Learn More About Significant Medicare Reporting Changes

The Centers for Medicare and Medicaid Services (CMS) has adopted new Medicare reporting requirements that may significantly impact oncology practices that treat patients covered by Medicare. Namely, CMS is shifting from offering incentives to providers for participating in certain reporting programs—the current system—to reducing reimbursements to those providers who do not participate.

Near-term action is required to prevent payment reductions. The greatest impact of these changes will be felt in 2015, but will be based on participation in CMS reporting programs in the coming year. The American Society of Clinical Oncology (ASCO) is urging practices to begin preparing for the new CMS reporting requirements now to avoid reductions in reimbursement later.

CMS Reporting Programs

Although CMS does not require participation in its designated reporting programs, the federal agency strongly encourages providers to share information on specific quality measures and the use of health information technology through three reporting programs: (1) the Physician Quality Reporting System (PQRS), (2) the Electronic Prescribing (eRx) Incentive Program, and (3) the Electronic Health Records (EHR) Incentive Program (“Meaningful Use”).

Previously, CMS has offered financial bonuses to practices as reporting incentives; these incentives are being phased out and will be eliminated completely within the next few years. If eligible providers don’t participate in the PQRS in 2013, CMS will reduce their Medicare Part B physician fee schedule reimbursements in 2015. Additionally, providers who do not have an electronic prescribing (eRx) system in place in 2012 (this year) will receive reduced reimbursements in 2013. Reductions also occur in 2015 for any provider not participating in the electronic health records (EHR) program.

Finally, in the 2013 Medicare Physician Fee Schedule proposed rule, CMS has proposed using participation in PQRS as a component of the new “value-based payment modifier” required by the Affordable Care Act. This payment modifier will affect select groups of physicians in 2015 (these groups are to be defined by CMS; in the proposed rule, CMS proposes practices with 25 or more physicians), and will affect most physicians by 2017. ASCO will closely monitor the final rule for details on how CMS will actually implement this payment modifier.

The timing and amount of reimbursement reductions vary depending on the specific CMS reporting program:

• PQRS: Physicians who do not participate in the Physician Quality Reporting System during the 2013 program year will lose the 0.5 percent bonus for 2013, and receive a 1.5 percent payment reduction in 2015.
• eRx: Physicians not participating in the Electronic Prescribing Incentive Program in 2012 will lose a possible 1.0 percent bonus for 2012, and have 1.5 percent automatically deducted from their reimbursements in 2013. Physicians not participating in Electronic Prescribing Incentive Program in 2013 lose a possible 0.5 percent bonus for 2013, and face a 2.0 percent payment reduction in 2014.
• EHR: Eligible professionals who are not meaningfully using electronic health records by 2015 will have their Medicare payments reduced by 1 percent in 2015, and reduced by an additional 1 percent every subsequent year for non-participation, up to a maximum of 5 percent.

Past participation rates in the CMS reporting programs have been low in oncology. According to CMS data, only 22 percent of eligible radiation oncologists and 30 percent of oncologists/hematologists successfully participated in the PQRS program in 2010.

Nevertheless, with reimbursement cuts looming for most oncology practices that care for Medicare patients but do not participate in these reporting programs, ASCO is ramping up its efforts to inform its membership of the upcoming changes. Participating in the CMS reporting programs requires administrative time and effort, and practices that don’t currently participate will need time to implement internal measures to establish a reliable reporting process.

ASCO Action

To help practices adapt quickly to the changing CMS reporting requirements, ASCO is increasing communications, outreach, and guidance on these programs, including a new web page with additional details on the impact of the Medicare reimbursement reductions at www.asco.org/CMSreporting.

REGISTER for ASCO's free national webinar on Tuesday, November 13th, from 4 PM - 5:30 PM ET. The webinar will cover the new CMS reporting requirements, including the PQRS, EHR Meaningful Use, and eRx programs. Registration is limited to ASCO members and associated practice staff. More detail about the webinar can be found here.

Read more here.