In 2013, you should take a fresh look at GPRO.
There has always been a tremendous advantage in reporting as a group. Individually, some specialties and some individuals are difficult to qualify for PQRS, having too few measures to qualify. With the GPRO option, the group sinks or swims together. It tends to be easier to find applicable measures with adequate patient numbers and accessible data when we can look across the entire Group patient panel instead of being limited to a single provider panel.
This is important, so let’s say it in another way to be sure that it is clear. When reporting as an individual, the individual provider must have seen the patient and provide the measured care in order to qualify for PQRS. In the GPRO option, so long as at least one provider in the group saw the patient and provides the care, every provider in the group qualifies. Providers with good measures and good data can “carry” the rest of the group.
There are four significant changes that make GPRO a lot more interesting and easier to do in 2013.
1) Groups with as few as two eligible professionals can report as a group.
2) Registry is an option as a reporting method.
3) The GPRO self-selection period has expanded
4) Only with a GPRO submission for 2013 can groups of 100 or more providers avoid a 1% Adjustment (Penalty) on 2015 charges in the new Value Based Modifier program
First: The number of eligible professionals defined as a “Group” in 2013 has changed. A group is defined as two or more PQRS eligible professionals, billing Medicare under the same Tax Identification Number (TIN). The incentive is paid on the performance of the group, rather than that of the individual professionals.
In prior years, the number of eligible professionals required to select the GPRO has varied and in 2012 was 25.
Second: The Registry option for GPRO can make reporting dramatically easier. In prior years, the only way to report via GPRO was to use the CMS web-based GPRO portal. Sometime near the end of the year, CMS populates the portal with a select list of patients that CMS identifies as belonging to the group. There are 29 measures that have to be reported. Groups of 100 or more providers have to report on the first 411 patients in the list eligible for each measure. Groups of 25 to 99 providers have to report on the first 218 patients eligible for each measure. It’s an onerous, predominantly manual process of abstracting the chart and filling out the web form.
Using the new GPRO Registry option, the group can submit data on any three “Individual Measures” to report through a Registry Vendor. If you have to abstract your data from a paper or a text-based electronic chart, you can report on just 3 measures instead of 29. And if you have structured data in an EMR, it’s possible to extract the data using database reporting tools, entirely automating the submission.
Third: In the past, you had to elect the GRPO option by January 31 of the reporting year. You can still self-select in January, but there is a new self-selection period that begins mid-June and ends October 15.
Fourth: Medicare introduces the “Value-Based Modifier” in the 2013 reporting year. In 2013, all groups of 100 or more providers are subject to the Value Based Modifier (“VBM”). The program is expected to expand every year. By 2017, all providers in any size group will be subject to the VBM. The VBM program introduces a new 1% adjustment (penalty). The only way to avoid the adjustment (penalty) is to submit quality of care PQRS data to CMS using one of the GPRO reporting methods. The submission must be GPRO, and for the 2013 reporting year the Registry Option and the Web-Based Tool option are the only two ways to submit GPRO.
Groups of 100 or more providers who do not submit GPRO in 2013, will see Medicare payments in 2015 reduced by 1%. The VBM adjustment is in addition to any PQRS or eRx adjustments to which the group is subject.
Watch for these deadlines:
October 15, 2013: To be considered for 2013 Physician Quality Reporting GPRO, all group practices must address all requirements in a self-nomination statement received via the web and select their reporting method. The method can change at any time prior to the October 15, 2013 deadline.
For more about GPRO—see the CMS website.
Dr. Dan Mingle shares key changes and strategies for success in 2020 for MIPS.