible professionals indicate the intention to begin reporting a measures group by submitting a measures group-specific G-code on the patient claim. There is one defined measures group- specific G-code for each Physician Quality Reporting System measures group. It is not necessary to submit the measures group-specific G-code on more than one claim. If the measures group-specific G-code for a given group is submitted multiple times during the reporting period, only the submission with the earliest date of service will be included in the Physician Quality Reporting System analyses; subsequent submissions of that code will be ignored. It is not necessary to submit the measures-group specific G-code for registry-based submissions. In addition, beginning for the 2009 Physician Quality Reporting System, if all quality actions for the applicable measures in a measures group have been performed for the patient, one Physician Quality Reporting System composite G-code may be reported in lieu of the individual quality-data codes for each of the measures within the group. There is one defined composite G-code for each Physician Quality Reporting System measures group. Similar to the specifications for individual Physician Quality Reporting System measures, when measures groups for a particular program year are selected from a prior year’s measures group set, the detailed measures group specifications for such a measures group may have been updated or modified during the National Quality Forum endorsement process or for other reasons. In 21 addition, the individual measures that comprise a specific measures group may change from year to year. Therefore, the Physician Quality Reporting System measures group specifications for any given measures group selected for use in a specific program year may be different from specifications for the same measures group used for a prior program year. For example, the measures that form the Diabetes Mellitus and CKD measures groups for the 2009 Physician Quality Reporting System are different from the measures that were included in these measures groups for 2008. Not only do eligible professionals need to ensure that they are using the measures groups specifications rather than the specifications for the individual Physician Quality Reporting System measures, but eligible professionals also must ensure that they are using the measures groups specifications for the correct program year.