We were fortunate to host Barbara J. Connors, DO, MPH, Chief Medical Officer at The Centers for Medicare & Medicaid Services Region III, in our recent webinar on the Value-Based Modifier (VBM) program, and she was kind enough to answer the questions we couldn’t accommodate in the webinar’s Question and Answer session.
Q: Will the Value-Based Modifier affect all specialties?
A: PQRS (the basis for the VBM) applies to all physicians and other eligible professionals (EP) listed at this link: http://www.cms.gov/Medicare/Quality-Initiatives-Patient-Assessment-Instruments/PQRS/How_To_Get_Started.html The Value-Based Modifier currently applies only to physicians.
Q: I’m a solo practitioner reporting first time PQRS in 2014; what do I expect in 2015? Is there a deadline for it?
A: There is a two-year look back for the PQRS program. If you did not report PQRS measures in 2013, you are subject to a payment adjustment beginning 2015 if you have 100+ providers in your practice. Solo practitioners will begin to see payment adjustments beginning in 2017, based on 2015 performance. See http://www.cms.gov/Medicare/Quality-Initiatives-Patient-Assessment-Instruments/PQRS/Downloads/2013MLNSE13__AvoidingPQRSPaymentAdjustment_083013.pdf
Q: We have 2 physicians who see Medicare patients; how can we participate in PQRS?
A: CMS has posted a “Step-by-Step Instruction in Getting Started with the Physician Quality Reporting System (PQRS)” that will help you through the process. Please refer to Step 2 on the attached web link and open the PQRS implementation Guide. You will find all the information you need to begin participation. http://www.cms.gov/Medicare/Quality-Initiatives-Patient-Assessment-Instruments/PQRS/How_To_Get_Started.html
Q: Are there “free” pqrs reporting tools, other than claims based?
A: You have several reporting options including claims based reporting or reporting through your EHR. Depending on your group size or if you are participating in an ACO in 2014 you can report measures through the Group Practice Reporting Option (GPRO) via Web Interface. http://www.cms.gov/apps/ama/license.asp?file=/PQRS/downloads/2014_PQRS_MeasuresList_ImplementationGuide_12132013.zip
Q. What is meant by the “50% threshold” mentioned in the webinar?
A: The “50% threshold” refers to this scenario: If a group does not seek to report quality measures as a group, CMS will calculate a group quality score if at least 50 percent of the eligible professionals within the group report measures individually.
At least 50% of EPs must successfully avoid the 2016 PQRS payment adjustment
Q: What is required to be a meaningful user for a solo EP? We are reporting PQRS info starting in 2014.
A: Please refer to this web link for all the information you need to know about becoming a meaningful user: http://www.cms.gov/Medicare/Quality-Initiatives-Patient-Assessment-Instruments/PQRS/Electronic-Health-Record-Reporting.html
Barbara J. Connors, DO, MPH, Chief Medical Officer at The Centers for Medicare & Medicaid Services Region III, has recently served as the Acting Associate Regional Administrator for the Division of Survey and Certification in CMS Northeast Consortium Regions I, II, and III.
As the Chief Medical Officer, she is responsible for ensuring the provider community is cognizant of CMS health care quality improvement initiatives, including current legislative issues that impact the provider community.
Learn more about the Value-Based Modifier program
Watch our free recorded webinar, The Value-Based Modifier Program: What’s the Impact on Your Practice?
See our free infographic: What is CMS’ Value-Based Modifier Program and How Will It Affect Your Practice?
Find more information about the Value-Based Modifier program is available at: http://www.cms.gov/Medicare/Medicare-Fee-for-Service-Payment/PhysicianFeedbackProgram/index.html
More information about the PQRS program is available at: http://www.cms.gov/Medicare/Quality-Initiatives-Patient-Assessment-Instruments/PQRS/index.html