Recently, I have had the opportunity to work with a number of eligible professionals (EPs) reporting for Physician Quality Reporting System (PQRS) in CY2016. There were many interesting questions from each of the engaged providers. One question included "Why should the EP participate in the Centers for Medicare & Medicaid (CMS) quality initiatives?" To learn more about participating in quality initiatives, review the Quality Reporting Road Map and companion resources available on the PQRS's "How to Get Started" webpage: http://www.cms.gov/Medicare/Quality-Initiatives-Patient-Assessment-Instruments/P. The information presented in this column is found within the "2016 Beginner Reporting Toolkit" link, specifically on the flowchart, on the same webpage. This beginner-level toolkit contains 2 documents to help individual EPs and PQRS group practices navigate their way through the various PQRS decision points and the impact of quality reporting. You'll need to download and open a zipped file to access the full document.
The PQRS data are used as part of the Medicare Electronic Health Record (EHR) Incentive Program:
* The Medicare EHR Incentive Program provides incentive payments to individual EPs, eligible hospitals, and critical access hospitals that adopt, implement, upgrade, or demonstrate meaningful use of certified EHR technology.
* The Medicare EHR Incentive Program asks providers to demonstrate meaningful use of the capabilities of their EHRs to achieve benchmarks that can lead to improved patient care.
* View the "Introduction to the Medicare EHR Incentive Program for Eligible Professionals Beginners Guide" to learn more about the Medicare EHR Incentive Program: http://www.cms.gov/Regulations-and-Guidance/Legislation/EHRIncentivePrograms/dow.
The PQRS data are used to calculate the Value Modifier for physicians and certain practitioners in 2018.
* The 2018 Value Modifier is based on quality of care and cost data from 2016. The Value Modifier will apply to payments under the Medicare Physician Fee Schedule (MPFS) for physicians, nurse practitioners, physician assistants, clinical nurse specialists, and certified registered nurse anesthetists who are solo practitioners or in groups with 2 or more EPs.
* To be eligible for upward, downward, or neutral payment adjustments under the Value Modifier quality-tiering methodology and to avoid an automatic downward Value Modifier payment adjustment in 2018, EPs in groups and solo practitioners must participate in PQRS and satisfy reporting requirements as a group or as an individual in 2016.
* Visit the Value-Based Payment Modifier webpage to learn more about the Value Modifier: http://www.cms.gov/Medicare/Medicare-Fee-for-Service-Payment/PhysicianFeedbackPr.
Several PQRS measures are publicly reported on Physician Compare, a website that displays information about individual EPs and group practices who provide care to people with Medicare.
* On Physician Compare, individual EPs and group practices can see their performance, as well as the performance of their peers, on a series of publicly reported measures.
* This website enables individual EPs and group practices to track their performance and allows consumers to make informed choices about the healthcare they receive. To learn more about Physician Compare, visit http://www.medicare.gov/physiciancompare/search.html.
This is a stark reminder to read payment adjustment information as set forth by the CMS (http://www.cms.gov/Medicare/Quality-Initiatives-Patient-Assessment-Instruments/P):
* Individual EPs and group practices who do not satisfactorily report data on quality measures for covered professional services will be subject to a negative payment adjustment under the PQRS beginning in 2015. Note that program participation during a calendar year will affect payments after 2 years (ie, 2016 program participation will affect 2018 payments).
* The PQRS negative payment adjustment applies to all of the individual EP's or PQRS group practice's Part B-covered professional services under the MPFS.
* Accordingly, individual EPs and group practices receiving a negative payment adjustment in 2016 (based on participation in 2014) will be paid 2.0% less than the MPFS amount for that service. For 2017 and 2018 (based on participation in 2015 and 2016 program years), the negative payment adjustment is also 2.0%.
The key to successful reporting is your engagement in the process. As the program year moves forward, it is important to know how your patient population influences your measure selection, and how your measure selection directly impacts your documentation captured for reporting. Next, check the progress of your reporting often to gauge your progress in meeting the measure's performance and reporting rate. And finally, reach out for assistance early in the PQRS process to report accurately and timely.