All Aboard the PQRS Train!

It’s already November, and for those of us who’ve been patiently—or not—waiting for CMS to announce their 2013 Physicians Quality Reporting System (PQRS, formerly known as PQRI) plans, our wait is over. So let’s talk about what’s new—and not so new—for 2013.

First, the basics: 2013 is the first year that PQRS is “mandatory.” Now, you could decide that it’s not worth your time and blow it off completely, but before you do, you should know that CMS will penalize you with a 1.5% adjustment to your fee schedule in 2015; and you’ll miss out on the .5% incentive CMS is offering this year for completion.

You may find yourself saying “pshh” and assuming that the government may dilly dally on all of this, and they won’t actually assess the fines and penalties, but that’s a risky proposition. Let’s face it: every dollar counts and I certainly wouldn’t want to take even the slightest chance of leaving money on the table—especially when we as rehab therapists work so hard to earn it. Plus, PQRS and everything that goes with it will happen—as it should, because functional outcome measures and pay-for-performance methodologies are where we want our profession to be heading. Don’t delay the inevitable; meet PQRS head on.

Now if you think that meeting it head on sounds like it will take too much time and work, don’t fret. It’s not nearly as bad as you think! As a matter of fact, you’re probably already performing the tests and recording the measures that you need to meet per PQRS requirements.

CMS only requires you select and complete three measures for every qualified Medicare patient you treat during 2013. Want an easy one? Measure #182, Functional Outcome measure, is one you should already be completing to meet Medicare requirements even without participating in PQRS. For your second and third measures, take a look at your patient demographics. Do you see a lot of diabetic patients? There are diabetic outcome measures you can choose. There also ones for BMI, Pain Assessment, and Fall Risk Assessment—all of which you’re probably already assessing with your patients.

Plus, you only need to report most of these measures in association with CPT™ 97001 once a year. That means you only report them on your initial examinations, and you’re done. And there are only a few EMRs that specialize in serving the rehab community and are approved by CMS as PQRS registries. That means your EMR will automatically aggregate your PQRS data from your assessments and send it to CMS at the end of the year—easy peasy.

Feeling better about PQRS? You should. It’s totally something you can handle, and there are plenty of resources out there to help should you have questions. For example, check out the WebPT blog this month (November) for everything you’ll ever need to know about PQRS, like G Codes, new outcome measures, and the difference between claims-based and registry-based reporting. Ultimately, we can’t choose how CMS decides to implement PQRS, but it’s crucial that we do choose our attitude about it. I’ve emphasized it plenty that PQRS is inevitable and we should get on board. But let’s not commence this journey with reluctance. PQRS will help us achieve evidence-based practice and therefore, elevate the profession. We’re the musculoskeletal experts, so don’t let a few Medicare regulations divert you from your passion to help those who need us. It’s inevitable that pay for performance is the wave of the insurance future. So embrace change  and move the bar upward. We are trailblazers, after all.

About the Author

Heidi Jannenga, PT, MPT, ATC/L
Heidi was a scholarship athlete at the University of California, Davis. Following a knee injury and subsequent successful rehabilitation, Heidi developed a passion for physical therapy. She started her 16-year physical therapy career after graduating with her Masters from the Institute of Physical Therapy in St. Augustine, Florida.

In 2008, Heidi and her husband Brad launched WebPT, the leading web-based Electronic Medical Record (EMR) and comprehensive practice management service for physical therapists. As the company’s COO, Heidi is responsible for product development/management, billing services, and customer support.

She now resides in Phoenix with Brad and their daughter Ava.