CMS Releases Payment, Penalty Data for PQRS, e-Rx Program

April 27, 2015 in News

Last week, CMS released incentive payment and participation data for its quality reporting and electronic prescribing incentive programs, Modern Healthcare reports (Tahir, Modern Healthcare, 4/24).

PQRS Data Details

Almost 40% of health care providers who participate in Medicare will see their reimbursements cut by 1.5% this year because they failed to meet CMS’ deadlines to submit quality data.

To avoid payment reductions under CMS’ Physician Quality Reporting System this year, providers in 2013 had to submit quality data on at least one of more than 100 possible measures. Physicians this year will need to report on at least nine of the measures in order to avoid future payment reductions. According to the Wall Street Journal, physicians who did submit such data most often reported on:

  • The percentage of patients who had blood pressure readings;
  • The share of patients who were offered smoking cessation counseling; and
  • The share of patients who were asked about their current medications.

According to CMS, more than 460,000 of the 1.25 million eligible Medicare providers did not meet deadlines to submit data for the Physician Quality Reporting System in 2013. The agency noted that about 70% of those who did not meet the deadlines see fewer than 100 Medicare patients annually.

Meanwhile, nearly 642,000 of eligible Medicare providers did comply with the quality reporting deadlines in 2013 and will receive a 0.5% reimbursement increase this year.

Overall, CMS said that provider participation in the program increased from 15% of eligible providers in 2007 to 51% in 2013 (Beck, Wall Street Journal, 4/26). According to the report, specialties with the largest percentage of providers failing to participate or meet PQRS requirements included:

  • Psychiatrists, at 67%; and
  • General practitioners, at 65%.

Those most likely to not incur payment reductions included:

  • Pathologists, with 15% being penalized; and
  • Radiologists, with 20% being penalized (Modern Healthcare, 4/24).

CMS said that federal officials are working to simplify the quality-reporting requirements to make them less burdensome (Wall Street Journal, 4/26).

E-Prescribing Program Data Details

Meanwhile, the report also showed that participation in CMS’ electronic prescribing incentive payment program grew by 9% from 2012 to 2013 (CMS fact sheet, 4/23). 

The final reporting period for the e-prescribing program was 2013. Eligible professionals now can qualify for incentive payments for sending prescriptions electronically through the meaningful use program.

Under the 2009 economic stimulus package, providers who demonstrate meaningful use of certified electronic health records can qualify for Medicaid and Medicare incentive payments (Modern Healthcare, 4/24).

The CMS data show that the number of eligible professionals who participated in the e-prescribing program reached 377,004 in 2013, representing about 47% of the 808,697 professionals who were eligible for the program.

In total, the program paid out $168,298,019 in incentive payments in the final reporting period (CMS fact sheet, 4/23). 

Meanwhile, nearly 50,000 eligible professionals saw their 2014 payments reduced under the program. Declining to participate in the program was the most common reason for the payment reductions, at 80% (Modern Healthcare, 4/24).

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