able to me, also, and it takes legions of accountants and lawyers to under- stand those,” Dr. Gilmer said. “We all want quality, and I want to know if I’m in the ballpark and if I’m doing the right thing. But CMS makes it impos- sible for me to find out.”
BRIGHT SPOTS AHEAD Organized medicine, including TMA, continues to advocate that Medicare streamline its quality reporting re- quirements and eliminate unwarrant-
ed penalties, while giving physicians timely feedback on their performance. In a Jan. 30 letter to CMS, the
Medical Group Management Associa- tion (MGMA) urges federal officials to start by using “one portal for phy- sicians and practices to report and access all information pertaining to Medicare Part B programs. … It makes no practical sense to have multiple systems which create unnecessary work.” At press time in mid-May, CMS
announced that starting July 13, it planned to transition from the cum- bersome system for PQRS users to a single portal for submitting data, re- trieving and viewing feedback reports, and other administrative and mainte- nance activities. Thanks to medicine’s ongoing ad-
vocacy, bright spots will appear with the sunset of the SGR formula. The consolidated MIPS quality re-
VALUE-BASED PAYMENT MODIFIER TAKES EFFECT
Penalty Year
2015 2016
2017 2018 2019†
Performance Year
2013 2014
2015 2016 2017
Who’s Affected
Physician groups of 100 or more eligible professionals*
Physician groups of 10 or more eligible professionals
All physicians All physicians All physicians
Maximum Penalties
4.5% 6.0%
9.0% 10.0% 4.0%‡
porting program that begins in 2019 will include clearer targets for im- provement and prompter feedback on physician performance. Instead of waiting to hear back from CMS, phy- sicians will know the threshold score for successful performance at the start of each performance period, and Medicare will issue quarterly QRURs. Doctors also will have more chances to get financial bonuses for their qual- ity improvement activities, instead of just facing penalties. Information on how many physi-
cians currently access the QRURs is not readily available. MGMA suggests the answer is “not enough”: The as- sociation’s letter points out that just 26,000 out of 546,000 physicians — a mere 5 percent — registered in CMS’ new Open Payments system to review the payments attributed to them when it launched last September. PQRS participation in Texas, how-
*Includes certain nonphysician health professionals †New Merit-Based Incentive Payment System (MIPS) takes effect. Congress created MIPS when it eliminated the Sustainable Growth Rate formula under the Medicare and CHIP Reauthorization Act of 2015. ‡MIPS also includes possible incentive payments. Bonuses and penal- ties range from 4% to 7% from 2019 to 2021, and cap at 9% in 2022 and beyond.
Source: Texas Medicine reporting 62 TEXAS MEDICINE July 2015
ever, is on the rise, suggesting physi- cians are doing their part. (See “PQRS Participation on the Rise in Texas,” page 61.) Dr. Gilmer says for that to continue, especially now that the incentive pay- ments for participation in CMS qual- ity initiatives have shifted entirely to penalties, CMS must do its part. “If the goal is to get physicians to sub- mit their quality data and participate in quality improvement, they need to start with the doctor in mind.” n
Amy Lynn Sorrel is associate editor of Texas Medi- cine. You can reach her by phone at (800) 880- 1300, ext. 1392, or (512) 370-1392; by fax at (512) 370-1629; or by email at
amy.sorrel@
texmed.org.
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