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CMS Announces the Release of the Physician Quality Reporting System (PQRS) 2014 Reporting Experience Including Trends (2007-2015)

The Centers for Medicare & Medicaid Services (CMS) released the 2014 Reporting Experience Including Trends (2007-2015), referred to as the 2014 PQRS Experience Report.

The PQRS Experience Report is released by CMS annually and provides data and trends on participation, incentive eligibility, incentive payments and payment adjustments as applicable since the beginning of PQRS, including measure performance and program participation broken down by specialty and geographic location. The full report can be found at on the PQRS Analysis and Payment webpage.

The 2014 report found an increase in participation from eligible professionals (EPs) across most reporting mechanisms. The report also indicates progress in CMS’ efforts to improve participation by redesigning the submission process to be user-centered and responsive, and lowering the reporting burden for EPs by aligning reporting requirements across CMS quality programs.

Report highlights include:

  • 1.32 million Professionals were eligible to participate in PQRS in 2014. In 2013, there were 1.25 million professionals eligible to participate in PQRS
  • Participation increased by 11 percent in 2014 from 2013. In 2014, a total of 822,810 (63 percent) EPs successfully participated through at least one reporting mechanism compared to 642,114 (51 percent) EPs who successfully participated in 2013.
  • Participation via Electronic Health Record (EHR) more than doubled in number since 2013. EHR reporting by EPs demonstrated strong growth in 2014, with over 50,000 participant reports received.
  • 558,885 EPs are currently subject to the 2016 PQRS negative payment adjustment. Based on 2014 PQRS reporting, 558,885 EPs are subject to a reduction of 2.0 percent of their 2016 Part B Medicare Physician Fee Schedule allowed charges. Of those professionals subject to the adjustment, 466,351 were non-participants (those EPs who did not attempt to participate) and 92,534 were participants who were unsuccessful in meeting the reporting requirements to avoid being subject to the PQRS negative payment adjustment in individual or group practices. This number accounts for less than half of all 2014 professionals who were eligible to participate.
  • Participation in PQRS GPRO had a large increase in 2014 compared to 2013. Nearly 3,000 group practices (1,545 Small GPRO, 855 Medium GPRO, and 585 Large GPRO) self-nominated or registered to participate via the PQRS GPRO in 2014. This was a large increase compared to 677 total practices that self-nominated for participation in PQRS GPRO in 2013.
  • The 2014 PQRS incentive payments paid equaled $224,088,411. Program year 2014 was the last year EPs could earn a PQRS incentive. The average incentive was $383 per EP and $4,950 per group practice, with 585,037 EPs and 45,273 group practices receiving incentive payments (excluding Maintenance of Certification Program). A total of $1,627,613,994 was paid over the eight years (2007-2014) that CMS provided PQRS incentive payments.

PQRS is a quality reporting program that requires individual EPs and group practices to report quality measure information to CMS. The PQRS negative payment adjustment will end in 2019 and aspects of the program will be consolidated into the Merit-Based Incentive Payment System (MIPS), which was established by the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA).

More information about PQRS, including information on how to avoid the negative payment adjustment, is available at https://www.cms.gov/Medicare/Quality-Initiatives-Patient-Assessment-Instruments/PQRS/index.html