The Physician Quality Reporting System (PQRS) and Value-based Payment Modifier (VBM) have been rolled into MIPS
The last performance year for the Physician Quality Reporting System (PQRS) and Value-Based Payment Modifier (VBM) program was 2016. For the 2017 performance year and beyond, CMS has rolled PQRS/VBM into the Quality category under the Merit-based Incentive Payment System (MIPS).
The Quality category will make up 60% of the total MIPS score for the first performance year and inherits some aspects of the measures and reporting infrastructure created by the PQRS/VBM program. For example, the array of PQRS reporting methods, including registry, EHR, and web interface, are largely preserved for purpose of reporting quality performance under MIPS.
On the other hand, there are some significant changes to how quality is reported and rated under MIPS versus the existing programs. A few of the key changes include:
- Measure Selection: For the registry, EHR, and qualified clinical data registry (QCDR) reporting methods currently requiring nine measures and three quality domains, the minimum quality reporting requirement is reduced to only six measures and can span any combination of quality domains. However, the six measures must include one outcome measure.
- Reporting Methods:
- For the registry and QCDR reporting methods, the data completeness standard is set for 50% of all patients for the first performance year.
- Clinicians intending to use the group practice (GPRO) reporting option will only need to declare their specific reporting method by June 30th of the performance year if they choose the CMS Web Interface reporting method and/or choose to report patient experience measures via the CAHPS for MIPS survey.
- Quality Performance Scoring and Benchmarking: Each measure earns quality points based on a percentile scale versus benchmarks, e.g. a 55% measure rate may be greater than that of 60% of all clinicians, so the measure earns seven out of a possible 10 points. Each reporting method will have a different set of measure benchmarks for the measures reported through that method
With so many program changes, clinicians who have traditionally avoided PQRS/VBM penalties may not have a high enough MIPS Quality score to avoid MIPS penalties.