More Than 500,000 Clinicians Will Be Hit With Medicare Penalty This Year

Charges could be as high as $2,000 for those who did not meet PQRS requirements

Approximately half a million clinicians who participated in the Centers for Medicare and Medicaid Services’ (CMS) Physician Quality Reporting System (PQRS) will be hit with a 2% Medicare penalty this year because they didn’t meet program requirements, according to a report from FierceHealthcare. These health care professionals are subject to reductions in their 2017 Part B fee-for-service charges based on 2015 PQRS reporting.

The PQRS, implemented by the CMS in 2007, rewarded eligible professionals (EPs) with a payment incentive and applied a payment adjustment based on whether the EPs met requirements for reporting information on standardized clinical quality measures. The last year in which EPs could earn an incentive payment was 2014.

Beginning in 2015, EPs who did not meet reporting requirements for program year 2013 or who did not have any other reason for avoiding the 2015 payment adjustment were subject to a 1.5% reduction in their Part B physician fee schedule (PFS) charges. PQRS reporting in program year 2014 was used to determine which eligible professionals would be subject to a 2% reduction in their 2016 Part B PFS charges, and PQRS reporting in program year 2015 was used to determine which eligible professionals would be subject to a 2% reduction in their 2017 Part B PFS charges.

A total of 501,933 EPs will be subject to the 2017 PQRS payment adjustment based on their 2015 reporting experience, before the final results from informal reviews, according to the CMS. Most of the EPs (79%) who are subject to the adjustment did not submit PQRS data in 2015.

Approximately 230,000 clinicians who face the penalty had $10,000 or less in Medicare charges that year––so a 2% cut will mean a drop of only $200 in Medicare revenue. On the other hand, 64,200 clinicians had charges that exceeded $100,000. The 2% penalty means that they will forfeit more than $2,000 if they bill Medicare for as much in 2017.

The cities with the highest percentage of EPs subject to the 2017 payment adjustment include Atlanta (17%), Chicago (16%), San Francisco (15%), and New York (12%).

Sources: FierceHealthcare; June 21, 2017; and PQRS Report; 2017.