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January 25, 2018

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Medicare Quality Incentive Programs See Upward Participation Trend

August 25, 2015:

More than half of eligible providers in the United States participated in Medicare’s Physician Quality Reporting System (PQRS) program in 2013 and are eligible to receive incentive payments for 2015, according to the Centers for Medicare and Medicaid Services’ 2013 Physician Quality Reporting System (PQRS) and Electronic Prescribing (ePrescribing) Incentive Program Experience Report. Data from 2013 determine 2015 incentive payments or adjustments.

For the first time, those who did not participate in the program in 2013 or failed to submit appropriate quality measures will have their Medicare Part B payments for allowed charges “adjusted” (reduced) by 1.5 percent. According to the report, released in April 2015, almost half of eligible professionals will be subject to the payment reduction. Of those, 43 percent treat 25 or fewer Medicare beneficiaries per year. About 340,000 of the approximately 470,000 EPs subject to the adjustment are having their payments reduced by $600 per year or less.

In 2013, more than 494,000 EPs qualified for an incentive payment, an increase of 35 percent over the previous year. The average incentive payment was $443 per EP and $4,531 per practice.

By far, the measure reported by the most EPs was documentation of current medications in the medical record. The next three most reported measures involved preventive care and screening, specifically tobacco use screening and cessation intervention, body mass index screening and follow-up, and pneumococcal vaccination for those 65 years and older.

More EPs specializing in emergency medicine and anesthesiology earned a PQRS incentive through claims-based individual measures than any other specialties. Of those reporting through claims-based measures groups or registries, the top specialties represented were internal medicine and family practice.

The eRx Incentive Program, which ran from 2009 through 2013, involved about 377,000 of 808,000 eligible professionals in 2013. There were nearly 260,000 successful ePrescribers in 2013, with an average individual incentive payment of $662 per EP and $3,131 per practice (0.5 percent of total allowed MPFS).

As with PQRS, over the last few years, the number of successful participants in the eRx program has been increasing, while fewer and fewer providers have been subject to payment adjustments. In 2012, for instance, the eRx payments of about 140,000 ePrescribers were reduced, whereas just under 50,000 ePrescribers were subject to a 1.5 percent eRx payment reduction in 2014.


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