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PQRS reporting mandatory for all eligible practices in 2015
About half of all ophthalmologists are participating in the Meaningful Use program, but for those who do not, penalties begin this year.
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A clinical registry is recommended, but not required, for practices participating in Medicare’s Physician Quality Reporting System, which was made mandatory in 2015 by the Affordable Care Act, according to one practice management consultant.
Physicians participating in the Physician Quality Reporting System (PQRS) must report on at least nine quality measures in 2015, Kevin J. Corcoran, COE, CPC, CPMA, FNAO, said in an update of Medicare’s incentive programs and utilization changes at Hawaiian Eye 2015.
Individual participants can report quality information through Medicare Part B claims, a qualified PQRS registry, a certified electronic health record system, an EHR data submission vendor or a qualified clinical data registry, Corcoran said.
“Participate in a qualified clinical data registry such as the American Academy of Ophthalmology’s IRIS Registry,” he said. “It’s not mandatory, but it’s worth serious consideration.”
The AAO launched the IRIS Registry in 2014.
The PQRS, along with the Value-Based Payment Modifier (VBPM) and Meaningful Use of EHRs, is included in a new Merit-Based Incentive Payment System (MIPS) created by legislation passed by Congress in April. With the repeal of the SGR formula, the Secretary of Health and Human Services intends to move away from traditional fee-for-service that emphasizes volume and toward a value-based payment system. Beginning in 2019, the MIPS will replace three previous incentive programs with a combined value-based payment program.
PQRS and Meaningful Use program
Practices that do not participate in the PQRS program in 2015 face a 1.5% penalty, Corcoran said.
“What happens if you do well? The answer is, no penalty,” he said. “What if you don’t? In 2014, the PQRS penalties applied 2 years out, that is 2016, and impose a 2% physician payment reduction. Additionally, PQRS will be used for the VBPM.”
The VBPM provides for a differential payment to a physician or group under the Medicare Physician Fee Schedule based on the quality of care and cost of care during a certain period.
The VBPM is in effect for groups of more than 10 professionals in 2016, based on performance in 2014. It will be in effect for all providers in 2017, based on 2015 performance, Corcoran said.
“This program is not yet well understood but may have the biggest impact on you,” he said.
The Meaningful Use (MU) program began in 2011, and the last year to begin participation was 2014. Penalties for not participating in the Meaningful Use program begin in 2015.
To qualify for MU incentive payments, participants must successfully demonstrate and attest to meaningful use for each year of participation, Corcoran said.
About half of all ophthalmologists are participating in the MU program, Corcoran said.
“Altogether, PQRS, MU, VBPM and MIPS have the potential to dramatically change physician reimbursement within the Medicare program,” he said.
Medicare utilization changes
In an update of Medicare utilization data for the past year, Corcoran said that CMS paid claim data show many changes in ophthalmic and optometric practice patterns between 2012 and 2013.
The greatest increases in ophthalmology were for tear osmolarity testing (380%), visual evoked potential testing (233%), electroretinography (133%), amniotic membrane placement on the ocular surface without sutures (79%), anterior segment OCT (23%), corneal topography (17%), retinal OCT (12%), foreign body removal (12%) and intravitreal injection (11%).
The greatest decreases were for photodynamic therapy (16%), laser choroid treatment (16%), level 5 evaluation and management encounters of new patients (12%), A-scan biometry (11%) and focal laser treatment (11%).
The top 10 ophthalmic procedures performed in 2013 according to CMS data were intravitreal injection, cataract removal with IOL implantation, Nd:YAG capsulotomy, punctum plug placement, epilation, complex cataract extraction, laser trabeculoplasty, blepharoplasty, focal laser treatment and laser peripheral iridotomy, Corcoran said. – by Matt Hasson
- For more information:
- Kevin J. Corcoran, COE, CPC, CPMA, FNAO, can be reached at Corcoran Consulting Group, 560 East Hospitality Lane, Suite 360, San Bernardino, CA 92408; email: kcorcoran@corcoranccg.com.
Disclosure: Corcoran is president of the Corcoran Consulting Group.