CMS Report Sheds Light on Success of PQRS and E-Prescribing Programs
The Centers for Medicare and Medicaid Services (CMS) recently released a report on the 2010 Physician Quality Reporting System (PQRS) and Electronic Prescribing Bonus programs. This report showed a dramatic growth in the bonuses distributed as part of the programs as they moved beyond their initial years. Physicians who were successful PQRS reporters in 2010 received a 2 percent bonus on Medicare allowed charges and those who reported electronic prescribing also received a 2 percent bonus for that year. Physicians were eligible for both incentives and bonuses were distributed as a lump sum in the fall of 2011.
Of the more than 1 million professionals eligible to participate in PQRS in 2010, approximately 240,000 attempted to participate in the program. Of those, approximately 190,000 were successful and received the 2 percent bonus. In 2010, CMS included expanded opportunities for professionals to participate other than the traditional claims-based method, including through registries and direct electronic health record submission. Those who reported via registry had a higher success rate than those who reported via claims – 90 percent for registries versus 61 percent for individual claims measures. There were only a handful of physicians who reported directly through an electronic medical record. The average incentive payment made to physicians for 2010 reporting was $2,157.
Of the nearly 700,000 professionals eligible for the E-Prescribing Incentive Program in 2010, 65,000 received a 2 percent bonus for successful reporting. The average payment from that program was $3,836 per professional.
Cardiologists showed a strong commitment to both programs in comparison to other specialties. Cardiologists had the highest e-prescribing participation rate (35 percent) of all medical specialties with an average bonus payment of $5,584. Similarly, 36 percent of eligible cardiologists received a PQRS bonus, higher than the overall average of 29 percent. The average bonus received by cardiologists from the PQRS program was $5,292, which was also much higher than the average. Since the first year of the program in 2007, the participation rate in PQRS for cardiology has grown from 20 percent to 36 percent. Cardiologists were more likely than others to report on PQRS via a registry, with more than 4,000 cardiologists reporting using this method.
The report can be found directly at http://www.cms.gov/PQRS/
The year that had the biggest bonus potential for physicians from the PQRS and e-prescribing programs was 2010. Since 2010, the bonus opportunities for these programs have only gone down. In 2012, physicians who participate in PQRS are only eligible for a half-percent bonus on Medicare allowed charges. Physicians who did not report electronic prescribing in the first half of 2011 have had their payments decreased by one percent in 2012 unless they were eligible for an exception (most cardiologists were not). Physicians who do not successfully report on PQRS in 2013 will not only fail to receive a half percent bonus, they will also receive a 1.5 percent penalty in 2015.
While the current bonus incentives were clearly not enough to convince all cardiologists to participate in these programs, there are important reasons to reconsider this decision in the future. First, as stated above, these programs will soon be moving into penalty phases. While the e-prescribing penalty program is completed in 2014, penalties associated with failing to use electronic medical records start in 2015 (based on 2014 use) and penalties for failure to participate in PQRS start in 2013 and go on indefinitely. Beyond that, CMS is required to adjust payment to physicians based on quality and resource use and many believe that the PQRS program may prove to be an important part of that quality determination. At a time when overall Medicare payments are under constant threat, penalties reducing Medicare payments may make the practice of cardiology financially untenable.
The ACC urges physicians to participate in these programs to ensure that they are ready for the next stage of physician payment. Learn more about PQRS and e-prescribing in the Advocacy section of CardioSource.org.
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