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TABLE 2. 2015 PQRS GENERAL SURGERY MEASURES GROUP
• #354 Anastomotic leak intervention
• #355 Unplanned reoperation within the 30-day postoperative period
• #356 Unplanned hospital readmission within 30 days of principal procedure
• #357 Surgical site infection (SSI)
• #358 Patient-centered surgical risk assessment and communication
• #130 Documentation of current medications in the medical record*
• #226 Preventive care and screening: Tobacco use: Screening and cessation intervention*
*New for 2015
January 1 through December 31, 2015. It is particularly
important to note the specifications for measure #354,
as it should only be reported if a patient has a procedure
performed specific to gastric bypass surgery or colectomy. The measure specifications for the General Surgery Measures Group can be found on pages 337–354
of the CMS Measure Group Manual.‡
EHR-based reporting option
In order to participate via the EHR-based reporting
option, EPs need to submit nine measures covering at
least three NQS domains. EPs should work with their
EHR vendor to make sure that the EHR system can
submit data on the PQRS-approved electronic measures for CY 2015.
QCDR reporting option
The qualified clinical data registry (QCDR) is a CMS-approved entity that collects clinical data for the purpose of patient and disease tracking to improve quality
of care provided to patients with specific health care
conditions. The QCDR reporting option allows entities
approved as a QCDR to determine their own quality
measures; therefore, EPs who participate in the QCDR
are not required to report on traditional PQRS measures. In comparison with traditional PQRS measures,
QCDR measures are intended to be more relevant,
clinically appropriate, and actionable for EPs who are
participating in a clinical data registry.
Similar to traditional registries, QCDRs must
also receive CMS approval. CMS will publish a list of
approved QCDRs, likely in the spring. The ACS Metabolic and Bariatric Surgery Accreditation and Quality
Improvement Program (MBSAQIP) was approved as
a QCDR in CY 2014 and, at press time, was awaiting
CMS approval for CY 2015.
EPs interested in participating in PQRS through
a CMS-approved QCDR must report at least nine
individual measures, including at least two outcome
measures (or, in lieu of two outcome measures, at
least one outcome measure and one of the following other types of measures—resource use, patient
experience of care, efficiency/appropriate use, or
safety), covering at least three NQS domains, and
report each measure for at least 50 percent of their applicable patients (Medicare and non-Medicare) January 1
through December 31, 2015.
The VM’s effect on surgeons
For 2015, surgeons may be subject to an additional
penalty under VM, which will also be applied to their
Medicare Part B FFS payments in CY 2017. The VM
program provides incentives or penalties based on
CMS’ analysis of a provider’s cost and quality. PQRS
reporting satisfies part of the quality component of
the VM determination.
Essentially, payment penalty amounts differ based
on group size, successful or unsuccessful PQRS par-
ticipation, and performance. For example, in 2015, solo
practitioners and groups of up to nine providers who
unsuccessfully report to the PQRS will be subject to
a 2 percent penalty under the PQRS program and an
additional 2 percent penalty under the VM. Penalties
‡Centers for Medicare & Medicaid Services. License for use of Current
Procedural Terminology, Fourth Edition. Available at: www.cms.gov/
apps/ama/ license.asp?file=/PQRS/downloads/2015_PQRS_Measures-
GroupsSpecs_SupportingDocs_111214.zip. Accessed February 10, 2015.
