Why PQRS and VBM is Important to Your Practice this Year

PQRS2015PQRS (the Physician Quality Reporting System) started in 2009 as Medicare’s quality incentive program. Since that time it has been steadily expanded and, going forward, there are only penalties. More recently, the Value Based Modifier (VBM) program was added to measure cost and quality, with associated penalties and incentives. It is critical to note that VBM quality assessments are based on PQRS data: i.e. there is no separate VBM reporting. As a result, physicians who do not report PQRS in 2015 will see a -4 to -6% reduction in 2017 Medicare reimbursement. Unfortunately, both of these programs are complex and require thoughtful attention. This is because the quality measures to be reported must be chosen early in the year (e.g. now for 2015) so that they can be tracked and reported. Practice 1st, MDeverywhere's RCM system, fully supports automated PQRS coding. As the year progresses, it is important to monitor progress to identify any gaps or missing information. CMS is strongly encouraging registry reporting to make this easier. There is a small cost for a registry but it is much less than the potential reductions in Medicare payments for any practice with more than a few Medicare patients. To assist with this process, There is a full resource page for PQRS reporting for hospitalists on the MDeverywhere website (link) where measures grouped by specialty and 2015 changes are described. Medicare reimbursement in 2017 will be affected by PQRS/VBM reporting for 2015.

PQRS Reporting for Hospitalists

  • -2% penalty for not fully participating
  • Eligible professionals (EPs) must report a minimum of 9 PQRS measures across three NQS domains.
  • If the EP sees at least one Medicare patient in a face-to-face encounter (claims-based and registry reporting only), one of the reported measures needs to be a measure from the new cross-cutting measure set.
  • Those who do not have 9 measures to report will go through the MAV process for CMS to verify that the EP submitted the maximum number of measures that he/she performs.
  • CMS will no longer give EPs “an out” to avoid the penalty. In 2014, EPs only needed to report 3 measures to avoid the penalty but not qualify for the incentive.

VBM Reporting for Hospitalists

  • Physician groups up to 9 physicians: additional -2% penalty for not participating; potential for 0 to +2x for participants based on quality/cost performance (where x is TBD)
  • Physician groups with over 9 physicians: additional -4% penalty for not participating; potential for -4% to +4x for participants based on quality/cost performance (where x is TBD)

Look for more information on the VBM program in tomorrow's blog post.

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