Two incentive programs from the Center for Medicare and Medicaid Services (CMS) are encouraging physicians to start living the pay-for-performance future today. The Physician Quality Reporting System (formerly known as the Physician Quality Reporting Initiative, or PQRI) and the Electronic Prescribing (eRx) Incentive Program both pay dividends for compliance, and both are products of the Medicare Improvements for Patients and Providers Act of 2008 (MIPPA). Consider the incentives soon, before carrots turn to sticks.
Physician Quality Reporting
In this pay-for-reporting program, physicians submit quality data to CMS for an incentive payment via their claims or a registry. The incentives are "based on a percentage of the Medicare Part B Physician Fee Schedule (PFS) total estimated allowed charges for covered services provided during the longest or most advantageous reporting period for which the professional satisfied criteria for at least one reporting option."1
Participants file the CMS-1500 forms, adding a "measure" to the CPT and ICD-9 codes. Retina specialists choose from five measures related to age-related macular degeneration, diabetes and diabetic retinopathy. Diagnoses such as uveitis, retinoblastoma, retinal vein occlusions and others are absent.
The rewards for participation add up. In 2009, bonus payments for "satisfactory reporters" in the program were $1,956 per eligible professional and $18,525 per practice.2 Physicians in the program can compare their performance on quality measures through the Physician Compare website starting in 2013.
Incentives and the system's inevitability have drawn many participants, growing at a rate of 50% each year so far.2 If you're not inclined to participate now, keep it on your radar; Medicare payment reductions start in 2015 for physicians who choose not to participate.
eRx Incentive Program
The eRx Incentive Program rewards physicians for being "successful electronic prescribers." What does that mean? It means that you demonstrate that you're prescribing to patients using a system that is qualified to report CMS' eRx measure (qualification criteria available at www.cms.gov/ERxIncentive). The measure changes from year to year. You can participate through claims, a registry or your electronic health records.
Data for 2009 show that the eRx incentives add up to higher rewards than those for the Physician Quality Reporting System. Incentive payments averaged a bit over $3,000 per physician and $14,501 per practice.2
For 2012, incentives will be "1.0% of the total estimated allowed charges submitted not later than 2 months after the end of the reporting period."3 The incentive drops to 0.5% in 2013. Alternately, penalties for not participating start in 2012 with a 1.0% reduction in the amount on the Physician Fee Schedule, increasing to 1.5% in 2013 and 2.0% in 2014.3
Learn More
Visit the CMS website to learn more about the Physician Quality Reporting System (www.cms.gov/PQRS) and the eRx Incentive Program (www.cms.gov/erxincentive), including a group practice reporting option offered as an alternative to individual physician participation in these programs.
References
1. What are the financial benefits of participation in the Physician Quality Reporting System (Physician Quality Reporting, formerly called PQRI)? Updated 06/30/2011 https://questions.cms.hhs.gov/app/answers/detail/a_id/8876/~/what-are-the-financial-benefits-of-participation-in-the-physician-quality.
2. Press Release: CMS Data Show Gains in Key Quality Indicators Through Physician Quality Reporting System and ePrescribing Incentive Program. April 19, 2011. (https://www.cms.gov/apps/media/press_releases.asp)
3. E-Prescribing Incentive Program: Statute Regulations. (https://www.cms.gov/ERxIncentive/04_Statute_Regulations.asp). |
