PQRS Reporting

ASCO is pleased to announce that oncology practices can now complete all of their Physician Quality Reporting System (PQRS) requirements through the Quality Oncology Practice Initiative (QOPI®) platform free of charge to all practices with a current and registered ASCO member, regardless of whether your practice participated in the 2016 QOPI Rounds.

QOPI offers individual reporting by NPI/TIN for the Oncology Measures Group which requires submission of 20 charts (11 of which must be Medicare Part B FFS) for each eligible professional (EP) across seven oncology measures. QOPI is unable to offer the group reporting option (GPRO) or individual measures reporting at this time.

How to Register for PQRS Reporting Through QOPI

If your practice is not already registered with QOPI, please visit https://myqopi.asco.org/registration/login.aspx and select "New Registration."  **This requires at least one member of the practice to be an ASCO member.**

Once in the QOPI system, please send an email to QOPI@asco.org requesting access to the PQRS pathway with your practice name, practice ID number, and number of physician FTEs. The deadline to register for PQRS is 1/24/17, 5PM EST.

PQRS data abstraction will remain open until January 31st, 2017, 5PM EST.  ASCO will submit your data to CMS on your behalf at the Tax Identification Number/NPI level by March of 2017.

For more detailed information on the PQRS abstraction process, please view the video tutorial on the QOPI Dashboard under 'Current Round Documentation' - 'PQRS Chart Abstraction Resources'.

If you have any further questions or would like more information, please email QOPI@asco.org

2016 Reporting Timeline

ASCO will submit reports on behalf of EPs to CMS in March of 2017.

Data will be collected through QOPI for PQRS submission for the oncology measure group through January 31st, 2017, 5pm EST.

Please refer to the CMS website for more details.  Below is a summary of CMS requirements for PQRS reporting. 

PQRS Reporting Accordion

How to Get Started with PQRS Reporting

Step 1: Determine if you are expected to participate to avoid payment adjustment.

Eligible professionals are identified on claims by their individual National Provider Identifier (NPI) and Tax Identification Number (TIN), or PQRS group practices participating via the group practice reporting option (GPRO), and referred to as PQRS group practices.  Eligible professionals include Medicare Physicians, Practitioners (i.e.NP, PA) and Therapists. A full list of EPs can found via 2016 PQRS List of Eligible Professionals.

Step 2: Determine which PQRS reporting method best fits your practice. PQRS offers several methods to report quality data. An eligible professional may choose from the following methods to submit data to CMS: claims-based, registry-based, qualified Electronic Health Record (EHR), Qualified Clinical Data Registry (QCDR) or the Group Practice Reporting Option (GPRO). Please note: QOPI does not currently support the group practice reporting option (GPRO).

Step 3: If the chosen method to report is qualified registry-based, determine which measure reporting option (individual measures or measures group) best fits your practice. Review the specific criteria for the chosen reporting option in order to satisfactorily report.  Please note: QOPI currently only offers measures group reporting through the Oncology Measures Group.

How to Report through a Qualified Registry

Individual Measures

Step 1: Choose at least nine individual measures across three National Quality Strategy (NQS) domains or one measures group as an option to report on measures to CMS.

Step 2: Review information on the PQRS Payment Adjustment. To avoid being subject to a future PQRS payment adjustment, individual EPs can:

  1. Meet the requirements for satisfactory reporting or satisfactory participation in the 2016 PQRS, or
  2. Report 1-2 individual measures across at least 1 National Quality Strategy (NQS) domain via claims or registry on 50% or more of applicable Medicare Part B FFS patients across applicable domains. 

Measure Groups:

QOPI practices will be able to submit data by EP for the oncology measure group through QOPI. GPRO reporting is not available through QOPI at this time.

Step 1: Choose at least 1 measures group on which to report.

Step 2: Report on 20 patients per EP for all applicable measures within the measure group.

Step 3:Confirm that the majority of the patients in the measures group, at least 11 out of 20, are Medicare Part B FFS patients. 

Measure Selection for 2016 PQRS Reporting

Measure Selection for 2016 PQRS Reporting

When selecting measures on which to report, select those that encompass all of the following:

  • 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 for 2016
  • Other quality reporting programs in use or being considered

New for 2016 reporting, CMS requires one cross-cutting measure if the EP has at least one Medicare patient with a face-to-face encounter.

2016 PQRS Measures List

2016 PQRS List of Face-To-Face Encounter Codes

2016 Cross-Cutting Measures List

2016 Oncology Measures Group

Specialty Measure Sets:

CMS is collaborating with specialty societies to ensure that the measures represented within Specialty Measure Sets accurately illustrate measures associated within a particular clinical area. The Specialty Measure Sets are to be utilized as a guide to assist eligible professionals to choose measures applicable to their specialty beginning in Program Year 2015. The Specialty Measure Sets are NOT required measures but are suggested measures for a specific specialty.

Potential Oncology/Hematology Preferred Measure Set

Qualified Clinical Data Registry (QCDR) Reporting

A qualified clinical data registry (QCDR) is a new reporting mechanism available for the Physician Quality Reporting System (PQRS) first offered in 2014. A QCDR is different from a qualified registry in that it is not limited to measures within PQRS. A QCDR will complete the collection and submission of quality measures data on behalf of Eligible Professionals (EPs). For 2015, a QCDR is a CMS-approved entity that collects medical and/or clinical data for the purpose of patient and disease tracking to foster improvement in the quality of care provided to patients. EPs who satisfactorily participate in PQRS through a QCDR may avoid the 2017 payment adjustment (2.0%). To be considered a QCDR for purposes of PQRS, an entity must self-nominate and successfully complete a qualification process.  

Please note: A QCDR is different from a qualified registry in that it is not limited to measures within PQRS, please refer to the documents referenced below for more information.  

Criteria for Avoiding a Payment Adjustment via QCDR

Eligible Professionals (EPs) can avoid the 2017 payment adjustment by meeting the following criteria:

Individual EPs

1. Report at least 9 measures covering 3 National Quality Strategy (NQS) domains for at least 50% of the EP’s applicable patients seen during the 2015 participation period.

 2. Report on at least 2 outcome measures. If the QCDR does not possess 2 outcome measures, then the QCDR must possess at least 1 outcome measure and 1 of the following other type of measure: 1 resource use, OR patient experience of care, OR efficiency appropriate use, OR patient safety measure.*

Step 1:                  Determine if you are eligible to participate in PQRS

 Step 2:                 Choose the appropriate QCDR

A list of CMS-designated QCDRs will be available in mid-2015 on the QCDR Reporting page of the CMS PQRS website. The list of designated QCDRs includes information on each QCDR: • QCDR name. • Contact information. • Cost information. • Measures the QCDR has registered to report.

Once a QCDR is selected, the EP will be required to enter into and maintain an appropriate legal agreement. Such arrangements provide for the QCDR’s receipt of the patient-specific data and allow the QCDR to release quality measure data to CMS on the EP’s behalf. The QCDR will provide the EP with specific instructions on how to collect and provide patient data for use by the QCDR. The QCDR will submit 2015 data during the first quarter of 2016. EPs will work directly with their QCDRs to ensure data is submitted appropriately in order to avoid the PQRS negative payment adjustment.

2018 Payment Adjustment Information

If an eligible professional or group practice does not satisfactorily report or satisfactorily participate while submitting data on PQRS quality measures in 2016, a 2% payment adjustment will apply in 2018. Measures with a 0% performance rate will not be counted.

The adjustment results in 98% of the fee schedule amount that would apply to the services to covered professional services furnished by an eligible professional or group practice.

"Satisfactory reporting” refers to participating in PQRS to earn the incentive payment  while “satisfactory participation” refers to EPs participating in the new “qualified clinical data registry” reporting option.

For Group Practices

Group practices participating in the Group Practice Reporting Option (GPRO) can avoid 2016 payment adjustments by meeting one of the following criteria during the 2014 PQRS program year:

1. Meet the requirements for satisfactorily reporting for incentive eligibility as defined in the applicable 2015 PQRS measure specifications

2. Report at least 3 measures covering one NQS domain for at least 50 percent of the group practice’s Medicare Part B FFS patients via qualified registry

• Report 1-8 measures covering 1-3 NQS domains for which there is Medicare patient data (subjecting the group practice to the MAV process*), AND report each measure for at least 50% of the group practice’s Medicare Part B FFS patients seen during the reporting period to which the measure applies.

*A group practice who reports fewer than 3 measures covering 1 NQS domain via the registry-based reporting mechanism will be subject to the MAV process, which would allow CMS to determine whether a group practice should have reported on additional measures.

Please note that QOPI does not offer GPRO reporting at this time.

For complete details visit the CMS PQRS Reporting Page.