Most doctors headed for penalty over Medicare quality reporting
■ Growing numbers of physicians are earning reporting bonuses, but hundreds of thousands still have not participated in a program that turns punitive in 2013.
By Charles Fiegl amednews staff — Posted May 28, 2012
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Washington Absent a significant change in the trajectory of Medicare’s physician quality reporting system, a large majority of doctors will set themselves up for future rate cuts by failing to report enough quality measures to the federal government in 2013.
A recent trends report from the Centers for Medicare & Medicaid Services shows that fewer than 200,000 physicians, out of the more than 600,000 who were eligible for the incentive program, reported PQRS measures in 2010. More than 125,000 physicians reporting as individuals met enough of the requirements to share a total of nearly $400 million in bonuses, but hundreds of thousands of eligible doctors did not attempt to meet the pay-for-reporting criteria. More than 50,000 tried for the bonuses but did not report enough quality measures to hit the minimum.
The lack of participation has physician organizations concerned that a huge segment of those caring for Medicare patients soon will take a hit when CMS begins not only withholding bonuses from doctors who don’t participate in the PQRS but also cutting their pay rates. Physicians can consider 2012 to be their final year to try reporting risk-free: A 1.5% noncompliance penalty won’t be assessed until 2015, but that payment adjustment will be based on whether physicians report quality measures in 2013.
Organized medicine groups, including the American Medical Association, have urged CMS not to base 2015 PQRS penalties on the 2013 reporting year. Physicians are facing several deadlines for penalties related to quality and health information technology initiatives, said AMA President Peter W. Carmel, MD. The programs would require doctors to meet substantial requirements to avoid the penalties.
“While physicians may be aware of the 2015 PQRS deadline, many do not know that the penalty will be based on their performance in 2013,” Dr. Carmel said. “CMS data show that many physicians are not yet participating in the PQRS program. A significant number of those who are trying have been unable to participate, showing that barriers to success still remain.”
In 2010, overall PQRS participation rose to 244,145 physicians and other health professionals, but 76% of eligible professionals, or nearly 750,000 doctors, nurses and others enrolled in Medicare, chose not to report any quality data to CMS. Most who did report earned bonuses. About seven in 10 participating professionals qualified for payouts equal to 2% of their Medicare charges that year.
Bonuses went to a total of 168,843 health care professionals and 19,232 physician practices in 2010, and the average payout was $2,157 per doctor and $20,364 per practice. In 2009, about 120,655 health professionals pulled down incentives that averaged $1,962 per individual.
Those incentive amounts are becoming smaller, with doctors receiving a 1% bonus for successful reporting in 2011 and 0.5% for 2012, 2013 and 2014, the final year to receive higher pay before the first noncompliance penalty is applied to pay rates in 2015.
A flurry of Medicare penalties
Despite their successes in PQRS, physicians who have earned bonuses expressed doubts about their ability to prevent all the potential future penalties outlined by CMS. A 1% penalty was applied this year to thousands of physicians for not reporting enough eligible electronic prescribing encounters with patients in 2011.
In addition to the 2015 PQRS penalty, Medicare rates would be reduced by 1% that year for those who do not achieve meaningful use of an electronic health record system. CMS also plans to adjust pay with a value-based modifier for physicians starting in 2015. The modifier would increase pay for some doctors who are deemed to provide high-quality, efficient care, but it would decrease rates for an as-yet-unknown pool of other physicians.
“It’s tough for small practices,” said Brent W. Beasley, MD, an internist who works part time at Plaza Primary Care and Geriatrics in Kansas City, Mo. “We are doing our best to break even.”
The practice is working on a plan to meet the requirements of the multiple incentive programs, said Dr. Beasley, who also is a medical director for Saint Luke’s Care, a quality improvement organization within Saint Luke’s Health System in Kansas City, Mo. Improving quality is difficult in offices with just four or five physicians as those practices try to contain overhead costs. The larger health systems have the resources to keep up with Medicare’s demands, he said.
Plaza Primary Care and Geriatrics has used its EHR system to help capture thousands of dollars in PQRS bonuses, Dr. Beasley said. But he is uncertain about whether the success will continue as the program shifts into punitive mode. “I’m not confident we will avoid penalties. We’ll do our best.”
Meeting PQRS requirements is very difficult without an EHR system, said Derrick O’Connell, RN, the chief quality officer at Patients First Health Care in Washington, Mo. The 80-physician group has earned bonuses by having its doctors enter quality data into designated EHR fields during eligible patient encounters. Without such automation, quality data must be aggregated and reported by hand.
Success with group reporting option
Participation in PQRS was boosted somewhat by a new reporting option in 2010. Academic organizations such as the University of Texas Medical Branch and Loyola University Health System opted to send physician quality data as group practices. Thirty-five organizations, with 24,823 eligible professionals, later earned bonuses by using CMS’ new group practice reporting option that year.
The group option is patient-centered and cuts down on duplication, said Rex McCallum, MD, UTMB’s chief physician executive. For instance, the group would be credited when a physician reports a flu vaccine measure for a patient. If the patient sees another doctor at the group, that doctor would not report the flu measure but could focus on another applicable measure for which the group could claim credit.
About 500 physicians earned bonuses in 2010 at Loyola, said Daniel J. Post, senior vice president of ambulatory programs and system services. In previous years, some physicians would earn bonuses for reporting measures as individuals, while others would fail to meet the minimums.