Final Rule with Comment period: changes to Incentive Programs for
On November 1, 2011, the Centers for Medicare & Medicaid Services (CMS) issued a final rule with comment period that will update payment policies and rates for furnished services under the Medicare Physician (MPFS) on or after January 1, 2012. The final rule makes changes to several incentive programs that are associated with MPFS payments – electronic health records (EHRs), and the Physician Quality Reporting System (PQRS) - as well as changes to the Physician Compare tool.
The Medicare and Medicaid EHR Incentive Programs requires eligible professionals (EPs), eligible hospitals, and CAHs to electronically submit clinical quality measure (CQM) results as calculated by certified EHR technology beginning in the 2012 payment year. The July, 2010, final rule implementing the program also stated that the primary method for these providers to report required CQM information electronically would be to log into a CMS-designated portal and submit data through an upload process. Under the MPFS final rule announced today, CMS finalizes the following methods for reporting CQM’s in order to demonstrate meaningful use by EP’s:
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Continue with attestation for reporting CQMs
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Participate in a PQRS-Medicare EHR Incentive Pilot, established in this 2012 MPFS final rule that relies on the infrastructure of the Physician Quality Reporting System. EPs could report CQMs vial the pilot through either of two methods:
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By using a PQRS-qualified EHR data submission vendor to submit calculated results from the EP’s certified EHR to CMS on the EP’s behalf; or
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By submitting CQM data directly from certified EHR to CMS through a secure portal. The EHR must also be a qualified PQRS EHR product.
Under the MPFS final rule, CMS finalizes the following requirements for PQRS in 2012:
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Group Practice Reporting Option for reporting PQRS:
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CMS defines a “group practice” as a group of 25 or more individual eligible professionals, and makes conforming changes to the criteria for satisfying the reporting requirements to reflect the change in the definition.
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The rule also finalizes 29 measures for reporting under the Physician Quality Reporting System GPRO in order to align with other CMS quality reporting programs.
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Individual Eligible Professional reporting:
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A PQRS core measure set (seven measures, one of which is available for EHR reporting only) aimed at the prevention of cardiovascular conditions;
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Finalizes 211 individual measures available for claims and/or registry reporting, including 26 new measures;
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All 44 EHR measures currently reportable in the Medicare EHR Incentive Program
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Includes a reporting option for EHR-based reporting that aligns with the reporting requirements for reporting CQMs under the EHR Incentive Program; and
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Allows for submission of the PQRS EHR measures through an EHR data submission vendor in addition to direct submission from an EP’s EHR-based product to CMS
Maintenance of Certification Program Incentive
Payment Adjustment for 2015
Section 10331 of the Affordable Care Act requires CMS to implement a plan for making information on physician performance publically available no later than January 1, 2013. This provision supports CMS’s overarching goals to foster transparency and public reporting by providing the consumer with information to make informed decisions about their health care, while encouraging clinicians to improve the quality of the care they provide to their patients.
The MPFS final rule announced today finalizes the proposed plan initially based on public reporting of performance rates for group practices that submitted data under the PQRS GPRO reporting option for the 2012 reporting period. CMS finalizes its proposal to report performance rates for other CMS demonstrations using group practice reporting on the Physician Compare web site as early as 2013.
The final rule with comment period will appear in the November 28, 2011 Federal Register. CMS will accept comments on those provisions subject to comment until January 3, 2011 and will respond in the MPFS for CY 2013.