American Society of Hematology

Guide to Participating in PQRS and the Value-Based Modifier for 2014

ASH has developed the following guide to help practicing hematologists understand the Centers for Medicare & Medicaid Services' Physician Quality Reporting System (PQRS) and value-based modifier performance quality metrics in 2014. Since 2007, physicians have been given the opportunity to receive a bonus payment for reporting on at least three quality measures as part of the PQRS. The bonus payment changed through the years, going as high as two percent in one year. Many things are changing:

  • 2014 is the last year in which a physician can receive a PQRS bonus
  • The bonus is down to 0.5 percent of Medicare allowed charges under the physician fee schedule (excludes drug payments)
  • The threshold for successful reporting has increased to nine measures in most circumstances

While the bonus is going away, the PQRS program is not. In fact, 2013 marked the first year in which physicians were to be penalized for not participating in PQRS. Those who did not report a single quality measure in 2013 will have their payments reduced by 1.5 percent in 2015. In 2014 things change again:

  • The threshold for avoiding the penalty increases from a single measure reported once to three measures reported on at least 50 percent of eligible patients.
  • The penalty for not reporting in 2014 is a 2 percent payment reduction in 2016

Since inception in 2007, the PQRS was a pay-for-reporting program. Physicians would receive the bonus regardless of how well or poorly they performed on the recommended actions as long as they reported. In 2013, things began to change. Physicians in groups with 100 or more physicians or other eligible providers (e.g. NP/PA) could have their payments subject to adjustment based on their performance on PQRS measures as well as CMS-calculated measures. CMS gave those groups the opportunity to register and indicate if they wished to have their payments adjusted. For 2014, this will expand and change:

  • Physicians in groups of 10 or more will be subject to payment adjustment
  • There is no registration or choice in participating
  • Groups of 10-99 cannot have their payments adjusted down, but can receive bonuses for strong performance
  • Groups of 100 or more will have their payments adjusted up or down based on performance

How to participate in PQRS in 2014

How the value-based modifier works in 2014

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