Quality Measure Sets for PQRS

The Core Quality Measures Collaborative

The AAFP is advocating that the MIPS General Practice/Family Medicine specialty measure set include all measures from the PCMH/ACO/Primary Care Core Measure Set developed by the Core Quality Measures Collaborative.

The Physician Quality Reporting System (PQRS) is a pay-for-reporting program that assesses quality measures for care physicians deliver to Medicare Part B beneficiaries. Medicare bases payment adjustments on an eligible professional (EP) or group practice’s quality data from two years prior.

As a stand-alone program, PQRS will cease to exist after 2018 when the Medicare Access and CHIP Reauthorization Act (MACRA) is implemented in 2019. Many of the measures available under PQRS will remain options under MACRA’s Merit-based Incentive Payment System (MIPS), which will continue to include specialty-specific measures.

The Centers for Medicare & Medicaid Services (CMS) has proposed a General Practice/Family Medicine specialty measure set under MIPS (see table below). This set includes many of the same measures included in current PQRS reporting and some endorsed by the National Quality Forum (NQF). Becoming proficient at quality reporting under PQRS now will enable a smoother transition to reporting under MIPS by 2019.

To successfully report in the current PQRS program, EPs must report at least nine quality measures covering three National Quality Strategy domains. Those EPs in groups of 100 or more EPs must also report patient satisfaction through the Consumer Assessment of Healthcare Providers (CAHPS) for PQRS. Additionally, individual EPs with at least one Medicare patient with a face-to-face encounter must satisfactorily report at least one of 23 cross-cutting measures. A cross-cutting measure is one that can be broadly applied across multiple providers and specialties.

The table below lists the measure name with the corresponding PQRS and NQF numbers for the proposed MIPS General Practice/Family Medicine specialty measure set.

Proposed MIPS General Practice/Family Medicine Specialty Measure Set

PQRS #

NQF #

Measure Name

PQRS #

:

PQRS 001

NQF #

:

NQF 0059

Measure Name

:

Diabetes: Hemoglobin A1c Poor Control*

PQRS #

:

PQRS 005

NQF #

:

NQF 0081

Measure Name

:

Heart Failure (HF) Angiotensin-Converting Enzyme (ACE) Inhibitor or Angiotensin Receptor Blocker (ARB) Therapy for Left Ventricular Systolic Dysfunction (LVSD)

PQRS #

:

PQRS 009

NQF #

:

NQF 105

Measure Name

:

Anti-Depressant Medication Management+

PQRS #

:

PQRS 050

NQF #

:

N/A

Measure Name

:

Urinary Incontinence: Plan of Care for Urinary Incontinence in Women Aged 65 and older

PQRS #

:

PQRS 065

NQF #

:

NQF 0069

Measure Name

:

Appropriate Treatment for Children with Upper Respiratory Infection (URI)

PQRS #

:

PQRS 066

NQF #

:

NA

Measure Name

:

Appropriate Testing for Children with Pharyngitis

PQRS #

:

PQRS 093

NQF #

:

NQF 0654

Measure Name

:

Acute Otitis Externa (AOE): Systemic Antimicrobial Therapy - Avoidance of Inappropriate Use

PQRS #

:

PQRS 109

NQF #

:

NA

Measure Name

:

Osteoarthritis (OA): Function and Pain Assessment

PQRS #

:

PQRS 112

NQF #

:

NQF 2372

Measure Name

:

Breast Cancer Screening*

PQRS #

:

PQRS 113

NQF #

:

NQF 0034

Measure Name

:

Colorectal Cancer Screening*

PQRS #

:

PQRS 116

NQF #

:

NQF 0058

Measure Name

:

Antibiotic Treatment for Adults with Acute Bronchitis: Avoidance of Inappropriate Use*

PQRS #

:

PQRS 117

NQF #

:

NQF 0055

Measure Name

:

Diabetes Eye Exam*

PQRS #

:

PQRS 134

NQF #

:

NQF 0418

Measure Name

:

Preventive Care and Screening: Screening for Depression and Follow-Up Plan+

PQRS #

:

PQRS 154

NQF #

:

NQF 0101

Measure Name

:

Falls: Risk Assessment

PQRS #

:

PQRS 155

NQF #

:

NQF 0101

Measure Name

:

Falls: Plan of Care

PQRS #

:

PQRS 181

NQF #

:

NA

Measure Name

:

Elder Maltreatment Screen and Follow-Up Plan

PQRS #

:

PQRS 204

NQF #

:

NQF 0068

Measure Name

:

Ischemic Vascular Disease (IVD): Use of Aspirin or Another Antiplatelet*

PQRS #

:

PQRS 312

NQF #

:

NQF 0052

Measure Name

:

Use of Imaging Studies for Low Back Pain*+

PQRS #

:

PQRS 326

NQF #

:

NQF 1525

Measure Name

:

Atrial Fibrillation and Atrial Flutter: Chronic Anticoagulation Therapy

PQRS #

:

PQRS 331

NQF #

:

N/A

Measure Name

:

Adult Sinusitis: Antibiotic Prescribed for Acute Sinusitis (Overuse)

PQRS #

:

PQRS 332

NQF #

:

N/A

Measure Name

:

Adult Sinusitis: Appropriate Choice of Antibiotic: Amoxicillin With or Without Clavulanate Prescribed for Patients with Acute Bacterial Sinusitis (Appropriate Use)

PQRS #

:

PQRS 333

NQF #

:

N/A

Measure Name

:

Adult Sinusitis: Computerized Tomography (CT) for Acute Sinusitis (Overuse)

PQRS #

:

PQRS 334

NQF #

:

N/A

Measure Name

:

Adult Sinusitis: More than One Computerized Tomography (CT) Scan Within 90 Days for Chronic Sinusitis (Overuse)

PQRS #

:

PQRS 337

NQF #

:

N/A

Measure Name

:

Tuberculosis Prevention for Psoriasis, Psoriatic Arthritis and Rheumatoid Arthritis Patients on a Biological Immune Response Modifier

PQRS #

:

PQRS 338

NQF #

:

NQF 2082

Measure Name

:

HIV Viral Load Suppression

PQRS #

:

PQRS 342

NQF #

:

N/A

Measure Name

:

Paint Brought Under Control Within 48 Hours

PQRS #

:

PQRS 387

NQF #

:

N/A

Measure Name

:

Annual Hepatitis C Virus (HCV) Screening for Patients who are Active Injection Drug Users

PQRS #

:

PQRS 394

NQF #

:

NQF 1407

Measure Name

:

Immunizations for Adolescents

PQRS #

:

PQRS 398

NQF #

:

N/A

Measure Name

:

Optimal Asthma Control

PQRS #

:

PQRS 400

NQF #

:

N/A

Measure Name

:

One-Time Screening for Hepatitis C Virus (HCV) for Patients at Risk

PQRS #

:

PQRS 401

NQF #

:

N/A

Measure Name

:

Hepatitis C: Screening for Hepatocellular Carcinoma (HCC) in Patients with Cirrhosis

PQRS #

:

PQRS 408

NQF #

:

N/A

Measure Name

:

Opioid Therapy Follow-up Evaluation

PQRS #

:

PQRS 412

NQF #

:

N/A

Measure Name

:

Documentation of Signed Opioid Treatment Agreement

PQRS #

:

PQRS 414

NQF #

:

N/A

Measure Name

:

Evaluation or Interview for Risk of Opioid Misuse

PQRS #

:

PQRS 418

NQF #

:

NQF 0053

Measure Name

:

Osteoporosis Management in Women Who Had a Fracture

PQRS #

:

PQRS 438

NQF #

:

N/A

Measure Name

:

Statin Therapy for the Prevention and Treatment of Cardiovascular Disease

AAFP PQRSwizard

Quality measures reporting is easy with PQRSwizard, a simple and cost-effective online tool that collects and reports quality measures data under the CMS PQRS program.

Use PQRSwizard to organize clinical data and to help provide evidence-based care to your patients.

+Measure not previously included in PQRS General Practice/Family Medicine Specialty Set

*Measure included on the PCMH/ACO/Primary Care Core Measure Set

The Core Quality Measures Collaborative

The AAFP is advocating that the MIPS General Practice/Family Medicine specialty measure set include all measures from the PCMH/ACO/Primary Care Core Measure Set developed by the Core Quality Measures Collaborative.

AAFP PQRSwizard

Quality measures reporting is easy with PQRSwizard, a simple and cost-effective online tool that collects and reports quality measures data under the CMS PQRS program.

Use PQRSwizard to organize clinical data and to help provide evidence-based care to your patients.