Almost half of health providers will see PQRS pay cut


About half of all doctors who participate in the Physician Quality Reporting System (PQRS) soon will learn that their Medicare pay will be cut by up to 2% in 2017.

The Centers for Medicare & Medicaid Services has completed its assessments for reporting year 2015 and has begun notifying physicians that a 2.0% negative payment adjustment is forthcoming for those who did not satisfactorily report PQRS quality measures or who failed to satisfactorily participate in a qualified clinical data registry.

Doctors have just 2 months to challenge findings that they believe were made in error to spare themselves the 2017 cut, according to a CMS announcement.

If doctors believe their 2017 PQRS pay cut is erroneous, they can submit an informal review request by 11:59 p.m. EST on Nov. 30. CMS will investigate the merits of all review requests and issue a decision within 90 days. All requests for informal review must be submitted via a Web-based tool on the quality reporting communication support page. There are no hardship exemptions for the PQRS pay cuts.

In addition, some 2015 PQRS performance scores will be publicly reported on the Physician Compare website. CMS is hosting two sessions in October to provide further information about such public reporting.

In 2015, approximately 1.15 million professionals were eligible and able to participate in PQRS; just over half (624,077 or 54%) of eligible professionals successfully submitted data. The rest – about 528,000, or 46% – will see a pay cut in 2017, according to CMS.

Last year, slightly more health providers – 558,885 eligible professionals – were subject to the 2016 PQRS pay cut based on their 2014 reporting experience.

Walter J. Gorski, director of regulatory affairs for the American College of Physicians, said the college will be monitoring the notifications as they go out to physicians to assess impacts at the individual practice level and overall.

“In past years, the PQRS experience reports have shown a low level of participation in the program and, thus, a large number of physicians being subject to these negative adjustments,” Mr. Gorski said in an interview. “This low level of overall participation has long been a concern of ours and something we have recommended that CMS work to mitigate by simplifying reporting – something that we are pushing strongly for as the program is rolled into the new MIPS pathway [Merit-Based Incentive Payment System] within the [Quality Payment Program].”

The new Quality Payment Program will replace both PQRS and the Value Modifier program, as well as the separate payment adjustments under the Medicare EHR Incentive Program. The streamlined program will have reduced quality reporting requirements and a flexible design that allows eligible clinicians to pick the pace of participation during the first year, according to CMS.

“The newly announced ‘pick your pace’ approach for the first year of MIPS reporting will give physicians an opportunity to get their feet wet with quality reporting in a way that will protect them from future negative adjustments,” Mr. Gorski said.

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