Fact sheets: Changes
for Calendar Year 2015 Physician Quality Programs and Other Programs in the
Medicare Physician Fee Schedule
On July 3, 2014,
the Centers for Medicare & Medicaid Services (CMS) issued a proposed rule
that would update payment policies and payment rates for services furnished
under the Medicare Physician Fee Schedule (MPFS) on or after Jan. 1, 2015. The
proposed rule also proposes changes to several of the quality reporting
initiatives that are associated with PFS payments, including the Physician
Quality Reporting System (PQRS), Medicare Electronic Health Record (EHR)
Incentive Program, and the Medicare Shared Savings Program, as well as changes
to the Physician Compare tool on the Medicare.gov website. Changes to other CMS
programs and initiatives, including the Comprehensive Primary Care Initiative,
are also discussed in this fact sheet.
Physician
Quality Reporting System (PQRS)
The Physician Quality Reporting System (PQRS) is a
pay-for-reporting program that uses a combination of incentive payments and
downward payment adjustments to promote reporting of quality information by
eligible professionals (EPs). The program provides an incentive payment through
2014 to EPs and group practices who, during the applicable reporting period,
satisfactorily report data on quality measures for covered professional
services furnished to Medicare Part B fee-for-service beneficiaries or
satisfactorily participate in a qualified clinical data registry
(QCDR). Beginning in 2015, a downward payment adjustment will apply to EPs
who do not satisfactorily report data on quality measures for covered
professional services or satisfactorily participate in a QCDR. In the CY 2015
PFS proposed rule, CMS is proposing updates to the PQRS primarily related to
the 2017 PQRS payment adjustment
For 2015, we are proposing to add 28 new individual
measures and two measures groups to fill existing measure gaps. We are
proposing to remove 73 measures from
reporting for the PQRS. These proposed changes would bring the PQRS individual
measure set to 240 total measures.
Generally, eligible professionals need only report nine measures covering three
National Quality Strategy domains.. In addition, we are proposing to require
that eligible professionals who see at least one Medicare patient in a
face-to-face encounter report measures from a newly proposed cross-cutting
measures set i in addition to any other measures that the eligible professional
is required to report.
For the 2017 PQRS payment adjustment, we are proposing
criteria for satisfactory reporting and satisfactory participation by
individual eligible professionals that are generally similar to the criteria we
finalized for the 2014 PQRS incentive. An additional criteria being proposed
would be that eligible professionals who see at least one Medicare patient in a
face-to-face encounter and choose to report PQRS quality measures via claims
and registry would be required to report on at least two measures in the newly
proposed PQRS cross-cutting measures set.
Reporting PQRS measures as a group practice
under the Group Practice Reporting Option (GPRO)
We are proposing to change the number of patients for
which group practices report measures under the GPRO web interface from 411 for
group practices with 100+ eligible professionals and from 218 for group
practices with 25-99 eligible professionals to 248 for all group practices with
25 or more eligible professionals.
Group practices that have at least one eligible
professional who sees at least one Medicare patient in a face-to-face encounter
and choose to report via registry would be required to report on at least two
measures in the proposed PQRS cross-cutting measures set. If these group
practices report using both a certified survey vendor and a registry, only one
measure in the cross-cutting measures set would need to be reported.
Medicare Shared Savings Program
The Medicare Shared Savings Program (Shared Savings
Program) was established to facilitate coordination and cooperation among
Medicare enrolled providers and suppliers to improve the quality of care for
Medicare Fee-For-Service (FFS) beneficiaries and reduce the rate of growth in
health care costs through participation in an Accountable Care Organization
(ACO). The CY 2015 PFS proposed rule includes updates to parts of the Shared Savings
Program regulations.
Additional Quality Improvement
Reward
In this rule, we propose revising our quality scoring
strategy to recognize and reward ACOs that make year-to-year improvements in
quality performance scores on individual measures by adding a quality
improvement measure that adds bonus points to each of the four quality measure
domains based on improvement. Additionally, we seek comments on our proposed
approach for rewarding quality improvement and feedback on alternative
approaches that may be possible under the Shared Savings Program.
Revisions to Quality Measure Benchmarks
In response to stakeholder feedback regarding “topped
out” measures, we propose modifying our benchmarking methodology to use flat
percentages to establish the benchmark for a measure when the national FFS data
results in the 90th percentile being greater than or equal to 95 percent.
Modifications to the Quality
Measures that Make Up the Quality Reporting Standard
For2015, we are proposing revisions to reflect up-to-date
clinical guidelines and practice, reduce duplicative measures, increase focus
on claims-based outcome measures, and reduce ACO reporting burden. The proposed
changes increase the number of measures calculated through claims and decrease
the number of measures reported by the ACO through the GPRO Web Interface. The
total number of quality measures for quality reporting would increase from 33
to 37 measures under this proposal. Specifically, new measures would be added
to focus on avoidable admissions for patients with multiple chronic conditions,
heart failure and diabetes; depression remission; all cause readmissions to a
skilled nursing facility; and stewardship of patient resources; the existing
composite measures for diabetes and coronary artery disease would also be
updated.
Additionally, we are seeking public comment on future
quality measures for consideration that address the following areas:
·
Gaps in measures
and additional specific measures
·
Measures for
retirement (e.g., “topped out” measures)
·
Caregiver
experience of care
·
Alignment with the
Value-Based Payment Modified ( VBM)
·
Assess care in the
frail elderly population
·
Utilization
·
Health outcomes
·
Public health
We are also seeking suggestions on ways that we might
implement EHR-based reporting of quality measures in the Shared Savings Program
for consideration in future rulemaking.
Proposed Quality Performance
Standard for Measures that Apply to ACOs that Enter a Second or Subsequent
Participation Agreement
We propose to revise our regulations to provide that
during a second or subsequent participation agreement period, the ACO would
continue to be assessed on its performance on each measure that has been
designated as pay for performance. That is, an ACO would continue to be
assessed on the quality performance standard that would otherwise apply to an
ACO if it were in the third performance year of the first agreement period.
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