Nearly all otolaryngologists have been told about, seen a poster of or received an email from someone informing them that in 2015, the Centers for Medicare and Medicaid Services (CMS) will penalize physicians who do not comply with its Physician Quality Reporting System (PQRS). But David Niel-sen, MD, executive vice president and chief executive officer of the American Academy of Otolaryngology-Head and Neck Surgery (AAO-HNS), can’t emphasize enough the fact that physicians need to begin complying now—not in three years.
Explore This IssueDecember 2012
Welcome to the new world of PQRS, a mandatory version of the Physician Quality Reporting Initiative that has been in place since 2007 but, as of 2010, was only in use by roughly 25 percent of eligible providers, according to CMS data. PQRS, like its optional predecessor, is a pay-for-reporting system that will give compliant physicians a 0.5 percent incentive payment for total Medicare Part B Physician Fee Schedule (PFS) charges for covered services (which means the incentive covers all payments from PFS, not just those applied to the services being reported).
The landmark Affordable Care Act (ACA) has gone a step further, however: Nonparticipating physicians will lose 1.5 percent of allowable Medicare charges beginning in 2015. The cut increases to 2 percent in 2016. Unfortunately, too many physicians believe that the 2015 deadline applies to preparing for the program, Dr. Nielsen said. In reality, 2015 is the first year the penalties will be levied, but the payment adjustment will be based on data from the 2013 reporting period, Jan. 1 through Dec. 31, 2013.
Support Systems Available
“It isn’t that physicians haven’t heard the message; it’s just that it’s coming in so fast and so furious that it just washes over them like a wave, and they’re not really internalizing it and understanding it,” Dr. Nielsen said. “We have to let the physicians know that as confusing and overwhelming as this may seem, we have some organization structure and support for them.”
AAO-HNS is working with CECity to promote PQRIwizard, a PQRS registry. Ariann Polasky, director of provider products for CECity, said the registry works like an online tax preparation program. It costs $299 and will collect, validate, report and submit the results to CMS, according to marketing materials for the tool. Other than using a qualified PQRS registry, there are two other options to report data to CMS. One involves using a practice’s or institution’s electronic health record (EHR) system. The other uses claims-based reporting.