It’s Time to Get Ready for New Medicare Reporting Requirements

Medicare shifting in 2013 from offering incentives to reducing reimbursement

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It is critical that oncologists and their practice staff understand the importance of participation in these CMS reporting programs.

—Allen S. Lichter, MD

As if you didn’t already have enough to worry about, now add this: If your practice doesn’t meet the requirements of the Physicians Quality Reporting System (PQRS) and Electronic Prescribing (eRx) Incentive, you don’t just miss out on the bonuses the programs offered as incentive in recent years. If you fail to successfully participate in the PQRS in 2013, the Centers for Medicare & Medicaid Services (CMS) will reduce your reimbursement in 2015. And if you don’t have an eRx system in place this year, your Medicare reimbursement drops in 2013.

Further reductions are possible in 2015 due to lack of participation in CMS Electronic Health Records (EHR) Incentive Programs (“meaningful use”). So if you didn’t participate in these programs before, now is the time to start.

“It is critical that oncologists and their practice staff understand the importance of participation in these CMS reporting programs,” stressed ASCO Chief Executive Officer Allen S. Lichter, MD. “Gone are the days when a failure to report resulted in the loss of a bonus payment. Now, oncologists will see their Medicare reimbursements decrease as a result of nonparticipation.”

ASCO’s Website Can Help

To get practices started with reporting if they haven’t begun already, ASCO is stepping up communications, outreach, and guidance to oncologists, including establishing a new overview page on its website offering helpful information and links, In the fall, ASCO will provide a national webinar for members and their practice staff to outline CMS reporting program requirements for 2013.

Based on 2010 PQRS data released by CMS, 30% of eligible oncologists/hematologists successfully participated in the PQRS program that year, with the average potential incentive payment totaling $3,000. Twenty-two percent of eligible radiation oncologists participated in 2010, with an average potential incentive payment of about $8,000.

Incentives Previously Thought Not Worth It by Some

Already burdened with reams of data to input, many practices deemed those potential bonuses too low to worry about, said Jeffery C. Ward, MD, of Puget Sound Cancer Centers in Edmonds, Washington, and Chair of ASCO’s Clinical Practice Committee.

“Some practices weighed the costs and benefits of PQRS participation and decided that the effort wasn’t worth the small bonus,” he said.

It’s time to think again, though. Dr. Ward pointed out that when considering 2013 PQRS reporting, oncologists need to know that they will receive 1.5% less on Medicare Part B physician fee schedule reimbursement in 2015 if they do not report in 2013.

“So, a decision not to report in 2013 will result in a loss of the 0.5% payment increase for that year”—paid in a lump bonus payment in 2014—in addition to the 1.5% reduction in Medicare reimbursement throughout 2015,” he added.

CMS proposes a similar link between 2014 PQRS reporting and adjustments in 2016.

Getting it right takes time, added Dr. Ward. “PQRS is not just a spigot you can turn on and start collecting payments whenever you want,” he said. “My practice was an early adopter of PQRS, and it took a couple of years to get a reliable reporting process in place.”

As for eRx, physicians who don’t adopt a system and participate in the program this year will have 1.5% automatically deducted from their Medicare physician fee schedule–covered charges in 2013. Next year, the incentive declines to 0.5% and the accompanying penalty will increase to 2%, to be applied in 2014. There are no incentives for 2014, making 2013 the last possible year to earn an incentive.

CMS 2013 Fee Schedule’s Proposed Changes

The CMS physician fee schedule proposed rule was released in early July, suggesting several important components related to PQRS. Those included:

  • A vision and plan to better align the reporting requirements for PQRS, the EHR Incentive Program, and other CMS programs
  • Reduction in the number of patients for whom a measure group must be reported (from 30 to 20)
  • Increased reporting options for group-practice participants and a reduction in the number of providers required to qualify as a group practice (from 25 to 2)
  • A cancer measure group

Kristen McNiff, MPH, Senior Advisor in ASCO’s Quality & Guidelines Department, said she’s very pleased about the cancer measure group, which should greatly facilitate PQRS participation by allowing reporting on a manageable and set number of patients. While the PQRS program has more than 200 measures, only a handful are cancer-specific or even relevant to the care provided in oncology practices, she added.

PQRS and QOPI Go Hand in Hand

ASCO members who participate in the Quality Oncology Practice Initiative (QOPI) have long asked for the option to use their QOPI reporting as a way to meet PQRS requirements, Ms. McNiff said.

“We have advocated for years to have a cancer measure group added to the PQRS program,” she said. “If this measure group makes it to the final rule, we will be able to move forward with integration of PQRS reporting into the QOPI program.”

For more information on changes in Medicare reporting requirements and how to get your practice on board, go to ASCO’s new help page on the topic: ■

© 2012. American Society of Clinical Oncology. All rights reserved.