Medicare Approves New Measure Groups in PQRS for Otolaryngology

In 2007, the Centers for Medicare and Medicaid Services (CMS) established the Physician Quality Reporting Initiative (PQRI), which later morphed into the now ubiquitously referenced Physician Quality Reporting System (PQRS). Starting Jan. 1 this year, physicians who did not participate in the pay-for-reporting system stood to lose 1.5% of allowable Medicare charges.

For otolaryngology, the issue was even more dire than a practice losing a portion of its already strained revenue stream. The CMS system afforded the specialty no measures groups, the billing term for an aggregated list of individual measures that relate to the field. Instead, otolaryngologists could only choose to file for individual measures, whose reporting guidelines are more involved, time-consuming, and costly than measures groups.

But that grim situation is no more.

A measures group may particularly benefit the private practice otolaryngologist.

The American Academy of Otolaryngology–Head and Neck Surgery Foundation (AAO-HNSF) and the American Board of Otolaryngology (ABOto) came together early last year to create two new measures groups for otolaryngologists that were ultimately approved for use by CMS. The groups will cover acute otitis externa (AOE) and adult sinusitis.

“We’re a very heterogeneous specialty,” said Randal Weber, MD, chair of head and neck surgery at The University of Texas at MD Anderson Cancer Center in Houston and the ABOto president-elect. “Some of us see primarily head and neck cancer, while others see patients with ear problems. Some are in academic practice, and others are in solo or multi-specialty private practice arrangements. “So having a measure group may particularly benefit the private practice otolaryngologist, because it covers a spectrum of patients that they would normally see in their practice and opens up [PQRS participation] to a lot of practitioners in otolaryngology,” he added.

AAO-HNSF and other specialty associations began discussing proposed measures groups early in 2014, with the goal of presenting them to CMS for approval. Last summer, negotiations continued, and by the November release of the Medicare Physician Fee Schedule Final Rule, CMS approved the measures groups for inclusion in PQRS in 2015.

“It’s difficult to measure quality improvement without measures,” said James C. Denneny III, MD, the new executive vice president and chief executive officer of the AAO-HNS and its foundation. “Putting together parameters is very difficult, because it involves reviewing literature, hundreds of articles, by panels that are versed in doing this, and then selecting what has the evidence to support proven ways to do this, and a lot of that evidence does come from these types of clinical studies. So [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.”