Cooperating for better care.

Physician Quality Reporting System

Tag Archives

A field guide to CMS’s value-based modifier


Here’s a guide for physicians on how to deal with CMS’s new value-based modifier.

As Medscape notes: “VBM could increase your income by up to 2% in the first year, or lower your income by 1% in 2015 and 2% in 2016.”

A VBM is  an incentive or a penalty to be applied to  a physician’s Medicare revenue, on the basis of how CMS has judged the quality and efficiency of  patient care.  And, Medscape reports, “under  bipartisan bills introduced in both houses of Congress, ‘value-based payments’ to doctors would entail incentives or penalties of 4% in 2017, rising to 10% in 2020 and possibly to 12% in 2021 and beyond. These amounts would combine the current bonuses and penalties in the VBM, the Physician Quality Reporting System (PQRS), and the meaningful use programs. These carrots and sticks would replace the loathed Sustainable Growth Rate (SGR).”

To read the entire guide, please hit this link.

MIPS looms, but maybe you can opt out


Providers are girding their loins to comply not only  with the next stage of the Meaningful Use program, but also a  new mandated electronic reporting requirement: Medicare’s Merit-based Incentive Payment System (MIPS).

The MIPS combines parts of the Physician Quality Reporting System (PQRS), the Value-based Payment Modifier, and Meaningful Use into one single program based on quality, resource use and clinical-practice improvement.

Robert Tennant, senior policy adviser with the Medical Group Management Association (MGMA),  told MedPage Today that the two programs are very inter-twined:
“Even though Meaningful Use was sunsetted, it’s now effectively 25% of your MIPS score, so it never really goes away.” And because it is so much of the MIPS score, “it’s potentially more impactful on your reimbursement.”

But Linda Delo, D.O., a family physician in Port Saint Lucie, Fla., told the online news service that, as MedPage paraphrased her, “{P]hysicians can get out from under MIPS in some cases if they become part of an alternative payment model such as an Accountable Care Organization (ACO), a bundled payment model, or a patient-centered medical home (PCMH), rather than continue in the traditional fee-for-service Medicare program.”


New ambulatory vs. critical-care confusions


A look at the usefulness and reality of new federal quality and safety benchmarks this year, which are not leaving everyone happy.

Consider that, as Hospitals & Health Networks reports, a “major shift is taking place in Medicare’s Physician Quality Reporting System program, while the National Quality Forum is examining a group of relatively unpopular patient-safety measures for possible revision.”

”{S}ome physicians — including specialists who work in ambulatory care — continue to be concerned that they will have a difficult time finding measures that realistically can be met.

”Some of the worry is driven by changes to the measures that can be used in PQRS reporting. Emergency department physicians face a limited number of choices that can be applied to their specialty. ”

H&HN said that Catherine Polera, chief medical officer for the emergency medicine division of Sheridan Healthcare, noted that ”the Centers for Medicare & Medicaid Services removed some of the core measures that may have worked in an emergency department setting and replaced them with ambulatory care measures. The new measures ‘relate more to primary care than they do critical care.’

”Although primary-care measures have some application to the ED, ‘we see more trauma, we see more chest pain patients, more abdominal pain patients, and I’m not seeing those related measures,’ she says.”

‘”Determining the implications for a hospital is a little more complicated,” Akin Demehin, senior associate director of policy for the American Hospital Association (AHA), told H&HN {which is part of the AHA}. “‘It mainly boils down to whether a physician bills for the procedure or whether the hospital bills for the physician. Whoever submits the bill, generally speaking, is going to be responsible for the reporting.”’



Contact Info

(617) 230-4965

Wellesley, Mass