What is Physician Reporting?

Physician reporting also referred to as The Physician Quality Reporting System (PQRS), formerly known as the Physician Quality Reporting Initiative (PQRI), is a healthcare quality improvement incentive program initiated by the Centers for Medicare and Medicaid Services (CMS) in the United States in 2006. The primary goal of physicians is to provide the best care to patients. Hence it is important to answer clearly the question: What is Physician Reporting? Physicians have a legal and professional obligation to maintain the confidentiality of patient information.

There are circumstances, however, where physicians are either required or permitted to report particular events or clinical conditions to the appropriate government or regulatory agency. This policy clarifies the circumstances under which physician reporting duties are mandatory or permissive.

There are some mandatory reports that physicians must give, a major one is Child Abuse or Neglect

The purpose of the Child and Family Services Act (CFSA) is to promote the best interests, protection, and well-being of children.  Under the CFSA, physicians who have reasonable grounds 2 to suspect a child is or may be in need of protection, must immediately report the suspicion, and the information upon which it is based, directly to a children’s aid society.

A “child in need of protection” includes a child who has suffered, or is at risk of suffering abuse, neglect, or emotional harm. Physicians who have reasonable grounds to suspect a child is in need of protection must report directly to a CAS, and not rely on any other person to report on their behalf. The duty to report is ongoing. The Child and Family Services Act requires that physicians make a further report to the CAS if there are additional reasonable grounds to suspect that the child is or may be in need of protection.

Physicians have the same duty to report their suspicion that a child is in need of protection as any other member of the general public. The Child and Family Services Act recognizes, however, that professionals working closely with children have a special awareness of the signs of child abuse and neglect, and a particular responsibility to make a report.

Physicians are not obligated to report suspicions of abuse to the police. However, if the information provided by the physician to the CAS alleges that a criminal offense has been perpetrated against a child, the CAS will immediately inform the police, and work with the police according to established protocols for investigation.

Physicians who make a report about a child who is or may be in need of protection are generally protected from legal action unless the basis for doing so was malicious or without reasonable grounds. Physicians who fail to report a suspicion obtained in the course of their professional duties may be guilty of an offense punishable by a fine.

If the child has been abandoned, or the child’s parent is deceased, or is unavailable to exercise their custodial rights over the child, and has not made adequate provision for the child’s care and custody. The child is in a residential placement and the parent refuses or is unable or unwilling to resume the child’s care and custody. The child is under the age of 12 and has killed or seriously injured another person or caused serious damage to another person’s property.

The child’s parent or the person having charge of the child does not provide, refuses, is unable or unavailable to consent to the services or treatment necessary to prevent the child from committing the same or similar acts in the future.

It is important for physicians to understand these rules and the role they play in enforcing them by reporting suspicions.