The Centers for Medicare and Medicaid Services (CMS) recently released the 2013 Physician Quality Reporting System (PQRS) Experience Report, highlighting the growth of the PQRS program since its inception in 2007 and tracking the first year of payment adjustments for non- or unsuccessful participation.
Of the more than 1.2 million professionals who were eligible for PQRS in the 2013 reporting year, 51 percent (641,654) participated. The number of participating eligible professionals increased by 47 percent between 2012 and 2013 and increased six-fold since 2007, when approximately 100,000, or 15 percent, of eligible providers participated.
Of those participating, 77 percent (494,619) of eligible providers earned an incentive payment of .5 percent of 2013 Medicare allowed amounts. Total incentives earned in 2013 amounted to more than $215 million, with average incentive payments of $443 per eligible professional and $4,531 per practice, a slight decrease from 2012 even though the percentage of incentive was .5 percent both years.
Meanwhile, almost 470,000, or approximately 40 percent, of eligible professionals are subject to a 1.5 percent payment adjustment in 2015 resulting from their 2013 PQRS performance or lack thereof. Ninety-eight percent of those subject to the adjustment did not attempt to participate in PQRS in 2013, while 1.7 percent attempted participation but were not successful because they submitted only invalid QDCs and did not avoid the 2015 PQRS payment adjustment for any other reason.
During the 2013 reporting year, CMS provided opportunities for eligible professionals to avoid the payment adjustment short of fulfilling the requirements for earning an incentive, such as registering through the claims administrative option or reporting only one PQRS measure. As well, some eligible professionals did not receive a payment adjustment because though they were eligible for the program, they did not meet the definition of an eligible professional for the PQRS payment adjustment, had no 2013 MPFS charges, or did not have at least one denominator-eligible claim.
While the recent Medicare Access and CHIP Reauthorization Act (MACRA) will eventually phase out the PQRS program after 2018, quality reporting and pay-for-performance models are becoming more prominent in the healthcare industry. Even the Wall Street Journal recently reported on the 2013 Physician Quality Reporting System (PQRS) Experience Report, and current federal guidelines will allow CMS to report some of a physician’s PQRS results on the Physician Compare Website in the coming years.
What Should You Do?
- Continue to participate in the PQRS, Value-Based Payment Modifier, and other CMS quality programs. Rely on CIPROMS to keep you up-to-date about guidelines and deadlines.
- Watch for more and more commercial payers to follow after CMS and begin requiring quality reporting and moving toward performance-based payment models.
- Be prepared to talk with patients about quality reporting programs as more information is presented by the media and on CMS patient websites.
- Read the CMS Physician Quality Reporting Programs Strategic Vision report to learn how CMS “will build on its current successes in quality measurement and public reporting to advance the goals and objectives for quality improvement outlined in the CMS Quality Strategy.”
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