There's an important deadline looming on June 30, 2015, the end of the reporting year for CMS' Physician Quality Reporting System.
Any practice with at least two doctors using the same tax ID has the option to declare by that deadline that they will report PQRS measures as a group rather than as individual physicians.
Those who declare for the group practice reporting option (GPRO) of PQRS may participate in any of five ways: (1) through a qualified PQRS registry; (2) via Web interface [for groups of more than 25 providers]; (3) directly using certified EHR technology; (4) using certified EHR technology via data submission vendor; or (5) via CMS-certified survey vendor [for groups of more than 25 providers].
"The bottom line is there is a set of complicated rules around how to determine which method is going to get you the best result. There is a lot of money at stake, so you want to put yourself in the best light," explained Tom Lee, CEO of SA Ignite, which assists about 10,000 providers with reporting tasks under pay-for-performance programs such as meaningful use and PQRS.
Lee added that the GPRO option could reduce administrative burden because it is easier to make one PQRS submission rather than separate submissions for individual providers. However, the overall decision requires careful consideration because scores directly impact Medicare reimbursement and could be substantially different depending on the method selected.
The five GPRO options are intended to give practices the flexibility to choose the method that yields the best result.
"A lot of providers made the wrong decision last year," said Lee. "They need to determine how to come out looking good on the quality score for the Value-Based Modifier, which accounts for up to 4 percent of reimbursement from Medicare."
CMS is gradually phasing in implementation of the VBM. In 2015, it is applied only to groups of more than 100 eligible providers (based on 2013 performance). Next year, it applies to groups of 10 or more EPs based on 2014 performance. It will apply to all physicians and groups in 2017.
"Come 2016," Lee added, "it will not be simply reporting without regard to values like in the old days. It will be true pay-for-performance, and CMS will be ranking your performance relative to your peers nationally. That will determine whether you'll have a reimbursement reduction or not."