The Centers for Medicare and Medicaid Services (CMS) Physician Quality Reporting System (PQRS) is a reporting program that currently uses both incentive payments (bonus) and payment adjustments (penalty) to encourage physicians to submit quality information to CMS. The incentives and adjustments are based on payments for covered Physician Fee Schedule services furnished to Medicare Part B Fee-for-Service beneficiaries.

2014 PQRS and Physician Value Based Payment Modifier (VM) Changes

The Centers for Medicare and Medicaid Physician Fee Schedule Final Rule includes many changes that will apply to radiologists in 2014. Most significantly, there are increased reporting requirements in order to gain the PQRS incentive and to avoid the penalty , but new reporting methods are also available that offer additional measure reporting opportunities. Individuals can now meet PQRS requirements by satisfactorily participating in a CMS Qualified Clinical Data Registry (QCDR), potentially such as the ACR NRDR. In the Value Modifier program, CMS has finalized that groups with 10 or more eligible professionals will be affected by the VM in 2016 based on 2014 reporting.

HIGHLIGHTS:

Group Practices Can Now Register for the 2014 PQRS Group Practice Reporting Option (GPRO). Access the PV-PQRS Registration System here.

Beginning in 2014, in addition to the number of measures that an EP or group is required to report, there is also a requirement to report measures covering at least 3 National Quality Strategy (NQS) domains for incentive purposes. The domains associated with the measures are as follows:

  • Patient Safety
  • Person and Caregiver-Centered Experience and Outcomes
  • Communication and Care Coordination
  • Effective Clinical Care
  • Community/Population Health
  • Efficiency and Cost Reduction

The domain associated with each measure is found in the CMS measure specification and measures list document available here.

For more information on 2014 PQRS, including the new radiology Optimizing Patient Exposure to Ionizing Radiation (OPEIR) measures group, detailed measure information and reporting methods, ollow the “2014 Physician Quality Reporting System” link below.

PHYSICIAN VALUE BASED PAYMENT MODIFIER:

The Physician Value Based Payment Modifier or Value Modifier (VM) extends the PQRS program by basing, in part, Medicare Part B FFS reimbursement on comparative PQRS measure performance as well as on cost measure performance. CMS begin implementing the VM program in 2013 for groups of 100+ eligible professionals. Smaller groups will be affected in 2014 as summarized in the below table.

Performance Year/VM Year

Group Size

Possible VM Outcomes

2013/2015

100+

  • Downward Adjustment (-2.0%)
  • No Adjustment
  • Upward Adjustment (Budget Neutral)
    of total Medicare Part B FFS Charges

2014/2016

100+

  • Downward Adjustment (-2.0%)
  • No Adjustment
  • Upward Adjustment  (Budget Neutral)
    of total Medicare Part B FFS Charges
 2014/2016

10+

  • No Adjustment
  • Upward Adjustment  (Budget Neutral)
    of total Medicare Part B FFS Charges

2015/2017

ALL INDIVIDUAL PHYSICIANS

  • Downward Adjustment (TBD)
  • No Adjustment
  • Upward Adjustment  (Budget Neutral)
    of total Medicare Part B FFS Charges

 

Value Based Payment Modifier (VBM) for Eligible Professionals in 2016
(Based on 2014 quality and cost data)

Value Based Payment Modifier (VBM) for Eligible Professionals in 2016 thumbnail
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How to GET STARTED with PQRS


2014 Physician Quality Reporting System (PQRS)


PQRS Measures Relevant to Radiology


2014 PQRS Validation of Successful Reporting


Maintenance of Certification Program Incentive

The Affordable Care Act requires CMS to provide an option for physicians to report data on quality measures through a Maintenance of Certification Program operated by a specialty body of the American Board of Medical Specialties. There are no changes to this additional incentive for 2014.



Value-Based Payment Modifier and Quality Resource and Use Reports (QRURs)