2013 PQRS Participation Decides 2015 PQRS Penalty Adjustment
January 2012 marks the start of a new year of Physician Quality Reporting System
(PQRS) and ePrescribing (eRx) reporting. For those who have not yet participated
in PQRS, this is the year to start. 2012 is the last year to "practice" and
master reporting as 2013 results will drive the "payment adjustments"
(penalties) in 2015. The Centers for Medicare & Medicaid Services (CMS) will
impose a 1.5% penalty in 2015 and a 2% penalty for 2016 and after.
Incentives and Penalties
Three years remain in the incentive phase of PQRS. The
2012-2014 incentive is 0.5% of the EP's estimated total allowed charges for
covered Medicare Part B PFS services provided during the reporting period. All
EPs are encouraged to participate now to benefit from the remaining available
incentive and to have tested practices in place by 2013, the reporting year for
2015, when the "payment adjustment" (i.e., penalty phase begins with a -1.5%
adjustment for those not participating). The penalty increases to -2% in 2016
and will be applied thereafter. With reimbursement on a continual decline,
practices should take advantage of the incentive while it is offered.
Incentive Notes:
CMS also has indicated that the PQRS will be the basis for the
Value-Based Modifier (VBM). CMS intends to move Medicare from the position of
passive payer to a purchaser of high quality efficient care through a
value-based purchasing (VBP) initiative. The Affordable Care Act mandates that
by 2015 CMS must begin to apply a VBM under the Medicare PFS. Cost and quality
data will be considered in the calculation of payments for physicians. Starting
in 2015, some payments will be affected by the VBM; by 2017, most physician
payments will be affected by the VBM. In the meantime, CMS, through PQRS,
provides feedback reports so providers can see how their performance compares
with their peers. These quality and cost results will be the basis for the VBM.
Again, this is a good reason to participate in PQRS in 2012 if you have not yet
done so. For more information on the VBM, access https://www.cms.gov/PhysicianFeedbackProgram/.
PQRS Alignment with the EHR Incentive Program
To better align PQRS measures with those under the EHR
program, CMS includes all 44 of the clinical quality measures of the EHR program
in the 2012 PQRS, and introduces a Physician Quality Reporting System-Medicare
EHR Incentive Pilot to meet both the 2012 clinical quality measure requirements
of the Medicare EHR Incentive Program and the 2012 PQRS program. In the recently
released proposed rules for the Medicare and Medicaid Programs; Electronic
Health Record Incentive Program--Stage 2, CMS outlines additional proposals to
further align clinical quality measures across multiple programs including PQRS
beginning in 2014.
(PQRS) and ePrescribing (eRx) reporting. For those who have not yet participated
in PQRS, this is the year to start. 2012 is the last year to "practice" and
master reporting as 2013 results will drive the "payment adjustments"
(penalties) in 2015. The Centers for Medicare & Medicaid Services (CMS) will
impose a 1.5% penalty in 2015 and a 2% penalty for 2016 and after.
Incentives and Penalties
Three years remain in the incentive phase of PQRS. The
2012-2014 incentive is 0.5% of the EP's estimated total allowed charges for
covered Medicare Part B PFS services provided during the reporting period. All
EPs are encouraged to participate now to benefit from the remaining available
incentive and to have tested practices in place by 2013, the reporting year for
2015, when the "payment adjustment" (i.e., penalty phase begins with a -1.5%
adjustment for those not participating). The penalty increases to -2% in 2016
and will be applied thereafter. With reimbursement on a continual decline,
practices should take advantage of the incentive while it is offered.
Incentive Notes:
- An EP may submit measures and measures groups,
but will be paid only one incentive. - An EP affiliated with a group practice
participating in the PQRS is only able to earn an incentive as part of the group
practice and not as an individual EP.
CMS also has indicated that the PQRS will be the basis for the
Value-Based Modifier (VBM). CMS intends to move Medicare from the position of
passive payer to a purchaser of high quality efficient care through a
value-based purchasing (VBP) initiative. The Affordable Care Act mandates that
by 2015 CMS must begin to apply a VBM under the Medicare PFS. Cost and quality
data will be considered in the calculation of payments for physicians. Starting
in 2015, some payments will be affected by the VBM; by 2017, most physician
payments will be affected by the VBM. In the meantime, CMS, through PQRS,
provides feedback reports so providers can see how their performance compares
with their peers. These quality and cost results will be the basis for the VBM.
Again, this is a good reason to participate in PQRS in 2012 if you have not yet
done so. For more information on the VBM, access https://www.cms.gov/PhysicianFeedbackProgram/.
PQRS Alignment with the EHR Incentive Program
To better align PQRS measures with those under the EHR
program, CMS includes all 44 of the clinical quality measures of the EHR program
in the 2012 PQRS, and introduces a Physician Quality Reporting System-Medicare
EHR Incentive Pilot to meet both the 2012 clinical quality measure requirements
of the Medicare EHR Incentive Program and the 2012 PQRS program. In the recently
released proposed rules for the Medicare and Medicaid Programs; Electronic
Health Record Incentive Program--Stage 2, CMS outlines additional proposals to
further align clinical quality measures across multiple programs including PQRS
beginning in 2014.