Monday Musings

On Mondays in the month of June I am focusing on the way that quality measures will be used to evaluate practitioner performance inside and outside a healthcare organization, including compensation packages and contracted rates with payers. Last month, CMS released the 2013 “Physician Quality Reporting System and Electronic Prescribing Incentive Program Experience Report.” In other words, they released the stats on PQRS. Participation in the PQRS program increased by 47% from 2012 to 2013. In 2013, approximately 51% of the 1.25 million professionals who were eligible to participate in PQRS did so. The 2013 PQRS incentive payments to participating clinicians totaled more than $214 million dollars.

In 2013, a staggering 469,755 eligible professionals were subject to a “negative payment adjustment of 1.5% of their 2015 Part B Medicare Physician Fee Schedule allowed charges. Among the professionals subject to the adjustment, 98% did not even attempt to participate in PQRS. In other words, in 2013, nearly half a million practitioners just let Medicare keep 1.5% of the money they billed. That’s true for almost all of the wound care practitioners that I know.

More information about PQRS, including the reporting criteria for incentive eligibility, which ended in 2014, and avoiding the negative payment adjustment, starting in 2015, is available at http://www.cms.gov/PQRS.