News & Press: Quality Improvement

2016 PQRS Experience Report and the 2018 Value Modifier Experience Report Are Now Available

Monday, September 17, 2018  
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U.S. Centers for Medicare and Medicaid Services (CMS)  2016 Physician Quality Reporting System (PQRS) Reporting Experience Including Trends (2007 – 2016) (commonly referred to as the 2016 PQRS Experience Report) provides a summary of the reporting experience of individual eligible professionals (EPs) and group practices who participated during the 2016 PQRS reporting period. This report provides historical trends on eligibility, participation, payment incentives and adjustments, and measure performance broken down by specialty and state. It gives a snapshot of this program and shows who participated, including the type of EP and their specialty, as well as what methods they used to participate.

 

These are the final Experience Reports for the PQRS and Value Modifier programs, as both programs sunset December 31, 2018.

In 2018, the PQRS payment adjustment is applied under the Medicare Physician Fee Schedule (PFS) for individual EPs and group practices based on submitted 2016 quality data. The final data submission timeframe for reporting 2016 PQRS quality date (to avoid the 2018 PQRS downward payment adjustment) was January 1, 2017 through March 31, 2017.

For the full 2016 PQRS Experience Report, visit the CMS PQRS Analysis and Payment webpage

Highlights of this year’s report include:

  • In 2016, nearly 1.39 million EPs were eligible to participate in PQRS, compared to 1.36 million in 2015. 
  • Of those eligible, 72% (1,001,731 EPs) participated in 2016. This is a 7% increase in reporting from 2015, when 69% (938,939 EPs) participated. 
  • Of those eligible in 2016, 69% (962,974 EPs) were successful and avoided the 2018 payment adjustment.
  • Of all EPs that were eligible in 2016, 31% (435,111) will receive a payment adjustment of -2% in 2018. Almost 85% of those subject to the adjustment did not attempt to participate in the program (that is, did not submit any data). 
  • EPs were more likely to be subject to payment adjustments if they were a part of a smaller practice, had lower PFS allowed charges, or had lower beneficiary volume.
  • 71% of all EPs who received the payment adjustment were from practices with fewer than 25 EPs. 
  • 68.8% of those EPs who received the payment adjustment had 100 or fewer Medicare beneficiaries.
  • 69.5% of those EPs who received the payment adjustment had PFS charges that were $30,000 or less and 48% had PFS charges that were $10,000 or less.

The 2018 Value-Based Payment Modifier Program Experience Report highlights characteristics of the practices subject to the Value Modifier in 2018 and compares program results across 2015, 2016, 2017, and 2018. In 2018, the Value Modifier applies upward, downward, and neutral payment adjustments at the practice level to Medicare PFS payments to physicians, nurse practitioners (NPs), physician assistants (PAs), clinical nurse specialists (CNSs), and certified registered nurse anesthetists (CRNAs) based their performance in 2016. For the full 2018 Value Modifier Experience Report and the factsheet on the 2018 Value Modifier Results, visit the CMS 2016 QRUR and 2018 Value Modifier webpage.

Questions 

  • Questions regarding PQRS and related topics, such as reporting requirements, downward payment adjustments, and feedback reports can be directed to the CMS QualityNet Help Desk at 1-866-288-8912 (TTY: 1-877-715-6222) between the hours of Monday–Friday; 7:00 a.m.–7:00 p.m. Central Time. 
  • Questions regarding the Value Modifier and Quality and Resource Use Reports (QRURs) can be directed to the CMS Physician Value Help Desk pvhelpdesk@cms.hhs.gov or 888-734-6433 (select option 3) between the hours of Monday–Friday; 7:00 a.m.–7:00 p.m. Central Time.

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