Medicare Payment Adjustments for Physician Quality Reporting System Begin in 2015

Each year Medicare provides health insurance for over 50 million Americans, which equates to over $500 billion in federal spending. With such a large share of the federal budget, the Centers for Medicare and Medicaid Services (CMS) wants to ensure beneficiaries are receiving quality care. In 2007, the CMS established the Physician Quality Reporting Initiative (PQRI), now known as PQRS, that provides incentive payments and payment adjustments to eligible physicians who successfully submit data on a set of quality measures. Participating physicians receive the incentive payments based on their allowable charges for Medicare Part B Physician Fee Schedule (PFS). PFS are the payments made to physicians to reimburse the costs of physician work, practice expense and professional liability insurance. 

Though the PQRS program is not mandatory, beginning in 2015, eligible professionals that do not satisfactorily report data on quality measures for the January 1, 2015 - December 31, 2015 reporting period, will be subject to a 2.0% adjustment in their fee schedule amount in 2017.

In addition to preserving their revenue, PQRS gives physicians the opportunity to evaluate their care and procedures. There are multiple conditions in the list of quality measures that physicians can report on. One example is “Preventive Care and Screening: Body Mass Index (BMI) Screening and Follow-Up Plan”. This measure requires the physician to report the percentage of patients, aged 18 years and older, with whom a BMI was calculated in the past six months. The data must also show that for patients with a BMI outside of normal parameters, that a follow-up plan is documented.

The instructions for this PQRS measure dictate that the provider is required to measure both height and weight. Both the height and the weight must be measured within the same six months and self-reported values cannot be used. This means that the provider’s facility must have a reliable and accurate method of measuring height and weight. Ideally, the office would have a digital scale that includes a built-in height rod and can also calculate BMI. Additionally, if the scale is connected to the facility’s EMR system it would drastically improve workflow and provide an efficient way to meet the criteria for this quality measure.

Medicare providers can be easily overwhelmed with so many new obligations such as PQRS and the Medicare Shared Savings Program. But utilizing up-to-date diagnostic equipment can help physicians meet criteria and improve their quality of care. 

For more information on the Physician Quality Reporting System, visit the PQRS page on the CMS website by clicking here

Source: http://kff.org/medicare/fact-sheet/medicare-spending-and-financing-fact-sheet/