Physician Practices MUST REPORT PQRS Data This Year to Avoid 2015 Penalty

Physicians who fail to report quality data this year through the federal government's Physician Quality Reporting System (PQRS) program will be docked 1.5% of of their Medicare reimbursements in 2015.

The Center for Medicaid and Medicare Services' (CMS') PQRS program allows for four reporting options: claims-based, registry-based, qualified electronic heath record (EHR), or the group practice reporting option.

A key date related to administrative claims-based reporting looms on October 15, 2013. Under this option, CMS will analyze every claim from an individual or group practice to determine whether those providers have met PQRS requirements. Providers simply submit the data to CMS via a Web portal that's expected to be available in July, according to CMS.

Physicians who choose the administrative claims-based reporting mechanism will not be eligible for bonus payments but could avoid penalties.

The overall goal of the PQRS, according to CMS, is to collect meaningful data that can help lead to improved patient care. The program uses a series of measures developed by leading physician organizations to evaluate the level of care being provided by doctors.

In general, PQRS is not something physicians need to sign up or register for. To qualify, a practice simply must meet CMS’ criteria for satisfactory reporting for a particular reporting period. Groups, however, must self-nominate to submit data as a group rather than individually, CMS notes.

Participants are able to choose from one of two reporting periods: 12 months (January 1, 2013, to December 31, 2013) or 6 months (July 1, 2013, to December 31, 2013).

For 2013, PQRS includes a total of 259 measures, which address areas such as preventive care, chronic- and acute-care management, procedure-related care, and care coordination. Physicians who choose to report 2013 PQRS individual measures should select at least three clinically applicable measures to submit, according to CMS' guide on how to get started with PQRS.

Currently, the PQRS program offers bonus payments of up to 0.5% of Medicare fees, but those bonus payments end in 2014 and will be replaced by the 1.5% penalty the following year. In 2016, the penalty for nonparticipation increases to 2% of Medicare reimbursements.

The PQRS program started in 2007, but its incentive payments haven't been enough to lure most physicians into participating. Only 21% of the more than 600,000 eligible physicians earned PQRS bonuses in 2010, the latest full year of reporting statistics available from CMS, American Medical News reported earlier this year.

A study published late last year by the American College of Radiology estimated that physicians could lose a total of up to $1.3 billion per year by either not participating in PQRS or failing to meet the program's criteria.

For more on PQRS, see Medical Economics'comprehensive look at the program earlier this month.

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