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Supporting_Stmt_A_PRA

ICR 201401-0938-005 · OMB 0938-1226 · Object 44243901.

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Part A. Supporting Statement
Physician Quality Reporting System and the Electronic Prescribing Incentive Program
A.

Background

This request is for clearance to conduct three surveys, one of Medicare beneficiaries, one of
eligible professionals, and one of administrators, in support of an evaluation of the Physician
Quality Reporting System (PQRS) and the Electronic Prescribing (eRx) Incentive Program. In
addition, we will interview a small number of eligible professionals and administrators. This
evaluation is designed to determine how well the PQRS and the eRx are contributing to better
and affordable health care for Medicare beneficiaries. The PQRS is a voluntary reporting
program that provides an incentive payment to eligible professionals who satisfactorily report
data on quality measures. The Centers for Medicare & Medicaid Services (CMS) uses quality
measures to promote improvements in care delivery and payment and to increase transparency.
The PQRS program rewards eligible professionals based on a percentage of the estimated
Medicare Physician Fee Schedule of their allowed Part B charges if they meet the defined
reporting requirements. The PQRS was initially referred to as the Physician Quality Reporting
Initiative, or PQRI.
The PQRS was first implemented in 2007 as an incentive for voluntary reporting of quality
measures in accordance with a section of the Tax Relief and Health Care Act of 2006. The PQRS
was further extended and enhanced by legislation such as the Medicare, Medicaid, and State
Children’s Health Insurance Program (SCHIP) Extension Act of 2007 (MMSEA) and the
Medicare Improvements for Patients and Providers Act of 2008 (MIPPA). A number of changes
have been made to the PQRS, including group measures, the group reporting option, and
additional measures. The PQRS was extended further with the enactment of MMSEA. MMSEA
provided professionals greater flexibility for participating in the PQRS for 2008 and 2009 by
authorizing CMS to establish alternative reporting criteria and alternative reporting periods for
the reporting measures groups and for the submission of data on the PQRS quality measures
through clinical data registries. MIPPA, enacted in July 2008, made the PQRS program
permanent, further enhanced the PQRS, and established a new stand-alone incentive program for
successful electronic prescribers.
The eRx Incentive Program, the other program being evaluated in this project, was first
implemented in 2009. The eRx is another incentive reporting program that uses a combination of
incentive payments and payment adjustments to encourage eRx by eligible professionals. The
program provides an incentive payment to practices with eligible professionals who successfully
e-prescribe for covered Physician Fee Schedule services furnished to Medicare Part B Fee-ForService (FFS) beneficiaries. Eligible professionals do not need to participate in PQRS to
participate in the eRx Incentive Program.
The PQRS and eRx incentive programs have grown over the years to promote participation and
reporting success.

1

Surveys of eligible professionals and administrators can help us understand possible motivations
for participating in PQRS/eRx. For example, providers who view quality measures as meaningful
and reliable indicators of the care that they provide may be more likely to participate in a quality
improvement program. Similarly, providers’ comfort and experience with HIT (Health
Information Technology) may influence the decision of whether to participate in programs like
PQRS/eRx and, once the decision has been made to participate, will clearly affect the choice of
data submission method. As such, it will be important to the implementation and impact
evaluation to collect this type of survey data from participating and non-participating eligible
professionals to help determine whether differences in attitudes and experiences toward HIT and
quality measurement might be associated with program participation. In addition, the
participation in these initiatives requires administrators (e.g., practice managers, billing
managers, and office managers) to address the technical aspects of the project regarding
experience with data submission. Therefore we will survey two groups: (1) eligible professionals
and (2) administrators who work at eligible professionals’ facilities.
Documents to be used in this study are in Attachments A through D as follows:
A. List of Eligible Professionals.
B. Eligible Professional and Administrator Surveys and Correspondence.
B1.

Eligible Professional Survey—Electronic.

B2.

Eligible Professional Survey—Hardcopy.

B3.

Administrator Survey—Electronic.

B4.

Administrator Survey—Hardcopy.

B5.

Eligible Professional and Administrator Surveys Correspondence.

B6.

File Type	application/pdf
File Title	Physician Quality Reporting System and the Electronic Prescribing Incentive Program
Author	Centers for Medicare and Medicaid Services
File Modified	2013-10-29
File Created	2013-10-29