Reform Update: Doc groups concerned over looming Medicare penalties tied to quality reporting

Medical Groups Concerned Over Medicare Reporting Penalties

Medical groups seeking to participate in the 2014 PQRS’ group practice reporting option must register by Sept. 30, yet those who participated in the 2013 program received notice last week if they qualified for incentive payments.

If physicians met PQRS quality-measure reporting criteria in 2009 and 2010, they received a 2% bonus of their Medicare Part B charges. This percentage fell to 1% for 2011 and to 0.5% for 2011 through 2014. This year’s financial incentive was also reduced by 2% under the broad federal budget cuts known as sequestration.

“The decreased incentive being offered is not that significant. The greater concern is on the penalty going forward,” said Anders Gilberg, the MGMA’s senior vice president for government affairs. For 2015, failing to participate could mean a 2% penalty.

The PQRS requirements for 2015 will not be known until the release of the final 2015 Medicare physician fee schedule in November, so the recently received feedback received for 2013 performance has limited usefulness, Gilberg said.

“It’s not the most actionable information,” Gilberg said. “It’s also resulting in a level of provider frustration that’s as high as it’s ever been.”

Some groups have discussed not participating in PQRS and just accepting whatever penalties are assessed, but Blom said that is short-sighted and often based on an incorrect assumption that the program won’t continue.

“Not only is it not going away, there will be more penalties and awards based on their ability to demonstrate they’ve delivered high-quality care at low cost,” she said. “If they don’t participate, the hit is going to be a lot more than they realize, and I think they will regret it.”

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