Go to homepage
News & Publications
PQRS – Physician practices have differing views
e-Reports, May 18, 2015
Font size: A  AIRSS feedRSSPrint
Untitled document

Nationwide, physicians are increasingly participating in the Physician Quality Reporting System (PQRS) program and have reaped the benefits. As of 2015, there are no longer any PQRS bonuses, simply the risk of penalty for non-participation.

Avoid a future penalty for your group
Purdue Healthcare Advisors reminds you the registration system is now open for physician/provider groups of two or more to register for the Physician Quality Reporting System (PQRS) during 2015 under the Group Practice Reporting Option (GPRO).

To ease the reporting burden, GPRO allows a group to report nine measures over three National Quality Strategy domains for the entire group. If your group wants to participate with the GPRO, you must indicate your intention and reporting method before June 30, 2015, at 11:59 ET.

There is no registration to participate in PQRS as an individual. Failure to report PQRS in 2015 will result in a -2 percent penalty on Medicare reimbursement in 2017 for all eligible providers.

Also, physician groups with two or more eligible providers must meet the criteria to avoid a 2017 PQRS pay adjustment in order to also avoid the automatic 2017 value-based modifier downward pay adjustment. The groups will qualify to earn value modifier adjustments based on performance. Payment adjustments range from -4 percent to +4X percent (X=an adjustment factor determined by CMS), depending on group size.

Find the PQRS GPRO registration website here.

To learn more about PQRS and value-based payment modifiers, contact Purdue Healthcare Advisors at (765) 496-1911 or email them.

According to a federal report based on 2013 data:

  • More than half of the 1.25 million eligible professionals who were participating received incentive payments totaling $214,551,741.
  • Of the 469,755 eligible professionals subject to a 2015 PQRS negative payment adjustment, 98 percent did not attempt to participate.

ISMA member practices give PQRS mixed reviews. Some complain the reporting requirements are burdensome and not worth the trouble. Others have found success in their reporting and are happy with the bonuses.

Rochester primary care physician Julius Sitjar, MD, began participation in 2014 and received a small bonus from its Medicare Advantage provider. To meet PQRS quality measures, Practice Manager Teresita Sitjar, RN, obtained help from MDinteractive, a PQRS registry.

“The hardest part is getting started,” she said. “I learned that to provide factual reporting, it helps to be involved with patients. This year, we have more measures to report and it’s hard to meet all the criteria.”

Cardiac Care Associates Office Manager Cheryl Agent in Crown Point explained that the practice of five physicians and one physician assistant has participated in PQRS since 2013 when they received a bonus of $7,000.

“Our cardiologists participate in PQRS not to receive any bonus, but simply not to be penalized by the 2 percent fee schedule reduction,” said Agent. “It is frustrating for physicians to be threatened with penalties for not checking a box in a medical record when the real concern in medicine should be the face-to-face visit and assessment of the patient.”

As a solo practitioner, Joseph Kacmar, MD, in Crown Point has participated in PQRS since the program began – even before the office obtained electronic health records.

“We did it at first to see if we could do it,” noted Practice Manager Barbara Kacmar. “We picked measures that we could work with, and we have received bonuses every year. It was a pleasant surprise.”

Kacmar noted that the process was easier using a registry, rather than a claim-based system. “If you go into it thinking it’s going to be terrible, it will be,” Kacmar said. “I advise offices to carefully choose their measures and find a workable group of patients.”

Dr. Kacmar shared the bonuses with his staff as an incentive to collect PQRS information.

Southeast Anesthesiologists, (SEA) PC, a 41-physician practice in Indianapolis, was among the first anesthesia groups in the nation to begin using the Qualified Clinical Data Registry (QCDR) – a PQRS reporting option.

PQRS participation

“In an age where quality reporting is what physician practices want and need to do, this was a great thing to jump on,” said Jaemy Hwang, MD, and SEA advisory board member. “It’s a limited system for anesthesia with few measures, questionable clinical value and an ambiguous audit process. With up to 6 percent of our Medicare payments on the line, we wanted more certainty.”

He noted the reportable measures in QCDR are not limited to those in PQRS. That means the group is actually reporting more measures than is required.

The benefit of using QCDR includes more comprehensive quality reporting for all patients. On the other hand, the program requires more work for everyone in the practice.

SEA’s billing company, CIPROMS, Inc., not only created the interface with AQI for the data transfer but also captures quality data submitted by physicians and enters it into their practice management system for every single patient SEA treats. CIPROMS then makes monthly data transfers on behalf of SEA.

“We have great talent providing care to patients, and a more comprehensive reporting system is able to detect problems that weren’t even on our radar previously,” noted Dr. Hwang.

The AMA offers resources here or call the CMS Quality/Net Help Desk at (866) 288-8912.

Copyright: Information written and displayed on www.ismanet.org is the property of ISMA and may not be reproduced without expressed written permission of the Indiana State Medical Association.

For a more detailed sitemap click here.