The Centers for Medicare and Medicaid Services (CMS) issued two reminders recently that physicians must be working constantly to maintain compliance with the Medicare quality reporting programs. The current regulations call for adjustment of the fees paid to physicians for services to Medicare patients based on annual measurement of the physicians’ performance under quality and cost metrics. Radiologists must focus on their quality measures because the system assigns them to an Average Cost pool by default since they have little or no control over this factor.
In one bulletin to physicians, CMS announced the release of the 2015 Mid-Year Quality Resource and Use Report (QRUR). These mid-year reports are for informational purposes only. “The Mid-Year QRUR contains information on a subset of the measures used to calculate the 2017 Value Modifier”, says the CMS bulletin. The report includes information about performance on six cost and three quality outcomes measures for the period July 1, 2014 to June 30, 2015. The actual Value Modifier (VM) calculation that will affect Medicare payments under the Physician Fee Schedule (PFS) for 2017 will include performance measures for the calendar year of 2015.
The QRUR is one of many reports that are available from the CMS Enterprise Portal, as we have described in our recent article A Program for Successful PQRS Participation for Radiology Practices - Step 7, part of our continuing series on these important Medicare quality reporting programs. Radiology practices can use these reports to monitor their performance under the Physician Quality and Reporting System (PQRS) and make adjustments to achieve the highest score for the 2016 reporting period that is currently underway. This year’s scores will affect the VM calculation for adjustment of Medicare fee schedule payments in 2018.
CMS also announced that registration is open for physician groups to register to participate in PQRS by using the Group Practice Reporting Option (GPRO). Group practices are defined as those with 2 or more Eligible Professionals, or EPs, reporting under the same Taxpayer Identification Number. According to CMS, “Avoiding the 2018 PQRS payment adjustment by satisfactorily reporting via a PQRS GPRO is one of the ways groups can avoid the automatic downward adjustment (-2.0% or -4.0% depending on the size and composition of the group) and qualify for adjustments based on performance under the Value Modifier in 2018”.
Registration for GPRO reporting is open between April 1 and June 30, 2016. Groups that choose not to report via GPRO in 2016 “must ensure that the EPs in the group participate in the PQRS as individuals in 2016 and at least 50 percent of the EPs meet the criteria” in order for the group to avoid the automatic downward adjustment and be eligible for adjustments under the VM system in 2018.
The QRUR and registration for the GPRO are both available through an Enterprise Identity Management (EIDM) account on the CMS Enterprise Portal. Visit our blog for complete information about PQRS and VM compliance, including our whitepaper and series of articles on the 7 steps to successful PQRS reporting.