Physician Quality Reporting System: Incentive Today, Gone Tomorrow

Since 2007, physicians and other eligible health professionals have been eligible to receive bonus Medicare payments for voluntarily reporting data to the Physician Quality Reporting System (PQRS) program. Starting in 2013, that program will no longer be voluntary, and every physician and other health professional with a National Provider Identifier (NPI) number should be aware of important changes to the PQRS that will affect their Medicare payments (Table 1).

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The PQRS is a congressionally mandated program operated by the Centers for Medicare & Medicaid Services (CMS). The Tax Relief and Health Care Act of 2006 first authorized the incentive program, and the Medicare Improvement for Patients and Providers Act of 2008 made it permanent. The PQRS is not entirely unique. CMS maintains several quality measurement program initiatives to help it monitor the quality of care in different environments—including the End-Stage Renal Disease Quality Incentive Program for dialysis facilities—and holds that such quality initiatives aim to give providers and patients information that improves the overall delivery and coordination of care. In 2009, more than 210,000 eligible professionals voluntarily submitted data to the PQRS and received an average bonus payment of $2000.

Payment penalties in 2015

Currently, there is no requirement to participate in PQRS. Physicians and other eligible health professionals may receive a 0.5 percent bonus payment for submitting data to the PQRS in 2012. In earlier years of the PQRS program CMS provided up to a 2 percent bonus for reporting data, but has been decreasing that amount steadily. Providers who participate in 2012, 2013, and 2014 will receive a 0.5 percent bonus payment. Notably, providers may report data for 2012 to CMS through March 2013 to receive a bonus payment for 2012. Providers may submit data to CMS via claims, registries, or electronic health records. See the sidebar—and future issues of Kidney News—to learn how ASN is preparing to help you report your data efficiently and accurately via a registry in the coming weeks.

However, starting in 2015 CMS will reduce payments to eligible health professionals who did not successfully participate in the PQRS in 2013 (Table 2). Eligible health professionals will receive a 1.5 percent payment penalty in 2015 (based on lack of participation or unsuccessful participation in 2013) and a 2 percent payment penalty every year thereafter (based on lack of participation or unsuccessful participation 2 years prior). CMS will apply the PQRS penalty by adjusting providers’ Medicare Part B physician fee schedule. Consequently, it will be imperative for any provider with an NPI number to successfully participate in the PQRS program in 2013 in order to avoid payment reductions in 2015.

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Reporting options: individual or measure groups

Eligible professionals may report on either individual measures or report “measure groups” of similar measures each year. Providers reporting individual measures through a registry—such as the registry ASN will make available—must submit patient data for 80 percent or more of their patients on at least three individual measures to be considered “successful” participants. Providers reporting data for measure groups must submit patient data for at least 30 Medicare patients on one measure group to be considered “successful” participants. The tool ASN will make available will help collect and report data on either individual measures or measure groups directly to CMS.

For 2012 CMS maintains 208 quality measures and 22 measure groups in the PQRS. The measure group “Chronic Kidney Disease,” may be of particular interest to nephrologists. That measure is to be reported for patients aged 18 years and older with chronic kidney disease receiving office or other outpatient services and is comprised of the following measures: Influenza immunization, laboratory testing (lipid profile), blood pressure management,Plan of care— elevated hemoglobin for patients receiving erythropoiesis-stimulating agents. However, other measure groups such as “Diabetes Mellitus,” “Hypertension,” Cardiovascular Prevention,” and “Preventive Care,” may also be of interest to nephrologists.

PQRS and Maintenance of Certification

There is good news for physicians participating in the maintenance of certification process: they may qualify for an additional “PQRS MOC Incentive Program.” Physicians who successfully participate in the PQRS program and participate in a MOC program “more frequently” than is required to qualify or maintain board certification status are eligible for an additional 0.5% increase in Medicare reimbursement. Therefore, physicians who participate in the PQRS MOC in 2012, 2013, and 2014 may receive up to a 1% bonus. See www.asn-online.org/MOC for more information.

More support from ASN

As noted above and in the sidebar, ASN will be making a reporting tool available that is designed specifically for the nephrology health professional. Be on the lookout for more information and additional PQRS resources to come in the weeks ahead. For more information in the meantime, please contact education@asn-online.org.