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bonus payments. For 2013 and 2014, doctors can earn an additional 0.5 per- cent on their Medicare payments. In 2015, however, penalties will re- place the incentive payments. Physicians who do not participate in or meet the criteria for PQRS in 2013 will see their


2015 Medicare payments cut by 1.5 per- cent and payments cut by 2 percent in 2016 and beyond.


Physicians who do not comply with


PQRS also could face a double whammy in 2015 and 2017, when CMS imple- ments a value-based modifier to auto-


matically adjust Medicare payments based on quality performance. Under the change, mandated by the Patient Protection and Affordable Care Act, CMS will base those adjustments in part on PQRS data.


Incentives become penalties


Come 2015, many of the incentive payments for Medicare’s quality reporting initiatives will shift to penalties based on physician performance in 2013. Also in 2015, a new value-based payment system under development will kick in to adjust over- all Medicare payments based on 2013 Physician Quality Report- ing System (PQRS) scores. Here is a look at how these negative adjustments could add


up for physicians who do not participate in or fail to meet the criteria for the programs. Dollar amounts are per physician based on TMA and Medical Group Management Association data for average annual income for a multispecialty practice with 19-percent Medicare volume, and will vary by specialty.


Program


System E-prescribing


Meaningful use of EHRs Value-based modifier* Total Penalty Physician Quality Reporting 1.5% 2.0% 1.0% 1.0% 5.5% Amount $2,544 $3,392 $1,696 $1,696 $9,328


*For physician groups of 100 or more. Smaller practices will be impacted by the modifier beginning in 2017.


For more information about Medicare’s quality reporting ini-


tiatives, visit www.texmed.org/QualityImprovement on the TMA website.


36 TEXAS MEDICINE May 2013


Norman H. Chenven, MD


Ghassan F. Salman, MD


The possibility remains CMS could delay implementation of the program. But as it stands, physician groups of 100 or more will be subject to the value- based modifier in 2015 based on their 2013 PQRS performance and could see a 1-percent payment reduction, on top of the 1.5-percent PQRS nonreporting penalty. The value-based modifier will impact all physicians participating in fee-for-service Medicare in 2017. So far, Medicare ACOs are exempt. Although the program’s details are still being developed, CMS says it antici- pates proposing to increase the penalty amounts under the value modifier as it gains additional experience with the cost and quality methodologies. Physicians who do not e-prescribe also lose the opportunity for bonus pay- ments in 2014 and face a 2-percent pen- alty. Until then, CMS uses a combination of incentives and penalties to encourage the activity. And physicians who fail to demonstrate meaningful use of EHRs will be subject to payment reductions of 1 percent in 2015, 2 percent in 2016, and 3 percent in 2017. To put those numbers in perspective,


penalties ranging from 1.5 to 2 percent could cost the average multispecialty practice $2,544 to $3,392 per physician, respectively, based on TMA and Medical Group Management Association data for average annual income for a multi- specialty practice with 19-percent Medi- care volume. A 0.5-percent bonus would mean an extra $848.


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