What Is The PQRI Group Practice Reporting Option

The GPRO is a reporting option available to large group practices beginning with the 2010 PQRI. The PQRI GPRO is modeled after current CMS demonstration projects: Medicare Care Management Performance (MCMP) and Physician Group Practice (PGP).

Eligible participants include group practices of at least 200 eligible professionals (EPs) who have reassigned their billing rights to the Taxpayer Identification Number (TIN). The group practice must have self-nominated and been selected by CMS to participate in the GPRO reporting option. Once selected, all EPs (NPIs) under the group practice TIN must participate through the GPRO option and may not submit under other PQRI reporting options.

Selected group practices who satisfactorily submit data on PQRI quality measures via GPRO are eligible to earn an incentive of 2% of the group practice’s Medicare Part B PFS total estimated allowed charges for covered services furnished by the group during the reporting period (January 1, 2010 through December 31, 2010). This incentive will be earned in lieu of individual EP NPI-level PQRI incentive payments.

2011 Physician Quality Reporting System GPRO

GPRO Requirements for Submission of 2011 eRx Data. While participation in the eRx Incentive Program (either as an individual eligible professional or under the eRx GPRO) is voluntary for group practices participating in the Physician Quality Reporting System GPRO.

CMS requires that in order for a group practice to participate in the 2011 eRx GPRO, a group practice must comply with all requirements for participation in the Physician Quality Reporting System GPRO and be participating in the Physician Quality Reporting System GPRO for 2011.

A group practice that wishes to participate in both the Physician Quality Reporting System GPRO and in the eRx GPRO, must notify CMS of its desire to do so when self-nominating for the 2011 Physician Quality Reporting System GPRO.

GPRO I refers to groups with 200 or more NPI’s

GPRO II refers to group practices with 2 to 199 NPIs

2011 Physician Quality Reporting System (Physician Quality Reporting) Disease Modules and Preventive Care Measures for GPRO I Use only

Diabetes Mellitus (DM) Disease Module – (8 Measures)

GPRO DM-1 Diabetes Mellitus: Hemoglobin A1c Testing
GPRO DM-2 Diabetes Mellitus: Hemoglobin A1c Poor Control in Diabetes Mellitus
GPRO DM-3 Diabetes Mellitus: High Blood Pressure Control in Diabetes Mellitus
GPRO DM-5 Diabetes Mellitus: Low Density Lipoprotein (LDL-C) Control in Diabetes Mellitus
GPRO DM-6 Diabetes Mellitus: Urine Screening for Microalbumin or Medical Attention for Nephropathy in Diabetic Patients
GPRO DM-7 Diabetes Mellitus: Dilated Eye Exam in Diabetic Patient
GPRO DM-8 Diabetes Mellitus: Foot Exam
GPRO DM-9 Diabetes Mellitus: Lipid Profile

Heart Failure (HF) Disease Module – (7 Measures)

GPRO HF-1 Heart Failure: Left Ventricular Function (LVF) Assessment
GPRO HF-2 Heart Failure: Left Ventricular Function (LVF) Testing
GPRO HF-3 Heart Failure: Weight Measurement
GPRO HF-5 Heart Failure: Patient Education
GPRO HF-6 Heart Failure: Beta-Blocker Therapy for Left Ventricular Systolic Dysfunction (LVSD)
GPRO HF-7 Heart Failure: Angiotensin-Converting Enzyme (ACE) Inhibitor or Angiotensin Receptor Blocker (ARB) Therapy for Left Ventricular Systolic Dysfunction (LVSD)
GPRO HF-8 Heart Failure: Warfarin Therapy for Patients with Atrial Fibrillation

Coronary Artery Disease (CAD) Disease Module – (4 Measures)

GPRO CAD-1 Coronary Artery Disease (CAD): Oral Antiplatelet Therapy Prescribed for Patients with CAD
GPRO CAD-2 Coronary Artery Disease (CAD): Drug Therapy for Lowering LDL-Cholesterol
GPRO CAD-3 Coronary Artery Disease (CAD): Beta-Blocker Therapy for CAD Patients with Prior Myocardial Infarction (MI)
GPRO CAD-7 Coronary Artery Disease (CAD): Angiotensin-Converting Enzyme (ACE) Inhibitor or Angiotensin Receptor
Blocker (ARB) Therapy for Patients with CAD and Diabetes and/or Left Ventricular Systolic Dysfunction
(LVSD)

Hypertension (HTN) Disease Module – (3 Measures)

GPRO HTN-1 Hypertension (HTN): Blood Pressure Measurement
GPRO HTN-2 Hypertension (HTN): Blood Pressure Control
GPRO HTN-3 Hypertension (HTN): Plan of Care

Preventive (Prev) Care Measures – (4 Measures – Individually Sampled)

GPRO Prev-5 Preventive Care and Screening: Screening Mammography
GPRO Prev-6 Preventive Care and Screening: Colorectal Cancer Screening
GPRO Prev-7 Preventive Care and Screening: Influenza Immunization for Patients aged 50 Years and Older
GPRO Prev-8 Preventive Care and Screening: Pneumonia Vaccination for Patients 65 Years and Older

PQRI GPRO measure specifications and materials are available at http://www.cms.gov/PQRI/22_Group_Practice_Reporting_Option.asp#TopOfPage