PQRS and the MACRA: Value-Based Payments Have Moved from Concept to Reality

Article Figures & Data

Table 1:

Glossary of terms commonly used in literature regarding care delivery and quality metrics

ABR: American Board of Radiology

ACA: Patient Protection and Affordable Care Act

ACO: Accountable Care Organization

ACR: American College of Radiology

AMA: American Medical Association

API: Application program interfaces

APM: Alternative Payments Model

ASNR: American Society of Neuroradiology

CEHRT: Certified EHR Technology

CHIP: Children's Health Insurance Program

CMS: Centers for Medicare & Medicaid Services

CPIA: Clinical Practice Improvement Activities

EHR: Electronic Health Record

EP: Eligible Professionals

HCPLAN: Health Care Payment Learning Action Network

IOM: Institute of Medicine

MACRA: Medicare Access and CHIP Reauthorization Act

MAP: Measures Application Partnership

MEI: Medicare Economic Index

MIPS: Merit-Based Incentive Payment System

MPFS: Medicare Physician Fee Schedule

NQF: National Quality Forum

NQS: National Quality Strategy

NRDR: National Radiology Data Registry

OBRA: Omnibus Budget Reconciliation Act

PQI: Practice Quality Improvement

PQRS: Physician Quality Reporting System

QCDRs: Qualified Clinical Data Registries

QRUR: Quality and Resource Use Reports

SCHIP: State Children's Health Insurance Program

SGR: Sustainable Growth Rate Formula

TRHCA: Tax Relief and Health Care Act

Table 2:

Select examples from the Qualified Clinical Data Registry^{^a}

Non-PQRS Measure	Measure Title	Description of Measure	NQS Domain	NRDR Data Base
ACRad 3	Screening Mammography Cancer Detection Rate	Fraction of screening mammograms interpreted as abnormal with tissue diagnosis of cancer confirmed within 12 mo	Effective Clinical Care	National Mammography Database
ACRad 9	Median Dose-Length Product for CT Head/Brain Without Contrast	Median dose-length product for CT head/brain without contrast, measured at a facility/group level for all physicians who interpret CT scans	Patient Safety	Dose Index Registry
ACRad 14	Participation in a National Dose Index Registry	No. of CT examinations performed at the facility and submitted to the Dose Index Registry	Patient Safety	Dose Index Registry
ACRad 17	Report Turnaround Time: MRI	Mean MRI report turnaround time	Communication and Care	General Radiology Improvement Database
ACRad 20	CT IV Contrast Extravasation Rate	Percentage of CT examinations with contrast performed that resulted in extravasation, measured at a facility/group level for all physicians who interpret CT scans	Patient Safety	General Radiology Improvement Database
ACRad 23	Lung Cancer Screening Abnormal Interpretation Rate	The percentage of screenings for lung cancer interpreted as positive	Efficiency and Cost	Lung Cancer Screening Registry

Note:—ACRad indicates American College of Radiology.
↵a These represent non-PQRS measures. QCDRs collect medical and/or clinical data for the purpose of patient and disease tracking. Data from the National Radiology Data Registry.31

Table 3:

Strategic approach to assist with preparation for the impact of quality measures in health care reimbursement

What Should I Do?	Where Should I Find It?
Learn about quality measures and the impact on your practice, including effort made by the practice to date	Read articles and Web sites (including material referenced in this article), engage practice administration, share insights with other providers
Select measures for which to be accountable (PQRS and QCDR)	www.acr.org/nrdr, www.cms.gov
Ensure method presently exists to record the metrics required for the selected measures and if not then establish one	Discuss with practice administration
Assess whether current EHR meets criteria for a CEHRT; if so, configure to enable direct database reporting to www.acr.org/nrdr	EHR vendor, hospital, or practice information technology service
Access QRUR to evaluate performance compared with other groups, including public reporting from CMS	https://www.cms.gov/medicare/quality-initiatives-patient-assessment-instruments/physician-compare-initiative/
Adjust accordingly (either data collection or metric chosen)	Practice administration
Adjust budgeting on the basis of impact quality performance will have on practice finances	Practice administration

Note:—PQRS indicates Physician Quality Reporting System; QCDR, Qualified Clinical Data Registry; EHR, Electronic Health Record; CEHRT, Certified EHR Technology; QRUR, Quality and Resource Use Reports.