WebPT’s Recommendations on How to Approach PQRS in 2014

If you’ve been following the WebPT Blog, hopefully by now you’re up to snuff on the basics of PQRS 2014, including the reporting requirements, the available measures, and the associated incentives and penalties. (If you’re still mostly in the dark, read this blog post to bring yourself up to speed.)

Now, you’ve got some decisions to make: How will you submit your PQRS measures? How many measures will you report? Which measures will you report? If those questions make you feel a wee bit overwhelmed, just close your eyes, take a deep breath, and calm down, because WebPT is here to help.

Choosing Your Reporting Method

First off, there are two main ways to submit your PQRS data to CMS: via claims or via a registry. With claims-based reporting, you submit all of your own reporting information to CMS. And because you’re in control of your data, the burden of compliance is completely on your shoulders. If you report via a Certified PQRS Registry like WebPT, on the other hand, the registry handles most of PQRS for you. WebPT, for example, merges PQRS with your standard documentation, so all you have to do is report your measures directly within your notes. Then, we compile your data and submit it to CMS on your behalf.

So, while reporting via claims certainly works, we definitely recommend reporting via registry—especially considering that the PQRS requirements for 2014 are much tougher than they were in 2013. For example:

• Most eligible professionals will have to report on nine measures to earn the 0.5% incentive (up from three last year)
• Most eligible professionals will have to report on three measures to avoid the penalty (up from one last year)
• The penalty for noncompliance in 2014 is 2% of total Medicare payments (up from 1.5% last year)

Once you’ve decided how you will report, you’ll need to decide the degree to which you want to report. As mentioned in the bullets above, there’s a 0.5% incentive available to eligible professionals who successfully meet all reporting criteria. There’s also a penalty of 2% (assessed as a payment adjustment in 2016) that you’ll incur if you don’t at least meet the minimum reporting requirements. (Again, for details on those requirements, refer to this blog post.) With that in mind, here are our recommendations for degree of reporting, separated by registry-based and claims-based.

Sugggestions for Registry-Based Reporting

If you’re reporting via registry, the easiest, most efficient way to ensure you avoid the penalty and earn the incentive is to report on the back pain measures group. This group includes four measures—all related to back pain—that you must report for at least 20 patients. However, this route is only available to physical therapists using registry-based reporting. Remember, though, that if Medicare patients make up only a small percentage of your payer mix, then this option might not be suitable for your clinic (i.e., you might not have 20 patients who are eligible for the back pain measures group.)

For OTs, SLPs, and PTs who are not eligible to report on this measure group, WebPT recommends weighing the incentive amount against additional workload and potential loss of productivity. We bet you’ll find that the incentive is not enough to account for the reporting burden. Thus, we recommend simply reporting to avoid the penalty. To do that, you’ll need to report on three measures, as detailed in this blog post.

If you decide to go for the incentive, you’ll need to select and report on as many measures that apply to you as an eligible professional (i.e., as a PT, OT, or SLP), up to nine measures. For PTs, that would amount to a total of eight measures.

Suggestions for Claims-Based Reporting

 If you decide to go with claims-based reporting, you are not eligible to report on the back pain measures group. Thus, the only way to earn the incentive would be to report on the maximum number of measures applicable to you as an eligible professional, up to nine measures. That’s a lot of reporting—and, because you must record and submit your own data, a lot of time on your end. Thus, for those providers reporting via claims, we recommend foregoing the incentive and simply reporting to avoid the penalty. To do that, you’ll need to report on three measures, as detailed in this blog post.

Still not sure how you should approach PQRS in the New Year? Leave your questions in the comment section below, and we’ll get you an answer.