Fact Sheets

FINAL CHANGES FOR CALENDAR YEAR 2012 PHYSICIAN INCENTIVE PROGRAMS

OVERVIEW

On Nov. 1, 2011, the Centers for Medicare & Medicaid Services (CMS) issued a final rule with comment period that will update payment policies and payment rates for services furnished under the Medicare Physician Fee Schedule (MPFS) on or after Jan. 1, 2012.  The final rule makes changes to several of the incentive programs that are associated with MPFS payments – electronic health records (EHRs), and the Physician Quality Reporting System (PQRS) – as well as changes to the Physician Compare tool on the Medicare.gov web site.  These changes are summarized below.

ELECTRONIC HEALTH RECORDS INCENTIVE PROGRAM

The Medicare and Medicaid EHR Incentive Programs requires eligible professionals (EPs), eligible hospitals, and CAHs to electronically submit clinical quality measure (CQM) results as calculated by certified EHR technology beginning in the 2012 payment year.  The July, 2010, final rule implementing the program also stated that the primary method for these providers to report required CQM information electronically would be to log into a CMS-designated portal and submit data through an upload process. Under the MPFS final rule announced today, CMS finalizes the following methods for the reporting of CQMs in order to demonstrate meaningful use by EPs:

• Continue with attestation for reporting CQMs.
• Participate in a PQRS-Medicare EHR Incentive Pilot, established in this 2012 MPFS final rule that relies on the infrastructure of the Physician Quality Reporting System. EPs could report CQMs via the pilot through either of two methods:

• By using a PQRS-qualified EHR data submission vendor to submit calculated results from the EP's certified EHR to CMS on the EP's behalf; or

• By submitting CQM data directly from his or her certified EHR to CMS via a secure portal.  The EHR also must be a qualified PQRS EHR product.

PHYSICIAN QUALITY REPORTING SYSTEM

Under the MPFS final rule, CMS finalizes the following requirements for the 2012 PQRS:

Reporting under the PQRS group practice reporting option (GPRO): CMS defines a “group practice” as a group of 25 or more individual eligible professionals, and makes conforming changes to the criteria for satisfying the reporting requirements to reflect the change in the definition.  The rule also finalizes 29 measures for reporting under the Physician Quality Reporting System GPRO in order to align with other CMS quality reporting programs.

Reporting as individual eligible professionals:

• Finalizes the following individual measures for reporting:
  • A PQRS core measure set (seven measures, one of which is available for EHR reporting only) aimed at promoting the prevention of cardiovascular conditions;
  • Finalizes 211 individual measures available for claims and/or registry reporting, including 26 additional new measures; and
  • All 44 EHR measures currently reportable in the Medicare EHR Incentive Program 
• Finalizes a total of 23 measures groups for reporting, including the following eight new measures groups for reporting:

• Cardiovascular Prevention,
• COPD,
• Inflammatory Bowel Disease,
• Sleep Apnea,
• Dementia,
• Parkinson’s,
• Elevated Blood Pressure, and
• Cataracts

• Includes a reporting option for EHR-based reporting that aligns with the reporting requirements for reporting CQMs under the EHR Incentive Program; and
• Allows for submission of the PQRS EHR measures via an EHR data submission vendor in addition to direct submission from an EP's EHR-based product to CMS.

Maintenance of Certification Program incentive: Provides more flexibility to entities sponsoring Maintenance of Certification Programs to define what an eligible professional is required to do to

“more frequently” participate in a Maintenance of Certification Program for purposes of the PQRS Maintenance of Certification Program Incentive.

2015 Payment Adjustment: Finalizes CY 2013 as the reporting period for the 2015 PQRS payment adjustment.

PHYSICIAN COMPARE WEBSITE

Section 10331 of Affordable Care Act requires CMS to implement a plan for making information on physician performance publicly available by no later than Jan. 1, 2013.   This provision supports CMS’s overarching goals to foster transparency and public reporting by providing consumers with information to make informed decisions about their health care, while encouraging clinicians to improve the quality of the care they provide to their patients.

The MPFS final rule announced today finalizes the proposed plan initially based on public reporting of performance rates for group practices that submitted data under the PQRS GPRO reporting option for the 2012 reporting period. CMS finalizes its proposal to report performance rates for other CMS demonstrations using group practice reporting on the Physician Compare Web site as early as 2013. 

The final rule with comment period will appear in the Nov. 28, 2011, Federal Register.  CMS will accept comments on those provisions that are subject to comment until Jan. 3, 2012, and will respond in the MPFS for CY 2013.

For more information, see: 

http://www.ofr.gov/inspection.aspx?AspxAutoDetectCookieSupport=1

For more information on the PQRS program visit: www.cms.gov/pqrs

For more information on the Medicare and Medicaid EHR Incentive Programs, visit: www.cms.gov/EHRIncentivePrograms

For more information on Physician Compare, visit: http://www.medicare.gov/find-a-doctor/provider-search.aspx

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