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Physician Quality Reporting System Penalties Snag 470K EPs

By Jennifer Bresnick

- Nearly half a million eligible professionals will be losing 1.5 percent of their Medicare reimbursements thanks to non-participation in the Physician Quality Reporting System (PQRS) program in 2013, CMS says.  Despite increasing participation between 2012 and 2013, ninety-eight percent of the EPs receiving cuts to their 2015 Part B Medicare Physician Fee Schedule allowed charges did not even attempt to attest to the PQRS program when they had the chance.

Physician Quality Reporting System payment adjustments

The Physician Quality Reporting Program is one of several CMS initiatives that require providers to report electronic data on clinical quality measures in order to benchmark the industry’s efforts to improve the quality and safety of care.  Along with the EHR Incentive Programs, the eRx Incentive Program, and the Value-Based Payment Modifier Program, CMS hoped that PQRS would help to quantify health IT-related efforts to cut expenses and incent providers to pay closer attention to how they deliver services.

However, the program has prompted its fair share of grumbling from the provider community thanks to duplicated reporting efforts and confusion over the impact of participation.  Thanks to the repeal of the Medicare Sustainable Growth Rate earlier in April, PQRS will be rolled into a newly streamlined, more comprehensive quality initiative called the Merit-based Incentive Payment System (MIPS), which will hopefully reduce some of the administrative burdens of multiple reporting systems. 

MIPS will absorb PQRS payment adjustments, beginning in 2019, into a single payment adjustment structure that also includes penalties and bonuses related to the EHR Incentive Programs and Physician Value-Based Modifier.

Yet providers will still be feeling the financial pinch from the ghosts of reporting periods past.  The 2015 cuts are linked to participation year 2013, and will affect 469,755 eligible professionals who either didn’t attest or failed their attestation efforts.

Despite the disappointment of providers who will be seeing smaller checks from CMS, the Physician Quality Reporting System has attracted an even larger number of successful participants.  Between 2012 and 2013, participation in PQRS jumped by 47 percent as the first payment cuts loomed large.  A total of 641,654 eligible professionals participated either as individuals or as part of a group reporting structure during the 2013 program year.  This represents just over half of the 1.25 million EPs who were eligible to share in the $214 million of incentive payments released to the industry.

CMS also released data about the final year of the e-Prescribing (eRx) Incentive Program, which ended in 2013 with 377,004 providers enrolled, a nine percent increase over the previous year.  Approximately 47 percent of the 800,000 providers eligible for the program successfully participated in 2013, scooping up more than $168 million in incentive payments.

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