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What PQRS Could Look Like in 2014On July 19, 2013, the Centers for Medicare & Medicaid Services (CMS) published the 2014 Medicare Physician Fee Schedule (MPFS) Notice of Proposed Rulemaking (NPRM) in the Federal Register. According to this summary, most of the policies were open for comment until September 6, 2013 and, pending final decisions (which hopefully will occur this month), will take effect on January 1, 2014.

The 605-page document contains proposals for policy changes on everything from reimbursements to the Physician Compare tool on the Medicare website, but today, let’s focus on what the rule proposes for the 2014 Physician Quality Reporting System (PQRS). Here are some of the highlights:

  • Eligible practitioners who do not satisfactorily complete PQRS in 2014 may receive a 2% payment adjustment (penalty) in 2016 for services they provide under the Medicare physician fee schedule.
  • Eligible practitioners who do satisfactorily complete PQRS in 2014 may earn a 0.5% bonus (note: 2014 would be the last year to earn an incentive.)
  • CMS may require practitioners to report measures from a certain number of the six categories of the National Quality Strategy (NQS) domains:
    • Person and Caregiver-Centered Experience Outcomes
    • Patient Safety
    • Communication and Care Coordination
    • Community/Population Health
    • Efficiency and Cost Reduction
    • Effective Clinical Care

Individual PQRS Reporting

  • Claims Reporting
    • Providers may need to report at least nine measures, covering three of the NQS domains, and report each measure for at least 50% of eligible patients.
    • The reporting period may be 12 months, from January 1 through December 31.
    • CMS is currently seeking comments as to whether or not they should eliminate the claims-based reporting option for PQRS 2017.
  • Registry Reporting
    • Providers may need to report at least nine measures, covering three of the NQS domains, and report each measure for at least 50% of eligible patients.
    • The reporting period may be 12 months, from January 1 through December 31.

GPRO PQRS Reporting

  • Registry Reporting
    • A group of two or more eligible practitioners may need to report at least nine measures, covering three of the NQS domains, for at least half of the group’s eligible patients. This would have to be done through a registry.
    • The reporting period may be 12 months, from January 1 through December 31.

 Measures Group Reporting

  • Registry Reporting
    • Beginning in 2014, measures groups may need to consist of at least six measures (instead of four), and in order to report measures groups, you may have to do so through a registry.
    • Proposed Back Pain Measures Group:
      • Documentation of Current Medications in the Medical Record (new)
      • Pain Assessment and Follow-Up (new)
      • Back Pain: Initial Visit
      • Back Pain: Physical Exam
      • Back Pain: Advice for Normal Activities
      • Back Pain: Advice Against Bed Rest

According to the American Medical Association, under the proposed rule, practitioners can avoid the 2016 penalty adjustment (although they won’t earn the incentive) by reporting three measures (instead of nine) for 50% of eligible patients.

Looking for some more great rule resources? If you’re an APTA member, you can download their highlights of the 2014 proposed rule here. If you’re not—or if you’d rather hear it from us—check out this WebPT blog post, where WebPT Co-Founder Heidi Jannenga, PT, MPT, ATC/L, and Senior Writer Charlotte Bohnett break down the APTA highlights.

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