The threads of payment reform and quality programs are coming together

It seems like forever now that practices have been dealing with multiple, complex, incentive and penalty initiatives from the federal government: Meaningful Use, PQRI/PQRS, eRx, PCMH and, more recently, "value-based" programs (value-based purchasing for hospitals, and the upcoming value-based purchasing modifier for physicians). If you're like us, the onslaught of these programs has seemed more like a series of separate carrots and sticks (amplified by private payer programs that have built on the government's pay-for-performance approach) than a coherent strategy for driving change.  Rarely do notices about these programs include helpful guidance as to how they're interrelated.  (Perhaps it would just be to hard to fit those details in amongst the deadlines, bureaucratic details and confusing specs!) That is why it is at least helpful to finally be seeing -- after years of programs popping up and interrupting practice operations, demanding attention without saying why (except when why was 'get a bonus' or 'avoid a penalty') -- the outlines of inter-connectedness among all of the government's many programs. For example, Medicare's Physician Compare website provides information about a physician's participation in various quality initiatives, like PQRS and ePrescribe.  (This is perhaps a good opportunity to remind you to check this -- and all -- the directories in which you or your providers are listed.  There are often errors -- if contact, specialty or location data is incorrect on a key directory, it can cost you patients.  And if the CMS has incorrect data about your participation in important incentive programs, you'll want to follow up on that immediately to remedy their data or your submissions.  As we say all the time, this need to check goes for payer directories (!) and public directories like Healthgrades and Vitals.) Anyway, a sample of quality participation data as it is displayed on the Medicare site appears below.  For some patients, knowing you're participating in these programs could make the difference in selecting your practice: Besides PQRS participation, the Physician Compare site shows participation in ePrescribe and Meaningful Use as well. Of course, the integration of this data into directories is just the beginning. 

By |2022-01-01T22:52:12-08:00November 26th, 2013|

Still time (but not much!) to avoid a PQRS penalty in 2015

There is still time for providers to avoid the PQRS penalty for 2013 reporting, which will mean a 1.5% deduction from Medicare reimbursements in 2015 (ouch!).  The following two methods still apply for individual providers: -Submit via a qualified EHR vendor -- if your EHR is provided by a vendor that has been permitted by the CMS to submit directly, submitting data could be much easier than you think.  Be sure to contact your vendor to find out what their capabilities are.  Even if not qualified to submit directly, your vendor may be able to help you submit via a registry -- the second method available to not just avoid the 1.5% penalty in 2015, but also earn a .5% incentive for 2013. -Submit a single, valid measure via a single claim.  You can do this!  This approach will not permit you to earn an incentive this year, but you will avoid the penalty in 2015 -- and you'll have gotten your feet wet for more comprehensive compliance in 2014.  (Do it now -- don't delay -- to be sure your claim is accepted and qualifies.)      

By |2013-11-24T17:46:46-08:00November 24th, 2013|
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