Physician Quality Reporting System
What Neurosurgeons Need to Know for 2016
The Physician Quality Reporting System (PQRS) is a federal program that requires physicians and
other eligible professionals (EPs) to report to the Centers for Medicare and Medicaid Services (CMS)
quality measures data related to services furnished to Medicare Part B beneficiaries. Eligible
professionals who do not participate or do not satisfactorily report data in 2016 will be subject to a
2.0% penalty on all Medicare Physician Fee Schedule services in 2018.
Although PQRS payment adjustments are based on reporting success and not performance, CMS
relies on PQRS measure data to calculate a separate performance-based payment adjustment
known as the Value-Based Payment Modifier. When payment penalties from these two programs
are combined and added to the penalties associated with a third program, the Medicare Electronic
Health Records (EHR) Incentive Program, neurosurgeons could be at risk of losing nearly 10% of
their Medicare payments in 2018.
CMS plans to make available to the public in late 2017 virtually all 2016 PQRS measure data. Up
until this point, CMS has only indicated to the public whether an EP participated in the PQRS.
However, going forward, CMS plans to release physician-specific performance data.
Given the increasing significance of successful PQRS participation, it is critical that neurosurgeons
understand the 2016 PQRS reporting requirements and the program’s various reporting options.
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