CMS Data Problems Impact 2016 Value Modifiers

If you are a physician who hired a vendor to submit data to the 2014 Physician Quality Reporting System (PQRS) via electronic health records and qualified clinical data registries (QCDR), your data is not going to be used for the 2016 value modifier.

The Centers for Medicare and Medicaid Services (CMS) reported at the end of August that various errors occurred in the system. If you are a physician or practice that reported directly, you’re okay.

The agency said the errors resulted in inconsistencies between the electronic health records (HER) and QCDR data so the information cannot be used to calculate quality performance for the 2016 value modifier, nor can PQRS performance information be included on Physician Compare.

The good news is that there is no impact on the physician for the meaningful use EHR incentive programs, because he/she is judged only on whether or not he/she successfully reported rather than on his/her actual performance.

There will be no need for physicians or group practices to submit a PQRS informal review request.

Value Modifier Problems

But the value modifier is a problem because that involves actual quality scores in addition to simply having reported. Therefore, CMS says it 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.

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

The American Medical Association (AMA) says because of the intervention of the AMA, CMS will only report information through star ratings on physicians and group practices 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, 2015. In order to review a preview report, a physician will have to access the report through the PQRS Portal and have an EIDM (Enterprise Identity Management System) account.