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Why should complex organizations get ready now for PQRS in 2014?

“We are doing Administrative Claims.” This is something we hear a lot in 2013, especially from large complex health systems with multiple TINs.

It’s understandable—gathering data to report on PQRS for several groups, under multiple TINs, multiple specialties and often multiple record-keeping systems is a daunting task. It requires someone to coordinate, orchestrate manage and manipulate mountains of data—data that is not always easily accessible.

But here’s why we feel it’s important to start on that task now and not wait: 7%.

That’s the magic percent of cumulative penalties that will impact practices with as few as 10 eligible professionals if they do not participate in PQRS in 2015.

-2% PQRS penalty

-2% Value-based Modifier

-3% Meaningful Use Stage 2, CQMs reported electronically

Total:  -7%

Add to that mix the fact that the Value-Based Modifier Quality Tiering is mandatory in 2014 for groups of 100 or more. So that even if you submit your PQRS data, it doesn’t automatically exempt you from a penalty as it does in 2013.

Quality Tiering compares your data to the national mean not just on the quality measures you submit, but on the cost of the care you deliver. There is still the opportunity to incur a -2% penalty if your care is of low quality and high cost when compared to other organizations.

Medicare has begun to publish Quality Resource and Use Reports (QRURs) which will

increasingly preview the performance scores that will be used in calculating the value-based payment modifier. Beginning with the 2012 QRURs, CMS will provide reports (in 2013) solely to groups in which twenty-five or more eligible professional submit claims under a single tax identification number (TIN).

Look for your QRUR and see how you compare—considering what’s at stake you’ll want to start now to plan for PQRS submission in 2014.

To learn how to access your QRUR, check our FAQs

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