How To Choose Which PQRS Measures?
IYou must use at least 9 different PQRS measures, which cover at least 3 general areas or “domains.” And at least one of the 9 measures has to be a “cross-cutting” measure, which is a metric that is broadly applicable across various clinical settings, EPs, and group speciality practices.

Currently (as of 1/01/2016) there are 64 specialties for whom their professional organizations and/or CMS have determined measures useful in their fields, these include:

• Allergy & Immunology
• Cardiac Arrhythmia
• Colon & Rectal Surgery
• Diabetes & Endocrinology
• Endocrinology
• Gastroenterology
• Geriatric/Gerontology
• Hematology-Oncology
• Internal Medicine
• Clinical Social Work
• Neuromusculoskel Med
• OB/GYN & Women’s Hlth
• Ophthalmology
• Orthopedics
• Palliative Care
• Physical Therapy
• Podiatry
• Pulmonary Medicine
• Rheumatology
• Spine Specialists
• Urgent Care
• Women’s Health

• Audiology
• Chiropractic
• Dermatology
• Emergency Medicine
• Family Medicine
• General Surgery
• Hand Surgery
• Infectious Disease
• Lab Medicine
• Neurology
• Nuclear Medicine
• Oncology
• Oral/Maxillofacial Surg
• Pain Management
• Pediatrics
• Plastic Surg & Aesth Med
• Psychology
• Radiology
• Speech Therapy
• Transplantation
• Vascular Surgery

• Anesthesiology
• Cardiology
• Crit Care/Hospitalist
• Diagnostic Radiology
• ENT
• General Medicine
• Gynecology
• Hospitalist/Critical Care
• Interventional Radiology
• Nephrology
• Neurosurgery
• Occupational Therapy
• Optometry
• Otolaryngology
• Pathology & Lab Medicine
• Physical Med & Rehab
• Psychiatry & Mental Hlth
• Radiation Oncology
• Sleep Medicine
• Surgery
• Urology

In anesthesia (non-pain management) there are 30 metrics in 2015-16 determined by the Anesthesia Quality Institute that were adopted by CMS as approved measures. In Pain Medicine there are 15 measures approved by the CMS, of which six are cross-cutting.

In some specialties where a professional organization was unable to determine 9 individual measures, or 3 different domains worthy of assessment you need to do as much as you can; e.g., chiropractic has only two metrics that apply. However, some chiropractors might add Measure #134 if they are holistic approaches to Depression, or #317 if they measure and advise on BP. If you don’t have enough measures or domains to choose from to cover the 9/3 rule over most of your Medicare patients over a year, than you must do your best to choose the most appropriate measures you can.

Your professional organization will advise you on what makes sense for your profession, but you should add and use measures relevant to your own practice. The CMS will audit your claims to see if there were additional measures you could have used but failed to use over the year. This is called the “Measures Applicability Validation Process” or MAV, and if you fail the MAV audit you will be penalized in future Medicare payments starting in 2017 as described above.