The Centers for Medicare & Medicaid Services (CMS) released the 2014 Reporting Experience Including Trends (2007-2015), referred to as the 2014 Physician Quality Reporting System (PQRS) Experience Report. The report highlights trends that indicate a steady rise in quality measure program participation among eligible providers (EPs). Here’s a quick look at some of the statistics within the report:

  • 1.32 million professionals were eligible to participate in PQRS in 2014.
    In 2013, there were 1.25 million professionals eligible to participate in PQRS.1
  • Participation increased by 11% in 2014 from 2013.
    In 2014, a total of 822,810 (63%) EPs successfully participated through at least one reporting mechanism compared to 642,114 (51%) EPs who successfully participated in 2013.2
  • Participation via Electronic Health Record (EHR) more than doubled in number since 2013.
    EHR reporting by EPs demonstrated strong growth in 2014, with over 50,000 participant reports received.3

The steady rise in participation validates the importance of such programs, but the continued rise in successful participation demonstrates the determination to improve healthcare outcomes. Greater participation over the years will help foster less stress and prepare EPs and groups for the new 2017 program year.

With the release of the proposed rule on April 27, 2016, EPs and groups can begin thinking strategically about the upcoming merit-based incentive payment program, or MIPS. MIPS will absorb the three existing initiatives PQRS, The Value-based Payment Modifier (VBPM), and Meaningful Use (MU), and transform them into more flexible programs that are aligned with the CMS goal of providing quality of care.

MIPS Streamlines Administration Burden

Rather than having separate programs for reporting, scoring and quantifying clinical information, MIPS will streamline this administrative burden by creating an overall score, based on four components:

  1. Quality
  2. Resource Use
  3. Clinical Practice Improvement Activities
  4. Advancing Care Information

MIPS forges a path toward providing better, smarter healthcare based on value and quality of care. MIPS is designed to provide more feedback, support and guidance for our eligible clinicians, which has been lacking in the previous programs and continues to drive toward the utilization of smart technology and leveraging the exchange of health information.

Financial Adjustments

With the previous programs, MIPS will continue to provide both negative payment adjustments and incentive payments. Incentive payments will come to those who are able to demonstrate high quality care and improved outcomes. In 2019, the range is 4% positive or negative, but will continue to increase each year as the program not only develops further but becomes more inclusive to eligible clinicians.4

Even with the 11% rise in PQRS participation and almost doubling the number of participants in the EHR incentive program, there’s still enough changes coming in 2017 that warrants planning and preparation.

Next Steps

EP’s and groups should consider the following steps toward implementation:

  1. Make certain you are successfully participating in existing Medicare quality and EHR programs.
  2. Factor alternative payment model (APM) participation bonus into risk-based payment model adoption strategy.
  3. Understand which track your organization will likely fall into.
  4. Educate providers in your group on your payment track and what it means for provider payment in 2019.
  5. Stay current on forthcoming CMS proposed and final MACRA implementation rulings.
  6. Reach out to your vendor for education and content.
  7. Decide whether to comment to the proposed rule.

More importantly, take the time to discuss your strategy; what worked in the previous years, what didn’t work and how you can achieve greater success in the new program that puts the quality of your patient’s healthcare first.

12014 Reporting Experience Including Trends (2007-2015). Physician Quality Reporting System. April 15, 2016.

Selena Hood

About the author

Selena Hood, MS is Quality Measure and Reporting Program Manager of Business Performance Services.