More than 500K Clinicians Facing 2% Medicare Quality Reporting Penalty This Year


Slightly more than 500,000 clinicians who participated in the government’s Physician Quality Reporting System (PQRS) will be hit with a 2% Medicare penalty this year because they didn’t meet program requirements.

Some 501,933 clinicians are subject to a 2% reduction in their 2017 Part B fee-for-service charges based on 2015 PQRS reporting, according to a report from the Centers for Medicare & Medicaid Services.

Some 63% of the clinicians who participated in the government program avoided the adjustment.

Half of those who will see their fee-for-service Medicare payments reduced this year are physicians. Clinicians are being hit with the penalty for not meeting PQRS requirements in 2015.

PQRS was begun in 2007 and the final year for reporting in the program was 2016. The Medicare Access and CHIP Reauthorization Act of 2015 (MACRA) ended the Sustainable Growth Rate formula and replaced a patchwork collection of quality programs that included PQRS, with what’s been dubbed the Quality Payment Program. PQRS is being rolled into the Merit-based Incentive Payment System (MIPS) track. Clinicians will begin to be paid under MACRA in 2019 based on bonuses and penalties determined by their performance this year.

CMS has released a proposed rule with changes to MACRA for 2018—the second year of the value-based payment system.

Some of the major changes proposed under the rule include:

  • Increases the MIPS' low-volume threshold, thereby exempting more than 585,000 eligible clinicians from the program and its reporting requirements. CMS will increase the threshold to exclude clinicians or groups from those with $30,000 to $90,000 in Part B charges or fewer than 100 to 200 Part B beneficiaries.
  • Offers a virtual groups participation option under MIPS. Virtual groups would be composed of solo practitioners and groups of 10 or fewer eligible clinicians, eligible to participate in MIPS, who come together “virtually” with at least one other such solo practitioner or group to participate in MIPS for a performance period of a year.
  • Continues to allow the use of 2014 Edition CEHRT (Certified Electronic Health Record Technology), while encouraging the use of 2015 edition CEHRT.
  • Adds flexibilities for clinicians in small practices, including a new hardship exception for clinicians in small practices under the Advancing Care Information performance category, adds bonus points to their final score and continues to award small practices 3 points for measures in the quality performance category that don’t meet data completeness requirements.
  • Allows flexibilities for clinicians who are considered hospital-based or have limited face-to-face encounters with patients.
  • Puts in place new policies related to clinicians' ability to earn incentives for participation in advanced APMs.

(Source: Joanne Finnegan; Fierce Healthcare [6/21/2017])