Medicare Approves New Measure Groups in PQRS for Otolaryngology

[This is] a transition step to where we’re going now, where we’ll have precise parameters that are measurable across the country to guide consistency in treatment for patients across the board. —James C. Denneny III, MD

Why Measures Groups?

Given the fact that otolaryngologists already have the ability to report on individual measures, some practitioners might wonder why measures groups matter at all. Dr. Denneny said there are several reasons.

First, he estimates the percentage of otolaryngologists who participate in PQRS at roughly 35%. With the broader availability of measures groups, he believes that could rise to “well above 50%.” That is because measures groups require less overall reporting.

To wit, eligible physicians who use the PQRS “individual measure” option must report on 80% of their eligible Medicare Part B fee-for-service patients for that coding number. But physicians reporting for a measures group, often via

PQRSwizard, need only report on 20 patients for the group. “Having to only report on 20 patients for each group is considerably easier than picking a percentage of all the patients with that diagnosis,”

Dr. Denneny said. “It’s much more doable even in the era of electronic health records.”

A second reason a measures group is important, he added, is that it will further improve care delivery. “We were hoping that at the end of the day, measures like this will end up populating future registries that would subsequently report results which are standardized and, overall, continue to improve quality of care,” Dr. Denneny said.

To be clear, while the measures groups are in place starting this year, the reporting period is on a lag. The 2015 calendar year, which is subject to the 1.5% deduction, is based on the 2013 reporting period. In 2016, the payment reduction rises to 2%, based on 2014 data.

Dr. Denneny said the new measures groups will likely provide a reporting option for 70% to 75% of otolaryngologists. Still, laryngologists, for example, or head-and-neck surgeons might not see 20 patients with AOE or sinusitis. That means their only reporting option remains individual measures. Crafting additional measures groups that might help subspecialty otolaryngologists might seem like a good idea, but doing so before the efficacy of the first two groups can be analyzed would be premature, Dr. Weber said.

“We need to see how well this first measure group is accepted,” he added. “It does need to be as broad as possible, but I also think from this first measure group we will get insight into the mechanics, how easy is it to participate, and how easy is it to collect the data and report it.”