Physician Quality Reporting System

The Physician Quality Reporting System (PQRS) is a program under the Centers for Medicare & Medicaid Services (CMS). PQRS is designed to promote reporting of quality information by eligible professionals (EPs). EPs who do not satisfactorily report 50% performance on at least nine quality measures in three domains for the January 1, 2016 - December 31, 2016 reporting period will be subject to a 2.0% negative payment adjustment (penalty) in the 2018 Medicare Part B fee schedule.

The STS National Database has once again been designated a Qualified Clinical Data Registry (QCDR) for PQRS reporting in 2016. A QCDR is a CMS-approved entity that collects medical and/or clinical data for the purpose of patient and disease tracking to foster improvement in the quality of care furnished to patients. The data submitted to CMS via a QCDR cover quality measures across multiple payers and are not limited to Medicare beneficiaries or limited to measures within PQRS. CMS will publish physician results on a select set of measures from the 2016 PQRS submission on the Physician Compare website.

Individual surgeons who participate in the STS Adult Cardiac Surgery Database can take advantage of this program free of charge by signing a Data Sharing Consent and Release Form by October 31, 2016A new consent form must be signed every year

STS will not report for surgeons who are already enrolled in the Group Practice Reporting Option (GPRO) or as part of an Accountable Care Organization (ACO).

STS will report to CMS all of the following measures on behalf of individual consenting surgeons:

Measure#  Description (click on title for measure specifications) National Quality Domain
PQRS 21 Antibiotic selection Patient Safety
PQRS 22 Antibiotic discontinuation Patient Safety
PQRS 43 CABG IMA Use Effective Clinical Care
PQRS 44 CABG Preop Beta Blocker Effective Clinical Care
PQRS 164 CABG Prolonged Postop Ventilation* Effective Clinical Care
PQRS 165 CABG Deep Sternal Wound Infection* Effective Clinical Care
PQRS 166 CABG Postop CVA* Effective Clinical Care
PQRS 167 CABG Postop Renal Failure* Effective Clinical Care
PQRS 168 CABG Reoperation* Effective Clinical Care
PQRS 226 Tobacco Screening & Intervention Community/Population Health
STS 1PLOS Following CABG* Efficiency & Cost Reduction
STS 2SLOS Following CABG* Efficiency & Cost Reduction
STS 3PLOS Following CABG + Valve* Efficiency & Cost Reduction
STS 4SLOS Following CABG + Valve* Efficiency & Cost Reduction
STS 5PLOS Following Valve* Efficiency & Cost Reduction
STS 6SLOS Following Valve* Efficiency & Cost Reduction
STS 7Patient-Centered Risk Assessment/Communication Person/caregiver centered  experience & outcome

*Denotes outcome measure

If you have questions, contact Derek Steck, STS National Database Coordinator, at dmcdonald [at] sts [dot] org.

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