PQRS incentive program hits snags

May 11, 2011

Participation in Medicare’s Physician Quality Reporting System (PQRS) continued to falter in 2009 as a large segment of eligible professionals either failed to meet minimum requirements or simply ignored the initiative, amednews.com reports.

Washington - Participation in Medicare’s Physician Quality Reporting System (PQRS) continued to falter in 2009 as a large segment of eligible professionals either failed to meet minimum requirements or simply ignored the initiative, amednews.com reports.

In a mid-April report on the program, the Centers for Medicare & Medicaid Services (CMS) said more than 1 million physicians and other health professionals were considered eligible for the voluntary incentive program in 2009, but that only about 210,000 participated. Out of those, only about 120,000 earned bonuses, which averaged slightly less than $2,000 per professional, totaling a record $234 million.

Amednews.com quotes CMS administrator Donald M. Berwick, M.D., as saying that while participation in the pay-for-reporting programs is still optional, “It should be regarded as imperative in terms of medical professionals’ shared goal of improving quality of care and patient safety.” Starting in 2015, doctors who do not participate in the PQRS program face reduced Medicare pay.

According to the report, however, voluntarily participating physicians have found aspects of the PQRS program unwieldy and confusing. Many say they are frustrated by what they perceive as the program’s lack of timely feedback, while others complain that the coding system is too complicated and billing errors too common.

For their part, CMS officials said they have seen quality improvements over the program’s first three years. The total bonus amount more than doubled between 2008 and 2009, in part because Congress raised the incentive amount from 1.5 percent to 2 percent of a physician’s total annual Medicare charges, amednews.com reports.

Starting in 2015, CMS will reduce Medicare payments for physicians who fail to participate in the PQRS program. Total payment would be reduced by 1.5 percent in 2015 for failing to report quality codes satisfactorily. The penalty rises to 2 percent in 2016 and beyond.