Upcoming changes to PQRS

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It is important for SVS members to know, understand, and prepare for the upcoming changes to the Physician Quality Reporting System (PQRS). PQRS is a pay-for-reporting program that uses a combination of incentive payments and downward payment adjustments to promote reporting of quality information by eligible professionals (EPs). The program is administered by the Centers for Medicare and Medicaid Services (CMS) and affects covered professional services provided to Medicare Part-B fee-for-service beneficiaries.

The program currently provides an incentive payment of .5% through 2014 to EPs and group practices who satisfactorily report data on quality measures for covered services furnished to Medicare Part B fee-for-service beneficiaries. After 2014, the payment incentive will end and a downward payment adjustment will apply to EPs who do not satisfactorily report data on quality measures for covered professional services. This means that all EPs or group practices treating Medicare Part B fee-for-services beneficiaries that either don’t report at all, or don’t meet the reporting requirements set by the program, will automatically receive a downward payment adjustment. In addition to being the last year physicians can receive an incentive, 2014 will also serve as the performance year that will determine the application of the 2016 downward payment adjustment of 2%.

Key facts to know about the new PQRS requirements include:

  • The percentage of applicable patients a physician must report on was lowered from 80 percent to 50 percent in order to be considered a satisfactory reporter. In addition, CMS will eliminate the six-month reporting period for 2014.
  • For individual participation the number of measures that must be reported has increased from three to nine for incentive purposes. The measures must cover at least three of the National Quality Strategy domains.
  • CMS will no longer recognize the reporting of one measure or one measures group, or the election of Administrative Claims reporting conducted by CMS as viable reporting options for avoiding a PQRS penalty. However, physicians may report on only three measures on 50 percent of their applicable patients to avoid the 2016 PQRS penalty.
  • PQRS measures groups in 2014 will only be reportable through a registry.
  • Group practices comprising 25-99 EPs may still satisfy PQRS reporting in 2014 through the GPRO web-interface.
  • For group practices reporting individual measures via registry, CMS finalized its proposal to increase the number of measures that must be reported from three to nine measures and set a 50 percent threshold instead of an 80 percent threshold, which it also finalized for the individual satisfactory reporting criteria for the 2014 PQRS incentive.

It is important to note that the key fact list above is not a comprehensive list of current PQRS requirements, and it is imperative for providers to review the PQRS requirements in their entirety to determine which reporting option and measures will best work for their practice. For more detailed information regarding the new PQRS requirements, please see the PQRS information page on the CMS.gov website.

CMS.gov contains guidance and explanation of all of the requirements for both the 2014 incentive and penalty options, as well as requirements for 2015 and beyond. The website also provides resources detailing how to get started for practices or providers who are new to PQRS reporting, as well as phone numbers and contact information for those who need assistance or have questions.

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