CMS Pub. 100-22, ch. 1, § 70.2.1

Practices and Process for Reporting under the GPRO

(Rev. 10, Issued: 07-27-12, Effective: 10-29-12, Implementation: 10-29-12)

For purposes of determining whether a group practice satisfactorily submits Physician Quality

Reporting System quality measures data for a particular program year, each selected group

practice is required to complete this data collection web-interface for a specified number of

quality measures. The quality measures are grouped into disease modules plus a series of patient

care measures. Data from the January 1st through October 29th NCH file for the program year

(10 months) is used by CMS to randomly assign Medicare beneficiaries to each physician group

practice TIN. Medicare beneficiaries are retrospectively assigned to the TIN based on a

determination by CMS that the group practice provided the plurality of office or other outpatient

services to the beneficiary (with a minimum of at least two visits) in the 10-month period.

Furthermore, part-year and managed care patients are not considered since CMS would have

incomplete claims data for these beneficiaries and group practices may not have had sufficient

time to impact the quality of their care.

In 2011, for each disease module or patient care measure, the selected Physician Quality

Reporting System GPRO I practice was required to complete the data collection web-interface

for the first 411 consecutively assigned and ranked Medicare beneficiaries. Assigned

beneficiaries will be limited to those Medicare FFS beneficiaries with Medicare Part B for whom

Medicare is the primary payer. If the pool of eligible assigned beneficiaries was less than 411 for

any module/measure, then the group practice was required to report on 100% (all) of the

assigned beneficiaries for that module/measure to satisfactorily participate in the Physician

Quality Reporting System GPRO I. The reporting mechanism, reporting period, and criteria for

satisfactory reporting under the GPRO I for 2011 are summarized in the Table 6 below.

Table 6: 2011 Physician Quality Reporting System Process for Physician Group Practices

to Participate as Group Practices and Criteria for Satisfactory Reporting of Data on

Quality Measures by Group Practices for GPRO I

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Reporting

Mechanism

Reporting Criteria Reporting

Period

A pre-populated

data

collection

web-interface

provided by

CMS

• Report on all measures included in the data collection

web-interface (26 measures); and

• Complete the web-interface for the first 411 consecutively

ranked and assigned beneficiaries in the order in which

they appear in the group’s sample for each disease module

or patient care measure. If the pool of eligible assigned

beneficiaries is less than 411, then report on 100% of

assigned beneficiaries.

January 1,

2011–

December

31, 2011

In addition, for 2011, GPRO II groups were required to report on a specified number of

individual measures and measures groups depending on the group practice's size. For individual

measures reporting, GPRO II groups were required to report on a specified percentage of

patients. To satisfactorily report measures groups for the 2011 Physician Quality Reporting

System GPRO II, the group practice need only report on the minimum number of patients

specified in Table 9 for their group size. In addition, since we did not have the ability to

determine whether the registries can ensure that only unique patients are counted, GPRO II

groups were required to report the 2011 Physician Quality Reporting System data via claims

unless the only measures groups that apply to the practice are one of the four registry-only

measures groups. Group practices that must report on one of the four registry-only measures

groups in order to meet the criteria for satisfactory reporting were able to use the registry-

reporting mechanism to submit all of their 2011 Physician Quality Reporting System data via the

registry reporting mechanism. The reporting mechanism, reporting period, and criteria for

satisfactory reporting under the GPRO II for 2011 are summarized in the Table 7 below.

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Table 7: 2011 Physician Quality Reporting System Process for Physician Group Practices

to Participate as Group Practices and Criteria for Satisfactory Reporting of Data on

Quality Measures by Group Practices for GPRO II

Group size

(number of

eligible

professionals)

Number of

measures

groups

required to

be reported

Minimum

number of

Medicare

Part B

patients in

denominator

for

satisfactory

reporting of

measures

groups

Number of

individual

measures

required to

be reported

Percent of

Medicare

Part B

patients in

denominator

for

satisfactory

reporting of

individual

measures via

claims (%)

Percent of

Medicare

Part B

patients in

denominator

for

satisfactory

reporting of

individual

measures via

registries

(%)

2-10 1 35 3 50 80

11-25 1 50 3 50 80

26-50 2 50 4 50 80

51-100 3 60 5 50 80

101-199 4 100 6 50 80

In 2012, the GPRO II reporting option was eliminated, leaving a single GPRO reporting option.

However, CMS finalized two different satisfactory reporting criteria under the GPRO for groups

comprised of 25-99 eligible professionals and groups comprised of 100+ eligible professionals.

With respect to the criteria for satisfactory reporting for groups comprised of 25-99 eligible

professionals, for each disease module or patient care measure, the selected Physician Quality

Reporting System GPRO practice must complete the data collection web-interface for the first

218 consecutively assigned and ranked Medicare beneficiaries. Assigned beneficiaries will be

limited to those Medicare FFS beneficiaries with Medicare Part B for whom Medicare is the

primary payer. If the pool of eligible assigned beneficiaries was less than 218 for any

module/measure, then the group practice is required to report on 100% (all) of the assigned

beneficiaries for that module/measure to satisfactorily participate in the Physician Quality

Reporting System GPRO.

With respect to the criteria for satisfactory reporting for groups comprised of 100+ eligible

professionals, for each disease module or patient care measure, the selected Physician Quality

Reporting System GPRO practice must complete the data collection web-interface for the first

411 consecutively assigned and ranked Medicare beneficiaries. Assigned beneficiaries will be

limited to those Medicare FFS beneficiaries with Medicare Part B for whom Medicare is the

primary payer. If the pool of eligible assigned beneficiaries was less than 411 for any

module/measure, then the group practice was required to report on 100% (all) of the assigned

beneficiaries for that module/measure to satisfactorily participate in the Physician Quality

Reporting System GPRO.

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The reporting mechanism, reporting period, and criteria for satisfactory reporting under the

GPRO for 2012 are summarized in the Table 8 below.

Table 8: 2012 Criteria for Satisfactory Reporting of Data on Quality Measures by Group

Practices for theGPRO

Group Size Reporting

Mechanism

Reporting Criteria Reporting

Period

25-99

eligible

professionals

A

submission

web

interface

provided by

CMS

• Report on all measures included in the

web-interface (29 measures); and

• Populate the data field for the first 218

consecutively ranked and assigned

beneficiaries in the order in which they

appear in the group’s sample (with an

over-sampler of 327) for each disease

module or patient care measure. If the

pool of eligible assigned beneficiaries is

less than 218, then report on 100% of

assigned beneficiaries.

January 1,

2012–

December

31, 2012

100+

eligible

professionals

A

submission

web

interface

provided by

CMS

• Report on all measures included in the

web-interface (29 measures); and

• Populate the date fields for the first 411

consecutively ranked and assigned

beneficiaries in the order in which they

appear in the group’s sample (with an

over-sample of 616) for each disease

module or patient care measure. If the

pool of eligible assigned beneficiaries is

less than 411, then report on 100% of

assigned beneficiaries.

January 1,

2012–

December

31, 2012