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Tuesday Nov 10, 2015

Beat the PQRS Deadline, Avoid 2 Percent Medicare Cut

CMS has announced that it is extending the 2014 informal review period for the Physician Quality Reporting System to Nov. 23. The previous deadline had been Nov. 9. All physicians who participate in the Medicare fee-for-service program, the Comprehensive Primary Care Initiative, PQRS group practice reporting option, or an accountable care organization are required to report quality measures through the PQRS program.

Starting in 2016, physicians who did not report quality measures in 2014 face a negative 2 percent payment adjustment on all Medicare services. If you are uncertain about your status with respect to the 2014 PQRS reporting year, the AAFP encourages you to contact CMS and initiate an informal review. All informal review requests must be submitted electronically via the Quality Reporting Communication Support Page(www.qualitynet.org) (CSP) by 11:59 p.m. Eastern on Nov. 23. According to CMS, all informal review requestors will be contacted via email with a final decision within 90 days of the original request.

The PQRS program, established by the Tax Relief and Health Care Act of 2006 and signed into law by President George W. Bush on Dec. 20, 2006, requires physicians participating in Medicare to submit quality data to CMS. The program initially provided positive payment incentives, but starting this year penalties were implemented. The negative 2 percent payment adjustment being implemented in 2016 will remain in effect until the PQRS program is revised by the Merit-Based Incentive Payment System, established by the Medicare Access and CHIP Reauthorization Act.

The AAFP has extensive PQRS resources that can assist you. Family Practice Management also has information that you may find beneficial. You may also wish to review CMS’s 2014 Physician Quality Reporting System (PQRS): Incentive Eligibility & 2016 Negative Payment Adjustment -- Informal Review Made Simple(www.cms.gov). Finally, you can contact the CMS QualityNet Help Desk at 1-866-288-8912 (TTY 1-877-715-6222) or Qnetsupport@hcqis.org Monday through Friday from 7 a.m. to 7 p.m. Central.

Mr. Speaker

On Oct. 29, Paul Ryan, R-Wis., was sworn in as the 54th speaker of the House of Representatives(www.speaker.gov). He was elected to the position by the full House following the retirement of Speaker John Boehner, R-Ohio. Ryan, who was the Republican candidate for vice president in 2012, was first elected to the House in 1998 at the age of 28. He is a former chairman of the House Budget Committee and was most recently chairman of the powerful House Ways and Means Committee. He is the co-author of the Bipartisan Budget Act of 2013, better known as the Ryan-Murray. This legislation averted a sustained financial crisis and looming government shutdown -- scenarios he once again faces as the new speaker.

On Nov. 4, the Kevin Brady, R-Texas, was selected to replace Ryan as the chairman of the House Ways and Means Committee. Congressman Brady was previously chairman of the committee’s Subcommittee on Health.

Wonk Hard
BMJ has published a new report(www.bmj.com) entitled “Physician Spending and Subsequent Risk of Malpractice Claims: Observational Study.” The authors examined the long-standing issue of the relationship between medical liability claims against physicians and defensive medicine. They note that, “Despite widespread agreement that physicians practice defensive medicine to reduce malpractice liability, there are no studies of whether greater resource use by physicians, whether it is defensively motivated or not, is associated with reduced claims for malpractice. This lack of evidence is surprising, given that defensive medicine is premised on greater resource use reducing malpractice liability.”

So what did the researchers find? Well, defensive medicine likely grew due to the simple fact that it may actually work. According to the findings, “in six of seven specialties, we found that greater resource use was associated with statistically significantly lower subsequent rates of alleged malpractice incidents.”  

The authors note that this study has limitations, but the findings have important policy implications. In an era where the costs of health care are front of mind for individuals and policy-makers, it may be time to place greater emphasis on medical liability reform as a means of managing escalating costs.

Posted at 07:00AM Nov 10, 2015 by Shawn Martin

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ABOUT THE AUTHOR



Shawn Martin, AAFP Senior Vice President of Advocacy, Practice Advancement and Policy.

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The opinions and views expressed here are those of the authors and do not necessarily represent or reflect the opinions and views of the American Academy of Family Physicians. This blog is not intended to provide medical, financial, or legal advice. All comments are moderated and will be removed if they violate our Terms of Use.