Roughly 500,000 clinicians — half of them physicians — will see their fee-for-service Medicare payments trimmed by 2% this year because they didn't meet the requirements of the Physician Quality Reporting System (PQRS) in 2015, the government announced earlier this month. For a substantial number of these clinicians, the impact of the revenue cut will be minor. In a report on PQRS performance in 2015, the Centers for Medicare & Medicaid Services (CMS) said that almost 230,000 clinicians being penalized had $10,000 or less in Medicare allowed charges that year. A 2% pay cut based on the same level of charges in 2017 will top out at $200. However, another 64,200 clinicians subject to the 2% penalty this year had Medicare charges in 2015 that exceeded $100,000. If they bill Medicare for just as much in 2017, they will forfeit more than $2000. PQRS, launched in 2007, is a pay-for-reporting program widely decried by physicians as unduly complicating their professional lives. Through 2014, Medicare awarded bonuses to clinicians who successfully informed CMS how they did on various measures of clinical quality. In 2015, Medicare began to penalize clinicians who didn't meet PQRS requirements, nicking them by 1.5% if they unsuccessfully reported their performance in 2013 or if they didn't report it all. The last year for PQRS penalties is 2018, when physicians will suffer the consequences for botched or skipped reporting in 2016. In 2019, a new Medicare reimbursement scheme called the Quality Payment Program (QPP) will apportion bonuses and penalties on the basis of performance in 2017. One track of the QPP — the Merit-based Incentive Payment System (MIPS) — combines and modifies PQRS, the Medicare electronic health record incentive program, and the value-based modifier program. MIPS Will Be Easier Than PQRS, Feds Say Almost 1.4 million clinicians were eligible to participate in PQRS in 2015, either by reporting quality data individually or by belonging to a group that did. As in the past, most of the clinicians subject to a 2% PQRS penalty this year simply hadn't submitted any quality data to Medicare. However, the percentage of penalized clinicians who had blown off the program in a prior performance year decreased, going from 98% in 2015 to roughly 79% in 2017. That paralleled an increase in the percentage of eligible clinicians who participated in PQRS — 69% in 2015 compared with 51% in 2013. Physicians least likely to participate in PQRS were those having fewer than 25 Medicare patients. Only about 54% of MDs and DOs in this category submitted quality data in 2015, compared to almost 49% for all clinicians. Participation rates varied by medical specialty, with pathologists and radiologists ranking the highest at 89% and 87%, respectively. The specialities with the lowest participation rates were psychiatry (39%) and general practice (42%). There were wide disparities in participation in terms of geography, too. In Wisconsin, physicians and other clinicians posted the highest rate at 82%. In last place was Alaska at 48%. In general, states in the Southeast, Midwest, and New England led the way. CMS cautions that no one should predict the level of participation in MIPS on the basis of PQRS trends. For one thing, the quality-reporting requirements under MIPS will be less complicated. In addition, MIPS will exempt clinicians if they have 100 or fewer Medicare patients or $30,000 or less in Medicare allowed charges, thresholds that don't exist in PQRS. Source
