CMS Discovers PQRS Data Errors

The Centers for Medicare and Medicaid Services (CMS) recently announced that various errors were discovered in the 2014 Physician Quality Reporting System (PQRS) data submitted by vendors on behalf of physicians and group practices that reported via electronic health records (EHR) and qualified clinical data registries (QCDR). Physicians who participated and reported in 2014 PQRS through claims and clinical registries are not affected.

• The good news: For those APA members reporting via claims, the majority of APA solo practitioners are safe.

• The bad news: Large groups (for example, hospitals) that more frequently use EHRs will be negatively affected.

Because of the errors, the EHR and QCDR data are inconsistent and cannot be used to calculate quality performance for the 2016 value modifier, nor can PQRS performance information be included on Physician Compare. For PQRS and the meaningful use EHR incentive programs, there is no impact because physicians are judged on whether they successfully reported, rather than on their actual performance; simply receiving the data will allow CMS to deem a physician or group practice successful for purposes of avoiding a payment adjustment in 2016 or for receiving a 2014 incentive. There will be no need for physicians or group practices to submit a PQRS informal review request.

• The good news: Those who use an EHR or QCDR to report on PQRS or the meaningful use Incentive program will still receive incentive payments.

• The bad news: Those who take advantage of the Value Modifier (a Medicare program that alters clinician payment based on quality of care furnished compared with cost during a performance period) cannot have their quality of performance evaluated. Also, their reporting will not be included on the Physician Compare website, a site that consumers can use to select a physician. Information on physician quality is included to inform consumers.

For the value modifier, which involves calculating actual quality scores in addition to determining whether quality measures were reported, CMS has acknowledged the vendor data errors may create problems. Specifically, CMS will not be able to accurately calculate the PQRS portion of the Quality Composite Score. Instead, the score will be based solely on the claims-based outcomes measures and Consumer Assessment of Healthcare Providers and Systems Survey, if applicable.

2014 PQRS Quality Measures May be Publicly Reported

For the first time, CMS will publicly display a subset of individual 2014 PQRS measures through star ratings on physicians’ individual profile pages in late 2015. Since 2014, CMS has publicly reported PQRS quality information on group practices participating under the group practice reporting option through star ratings.

In response to AMA advocacy, CMS will report information only through star ratings on physicians and group practice that were successful with 2014 PQRS. Physicians and group practices will also have the opportunity to review the information before it goes live and flag problematic information. The preview period will last 30 days and is expected to start October 5. To review a preview report, physicians must use the PQRS Portal and have an EIDM account.

The AMA will continue to advocate for a longer preview period and ensure that displayed information is accurate and statistically valid and reliable.

CMS will host three one-hour webinars during which physicians and stakeholders will have the opportunity to ask questions about public reporting on Physician Compare and the 2014 quality measure preview period. All sessions will present the same information.

• September 22, 1 p.m. EDT

• September 23, 4 p.m. EDT

• September 24, 1 a.m. EDT

Register today for a session. ■