Providers will be at risk for penalties with the new physician quality reporting system (PQRS) and value modifier requirements for 2015. Most of the proposed changes to the PQRS program were approved in the final physician fee schedule. Success with PQRS in 2015 will help providers avoid the penalties that go into effect in 2017 for quality reporting and value modifiers.
Providers who have participated in the PQRS program in the past might have to take a different approach to the program in order to adapt to the new 2015 requirements. Below are some of the important changes:
- Providers who do not report nine measures in 2015 and fail measures – applicability validation review will receive a two percent penalty.
- Providers performing face-to-face visits in 2015 need to report at least one of the 19 new cost-cutting measures.
- Measure groups were redefined and four were deleted. The measure groups are now in subsets that have a particular clinical condition or focus in common. The four groups that were deleted include:
- Perioperative care
- Back pain
- Cardiovascular prevention
- Ischemic vascular disease
- The Centers for Medicare & Medicaid (CMS) added 20 individual measures, deleted 50, and shifted 17, so do not assume all measures that were used in 2014 will apply to 2015.
- The value modifier adjustment, based on PQRS performance, will include solo practitioners, non-physician practitioners, and groups of up to nine eligible providers in 2015. However, small practices will not face a penalty based on their value modifier performance, but could receive a two percent bonus. Groups of 10 or more providers could receive a four percent penalty for their value modifier performance and an additional two percent penalty for not meeting all of their PQRS requirements in 2015.
More information regarding the changes for PQRS in 2015 can be found in the Final 2015 Medicare Physician Fee Schedule http://www.cms.gov/Medicare/Quality-Initiatives-Patient-Assessment-Instruments/PQRS/Downloads/2015_Medicare_Physician_Fee_Schedule_Final_Rule.pdf