- Per CMS, the following factors should be considered when deciding which measures to select for PQRS reporting:
- Clinical conditions usually treated;
- Types of care typically provided (e.g., preventive, chronic, acute);
- Settings where care is usually delivered (e.g., office, emergency department [ED], surgical suite);
- Quality improvement goals;
- Other quality reporting programs in use or being considered;
- Find out if any of the PQRS measures groups apply to your specialty. You can find the list of PQRS measures groups here. It is usually easier to report measures groups because a health provider only needs to report a minimum 20 eligible patient sample (at least 11 patients need to have Traditional Fee for Service Medicare). For example, family practice or internal medicine providers usually report the Diabetes Measure Group or the Preventive Care Measures Group. Cardiologists usually report the CAD Measures Group. If there is no measures group that applies directly to your specialty, you could choose the Cardiovascular Prevention Measures Group or the Preventive Care Measures Group.
- If you cannot report PQRS using a Measures Group, you will have to report using individual measures. Unlike the measures groups where you only need to report a minimum 20 patient sample, when reporting individual measures you will need to report at least 50% of the Medicare eligible patients for each measure. Tip: If possible, when selecting measures you could avoid measures that are very broadly applicable to all of your Medicare patients. For example:
- It would be easier to report more specific measures that apply to smaller patient populations. For example, dermatologists could report melanoma measures #137, #138 and #224.
- CMS created Clusters of Clinically Related Measures. If reporting less than 9 measures or less than 3 domains, a provider must report ALL the individual PQRS measures INSIDE a cluster of Clinically Related Measures. For example, a dermatologist reporting measures 137 and 224, also needs to report measure 138 that belongs to the melanoma cluster.
- When reporting individual measures, at least one cross-cutting measure must be satisfactorily reported by individual providers or group practices that have at least one Medicare Patient with a face-to-face encounter. Please note that some cross-cutting measures can apply to most Medicare patients or even to most Medicare visits. For example if you have 1000 Medicare office visits during the year, you would be expected to report cross-cutting measure #130 Documentation of Current Medications in the Medical Record on at least 50% of those visits.There are however some cross-cutting measures that may apply to smaller patient populations:
