2015 is the first year there is no longer an incentive payment for PQRS participation.

The PQRS program now carries an automatic 2% penalty for non-participation in reporting PQRS measures by eligible solo providers and GPRO group practices.

PQRS is the quality reporting program that uses negative payment adjustments to promote reporting of quality information by individual Eligible Professionals and group practices. Those who did not satisfactorily report data on quality measures for covered Medicare Physician Fee Schedule (MPFS) services furnished to Medicare Part B beneficiaries (including Railroad Retirement Board, Medicare Secondary Payer, and Critical Access Hospitals [CAH] method II) will be subject to a negative payment adjustment under PQRS. Medicare Part C–Medicare Advantage beneficiaries are not included.

Changes in the 2015 PQRS Program

2014 2015
Measures Groups

 

Subset of 4+ PQRS measures which have a clinical condition or focus in common

 

Now defined as a subset of 6+ PQRS measures which have a clinical condition or focus in common

 

Measure Groups

 

25 Measure Groups

 

RETIRED: Perioperative Care, Back Pain, Hypertension, Ischemic Vascular Disease, Cardiovascular Prevention

ADDED: Sinusitis and Acute Otitis Externa

Individual Measures

 

285 measures ADDED 23 measures
RETIRED 50 measures
Penalty Avoidance

 

Report on 3 measures to avoid penalty Must report on a minimum of 9 measure, across 3 domains and 1 cross-cutting measure (if applicable)

 

PQRS Incentive

 

0.5% No longer available
VBM  

Applied to groups of 10+

 

Now applies to ALL physicians and physician groups, regardless of group size

 

VBM Penalty (no PQRS or less than 50% in TIN)

 

1-9:not applicable
10-99:2% penalty
100+:2% penalty
1-9: 2% penalty
10+: 4% penalty
VBM Quality-tiering

 

1-9: not applicable
10-99:neutral (0%) or upward (up to 2%) adjustment
100+: negative (up to -2%), neutral (0%) or upward (up to 2%) adjustment
1-9:neutral (0%) or upward (up to 2%) adjustment
10+:negative (up to -4%), neutral (0%) or upward (up to 4%) adjustment

A video recording of the "PQRS/Value-Based Provider Modifier: What Medicare Professionals Need to Know in 2015" presentation has been posted to the CMS MLN Connects® page on YouTube.  This presentation is the same as the webinars that were delivered on March 31, 2015 and April 7, 2015.  A link to the video can be found here:

https://youtu.be/Ww0oH-FhaYM

References: http://www.cms.gov/Medicare/Quality-Initiatives-Patient-Assessment-Instruments/PQRS/

 

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