Medical groups seeking to participate in the 2014 PQRS' group practice reporting option must register by Sept. 30, yet those who participated in the 2013 program received notice last week if they qualified for incentive payments.
If physicians met PQRS quality-measure reporting criteria in 2009 and 2010, they received a 2% bonus of their Medicare Part B charges. This percentage fell to 1% for 2011 and to 0.5% for 2011 through 2014. This year's financial incentive was also reduced by 2% under the broad federal budget cuts known as sequestration.
“The decreased incentive being offered is not that significant. The greater concern is on the penalty going forward,” said Anders Gilberg, the MGMA's senior vice president for government affairs. For 2015, failing to participate could mean a 2% penalty.
The PQRS requirements for 2015 will not be known until the release of the final 2015 Medicare physician fee schedule in November, so the recently received feedback received for 2013 performance has limited usefulness, Gilberg said.
“It's not the most actionable information,” Gilberg said. “It's also resulting in a level of provider frustration that's as high as it's ever been.”
A chief concern for the MGMA has been the subtle differences and redundant reporting of the same data for PQRS, the CMS value-based payment modifier, and the incentive program for the meaningful use of electronic health records.
When all of these programs move from awarding bonuses to issuing penalties, doctors could face a cumulative 11% reduction in Medicare payments, by the association's tally.
Current plans, as mandated by the Patient Protection and Affordable Care Act, call for applying the value-based payment modifier, or VBPM, to Medicare payments in 2017 based on 2015 PQRS data.
The current state of provider thinking on PQRS could be summed up in one word: “confusion,” said Melissa Blom, an account executive with Covisint, a company offering Web-based applications for PQRS participation.
Blom said the same cycle of data release and registration requirements happened last year, so medical groups should have been prepared. She added that the 2013 data—if released earlier—could have been used to help validate physician decisions to either report individually or as a group.
“While it could have made a difference for some, they should have already have had an idea of what they might do,” Blom said.
Some groups have discussed not participating in PQRS and just accepting whatever penalties are assessed, but Blom said that is short-sighted and often based on an incorrect assumption that the program won't continue.
“Not only is it not going away, there will be more penalties and awards based on their ability to demonstrate they've delivered high-quality care at low cost,” she said. “If they don't participate, the hit is going to be a lot more than they realize, and I think they will regret it.”