Individual and Small Group Eligible Professionals Must Act Now to Avoid Multiple Quality Reporting Penalties

Successful 2016 physician quality reporting systems (PQRS) will be doubly important for individual practitioners and groups with fewer than nine eligible professionals (EPs), as their PQRS reporting will also affect their 2018 value-based payment modifier (VBPM), possibly resulting in two negative payment penalties of 2% each.

In previous years, as long as they successfully reported data to PQRS, these individual and small group practitioners were not penalized in the VBPM program, regardless of performance.  However, beginning this year, failure to successfully report PQRS data will result in an automatic VBPM 2% negative payment adjustment.  In addition, those who do successfully report to PQRS will see a 2018 VBPM adjustment from anywhere to approximately +2.0% to -2.0%, as determined by the actual cost and quality data submitted.

Non-Physician Practitioner Performance Data to be Included in VBPM Determination

Another key policy change is that the 2018 VPBM will be applied to certain non-physician practitioners (NPPS), such as physician assistants and nurse practitioners, whose payments will be adjusted along with those of the physician providers.

Key 2018 Value-Based Payment Modifier Takeaways:

  • Those who don’t successfully report in 2016 will see an automatic -2% adjustment
  • The adjustment of those who do successfully participate will be determined by their data
  • Certain NPPs payments will now be adjusted at the same rate as the group’s physicians

What an Individual or Small Group Should do to Increase Chances of Success

Group practitioners should be aware of the most current PQRS measures and how to successfully report them.  If you have any questions on whether you will be affected by these policy changes, contact the Anders Health Care Group.