Blog Post

5 Things PTs, OTs, and SLPs Need to Know About PQRS 2016

The details regarding PQRS 2016 have finally arrived; here's what physical, occupational, and speech therapists need to know.

Charlotte Bohnett
5 min read
November 10, 2015
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Ah, fall. The leaves are changing, we’re consuming pumpkin-flavored everything, and healthcare providers across the country are poring over the Medicare Final Rule to learn all the requirements for satisfying PQRS in 2016. Maybe that last thing isn’t one of the festive fall traditions we’ve all come to love, but it is a fall tradition nonetheless. It is our sixth year covering PQRS here at WebPT, after all.

So, without further ado, here’s what you need to know about PQRS 2016.

1. In the grand scheme of things, reporting requirements are nearly the same as last year.

For both claims- and registry-based individual reporting, eligible professionals (EP) must report on nine measures across three NQS domains for at least 50% of their Medicare Part B fee-for-service patients. And Medicare will not count any measures that have a 0% performance rate.

Oh, and MAV and cross-cutting measures are back.

Now, if fewer than nine measures apply, then you as the EP must report on all the measures available to your specialty (up to eight measures) for at least 50% of your Medicare Part B FFS patients. If this occurs, you’ll be subject to Measures Applicability Validation (MAV), a process that allows Medicare to determine whether you should have reported on additional measures. Also, if you see at least one Medicare patient in a billed visit during 2016, then you must report on at least one cross-cutting measure, even if fewer than nine measures apply to you as an eligible professional.

The penalty stays the same, too.

If you fail to satisfy the reporting requirements for 2016, then you’ll receive a 2% negative payment adjustment on all Medicare Part B payments in 2018.

2. GPRO has changed, but only slightly.

GPRO is a registry-based group reporting method for PQRS, and if you check out last year’s blog post, you’ll see that the reporting requirements had a lot going on. So much so, that I won’t repeat it all here. All you really need to know is that we didn’t really think it was worth it. So, what’s new for 2016? Well, Medicare didn’t simplify GPRO. Instead, the organization added another layer to the MAV process for it, tossing in a review of cross-cutting measure applicability.

3. There are more measures.

If you thought 225 measures in 2015 was child’s play, then buckle up, because 2016 has a total of 281 PQRS measures. And no Final Rule would be complete without changes to those measures. Here are the changes that apply to rehab therapy:

  • Measure 431 (unhealthy alcohol use: screening and brief counseling) will replace Measure 173 (screening for unhealthy alcohol use). This registry-based measure will apply to OTs.
  • Measures 154 (falls: risk assessment), 155 (falls: plan of care), and 431 are now cross-cutting measures.
  • Measure 131 (pain assessment and follow-up) will move from the Community, Population and Public Health NQS domain to the Communication and Care Coordination NQS domain. Additionally, SLPs will be eligible to report on this measure.

4. There are no measures group.

While there are new measures groups for 2016, none of them apply to PTs, OTs, and/or SLPs.

5. This coming year (2016) might be the last reporting year for PQRS.

The Medicare Access and CHIP Reauthorization Act of 2015 (MACRA) confirms that the downward payment adjustment associated with PQRS will be in effect through 2018—but the language implies that PQRS penalties may not apply to any subsequent years. No more payment adjustments means no more PQRS. And because the 2018 penalty is based on the 2016 reporting data, there’s a chance that PQRS reporting could cease to exist as early as 2017. Now, before you rejoice over the imminent demise of PQRS, check out Heidi Jannenga’s founder letter on the topic.

This summary of PQRS 2016 is just the tip of the iceberg. Stay tuned for details regarding the specific measures applicable to PTs, OTs, and SLPs. Have lingering questions about the program in general? Ask them in the comment section below.


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