Improving health is our policy
Phases down incentive payments for reporting of quality measures under the Physician Quality Reporting System (PQRS) by 2015, at which time penalties for non-reporting begin, increasing to 2% of physician payments by 2016. Authorizes physicians to submit quality data to approved Maintenance of Certification (MOC) programs, with an extra 0.5% bonus for physicians who complete an MOC practice assessment.
In 2013, physicians are still receiving bonus payments for voluntarily reporting on quality measures. For more information, see the CMS Physician Quality Reporting System (PQRS) website. Physicians may access PQRS feedback reports here. See also CMS’s Physician Compare website.
In a related event, on February 4, 2013, CMS issued a request for information (RFI) in which it sought feedback on the ways in which an eligible professional (EP) might use the clinical quality measures (CQM) data reported to specialty boards, specialty societies, regional health care quality organizations or other non-federal reporting programs to also report under the PQRS, as well as the EHR Incentive Program. CMS also solicits ways in which the entities already collecting CQM data for other reporting programs to submit this data on behalf of EPs and group practices for reporting under the PQRS and the EHR Incentive Program. Finally, CMS seeks feedback regarding section 601(b) of the American Taxpayer Relief Act of 2012 (ATRA) which provides for treating an EP as satisfactorily reporting data on quality measures if the EP is satisfactorily participating in a qualified clinical data registry. Comments were due by April 8.
On April 8, 2013, CMS posted the Qualified Maintenance of Certification (MOC) Program Incentive Entities for 2013 listing qualifying Boards. Also see the agency’s 2013 MOC Qualification Requirements related to eligibility for the PQRS incentive available for MOC.
On May 17, CMS posted a call for measures noting that it is accepting potential measures and measure groups for the PQRS program through 5 p.m. EDT on July 1, 2013.
On July 8, in CMS’s CY 2014 Physician Fee Schedule proposed rule, the agency proposes the “next phase of the plan to publicly report physician performance information on Physician Compare,” as detailed in the rule and summarized in an accompanying quality-focusedfact sheet. Comments are due on September 6, 2013.
On November 27, 2013, CMS issued the CY14 Medicare Physician Fee Schedule (MPFS) final rule, in which it decided not to finalize proposed cuts to potentially misvalued codes with higher reimbursement rates than in the hospital outpatient setting. The rule did make some RVU changes that cut some specialties, however, and added a separate payment for non-face-to-face chronic care management services. Comments on the rule are due by January 27.
On July 2, CMS issued its CY15 Medicare Physician Fee Schedule (MPFS) proposed rule delineating a number of payment policies impacting over one million physicians and other practitioners paid under the MPFS each year. The proposed rule also sets payment policies for the Clinical Laboratory Fee Schedule (CLFS) and other Part B payments for the upcoming year. These key ACA provisions are addressed in the underlying rule. See also: CMS’ accompanying facts sheets on the rule (here and here). Comments are due by September 2, 2014.
Key updates in July included:
As noted here in early Oct., the 30-day preview period for group practices to review their quality measures prior to public reporting on Physician Compare ends on Nov. 7, 2014. CMS information about its Call for PQRS Quality Measures is available here.
On Oct. 31, CMS posted the CY 15 Medicare Physician Fee Schedule (MPFS) final rule with comment (fact sheet) addressing a number of ACA provisions related to physician payment and quality. Citing the April 1 doc fix, the Protecting Access to Medicare Act (PAMA) of 2014, CMS notes that a 0.0% update applies between Jan. 1, 2015, and March 31, 2015, for a conversion factor (CF) of $35.8013 during that period (after budget neutrality adjustments). The SGR calculation applies thereafter (April 1, 2015-Dec. 31, 2015), with the final rule conveying a 21.2% payment reduction for this period relative to the CY14 CF, with a CF of $28.2239.
On Jan. 22, 2015, CMS unveiled (press announcement; blog post) the official launch of the addition of star ratings to the Dialysis Facility Compare DFC website, which the agency plans to update on an annual basis beginning this Oct.
On Feb. 17, CMS announced submission timeframes for 2014 PQRS data.
On Mar. 6 CMS released guidance on the Physician Quality Reporting System (PQRS) 2013 Reporting Year and 2015 Payment Adjustment for Rural Health Clinics (RHCs), Federally Qualified Health Centers (FQHCs), and Critical Access Hospitals (CAHs).
Mar. 20 marked the last day for groups to submit quality data through the GPRO Web Interface.
On Mar. 23, CMS hosted Virtual Office Hours as part of its ‘Getting Started with Quality Measures’ for the 2015 PQRS series.
On Apr. 9, CMS announced that groups can now register to participate in the 2015 Physician Quality Reporting System (PQRS) Group Reporting Option (GPRO) via the Physician Value – Physician Quality Reporting System (PV-PQRS) Registration System. PQRS GPRO is an option available to groups with 2 or more eligible professionals (EPs).
On Apr. 17, as part of a proposed rule updating FY 2016 Medicare payment policies and rates for inpatient stays at general acute care and LTCHs (IPPS/LTCH), CMS proposed “four clinical episode-based payment measures for inclusion in the Hospital IQR Program beginning with the FY 2018 payment determination: Kidney/Urinary Tract Infection Clinical Episode-Based Payment measure, the Cellulitis Clinical Episode-Based Payment measure, the Gastrointestinal Hemorrhage Clinical Episode-Based Payment measure, and the Lumbar Spine Fusion/Refusion Clinical Episode-Based Payment measure.”
On June 30, the period to register to participate in the PGRS Group Practice Reporting Option (GPRO) closed.
On July 8, CMS posted the CY 16 Medicare Physician Fee Schedule (MPFS) proposed rule, which delineates payment policies impacting physicians and other practitioners paid under the MPFS each year (see fact sheet here). Citing the latest doc fix (P.L. 114-10), the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA), CMS effectuates the statutory 0.5% increase. The proposed rule addressed this provision of the ACA. Comments are due Sept. 8.
2016
On Jan. 6, 2016, CMS announced updated submission timeframes for 2015 PQRS data and conveyed details pertaining to the self-nomination period for 2016 Qualified Registries
On Jan. 8, CMS released a PQRS measure search tool that the agency says “will assist eligible professionals and group practices to identify applicable claims and registry measures, and it will help to find measures that meet reporting requirements for 2016.”
On Feb. 16, CMS announced along with America’s Health Insurance Plans (AHIP) (AHIP press release) the release of seven sets of core clinical quality measures for the first time intended for use in multi-payer settings.
On Feb. 25, CMS released a new FAQ, providing guidance on the Physician PQRS and providing answers to some frequently asked questions raised by staff at Rural Health Clinics (RHCs), Federally Qualified Health Centers (FQHCs), and Critical Access Hospitals (CAHs) who submit claims to Medicare Administrative Contractors (MACs) for services furnished to Medicare beneficiaries.
Key updates include CMS’ posting here of: (1) the Financial Alignment Initiative Early Consumer Assessment of Healthcare Providers and Systems (CAHPS) Survey Results; (2) a memorandum addressing Submission of Plan Benefit Packages for Contract Year (CY) 2017, Applicability of Final Call Letter Provisions to Medicare-Medicaid Plans (MMPs) for CY 2017, CY 2017 Final Call Letter, including MMP Annual Requirements and the CY 2017 Medication Therapy Management Program Guidance and Submission Instructions; and (3) various guidance pertaining to the New York FIDA demonstration.
On May 19, CMS announced the 2014 “Reporting Experience” report providing data and trends on participation, incentive eligibility, incentive payments, and payment adjustments under the PQRS.
On May 26, CMS said the Physician Value – PQRS (PV-PQRS) Registration System is now open through June 30 for groups to select a GPRO reporting mechanism.
On June 3, CMS released the 2016 PQRS Implementation Guide with information related to the program itself, measures and analysis, and where to go to learn more about each PQRS reporting mechanism.
On Aug. 4, CMS announced that two new datasets are available through the Physician Compare Downloadable Database.
On Aug. 15, CMS announced the upcoming availability of the 2015 PQRS feedback reports and the 2015 Annual Quality and Resource Use Reports (QRURs). The agency did not provide specific dates, but indicated that both sets of reports will be released in September of 2016.
On Aug. 22, CMS released a change request that amends files submitted to MACs based upon the CY 2017 MPFS Final Rule. The guidance notes key CPT/HCPCS code changes.
On Sept. 27, CMS posted key updates regarding the PQRS program.
On Oct. 15, CMS made available 2015 Supplemental Qualityand Resource Use Reports (QRURs), which confidentially provide information to medical group practices and solo practitioners on resource use measures for episodes of care.
On Nov. 2, CMS released its CY 2017 Medicare Physician Fee Schedule (MPFS) final rule delineating wide-ranging Medicare Part B payment policies. CMS finalized a fee schedule conversion factor of 35.89 for physicians participating in Medicare Part B. CMS further notes that the policies contained in the rule would improve how Medicare pays for services for patients with multiple chronic conditions and mental and behavioral health issues.
SEC. 3002. IMPROVEMENTS TO THE PHYSICIAN QUALITY REPORTING SYSTEM. (a) EXTENSION.—Section 1848(m) of the Social Security Act (42 U.S.C. 1395w–4(m)) is amended— (1) in paragraph (1)— (A) in subparagraph (A), in the matter preceding clause (i), by striking ‘‘2010’’ and inserting ‘‘2014’’; and (B) in subparagraph (B)— (i) in clause (i), by striking ‘‘and’’ at the end; (ii) in clause (ii), by striking the period at the end and inserting a semicolon; and (iii) by adding at the end the following new clauses: ‘‘(iii) for 2011, 1.0 percent; and ‘‘(iv) for 2012, 2013, and 2014, 0.5 percent.’’; (2) in paragraph (3)— (A) in subparagraph (A), in the matter preceding clause (i), by inserting ‘‘(or, for purposes of subsection (a)(8), for the quality reporting period for the year)’’ after ‘‘reporting period’’; and (B) in subparagraph (C)(i), by inserting ‘‘, or, for purposes of subsection (a)(8), for a quality reporting period for the year’’ after ‘‘(a)(5), for a reporting period for a year’’; (3) in paragraph (5)(E)(iv), by striking ‘‘subsection (a)(5)(A)’’ and inserting ‘‘paragraphs (5)(A) and (8)(A) of subsection (a)’’; and (4) in paragraph (6)(C)— (A) in clause (i)(II), by striking ‘‘, 2009, 2010, and 2011’’ and inserting ‘‘and subsequent years’’; and (B) in clause (iii)— (i) by inserting ‘‘(a)(8)’’ after ‘‘(a)(5)’’; and (ii) by striking ‘‘under subparagraph (D)(iii) of such subsection’’ and inserting ‘‘under subsection (a)(5)(D)(iii) or the quality reporting period under subsection (a)(8)(D)(iii), respectively’’. (b) INCENTIVE PAYMENT ADJUSTMENT FOR QUALITY REPORT- ING.—Section 1848(a) of the Social Security Act (42 U.S.C. 1395w– 4(a)) is amended by adding at the end the following new paragraph: ‘‘(8) INCENTIVES FOR QUALITY REPORTING.— ‘‘(A) ADJUSTMENT.— ‘‘(i) IN GENERAL.—With respect to covered professional services furnished by an eligible professional during 2015 or any subsequent year, if the eligible professional does not satisfactorily submit data on quality measures for covered professional services for the quality reporting period for the year (as determined under subsection (m)(3)(A)), the fee schedule amount for such services furnished by such professional during the year (including the fee schedule amount for purposes of determining a payment based on such amount) shall be equal to the applicable percent of the fee schedule amount that would otherwise apply to such services under this subsection (determined after application of paragraphs (3), (5), and (7), but without regard to this paragraph). ‘‘(ii) APPLICABLE PERCENT.—For purposes of clause (i), the term ‘applicable percent’ means— ‘‘(I) for 2015, 98.5 percent; and ‘‘(II) for 2016 and each subsequent year, 98 percent. ‘‘(B) APPLICATION.— ‘‘(i) PHYSICIAN REPORTING SYSTEM RULES.—Paragraphs (5), (6), and (8) of subsection (k) shall apply for purposes of this paragraph in the same manner as they apply for purposes of such subsection. ‘‘(ii) INCENTIVE PAYMENT VALIDATION RULES.— Clauses (ii) and (iii) of subsection (m)(5)(D) shall apply for purposes of this paragraph in a similar manner as they apply for purposes of such subsection. ‘‘(C) DEFINITIONS.—For purposes of this paragraph: ‘‘(i) ELIGIBLE PROFESSIONAL; COVERED PROFESSIONAL SERVICES.—The terms ‘eligible professional’ and ‘covered professional services’ have the meanings given such terms in subsection (k)(3). ‘‘(ii) PHYSICIAN REPORTING SYSTEM.—The term ‘physician reporting system’ means the system established under subsection (k). ‘‘(iii) QUALITY REPORTING PERIOD.—The term ‘quality reporting period’ means, with respect to a year, a period specified by the Secretary.’’. (c) MAINTENANCE OF CERTIFICATION PROGRAMS.— (1) IN GENERAL.—Section 1848(k)(4) of the Social Security Act (42 U.S.C. 1395w–4(k)(4)) is amended by inserting ‘‘or through a Maintenance of Certification program operated by a specialty body of the American Board of Medical Specialties that meets the criteria for such a registry’’ after ‘‘Database)’’. (2) EFFECTIVE DATE.—The amendment made by paragraph (1) shall apply for years after 2010. (3) AUTHORITY.—For years after 2014, if the Secretary of Health and Human Services determines it to be appropriate, the Secretary may incorporate participation in a Maintenance of Certification Program and successful completion of a qualified Maintenance of Certification Program practice assessment into the composite of measures of quality of care furnished pursuant to the physician fee schedule payment modifier, as described in section 1848(p)(2) of the Social Security Act (42 U.S.C. 1395w–4(p)(2)). øAs added by section 10327(b)¿ (d) INTEGRATION OF PHYSICIAN QUALITY REPORTING AND EHR REPORTING.—Section 1848(m) of the Social Security Act (42 U.S.C. 1395w–4(m)) is amended by adding at the end the following new paragraph: ‘‘(7) INTEGRATION OF PHYSICIAN QUALITY REPORTING AND EHR REPORTING.—Not later than January 1, 2012, the Secretary shall develop a plan to integrate reporting on quality measures under this subsection with reporting requirements under subsection (o) relating to the meaningful use of electronic health records. Such integration shall consist of the following: ‘‘(A) The selection of measures, the reporting of which would both demonstrate— ‘‘(i) meaningful use of an electronic health record for purposes of subsection (o); and ‘‘(ii) quality of care furnished to an individual. ‘‘(B) Such other activities as specified by the Secretary.’’. øSection 10327(a), p. 871, also added a paragraph (7) to section 1848(m) adding an additional incentive payment relating to physician quality reporting¿ (e) FEEDBACK.—Section 1848(m)(5) of the Social Security Act (42 U.S.C. 1395w–4(m)(5)) is amended by adding at the end the following new subparagraph: ‘‘(H) FEEDBACK.—The Secretary shall provide timely feedback to eligible professionals on the performance of the eligible professional with respect to satisfactorily submitting data on quality measures under this subsection.’’. (f) APPEALS.—Such section is further amended— (1) in subparagraph (E), by striking ‘‘There shall’’ and inserting ‘‘Except as provided in subparagraph (I), there shall’’; and (2) by adding at the end the following new subparagraph: ‘‘(I) INFORMAL APPEALS PROCESS.—The Secretary shall, by not later than January 1, 2011, establish and have in place an informal process for eligible professionals to seek a review of the determination that an eligible professional did not satisfactorily submit data on quality measures under this subsection.’’. [Section 10331, p. 875, also provides for public reporting of performance information for eligible professionals who participate in the Physician Quality Reporting Initiative]
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