CMS-10482 Attachment B - Eligible Professionals and Practice Admin

Attachment B: Eligible Professional and Administrator Surveys and Correspondence







Eligible Professional Survey – Electronic
Eligible Professional Survey – Hardcopy
Administrator Survey – Electronic
Administrator Survey – Hardcopy
Eligible Professional and Administrator Survey Correspondence

Attachment B1. Eligible Professional Survey—Electronic
Note: Question B1 is designed as a drop-down menu. If the survey participant’s main specialty
does not appear in the list of items available, the survey participant will select the “Other
specialty” option and enter the appropriate text in the corresponding box below this option.
The contents of Question B1 are as follows:
Anesthesiology
Cardiovascular diseases
Chiropractor
Counseling/Psychology
Dentistry
Dermatology
Emergency medicine
Family practice
Gastroenterology
General surgery
General internal medicine
Nephrology
Neurology
Nurse anesthetist
Nurse practitioner
Obstetrics and Gynecology

Oncology
Ophthalmology
Optometry
Orthopedic surgery
Otolaryngology
Physical/Occupational therapy
Podiatry
Psychiatry
Pulmonology
Radiology
Registered nurse
Social work
Urology
Other specialty (enter text below)
___________________________________

Evaluation of PQRS and eRx: Eligible Professional Survey
Date
Centers for Medicare & Medicaid Services
United States Department of Health and Human Services

Survey Instructions
The following survey asks questions about your participation in the Physician Quality
Reporting System (PQRS) and Electronic Prescribing (eRx) Incentive Program. As you
answer each question, please remember there is no right or wrong answer; we are just
interested in your thoughts and opinions on this topic.
Answer each question by clicking your cursor on the box to the left of your answer.
Sometimes the survey will skip over certain questions automatically based on your
response.
If you have any questions or need help completing the survey, please contact Econometrica
toll-free at 1-888-207-0728 from 9:00 a.m. to 5:00 p.m. CST or send an email to
PQRSeRx@econometricainc.com.
Please begin the survey now.

A: SURVEY ELIGIBILITY

A1. Are you a physician, a nurse practitioner, a physician assistant, or some other
type of health care provider?






Physician (MD/DO)
Nurse Practitioner
Physician Assistant
Not a Health Care Provider
Other (please specify):

A2. Do you accept payment from Medicare?
 Yes
 No

A3. How many years have you been in practice since you completed your training?






Still in residency or training (e.g., completing field work, clinical experience) Stop
Less than 1 year
1-5 years
6-10 years
Greater than 10 years

1

A4. In a typical week, how many hours of direct patient care do you provide?
(Patient care includes seeing patients, reviewing tests, preparing for and performing
surgical procedures, and providing other related patient-care services.)






None Stop
1-9 hours Stop
10-19 hours Stop
20-29 hours
30 or more hours

B: BACKGROUND

B1. What is the main specialty in which you practice?

B2. Which of the following best describes your main practice setting?
 Hospice
 Hospital, teaching
 Hospital, non-teaching
 Laboratory
 Multi-specialty group practice or clinic
 Physician’s office, single specialty group practice
 Physician’s office, solo practice
 Skilled nursing facility
 Urgent care facility
Other (please specify):
________________________________________________________________________________
________________________________________________________________________________
B3. Including yourself, how many full-time equivalent (FTE) health practitioners are
in your practice?
(Full-time equivalent health practitioners are clinicians who work 20 hours or more,
per week. Each person who works more than 20 hours is counted as 1 FTE.)
Number of FTE physicians:
Number of FTE nurse
practitioners:
Number of FTE physician
assistants:
Number of other clinical
providers (excluding clinic
assistants)

_______________
_______________
_______________
_______________

B4. Are you a full-owner or part-owner of your practice?
 Yes
 No

2

C: PHYSICIAN QUALITY REPORTING SYSTEM (PQRS) PARTICIPATION

C1. Have you heard of the PQRS program, formerly known as the Physician Quality
Reporting Initiative (PQRI)?
 Yes
 No
C2. Did you participate in the 2013 PQRS program?
 Yes
 No

C3. Which of the following influenced your decision to participate in PQRS in 2013?
(Select all that apply.)
 Believe it is important to continuously improve patient care
 Incentives from private payers for participation in quality reporting initiatives
 Internal cost reduction effort
 Public reporting/transparency
 Required by my practice/organization
 To avoid Medicare penalty or reduction in payment
 To earn Medicare incentive payment for PQRS
 To prepare for a time when quality is a significant factor in Medicare reimbursement
Other (please specify):
________________________________________________________________________________
________________________________________________________________________________
C4. Please rate the extent to which you agree that PQRS participation has:
Strongly
Disagree
Agree
Strongly
disagree
agree




a. Helped me improve the
quality of care I provide to my
Medicare patients




b. Enhanced my ability to
provide preventive care to
my Medicare patients




c. Improved the overall
health for a majority of my
Medicare patients




d. Reduced avoidable health
care costs for my Medicare
patients
C5. As a program participant, how likely would you be to recommend PQRS to other
practitioners?
 Highly unlikely
 Somewhat unlikely
 Neither likely nor unlikely
 Somewhat likely
 Highly likely

3

C6. What impact does the level of incentive you receive from participating in PQRS
have on your ability to provide better care?
 No impact
 A small impact
 A moderate impact
 A large impact
D: PQRS FEEDBACK REPORT
D1. Have you ever read a PQRS feedback report from CMS?
 Yes
 No

D2. If yes, what year(s) was the PQRS feedback report for?
(Select all that apply.)








2007
2008
2009
2010
2011
2012
2013

D3. How helpful was the PQRS feedback report in providing you with the information
needed to improve care for your Medicare patients?





Not at all helpful
Neither helpful nor unhelpful
Somewhat helpful
Very helpful

E: PQRS NON-PARTICIPATION
E1. Have you ever participated in the PQRS program, formerly known as the
Physician Quality Reporting Initiative (PQRI)?
 Yes
 No

E2. If yes, what year(s) did you participate in PQRS?
(Select all that apply.)







2007
2008
2009
2010
2011
2012

4

E3. To what extent do you agree or disagree that each of the following factors
prevents you from participating in the PQRS program?
Strongly
Disagree
Agree
Strongly
disagree
agree




a. Financial cost of
implementation is too high




b. Lack of time




c. Lack of appropriately
trained personnel




d. Current measures do not
apply to my practice
specialty




e. Unsure of how to
implement the program in my
practice.




f. Feel that the program is
unnecessary




g. Feel that it is not the
government’s role to

F: ELECTRONIC PRESCRIBING (eRx) INCENTIVE PROGRAM PARTICIPATION
F1. Have you heard of the eRx program?
 Yes
 No
F2. Did you participate in the 2013 eRx program?
 Yes
 No
 No, I am exempt.

F3. Which of the following influenced your decision to participate in eRx? (Select all
that apply.)
 Believe it is important to continuously improve patient care
 Incentives from private payers for participation in quality reporting initiatives
 Internal cost reduction effort
 Public reporting/transparency
 Required by my practice/organization
 To avoid Medicare penalty or reduction in payment
 To earn Medicare incentive payment for eRx
 To prepare for a time when quality is a significant factor in Medicare reimbursement
Other (please specify):
________________________________________________________________________________
________________________________________________________________________________

5

F4. What is the effect of eRx participation on coordination of care efforts with other
practitioners within or outside of your practice?





No effect
A small effect
A moderate effect
A large effect

F5. Please rate the extent that you agree that eRx participation has:
Strongly
Disagree
Agree
Strongly
disagree
agree




a. Helped me reduce the
prescription of medication
that is contraindicated or
could cause adverse
reactions for my Medicare
patients
b. Helped me improve the
quality of care that I provide
to my Medicare patients
c. Improved the overall
health for a majority of my
Medicare patients
d. Reduced avoidable health
care costs for my Medicare
patients
e. Increased patient
satisfaction

































F6. As a program participant, how likely would you be to recommend eRx to other
practitioners?






Highly unlikely
Somewhat unlikely
Neither likely nor unlikely
Somewhat likely
Highly likely

F7. Did you receive a penalty in eRx?
 Yes
 No
 No, I am exempt.

F8. If yes, what year(s) was the penalty received? (Select all that apply.)
 2012
 2013

6

G: eRx FEEDBACK REPORT
G1. Have you ever read any eRx feedback report from CMS?
 Yes
 No

G2. If yes, what year(s) was the eRx feedback report for?
(Select all that apply.)






2009
2010
2011
2012
2013

G3. How helpful was the eRx feedback report in improving care for your patients?
 Not at all helpful
 Neither helpful nor unhelpful
 Somewhat helpful
 Very helpful

H: eRx NON-PARTICIPATION
H1. Have you ever participated in eRx?
 Yes
 No

H2. If yes, what year(s) did you participate in eRx?
(Select all that apply.)





2009
2010
2011
2012

7

H3. To what extent do you agree or disagree that each of the following factors
prevents your practice from participating in the eRx program?

a. Financial cost of
implementation is too high
b. Lack of time
c. Lack of appropriately
trained personnel
d. Unsure of how to
implement the program in my
practice
e. Feel that the program is
unnecessary
f. Feel that it is not the
government’s role to monitor
physician quality

Strongly
disagree


Disagree

Agree





Strongly
agree






































H4. Did you receive a penalty in eRx?
 Yes
 No
 No, I am exempt

H5. If yes, what year(s) was the penalty received?
(Select all that apply.)
 2012
 2013

I: DEMOGRAPHICS
I1. Please indicate your gender.
 Male
 Female
I2. Please indicate your four-digit year of birth.
_______________

J: CONCLUSION
J1. Who completed the survey?
 The professional to whom the survey was addressed
 Administrative staff
 Other eligible professional
Other (please specify):
________________________________________________________________________________
________________________________________________________________________________
8

J2. We appreciate your feedback. Feel free to use this space to comment on the
survey or program issues you would like to see addressed in future evaluations.
________________________________________________________________________________
________________________________________________________________________________
________________________________________________________________________________
________________________________________________________________________________
________________________________________________________________________________
________________________________________________________________________________
________________________________________________________________________________
________________________________________________________________________________
________________________________________________________________________________
J3. Please include your name, email, and phone number in case we have a question
about your survey.
Title:
_______________________________________________________________________________________________
First name:

________________________________________________________________________________
Last name:

________________________________________________________________________________
Phone number:

________________________________________________________________________________
Alternate phone number:

________________________________________________________________________________
Email:

________________________________________________________________________________
J4. Would you like to receive the $100 incentive that will be sent electronically to the
email above?
 Yes
 No
J5. Are you willing to participate in a 30-minute follow-up phone interview to talk
more about your reasons for your participation decision, if applicable, and your
experiences with the PQRS/eRx program(s)?
You will receive an additional $100 gift card if you participate in the phone interview in
addition to completing this survey.
 Yes
 No

THERE ARE NO MORE QUESTIONS.
THANK YOU FOR YOUR PARTICIPATION IN THIS SURVEY!

9

Evaluation of PQRS and eRx:
Eligible Professional Survey
Date
Centers for Medicare & Medicaid Services
United States Department of Health and Human Services

Survey Instructions


Answer each question by marking the box to the left of your answer.



You are sometimes told to skip over certain questions in this survey. When this happens you will see an arrow
with a note that tells you what question to answer next, like this:
Yes
No



Go to B.

If you have any questions or need help completing the survey, please contact Econometrica toll-free at 1-888207-0728 from 9:00 a.m. to 5:00 p.m. CST or send an email to PQRSeRx@econometricainc.com.

Please begin the survey now.

A: SURVEY ELIGIBILITY
A1. Are you a physician, a nurse practitioner, a physician assistant, or some other type of health care provider?
☐ Physician (MD/DO)
☐ Nurse Practitioner
☐ Physician Assistant
☒ Other (please specify): ___________________________________________________________________
☐ Not a Health Care Provider
Stop
Do not continue. Please return the survey in the enclosed
envelope and we will remove your name from our list.

A2. Do you accept payment from Medicare?
☐ Yes
☐ No

Stop

Do not continue. Please return the survey in the enclosed
envelope and we will remove your name from our list.

A3. How many years have you been in practice since you completed your training?
☐ Still in residency or training
(e.g., completing field work,
clinical experience)

☐
☐
☐
☐

Stop

Less than 1 year
1–5 years
6–10 years
Greater than 10 years

Do not continue. Please return the survey in the enclosed
envelope and we will remove your name from our list.

A4. In a typical week, how many hours of direct patient care do you provide?
(Patient care includes seeing patients, reviewing tests, preparing for and performing surgical procedures, and providing
other related patient-care services.)

☐
☐
☐
☐

None
1–9 hours
10–19 hours
20–29 hours

Stop
Stop
Stop

Do not continue. Please return the survey in the enclosed
envelope and we will remove your name from our list.

☐ 30 or more hours

Page 2 of 8

B: BACKGROUND

B4. Are you a full-owner or part-owner of your
practice?

B1. What is the main specialty in which you
practice?
☐
☐
☐
☐
☐
☐
☐
☐
☐
☐

☐ Yes
☐ No

Cardiovascular diseases
Emergency medicine
Family practice
General internal medicine
Nephrology
Oncology
Ophthalmology
Psychiatry
Urology
Other (please specify): ________________

C: PHYSICIAN QUALITY REPORTING
SYSTEM (PQRS) PARTICIPATION
C1. Have you heard of the PQRS program,
formerly known as the Physician Quality
Reporting Initiative (PQRI)?
☐ Yes
☐ No
C2. Did you participate in the 2013 PQRS
program?

______________________________________

☐ Yes
☐ No

B2. Which of the following best describes your
main practice setting?
☐
☐
☐
☐
☐
☐
☐
☐
☐
☐

Hospice
Hospital, teaching
Hospital, non-teaching
Laboratory
Multi-specialty group practice or clinic
Physician’s office, single specialty group
practice
Physician’s office, solo practice
Skilled nursing facility
Urgent care facility
Other (please specify): ________________

C3. Which of the following influenced your
decision to participate in PQRS in 2013?
(Select all that apply.)
☐ Believe it is important to continuously
improve patient care
☐ Incentives from private payers for
participation in quality reporting
initiatives
☐ Internal cost reduction effort
☐ Public reporting/transparency
☐ Required by my practice/organization
☐ To avoid Medicare penalty or reduction in
payment
☐ To earn Medicare incentive payment for
PQRS
☐ To prepare for a time when quality is a
significant factor in Medicare
reimbursement
☐ Other (please specify): _______________

______________________________________
B3. Including yourself, how many full-time
equivalent (FTE) health practitioners are in
your practice?
(Full-time equivalent health practitioners are
clinicians who work 20 hours or more, per
week. Each person who works more than 20
hours is counted as 1 FTE.)
Number of FTE physicians:

__ __ __ __

Number of FTE nurse
practitioners:

__ __ __ __

Number of FTE physician
assistants:

__ __ __ __

Number of other clinical
providers (excluding clinic
assistants):

__ __ __ __

Go to E.

__________________________________

Page 3 of 8

D: PQRS FEEDBACK REPORT

C4. Please rate the extent to which you agree that
PQRS participation has:

D1. Have you ever read a PQRS feedback report
from CMS?

a. Helped me improve the quality of care I
provide to my Medicare patients
☐
☐
☐
☐

☐ Yes
☐ No

Strongly disagree
Disagree
Agree
Strongly agree

D2. If yes, what year(s) was the PQRS feedback
report for?
(Select all that apply.)

b. Enhanced my ability to provide preventive
care to my Medicare patients
☐
☐
☐
☐

☐
☐
☐
☐

Strongly disagree
Disagree
Agree
Strongly agree

2007
2008
2009
2010

☐ 2011
☐ 2012
☐ 2013

D3. How helpful was the PQRS feedback report in
providing you with the information needed to
improve care for your Medicare patients?

c. Improved the overall health for a majority
of my Medicare patients
☐
☐
☐
☐

Go to E.

☐
☐
☐
☐

Strongly disagree
Disagree
Agree
Strongly agree

Not at all helpful
Neither helpful nor unhelpful
Somewhat helpful
Very helpful

E: PQRS NON-PARTICIPATION
d. Reduced avoidable health care costs for my
Medicare patients
☐
☐
☐
☐

E1. Have you ever participated in the PQRS
program, formerly known as the Physician
Quality Reporting Initiative (PQRI)?

Strongly disagree
Disagree
Agree
Strongly agree

☐ Yes
☐ No

E2. If yes, what year(s) did you participate in
PQRS?
(Select all that apply.)

C5. As a program participant, how likely would
you be to recommend PQRS to other
practitioners?
☐
☐
☐
☐
☐

☐ 2007
☐ 2008
☐ 2009

Highly unlikely
Somewhat unlikely
Neither likely nor unlikely
Somewhat likely
Highly likely

C6. What impact does the level of incentive you
receive from participating in PQRS have on
your ability to provide better care?
☐
☐
☐
☐

Go to E3.

No impact
A small impact
A moderate impact
A large impact

Page 4 of 8

☐ 2010
☐ 2011
☐ 2012

E3. To what extent do you agree or disagree
that each of the following factors prevents you
from participating in the PQRS program?

F: ELECTRONIC PRESCRIBING (eRx)
INCENTIVE PROGRAM
PARTICIPATION

a. Financial cost of implementation is too high
☐
☐
☐
☐

F1. Have you heard of the eRx program?

Strongly disagree
Disagree
Agree
Strongly agree

☐ Yes
☐ No
F2. Did you participate in the 2013 eRx program?

b. Lack of time
☐
☐
☐
☐

☐ Yes
☐ No, because I am exempt.
☐ No
Go to H.

Strongly disagree
Disagree
Agree
Strongly agree

F3. Which of the following influenced your
decision to participate in eRx?
(Select all that apply.)

c. Lack of appropriately trained personnel
☐
☐
☐
☐

Strongly disagree
Disagree
Agree
Strongly agree

☐ Believe it is important to continuously
improve patient care
☐ Incentives from private payers for
participation in quality reporting
initiatives
☐ Internal cost reduction effort
☐ Public reporting/transparency
☐ Required by my practice/organization
☐ To avoid Medicare penalty or reduction in
payment
☐ To earn Medicare incentive payment for
eRx
☐ To prepare for a time when quality is a
significant factor in Medicare
reimbursement
☐ Other (please specify): _______________

d. Current measures do not apply to my
practice specialty
☐
☐
☐
☐

Strongly disagree
Disagree
Agree
Strongly agree

e. Unsure of how to implement the program in
my practice
☐
☐
☐
☐

Strongly disagree
Disagree
Agree
Strongly agree

_____________________________________

f. Feel that the program is unnecessary
☐
☐
☐
☐

F4. What is the effect of eRx participation on
coordination of care efforts with other
practitioners within or outside of your practice?

Strongly disagree
Disagree
Agree
Strongly agree

☐
☐
☐
☐

g. Feel that it is not the government’s role to
monitor physician quality
☐
☐
☐
☐

Go to I.

Strongly disagree
Disagree
Agree
Strongly agree

Page 5 of 8

No effect
A moderate effect
A small effect
A large effect

F7. Did you receive a penalty in eRx?

F5. Please rate the extent that you agree that eRx
participation has:

☐ Yes
☐ No
☐ No, I am exempt.

a. Helped me reduce the prescription of
medication that is contraindicated or could
cause adverse reactions for my Medicare
patients
☐
☐
☐
☐

F8. If yes, what year(s) was the penalty received?
(Select all that apply.)

Strongly disagree
Disagree
Agree
Strongly agree

☐ 2012
☐ 2013

G: eRx FEEDBACK REPORT

b. Helped me improve the quality of care that I
provide to my Medicare patients
☐
☐
☐
☐

G1. Have you ever read any eRx feedback report
from CMS?

Strongly disagree
Disagree
Agree
Strongly agree

☐ Yes
☐ No

Strongly disagree
Disagree
Agree
Strongly agree

☐ 2009
☐ 2010

☐
☐
☐
☐

Strongly disagree
Disagree
Agree
Strongly agree

Not at all helpful
Neither helpful nor unhelpful
Somewhat helpful
Very helpful

H1. Have you ever participated in eRx?

Strongly disagree
Disagree
Agree
Strongly agree

☐ Yes
☐ No

Go to I.

H2. If yes, what year(s) did you participate in eRx?
(Select all that apply.)

F6. As a program participant, how likely would
you be to recommend eRx to other
practitioners?
☐
☐
☐
☐
☐

☐ 2013

H: eRx NON-PARTICIPATION

e. Increased patient satisfaction
☐
☐
☐
☐

☐ 2011
☐ 2012

G3. How helpful was the eRx feedback report in
improving care for your patients?

d. Reduced avoidable health care costs for my
Medicare patients
☐
☐
☐
☐

Go to H.

G2. If yes, what year(s) was the eRx feedback
report for?
(Select all that apply.)

c. Improved the overall health for a majority
of my Medicare patients
☐
☐
☐
☐

Go to G.
Go to H.

☐ 2009
☐ 2010

Highly unlikely
Somewhat unlikely
Neither likely nor unlikely
Somewhat likely
Highly likely

Page 6 of 8

☐ 2011
☐ 2012

H4. Did you receive a penalty in eRx?

H3. To what extent do you agree or disagree
that each of the following factors prevents
your practice from participating in the eRx
program?

☐ Yes
☐ No
☐ No, I am exempt.

a. Financial cost of implementation is too
high
☐
☐
☐
☐

H5. If yes, what year(s) was the penalty received?
(Select all that apply.)

Strongly disagree
Disagree
Agree
Strongly agree

☐ 2012
☐ 2013

I: DEMOGRAPHICS

b. Lack of time
☐
☐
☐
☐

I1. Please indicate your gender.

Strongly disagree
Disagree
Agree
Strongly agree

☐ Male
☐ Female
I2. Please indicate your four-digit year of birth.

c. Lack of appropriately trained personnel
☐
☐
☐
☐

__ __ __ __

Strongly disagree
Disagree
Agree
Strongly agree

d. Unsure of how to implement the program
in my practice
☐
☐
☐
☐

Strongly disagree
Disagree
Agree
Strongly agree

e. Feel that the program is unnecessary
☐
☐
☐
☐

Strongly disagree
Disagree
Agree
Strongly agree

f. Feel that it is not the government’s role to
monitor physician quality
☐
☐
☐
☐

Go to I.
Go to I.

Strongly disagree
Disagree
Agree
Strongly agree

Page 7 of 8

J: CONCLUSION
J1. Who completed the survey?
☐
☐
☐
☐

The professional to whom the survey was addressed
Administrative staff
Other eligible professional
Other (please specify): ___________________________________________________________________

_________________________________________________________________________________________
J2. We appreciate your feedback. Feel free to use this space to comment on the survey or program issues you
would like to see addressed in future evaluations.
Comments: _______________________________________________________________________________
_________________________________________________________________________________________
_________________________________________________________________________________________
_________________________________________________________________________________________
J3. Please include your name, email, and phone number in case we have a question about your survey.
Title: ___________ First name: __________________ Last name: ___________________________________
Phone number: (_______) _________-________ Alternate phone number: (_______) _________-_________
Email: ________________________@_________________________________________________________
J4. Would you like to receive the $50 incentive that will be sent electronically to the email above?
☐ Yes
☐ No
J5. Are you willing to participate in a 30-minute follow-up phone interview to talk more about your reasons for
your participation decision, if applicable, and your experiences with the PQRS/eRx program(s)?
You will receive an additional $100 gift card if you participate in the phone interview in addition to
completing this survey.
☐ Yes
☐ No

THERE ARE NO MORE QUESTIONS.

THANK YOU FOR YOUR PARTICIPATION IN THIS
SURVEY!
PLEASE RETURN THE COMPLETED SURVEY TO ECONOMETRICA IN THE
ENCLOSED POSTAGE-PAID ENVELOPE.
Page 8 of 8

Evaluation of PQRS and eRx: Administrator Survey-Electronic
Date
Centers for Medicare & Medicaid Services
United States Department of Health and Human Services
Survey Instructions
The following survey asks questions about your participation in the Physician Quality
Reporting System (PQRS) and Electronic Prescribing (eRx) Incentive Program. As you
answer each question, please remember there is no right or wrong answer; we are just
interested in your thoughts and opinions on this topic.
Answer each question by clicking your cursor on the box to the left of your answer.
Sometimes the survey will skip over certain questions automatically based on your
response.
If you have any questions or need help completing the survey, please contact Econometrica
toll-free at 1-888-207-0728 from 9:00 a.m. to 5:00 p.m. CST or send an email to
PQRSeRx@econometricainc.com.
Please begin the survey now.
A: SURVEY ELIGIBILITY

A1. Does your practice accept payment from Medicare?
 Yes
 No

B: BACKGROUND

B1. What is the main specialty in which you practice?
 Cardiovascular diseases
 Emergency medicine
 Family practice
 General internal medicine
 Nephrology
 Oncology
 Ophthalmology
 Psychiatry
 Urology
Other (please specify):
________________________________________________________________________________

1

B2. Which of the following best describes your main practice setting?
 Hospice
 Hospital, teaching
 Hospital, non-teaching
 Laboratory
 Multi-specialty group practice or clinic
 Physician’s office, single specialty group practice
 Physician’s office, solo practice
 Skilled nursing facility
 Urgent care facility
Other (please specify):
________________________________________________________________________________
________________________________________________________________________________
B3. Including yourself, how many full-time equivalent (FTE) health practitioners are
in your practice?
(Full-time equivalent health practitioners are clinicians who work 20 hours or more, per
week. Each person who works more than 20 hours is counted as 1 FTE.)
Number of FTE physicians:
Number of FTE nurse practitioners:
Number of FTE physician assistants:
Number of other clinical providers
(excluding clinic assistants):

_______________
_______________
_______________
_______________

C: PHYSICIAN QUALITY REPORTING SYSTEM (PQRS) PARTICIPATION

C1. Have you heard of the PQRS program, formerly known as the Physician Quality
Reporting Initiative (PQRI)?
 Yes
 No
C2. Did your practice, or any providers in your practice, participate in the 2013 PQRS
program?
 Yes
 No

2

C3. Which of the following influenced your decision to participate in PQRS in 2013?
(Select all that apply.)
 Believe it is important to continuously improve patient care
 Incentives from private payers for participation in quality reporting initiatives
 Internal cost reduction effort
 Public reporting/transparency
 Required by my practice/organization
 To avoid Medicare penalty or reduction in payment
 To earn Medicare incentive payment for PQRS
 To prepare for a time when quality is a significant factor in Medicare reimbursement
Other (please specify):
________________________________________________________________________________
________________________________________________________________________________

D: PQRS REPORTING PROCESS
D1. What factor(s) influenced the selection of PQRS measures to report? (Select all
that apply.)
 Area targeted for improvement
 Current high level of performance
 Ease of submission
 High volume for practice
 Importance of measure on quality of care
Other (please specify):
________________________________________________________________________________
________________________________________________________________________________
D2. Which PQRS reporting option(s) has your practice selected? (Select all that apply.)
 Claims
 Data Submission Vendor
 Electronic Health Record Product
 Registry
Other (please specify):
________________________________________________________________________________
________________________________________________________________________________
D3. What is the typical weekly number of hours spent on reporting for the following
staff at your practice?
Physician
Registered nurse
Licensed practical nurse
Nursing assistant
Billing staff
Administrative staff
Other (please specify):
___________________________

_______________
_______________
_______________
_______________
_______________
_______________
_______________

3

D4. How would you characterize the process for preparing measures?





Very difficult
Difficult
Easy
Very easy

D5. How would you characterize the process for submitting measures?





Very difficult
Difficult
Easy
Very easy

D6. What difficulties did you have submitting data? (Select all that apply.)
 Difficulty with electronic billing software (e.g., stripping of quality data codes)
 Gaining access to CMS computer portal (IACS) (e.g., role assignment, password
expiration)
 Inadequate Electronic Health Record (EHR)
 Insufficient data
 Insufficient staff time
 Medicare carrier submission issues
 Missed deadline due to access issue with CMS computer portal (IACS)
 Problem with measure submission vendor (registration EHR vendor)
 QualityNet system not online/available
 Unforeseen change in business practice
Other (please specify):
________________________________________________________________________________
________________________________________________________________________________

E: PQRS FEEDBACK REPORT
E1. Have you successfully downloaded any PQRS feedback reports from CMS?
 Yes
 No

E2. If yes, what year(s) did you successfully download the PQRS feedback report?
(Select all that apply.)








2007
2008
2009
2010
2011
2012
2013

4

E3. How easy was it to download the PQRS feedback report?





Very difficult
Difficult
Easy
Very easy

E4. Did you share the PQRS feedback report with any health practitioners at your
practice?
 Yes
 No

F: PQRS NON-PARTICIPATION
F1. Have you ever participated in the PQRS program, formerly known as the
Physician Quality Reporting Initiative (PQRI)?
 Yes
 No

F2. If yes, what year(s) did you participate in PQRS? (Select all that apply.)







2007
2008
2009
2010
2011
2012

F3. To what extent do you agree or disagree that each of the following factors
prevents your practice from participating in the PQRS program?

a. Financial cost of
implementation is too high
b. Lack of time
c. Lack of appropriately
trained personnel
d. Current measures do not
apply to my practice
specialty
e. Unsure of how to
implement the program in my
practice.
f. Feel that the program is
unnecessary
g. Feel that it is not the
government’s role to monitor
physician quality

Strongly
disagree


Disagree

Agree





Strongly
agree














































5

G: ELECTRONIC PRESCRIBING (eRx) INCENTIVE PROGRAM PARTICIPATION
G1. Have you heard of the eRx program?
 Yes
 No
G2. Did your practice, or any providers in your practice, participate in the 2013 eRx
program?
 Yes
 No
G3. Which of the following influenced the practice’s decision to participate in eRx?
(Select all that apply.)
 Believe it is important to continuously improve patient care
 Incentives from private payers for participation in quality reporting initiatives
 Internal cost reduction effort
 Public reporting/transparency
 Required by my practice/organization
 To avoid Medicare penalty or reduction in payment
 To earn Medicare incentive payment for eRx
 To prepare for a time when quality is a significant factor in Medicare reimbursement
Other (please specify):
________________________________________________________________________________
________________________________________________________________________________
G4. Did your practice receive a penalty in eRx?
 Yes
 No
 No, I am exempt
G5. If yes, what year(s) was the penalty received? (Select all that apply.)
 2012
 2013

H: eRx FEEDBACK REPORT
H1. Have you successfully downloaded any eRx feedback reports from CMS?
 Yes
 No

6

H2. What year(s) did you successfully download the eRx feedback report? (Select all
that apply.)






2009
2010
2011
2012
2013

H3. How easy was it to download the eRx feedback report?





Very difficult
Difficult
Easy
Very easy

H4. Did you share the eRx feedback report with any health practitioners at your
practice?
 Yes
 No

I: eRx REPORTING PROCESS
I1. Which eRx reporting option(s) has your practice selected? (Select all that apply.)
 Claims
 Data Submission Vendor
 Electronic Health Record (EHR) Product
 Registry
Other (please specify):
________________________________________________________________________________
________________________________________________________________________________
I2. What is the typical weekly number of hours spent on reporting for the following
staff at your practice?
Physician
Registered nurse
Licensed practical nurse
Nursing assistant
Billing staff
Administrative staff
Other (please specify):
______________________

_______________
_______________
_______________
_______________
_______________
_______________
_______________

I2a. If other providers assisted in the reporting process, please specify:
________________________________________________________________________

7

I3. How would you characterize the process for preparing measures?





Very difficult
Difficult
Easy
Very easy

I4. How would you characterize the submission process?





Very difficult
Difficult
Easy
Very easy

I5. What difficulties did you have submitting data? (Select all that apply.)
 Difficulty with electronic billing software (e.g., stripping of quality data codes)
 Gaining access to CMS computer portal (IACS) (e.g., role assignment, password
expiration)
 Inadequate Electronic Health Record (EHR)
 Insufficient data
 Insufficient staff time
 Medicare carrier submission issues
 Missed deadline due to access issue with CMS computer portal (IACS)
 Problem with measure submission vendor (registration EHR vendor)
 QualityNet system not online/available
 Unforeseen change in business practice
Other (please specify):
________________________________________________________________________________
________________________________________________________________________________

J: eRx NON-PARTICIPATION
J1. Have you ever participated in eRx?
 Yes
 No
J2. If yes, what year(s) did you participate in eRx? (Select all that apply.)





2009
2010
2011
2012

8

J3. To what extent do you agree or disagree that each of the following factors
prevents your practice from participating in the eRx program?
Strongly
Disagree
Agree
Strongly
disagree
agree




a. Financial cost of
implementation is too high




b. Lack of time




c. Lack of appropriately
trained personnel




d. Unsure of how to
implement the program in my
practice




e. Feel that the program is
unnecessary




f. Feel that it is not the
government’s role to monitor
physician quality
J4. Did you receive a penalty in eRx?
 Yes
 No
 No, I am exempt

J5. If yes, what year(s) was the penalty received? (Select all that apply.)
 2012
 2013

K: QUALITYNET HELP DESK
K1. Did you contact the QualityNet help desk?
 Yes
 No
K2. To what extent were the responses to the questions you submitted to the
QualityNet help desk useful?





Not useful at all
Not very useful
Somewhat useful
Very useful

K3. What was the timeliness of the responses to the questions you submitted to the
QualityNet help desk?





Within one day
Within two to three days
Within a week
Longer than a week

9

L: CONCLUSION
L1. Who completed the survey?
 The professional to whom the survey was addressed
 Another administrator
Other (please specify):
________________________________________________________________________________
________________________________________________________________________________
L2. We appreciate your feedback. Feel free to use this space to comment on the
survey or program issues you would like to see addressed in future evaluations.
________________________________________________________________________________
________________________________________________________________________________
________________________________________________________________________________
________________________________________________________________________________
________________________________________________________________________________
________________________________________________________________________________
________________________________________________________________________________
________________________________________________________________________________
________________________________________________________________________________
L3. Please include your name, email, and phone number in case we have a question
about your survey.
Title:
First name:
Last name:
Phone number:
Alternate phone number:
Email:

___________________________________________________________
___________________________________________________________
___________________________________________________________
___________________________________________________________
___________________________________________________________
___________________________________________________________

L4. Would you like to receive the $100 incentive that will be sent electronically to the
email above?
 Yes
 No
L5. Are you willing to participate in a 30-minute follow-up phone interview to talk
more about your reasons for your participation decision, if applicable, and your
experiences with the PQRS/eRx program(s)?
You will receive an additional $100 gift card if you participate in the phone interview in
addition to completing this survey.
 Yes
 No

THERE ARE NO MORE QUESTIONS.
THANK YOU FOR YOUR PARTICIPATION IN THIS SURVEY!

10

Evaluation of PQRS and eRx:
Administrator Survey-Hardcopy
Date
Centers for Medicare & Medicaid Services
United States Department of Health and Human Services

Survey Instructions
The following survey asks questions about your participation in the Physician Quality Reporting System (PQRS) and
Electronic Prescribing (eRx) Incentive Program. As you answer each question, please remember there is no right or wrong
answer; we are just interested in your thoughts and opinions on this topic.


Answer each question by marking the box to the left of your answer.



You are sometimes told to skip over certain questions in this survey. When this happens you will see an arrow
with a note that tells you what question to answer next, like this:
Yes
No



Go to B.

If you have any questions or need help completing the survey, please contact Econometrica toll-free at 1-888207-0728 from 9:00 a.m. to 5:00 p.m. CST or send an email to PQRSeRx@econometricainc.com.

Please begin the survey now.

A: SURVEY ELIGIBILITY
A1. Does your practice accept payment from Medicare?
☐ Yes
☐ No
Stop Do not continue. Please return the survey in the enclosed
envelope and we will remove your name from our list.

Page 2 of 8

C: PHYSICIAN QUALITY REPORTING
SYSTEM (PQRS) PARTICIPATION

B: BACKGROUND
B1. What is the main specialty in which you
practice?
☐
☐
☐
☐
☐
☐
☐
☐
☐
☐

C1. Have you heard of the PQRS program,
formerly known as the Physician Quality
Reporting Initiative (PQRI)?

Cardiovascular diseases
Emergency medicine
Family practice
General internal medicine
Nephrology
Oncology
Ophthalmology
Psychiatry
Urology
Other (please specify): ________________

☐ Yes
☐ No
C2. Did your practice, or any providers in your
practice, participate in the 2013 PQRS
program?
☐ Yes
☐ No

C3. Which of the following influenced your

______________________________________

decision to participate in PQRS in 2013?
(Select all that apply.)

B2. Which of the following best describes your
main practice setting?
☐
☐
☐
☐
☐
☐
☐
☐
☐
☐

☐ Believe it is important to continuously
improve patient care
☐ Incentives from private payers for
participation in quality reporting initiatives
☐ Internal cost reduction effort
☐ Public reporting/transparency
☐ Required by my practice/organization
☐ To avoid Medicare penalty or reduction in
payment
☐ To earn Medicare incentive payment for
PQRS
☐ To prepare for a time when quality is a
significant factor in Medicare
reimbursement
☐ Other (please specify): _______________

Hospice
Hospital, teaching
Hospital, non-teaching
Laboratory
Multi-specialty group practice or clinic
Physician’s office, single specialty group
practice
Physician’s office, solo practice
Skilled nursing facility
Urgent care facility
Other (please specify): ________________

______________________________________
B3. Including yourself, how many full-time
equivalent (FTE) health practitioners are in
your practice?
(Full-time equivalent health practitioners are
clinicians who work 20 hours or more, per
week. Each person who works more than 20
hours is counted as 1 FTE.)
Number of FTE physicians:

____________________________________
D: PQRS REPORTING PROCESS
D1. What factor(s) influenced the selection of
PQRS measures to report?
(Select all that apply.)

__ __ __ __

Number of FTE nurse
practitioners:

__ __ __ __

Number of FTE physician
assistants:

__ __ __ __

Number of other clinical
providers (excluding clinic
assistants):

__ __ __ __

Go to E.

☐
☐
☐
☐
☐
☐

Area targeted for improvement
Current high level of performance
Ease of submission
High volume for practice
Importance of measure on quality of care
Other (please specify): ________________

______________________________________

Page 3 of 8

☐ Missed deadline due to access issue with
CMS computer portal (IACS)
☐ Problem with measure submission vendor
(registration EHR vendor)
☐ QualityNet system not online/available
☐ Unforeseen change in business practice
☐ Other (please specify): ________________

D2. Which PQRS reporting option(s) has your
practice selected?
(Select all that apply.)
☐
☐
☐
☐
☐

Claims
Data Submission Vendor
Electronic Health Record Product
Registry
Other (please specify): _______________

______________________________________

_____________________________________

E: PQRS FEEDBACK REPORT

D3. What is the typical weekly number of hours
spent on reporting for the following staff at
your practice?
☐
☐
☐
☐
☐
☐
☐

Physician
Registered nurse
Licensed practical nurse
Nursing assistant
Billing staff
Administrative staff
Other (please specify):

__
__
__
__
__
__

E1. Have you successfully downloaded any PQRS
feedback reports from CMS?
☐ Yes
☐ No

__
__
__
__
__
__

E2. If yes, what year(s) did you successfully
download the PQRS report?
(Select all that apply.)
☐
☐
☐
☐

__ __
D4. How would you characterize the process for
preparing measures?
☐
☐
☐
☐

☐ 2011
☐ 2012
☐ 2013

2007
2008
2009
2010

E3. How easy was it to download the PQRS
report?

Very difficult
Difficult
Easy
Very easy

☐
☐
☐
☐

D5. How would you characterize the process for
submitting measures?
☐
☐
☐
☐

Go to G.

Very difficult
Difficult
Easy
Very easy

E4. Did you share the PQRS feedback report with
any health practitioners at your practice?

Very difficult
Difficult
Easy
Go to E.
Very easy
Go to E.

☐ Yes
☐ No

F: PQRS NON-PARTICIPATION

D6. What difficulties did you have submitting
data? (Select all that apply.)

F1. Have you ever participated in the PQRS
program, formerly known as the Physician
Quality Reporting Initiative (PQRI)?

☐ Difficulty with electronic billing software
(e.g., stripping of quality data codes)
☐ Gaining access to CMS computer portal
(IACS) (e.g., role assignment, password
expiration)
☐ Inadequate Electronic Health Record
(EHR)
☐ Insufficient data
☐ Insufficient staff time
☐ Medicare carrier submission issues

☐ Yes
☐ No

Go to F3.

F2. If yes, what year(s) did you participate in
PQRS?
(Select all that apply.)
☐ 2007
☐ 2008
☐ 2009
Page 4 of 8

☐ 2010
☐ 2011
☐ 2012

G: ELECTRONIC PRESCRIBING (eRx)
INCENTIVE PROGRAM
PARTICIPATION

F3. To what extent do you agree or disagree that
each of the following factors prevents your
practice from participating in the PQRS
program?

G1. Have you heard of the eRx program?

a. Financial cost of implementation is too high
☐ Strongly disagree
☐ Disagree
☐ Agree
☐ Strongly agree

☐ Yes
☐ No
G2.Did your practice, or any providers in your
practice, participate in the 2013 eRx program?

b. Lack of time
☐ Strongly disagree
☐ Disagree
☐ Agree
☐ Strongly agree

☐ Yes
☐ No

G3. Which of the following influenced the
practice’s decision to participate in eRx?
(Select all that apply.)

c. Lack of appropriately trained personnel
☐
☐
☐
☐

☐ Believe it is important to continuously
improve patient care
☐ Incentives from private payers for
participation in quality reporting initiatives
☐ Internal cost reduction effort
☐ Public reporting/transparency
☐ Required by my practice/organization
☐ To avoid Medicare penalty or reduction in
payment
☐ To earn Medicare incentive payment for
eRx
☐ To prepare for a time when quality is a
significant factor in Medicare
reimbursement
☐ Other (please specify): ________________

Strongly disagree
Disagree
Agree
Strongly agree

d. Current measures do not apply to my
practice specialty
☐ Strongly disagree
☐ Disagree
☐ Agree
☐ Strongly agree
e. Unsure of how to implement the program in
my practice
☐
☐
☐
☐

Strongly disagree
Disagree
Agree
Strongly agree

______________________________________
G4. Did your practice receive a penalty in eRx?
☐ Yes
☐ No
Go to H.
☐ No, I am exempt.

f. Feel that the program is unnecessary
☐ Strongly disagree
☐ Disagree
☐ Agree
☐ Strongly agree

Go to K.

G5. If yes, what year(s) was the penalty received?
(Select all that apply.)
☐ 2012

g. Feel that it is not the government’s role to
monitor physician quality
☐
☐
☐
☐

Go to H.

☐ 2013

H: eRx FEEDBACK REPORT

Strongly disagree
Disagree
Agree
Strongly agree

H1. Have you successfully downloaded any eRx
feedback reports from CMS?
☐ Yes
☐ No

Page 5 of 8

Go to I.

I4. How would you characterize the submission
process?

H2. What year(s) did you successfully download
the eRx report?
(Select all that apply.)
☐ 2009
☐ 2010

☐ 2011
☐ 2012

☐
☐
☐
☐

☐ 2013

H3. How easy was it to download the eRx
report?
☐
☐
☐
☐

I5. What difficulties did you have submitting
data? (Select all that apply.)

Very difficult
Difficult
Easy
Very easy

☐ Difficulty with electronic billing software
(e.g., stripping of quality data codes)
☐ Gaining access to CMS computer portal
(IACS) (e.g., role assignment, password
expiration)
☐ Inadequate Electronic Health Record
(EHR)
☐ Insufficient data
☐ Insufficient staff time
☐ Medicare carrier submission issues
☐ Missed deadline due to access issue with
CMS computer portal (IACS)
☐ Problem with measure submission vendor
(registration EHR vendor)
☐ QualityNet system not online/available
☐ Unforeseen change in business practice
☐ Other (please specify): ________________

H4. Did you share the report with any health
practitioners at your practice?
☐ Yes
☐ No
I: eRx REPORTING PROCESS
I1. Which eRx reporting option(s) has your
practice selected?
(Select all that apply.)
☐
☐
☐
☐
☐

Claims
Data Submission Vendor
Electronic Health Record (EHR) product
Registry
Other (please specify): _______________

______________________________________

J: eRx NON-PARTICIPATION

_____________________________________
I2. What is the typical weekly number of hours
spent on reporting for the following staff at
your practice?
☐
☐
☐
☐
☐
☐
☐

Physician
Registered nurse
Licensed practical nurse
Nursing assistant
Billing staff
Administrative staff
Other (please specify)

__
__
__
__
__
__

____________________

__ __

J1. Have you ever participated in eRx?
☐ Yes
☐ No

__
__
__
__
__
__

Go to K.

J2. If yes, what year(s) did you participate in eRx?
(Select all that apply.)
☐ 2009
☐ 2010

I3. How would you characterize the process for
preparing measures?
☐
☐
☐
☐

Very difficult
Difficult
Easy
Go to K.
Very easy
Go to K.

Very difficult
Difficult
Easy
Very easy
Page 6 of 8

☐ 2011
☐ 2012

J3. To what extent do you agree or disagree that
each of the following factors prevents your
practice from participating in the eRx
program?

K: QUALITYNET HELP DESK
K1. Did you contact the QualityNet help desk?

☐ Yes
☐ No

a. Financial cost of implementation is too high
☐Strongly disagree
☐Disagree
☐Agree
☐Strongly agree

K2. To what extent were the responses to the
questions you submitted to the QualityNet help
desk useful?
☐
☐
☐
☐

b. Lack of time
☐Strongly disagree
☐Disagree
☐Agree
☐Strongly agree
Strongly disagree
Disagree
Agree
Strongly agree

☐
☐
☐
☐

d. Unsure of how to implement the program in
my practice
☐
☐
☐
☐

Strongly disagree
Disagree
Agree
Strongly agree

e. Feel that the program is unnecessary
☐
☐
☐
☐

Strongly disagree
Disagree
Agree
Strongly agree

f. Feel that it is not the government’s role to
monitor physician quality
☐
☐
☐
☐

Strongly disagree
Disagree
Agree
Strongly agree

J4. Did you receive a penalty in eRx?
☐ Yes
☐ No
Go to K.
☐ No, I am exempt.

Go to K.

J5. If yes, what year(s) was the penalty received?
(Select all that apply.)
☐ 2012

Not useful at all
Not very useful
Somewhat useful
Very useful

K3. What was the timeliness of the responses to
the questions you submitted to the QualityNet
help desk?

c. Lack of appropriately trained personnel
☐
☐
☐
☐

Go to L.

☐ 2013
Page 7 of 8

Within one day
Within two to three days
Within a week
Longer than a week

L: CONCLUSION
L1. Who completed the survey?
☐ The professional to whom the survey was addressed
☐ Another administrator
☐ Other (please specify): ___________________________________________________________________
_________________________________________________________________________________________
L2. We appreciate your feedback. Feel free to use this space to comment on the survey or program issues you
would like to see addressed in future evaluations.
Comments: _______________________________________________________________________________
_________________________________________________________________________________________
_________________________________________________________________________________________
_________________________________________________________________________________________
L3. Please include your name, email, and phone number in case we have a question about your survey.
Title: ___________ First name: __________________ Last name: ___________________________________
Phone number: (_______) _________-________ Alternate phone number: (_______) _________-_________
Email: ________________________@_________________________________________________________
L4. Would you like to receive the $50 incentive that will be sent electronically to the email above?
☐ Yes
☐ No
L5. Are you willing to participate in a 30-minute follow-up phone interview to talk more about your reasons for
your participation decision, if applicable, and your experiences with the PQRS/eRx program(s)?
You will receive an additional $100 gift card if you participate in the phone interview in addition to
completing this survey.
☐ Yes
☐ No

THERE ARE NO MORE QUESTIONS.

THANK YOU FOR YOUR PARTICIPATION IN THIS
SURVEY!
PLEASE RETURN THE COMPLETED SURVEY TO ECONOMETRICA IN THE
ENCLOSED POSTAGE-PAID ENVELOPE.
Page 8 of 8

CMS Pre-Notification Letter to Eligible Professionals and
Administrators
(CMS Letterhead)
Date
Dear Dr./Mr./Ms. [LAST NAME]:
The Centers for Medicare & Medicaid Services (CMS) of the U.S. Department of Health and
Human Services is sponsoring a national study to better understand motivations for the Physician Quality
Reporting System (PQRS) and Electronic Prescribing (eRx) Incentive Program participation and your
participation experience, if applicable. CMS will use the findings to evaluate how well PQRS/eRx meets
the aims of better care, healthy people, and affordable care, as set forth by the National Quality Strategy
(NQS).
As part of this study, CMS is conducting a national survey of physicians, other clinicians, and practice
managers who are eligible to participate in PQRS/eRx. You have been randomly selected to participate in
this survey because, based on a review of recent program and claims data, you or your practice is eligible to
participate in PQRS and/or eRx.
Within 10 days, Econometrica, our contractor for the survey, will mail you a letter that will provide
you with the link for taking the survey online. The survey should take only 15 minutes to complete. It is
very important that we hear back from you; your response is critical for obtaining an accurate and unbiased
picture of the motivation for PQRS and/or eRx program participation.
Econometrica will send you a $100 gift card for completing the survey. None of the information you
provide will be associated with your name or your practice; survey results will be presented in summary
form only. Econometrica is prepared to address any concerns you may have about the privacy of the data
you provide.
The enclosed fact sheet has additional information about the study. If you have any questions about
this survey, please contact Econometrica toll-free at 1-888-207-0728 from 9:00 a.m. to 5:00 p.m. (EST) or
via email at PQRSeRx@econometricainc.com, and survey staff will be happy to assist you.
Thank you in advance for your participation in this important study. We look forward to hearing from
you.
Sincerely,

Kate Goodrich, M.D., M.H.S.
Acting Director
Quality Measurement & Health Assessment Group
Center for Clinical Standards and Quality
Centers for Medicare & Medicaid Services
Enclosure: (1)

Thomas R. Jackson
Evaluation of PQRS and eRx Project Director

4416 East West Highway, Suite 215
Bethesda, MD 20814
www.econometricainc.com

Invitation Letter From Econometrica to Eligible Professionals and
Administrators
Date
Dear Dr./Mr./Ms. [LAST NAME]:
The Centers for Medicare & Medicaid Services (CMS) recently sent you a letter about an
important study of the Physician Quality Reporting System (PQRS) and Electronic Prescribing (eRx)
Incentive Program. And, in that letter, Econometrica, CMS’s survey contractor, was introduced.
CMS’ goal in sponsoring the Evaluation of PQRS and eRx program is to learn how well PQRS/eRx
meets the aims of better care, healthy people, and affordable care, as set forth by the National Quality
Strategy (NQS). Regardless of your PQRS and eRx program participation status, your input is
important to us! The survey asks questions regarding your decisions to participate or not to participate in
the programs, and, for those participating, the effect on your practice, cost to participate, impact on
beneficiary health, and your experience with the reporting method.
We have included the link to complete the survey online. Once you start, you may stop and return to
the online survey as necessary. If you qualify for the survey and complete it online, we will send you a
$100 gift card. Below is the URL for the online survey:

The survey will take no more than 15 minutes to complete. To provide CMS with the information it
needs in a timely manner, please complete the survey by [10 days from mailing date].
The enclosed fact sheet has additional information about the study. If you have any questions about
the survey or concerns about the privacy of the information you provide, please contact Econometrica at
1-888-207-0728 from 9:00 a.m. to 5:00 p.m. (EST) or send an email to PQRSeRx@econometricainc.com.
Thank you for your participation in this important study. We look forward to receiving your survey.
Sincerely,

Thomas R. Jackson
Project Director
Evaluation of PQRS and eRx

Enclosure: (1)

Thomas R. Jackson
Evaluation of PQRS and eRx Project Director

4416 East West Highway, Suite 215
Bethesda, MD 20814
www.econometricainc.com

Reminder Letter #1 From Econometrica to Eligible Professionals and
Administrators
Date

Dear Dr./Mr./Ms. [LAST NAME]:
Recently, Econometrica, Inc., the Centers for Medicare & Medicaid Services (CMS) evaluation
contractor, sent you a letter with information for completing the Evaluation of the Physician Quality
Reporting System (PQRS) and Electronic Prescribing (eRx) Incentive Program survey.
CMS’ goal in sponsoring the Evaluation of PQRS and eRx is to address how well PQRS/eRx meets
the aims of better care, healthy people, and affordable care, as set forth by the National Quality Strategy
(NQS). We recognize that your time is very valuable, but given the importance of this study not only to
national policy but to you in your role as a health care provider or administrator, we urge you to take 15
minutes to complete and return the survey.
It would help us meet the goals of the PQRS/eRx evaluation and provide CMS with the information
it needs to help meet the goals of NQS if you could complete the survey within the next 7 days. To
express our thanks, Econometrica will send you a gift card for $100 if you complete the survey. Below is
the URL for the online survey:

If you have already completed the survey online, thank you very much. Econometrica’s records
will catch up with you shortly. If you have questions or concerns or need additional information, please
contact Econometrica at 1-888-207-0728 from 9:00 a.m. to 5:00 p.m. (EST) or send an email to
PQRSeRx@econometricainc.com.
Sincerely,

Thomas R. Jackson
Project Director
Evaluation of PQRS and eRx

Thomas R. Jackson
Evaluation of PQRS and eRx Project Director

4416 East West Highway, Suite 215
Bethesda, MD 20814
www.econometricainc.com

Reminder Letters #2 and #3 From Econometrica to Eligible Professionals
and Administrators
Date
Dear Dr./Mr./Ms. [LAST NAME]:
Recently, Econometrica, Inc., the Centers for Medicare & Medicaid Services (CMS) evaluation
contractor, sent you a letter with information for completing the Evaluation of the Physician Quality
Reporting System (PQRS) and Electronic Prescribing (eRx) Incentive Program survey. CMS’ goal in
sponsoring the Evaluation of PQRS and eRx is to address how well PQRS/eRx meets the aims of better
care, healthy people, and affordable care, as set forth by the National Quality Strategy (NQS).
Unfortunately, we have not yet received your completed survey. Given the importance of this study
not only to national policy but to you in your role as a health care provider or administrator, we urge you
to take 15 minutes to complete and return the survey today.
The survey can be completed online by going to the following URL:

For your convenience, we have enclosed a hardcopy version of the survey. If you prefer, complete
the hardcopy version and return it to us using the business-reply envelope provided or via fax, using the
fax cover sheet provided.
If you have already completed the survey, thank you very much. Econometrica’s records will
catch up with you shortly.
To express our thanks, we will send you a gift card for $100 if you complete the online survey, or a
$50 gift card if you complete the paper version of the survey and return it to us.
If you have questions or concerns or need additional information, please contact Econometrica at 1888-207-0728 from 9:00 a.m. to 5:00 p.m. (EST) or send an email to PQRSeRx@econometricainc.com.
Sincerely,
Thomas R. Jackson
Project Director
Evaluation of PQRS and eRx

Enclosures: (3)

Thomas R. Jackson
Evaluation of PQRS and eRx Project Director

4416 East West Highway, Suite 215
Bethesda, MD 20814
www.econometricainc.com

Final Letter From Econometrica to Eligible Professionals and
Administrators
Date

Dear Dr./Mr./Ms. [LAST NAME]:
If you have already completed and returned your Evaluation of the Physician Quality
Reporting System (PQRS) and Electronic Prescribing (eRx) Incentive Program survey, thank you
very much. Our records will catch up with you shortly. If you have not had a chance to complete it, we
encourage you to please take 15 minutes or less to do so. The study will be ending soon.
For your convenience, we have included the online link below. To express our thanks, we will send
you a gift card for $100 if you complete the online survey.
Your response would help us conduct a survey with a high response rate to meet the goals of the
Evaluation of PQRS and eRx study and provide CMS with the information it needs to help meet the goals
of the National Quality Strategy. We would greatly appreciate it if you could complete the survey
within the next 7 days.
If you prefer to complete the survey via the Web, please visit the following URL:

We previously sent you a hardcopy of the survey. If you prefer, simply complete the survey and mail
or fax it back to us. If you need another copy of the survey, please call or email us (information below).
To express our thanks, we will send you a gift card for $50 after receiving your completed hardcopy
survey.
If you have questions about completing the survey or would like for us to send you another hardcopy
of the survey, please contact Econometrica at 1-888-207-0728 from 9:00 a.m. to 5:00 p.m. (EST) or send
an email to PQRSeRx@econometricainc.com, and we will respond right away.
Sincerely,

Thomas R. Jackson
Project Director
Evaluation of PQRS and eRx

E-Mail for Combined Interview Topic Guides with Eligible Professionals
and Administrators
Date

Dear Dr./Mr./Ms. [LAST NAME]:
Thank you for volunteering for a 30-minute phone interview in addition to completing the brief
survey evaluating the Physician Quality Reporting System (PQRS) and Electronic Prescribing (eRx)
Incentive Program.
CMS’ goal in including interviews as part of the Evaluation of PQRS and eRx programs is to learn
more about how well PQRS and eRx meet the aims of better care, healthy people, and affordable care, set
forth by the National Quality Strategy (NQS). Regardless of your PQRS and eRx program participation
status, your input is important to us!
We will contact you or your scheduler to set up a half-hour time that works with your schedule. If
you complete the interview, you will receive an additional $100 gift card.
If you have any questions about the interview or concerns about the privacy of the information you
provide, please contact Econometrica at 1-888-207-0728 from 9:00 a.m. to 5:00 p.m. (CST) or send an
email to PQRSeRx@econometricainc.com.
Thank you for your participation in this important study and we look forward to interviewing you.
Sincerely,

Thomas R. Jackson
Project Director
Evaluation of PQRS and eRx