Mandated by the Affordable Care Act of 2010, the Hospice Quality Reporting Program (HQRP) website contains updates regarding program requirements through the Centers for Medicare & Medicaid Services (CMS).
PQRS and other CMS quality reporting programs are required to apply penalties for failing to satisfy reporting requirements. Access key information you should be aware of regarding your participation in the Physician Quality Reporting System (PQRS).
2015 Annual QRURs and 2017 PQRS and Value Modifier Payment Adjustment Notices Now Available
In late September 2016, CMS made available 2015 Annual Quality and Resource Use Reports (QRURs) to every group practice and solo practitioner nationwide. The QRURs summarize 2015 performance on quality and cost measures used to calculate the 2017 Value Modifier, which could result in as much as a 4% reduction in Medicare Part B payments.
CMS also recently began distributing letters to physicians and group practices regarding 2017 Physician Quality Reporting System (PQRS) negative payment adjustments, which are based on 2015 reporting and could result in a separate Medicare Part B payment reduction of 2%. For the 2015 reporting period, the majority of eligible clinicians successfully reported to PQRS and avoided the negative payment adjustment.
For more information, please visit How to Obtain a QRUR. Authorized representatives of groups and solo practitioners can access the 2015 Annual QRURs on the CMS Enterprise Portal using an Enterprise Identify Data Management (EIDM) account with the correct role.
To determine whether you are subject to the PQRS payment adjustment, you can either review your QRUR or check your status.
Medicare Access and CHIP Reauthorization Act (MACRA)
The Medicare Access and CHIP Reauthorization Act (MACRA) repealed the sustainable growth rate (SGR) formula and is transitioning to an incentive based system for Medicare physician payments, known as MIPS. Avoid penalties, learn how to participate, and stay up to date as the law becomes final and as changes are issued by the Centers for Medicare & Medicaid Services.
Read the AAHPM Comment Letter to CMS on MACRA Proposed Rule
Watch a free webinar to learn about new payment rules, the CMS Quality Payment Program, and the challenges and opportunities it offers our field.
What is MACRA?
MACRA replaces existing quality programs with the Quality Payment Program (QPP) in which physician Medicare payments will be based on participation in one of two pathways:
- the Merit-Based Incentive Payment System (MIPS)
- Alternative Payment Models (APMs)
These programs reward physicians based on performance data and taking part in new payment and delivery models.
While Medicare physician reimbursements won't be based on MIPS until 2019, physician performance in 2017 will be used for scoring. CMS will be developing specific metrics used to determine bonus payments and penalties under MIPS. Payments will be based on quality, resources use, clinical practice improvement activities, and meaningful use of electronic health records.
Under MACRA, providers participating in quality APMs won't be measured under MIPS and will receive a 5% bonus payment between 2019-2024.
Read the full CMS Quality Measure Development Plan on MIPS and APMs.
MACRA Final Rule - Read the CMS MACRA Final Rule press release, including a fact sheet.
Preparing for MACRA
MACRA offers "Pick Your Pace" flexibility options to allow physicians to pick their pace of participation in MIPS, while avoiding penalties, for the first performance period on January 1, 2017. Read more about Pick Your Pace.
Use these resources to begin your preparations:
Prepare for a valued based care environment with these resources:
- "Preparing your practice for value-based care" - a module from AMA STEPS Forward® is a CME-accredited activity that guide your next steps, answers common questions and provides case vignettes
- "Inside Medicare's new payment system" - a podcast produced by ReachMD
- "Focus on Public Health Policy" - a podcast produced by ReachMD
- "Elevating Leadership" - a newsletter from the American College of Healthcare Executives offers practical steps leaders can take to thrive in a value based environment.
Quality Payment Program Resources
- Quality Payment Program overview - High-level overview of the Quality Payment Program
- Medicare Shared Savings Program - part of the Quality Payment Program