What is the difference between submitting as a group and as individuals?

What is the difference between individual measures, and a measure group?

The language used to describe the different methods of reporting is very confusing. Let’s start with reporting as individuals or a group (Group Practice Reporting Option, GPRO) .

Participating in PQRS as individuals means that you can report using either Individual Measures or a Measure Group. If you use individual measures, you need to select nine measures, in three domains, for each individual provider who is eligible for PQRS (eligible professionals) or you can report one Measure Group.

A Measure Group is a series of four to nine measures that have a common theme, for example, Diabetes or Oncology.

Reporting using GPRO allows you to select just nine measures for the entire group.And you also use the individual measures. You cannot use a Measure Group to report as a Group.

Individual Measures

• There are over 200 individual measures to choose from when submitting through a Registry.
• There are 64 individual measures when submitting from your EHR either through a Data-Submission Vendor (DSV) or EHR Direct.
• When you are reporting individual measures, you have to report nine measures on 50% of your Medicare Part B Fee-for-Service (FFS) patients to earn the incentive.

*Measure groups apply to Registry submissions only*

• There are 22 measure groups. (Measure Groups cannot be used for GPROs)
• Within each measure group, there are between 4 and 10 measures that apply to each group.
• You need 20 patients to be eligible for the measure group and 11 of those patients must be Medicare FFS Part B.
• All of the patients have to be eligible for the measures in the group with the exception of a few measure groups: For example, the Preventive Measures Group if the patient is male, Measure #112, Screening Mammography does not apply to that patient.

How do I decide what method or measures to report?

You select measures or a measure group you are eligible to report based on:

• Measures most relevant to your specialty.
• Measures that are easiest to report (fewest chart abstractions* or ease of EHR data extraction**)
• Measures that will give you the best performance–based on your actual data.

*Depending on the number of eligible patients, it can be easier to abstract data for four measures from 20 patient charts than 50% of eligible patients. OR conversely, if for example, only 10 patients are eligible for a measure, it can be fewer abstractions to collect data on 9 individual measures for 8 patients.

**Certain measures are more complex than others and will require a different level of data query

When you register for PQRS Solutions, you get access to the Measure Advisor and the Measure Analyzer that will recommend which measures to report.

Prepare for the transition to MIPS under MACRA. Read our post about the MIPS Quality measures.

MIPS and ACO Reporting under the Quality Payment Program

Dr. Dan Mingle and members of the team share their insights on how to maximize your success and payments for MIPS and APMs.

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