More than 500K clinicians will be hit with 2% Medicare quality reporting penalty this year

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Some 500,000 clinicians will see a 2% reduction in Medicare payments this year.

Slightly more than 500,000 clinicians who participated in the government’s Physician Quality Reporting System (PQRS) will be hit with a 2% Medicare penalty this year because they didn’t meet program requirements.

Some 501,933 clinicians are subject to a 2% reduction in their 2017 Part B fee-for-service charges based on 2015 PQRS reporting, according to a report from the Centers for Medicare & Medicaid Services.

Some 63% of the clinicians who participated in the government program avoided the adjustment.

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Half of those who will see their fee-for-service Medicare payments reduced this year are physicians. Clinicians are being hit with the penalty for not meeting PQRS requirements in 2015.

RELATED: CMS releases updated proposed rule for MACRA, eases burden on small and rural practices

How much of a reduction clinicians will see depends on the amount of Medicare charges. For many, the impact will be minor. According to the CMS report on PQRS performance for the 2015 reporting period, almost 230,000 clinicians who face the penalty had $10,000 or less in Medicare charges that year. So a 2% cut will only mean a drop of $200 in Medicare revenue.

On the other hand, 64,200 clinicians had charges that exceeded $100,000. The 2% penalty means they will forfeit more than $2,000 if they bill Medicare for as much in 2017.

PQRS was begun in 2007 and the final year for reporting in the program was 2016. The Medicare Access and CHIP Reauthorization Act of 2015 (MACRA) ended the Sustainable Growth Rate formula and replaced a patchwork collection of quality programs that included PQRS, with what’s been dubbed the Quality Payment Program. PQRS is being rolled into the Merit-based Incentive Payment System (MIPS) track. Clinicians will begin to be paid under MACRA in 2019 based on bonuses and penalties determined by their performance this year.

CMS also released a proposed rule yesterday with changes to MACRA for 2018—the second year of the value-based payment system.

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