Healthcare News & Insights

What’s in the future for the PQRS program?

The newest results from the Physician Quality Reporting System (PQRS) program were just released, but the program as you know it won’t be around much longer. 

ThinkstockPhotos-482566485The Centers for Medicare & Medicaid Services (CMS) recently released its report on PQRS participation, incentive payments and penalties for 2013.

CMS uses the program to collect provider data on the quality of care being provided, but many providers find the system unwieldy and difficult to use.

Thankfully, around the same time, CMS leadership also announced its “Strategic Vision” for the future of the program, giving some insight into how the program will be developed in the future to better benefit providers and their organizations.

PQRS results

As ModernHealthcare reports, there were almost as many providers who had their pay cut from the program, as there were those who had their pay increased.

More than 640,000 eligible providers met the quality reporting requirements and deadline in 2013, and will receive a .5% payment increase this year, the report says.

However, about 40%, or around 460,000, of eligible providers failed to submit quality data on time and will have to deal with a 1.5% pay cut.

Overall, CMS has seen PQRS participation climb over the last few years. In 2013, about 51% of all eligble providers and organizations participated compared to 2007, when only 15% participated.

But, as this year’s report shows, a large portion are still opting out of the program. One potential reason for this, is that providers have complained the program is too confusing and disjointed, prompting them to take their chances with the financial penalties.

Recently, CMS has tried to get more providers to report quality measures by increasing the penalties for not participating. And providers may see that trend continue.

But thankfully, before the penalties become even steeper, CMS is trying to improve the program and making it more transparent and less burdensome for providers to participate.

CMS’ ‘Strategic vision’ for PQRS

That’s what Patrick Conway, CMS’ Chief Medical Officer and Principal Deputy Administrator, promised in a recent CMS blog post about the agency’s “Strategic Vision” for the future of the PQRS.

The Strategic Vision, outlines how CMS intends to build on current quality reporting systems to advance its overarching goal of transitioning the industry into value-based reimbursement models. Overall, CMS’s goal is to simplify quality reporting, and give providers more options in what data is submitted and how it’s reported.

There are five guiding principles the Strategic vision will use to try and improve quality reporting:

  1. Quality reporting programs will be lead by feedback from stakeholders, like patients, caregivers and healthcare professionals.
  2. Improvements will be driven by a combination of data and feedback.
  3. Public reporting will result in actionable meaningful and transparent information.
  4. Quality reporting programs will rely on an aligned measure portfolio.
  5. Policies for quality reporting and Value-based purchasing programs will be aligned.

Specifically, CMS will be doing things like collaborating with and collecting feedback from patients and providers about how to develop the programs, and is planning to explore new methods for collecting care data.

The bottomline for providers though, is that quality reporting isn’t going anywhere, anytime soon. And more likely than not, it’s going to be increasingly detrimental to try and opt out of these programs.

So it’s going to be more important than ever to review your operations compared to CMS’ portfolio of quality measures, and determine which measures most accurately reflect the high quality of care you provide.

Subscribe Today

Get the latest and greatest healthcare news and insights delivered to your inbox.