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The Centers for Medicare and Medicaid Services (CMS) recently announced changes and updates to the 2011 CMS Physician Quality Reporting System (PQRS). The name change from Physician Quality Reporting Initiative (PQRI) to PQRS is just one of the changes. CMS believes that changes to PQRI authorized under the Affordable Care Act (ACA) of 2010 lend permanency to the reporting program. To reflect the transition to a permanent program, CMS will, hereafter, refer to the program as the Physician Quality Reporting System.

Major changes include:

• The minimum “sample size” requirement of 80% has been reduced to 50% for claims-based reporting. Currently, an eligible professional (EP) must report a measure on at least 80% of Medicare patients for whom the measure applies.
• The ACA requires CMS to put in place an informal review process for EPs to seek a review if determined they did not satisfactorily submit data on quality measures under the PQRS.
• There is one new measure for diagnostic radiology in PQRS 2011, # 225 Radiology: Reminder System for Mammograms.  The measure, developed by the AMA Physician Consortium and ACR in 2007, is described as the percentage of patients aged 40 years and older undergoing a screening mammogram whose information is entered into a reminder system with a target due date for the next mammogram.
• There are a few code updates, terminology clarifications and verbiage changes to some measures potentially reportable by diagnostic radiologists, interventional radiologists and radiation oncologists. Complete 2011 measure specifications, specification release notes and 2011 program information can be found in the “Downloads” section of this CMS webpage.

Source: ACR