The PQRS/eRx Experience Report is released by CMS annually and provides trends on participation, incentive eligibility, and incentive payments since the beginning of PQRS and the eRx Incentive Program, including measure performance and program participation broken down by specialty and state. Statistics on the 2015 PQRS payment adjustment will be released to the public for the first time through this report. The full report can be found at http://www.cms.gov/Medicare/Quality-Initiatives-Patient-Assessment-Instruments/PQRS/AnalysisAndPayment.html.
The 2013 report found that there was an increase in participation from eligible professionals and in reporting clinical quality information for both PQRS and the eRx Incentive Program, reflecting both increased use of eRx as well as increased tracking and reporting of important quality information. The report also indicates progress in CMS’ efforts to improve quality measurements, and to encourage building a national electronic health information infrastructure in the United States.
Report highlights include:
- Participation in the PQRS program increased by 47 percent from 2012 to 2013. In 2013, 641,654 eligible professionals participated either as individuals or as part of PQRS group practices, through at least one reporting mechanism, a 47 percent increase from the 435,931 who participated in 2012. Approximately 51 percent of the 1.25 million professionals who were eligible to participate in 2013 participated in PQRS. The 2013 PQRS incentive payments totaled $214,551,741.
- 469,755 eligible professionals were subject to a 2015 PQRS negative payment adjustment. Based on 2013 PQRS reporting, 469,755 eligible professionals are subject to a reduction of 1.5 percent of their 2015 Part B Medicare Physician Fee Schedule allowed charges. Of those professionals subject to the adjustment, 98 percent did not attempt to participate in PQRS. In addition, 43 percent of the professionals subject to the payment adjustment treat 25 or fewer Medicare beneficiaries a year.
- 2013 participation in the eRx program rose by 9 percent from 2012. In the final year of reporting under the eRx Incentive Program, 377,004 eligible professionals participated, a 9 percent increase from the 344,676 who participated in 2012. Approximately 47 percent of the 808,697 professionals who were eligible participated in 2013. The 2013 eRx incentive payments totaled $168,298,019.
PQRS initially used incentive payments to encourage participation. Beginning in 2015, based on 2013 reporting, negative payment adjustments were implemented as required by statute, which encourages eligible health care professionals to report on designated quality measures. The eRx Incentive Program used a combination of incentive payments and payment adjustments to encourage electronic prescribing by eligible professionals; 2013 was the last year of the program but electronic prescribing continues with Meaningful Use.
More information about PQRS, including the reporting criteria for incentive eligibility, which ended in 2014, and avoiding the negative payment adjustment, starting in 2015, is available at http://www.cms.gov/PQRS.
More information about the eRx Incentive Program, which ended in 2013, can be found at http://www.cms.gov/ERxIncentive/.