Focus on Health Care Reform – PQRI Participation Becomes Mandatory to Avoid Penalties in 2015



The Patient Protection and Affordable Care Act of 2010, signed into law on March 23rd, implements many changes to the way physicians practice medicine.  Efforts to enhance the quality of care and expand reporting requirements for physicians are among the notable changes.  Effective 2015, the law will impose a 1.5% penalty on Medicare reimbursement for physicians who do not participate in the Physician Quality Reporting Initiative (PQRI) and do not “satisfactorily submit data on quality measures for covered professional services.”  The penalty will increase to 2% beginning in 2016. 

Physicians have reported that the current PQRI system is fraught with administrative flaws, making the process for determining successful reporting inconsistent. In an effort to address these concerns the law also requires the  Secretary of Health and Human Services to “provide timely feedback” regarding performance and to also set criteria for an “informal appeals process.” A copy of the new regulation can be found in Section 3002 of the Patient Protection and Affordable Care Act.


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  • Victoria Rhodes, PAC

    What exactly is this?

  • Robert A. Appel, MD

    If this provision is not rescinded, I’ll become a non-participant in M’care if I don’t do so for other reasons sooner than 2015.