American College Of Surgeons - Inspiring Quality: Highest Standards, Better Outcomes

How to Avoid Medicare Penalties

Medicare oversees several programs that offer physicians incentives for successful participation and/or penalties for nonparticipation. These programs include:

  • The Physician Quality Reporting System (PQRS)
  • The Value-Based Payment Modifier (VM)
  • The Electronic Health Record (EHR) Incentive Program, also called the EHR Meaningful Use program

2014 was the last year that physicians can earn incentives for some of these programs as they are currently structured. Lack of participation in these programs in 2016 may result in a total penalty of 10 percent, which will be applied to physicians in 2018. Please note that for most Medicare incentive programs, penalties will apply to your Medicare payments two years after your performance in the programs (i.e., 2016 performance determines 2018 payment).

Medicare Potential Penalties from 2016–2018

Program

2016

2017

2018

Physician Quality Reporting System

-2%

-2%

-2%

Value-Based Payment Modifier

-2%

-4%

-4%

EHR Incentive Program
(2014 was the last year to begin participation to earn an incentive payment, which is paid over three years)**

-2%

-3%

-4%

Total Potential Penalty

-6%

-9%

-10%

*The eRx Incentive Program has ended. However, providers who did not participate in the eRx Incentive Program in 2012 or the first six months of 2013, or did not get approved for a 2013 eRx hardship exemption, may still be subject to -2.0% penalty in 2014. Additionally, if these providers do not participate in the EHR Incentive Program in 2014, they will be subject to an additional 1% penalty for the EHR program in 2015, thus resulting in a 2% penalty for the EHR program in 2015.

**Visit the ACS website for more information and resources on the EHR Incentive Program for physicians who started participation prior to the incentive cutoff performance year of 2014.

How Is ACS Helping You?

Surgeon Specific Registry (SSR)

The SSR, formerly known as the ACS Case Log, allows surgeons to track their cases and outcomes in a convenient, easy-to-use, and confidential manner. The SSR can also be used to comply with regulatory requirements, such as submitting 2016 PQRS data. The SSR allows individual surgeons to report on:

  • The PQRS General Surgery Measures Group (surgeons can choose to report on as few as 20 patients (11 of which must be Medicare patients)
  • 2016 PQRS individual measures
  • 2016 ACS SSR Qualified Clinical Data Registry (QCDR) – Trauma Measures Option

Surgeons will have until January 31, 2017, to submit CY 2016 patient information in the SSR. The SSR will submit the PQRS data to CMS.

The SSR is currently free of charge to ACS surgeon members and is available to non-member surgeons for an annual fee of $299. Surgeons who have used the Case Log in the past can log on to the SSR with the same username and password and begin entering cases. For current users, the SSR can produce a report that indicates the surgeon’s eligible PQRS cases based on measures group CPT codes. These cases may be easily edited with PQRS-specific data through the report. If surgeons have not used the SSR in the past, they can register on the ACS website.

Metabolic and Bariatric Surgery Accreditation and Quality Improvement Program (MBSAQIP)

The MBSAQIP has been submitted for approval by CMS as a QCDR for PQRS 2016. MBSAQIP participants will have the opportunity to voluntarily elect that their MBSAQIP QCDR quality measures results be submitted to CMS for PQRS participation. Metabolic and bariatric surgeons will receive reports of their QCDR measures results so they can track, and have the opportunity to improve, their results. The MBSAQIP will submit approved 2016 QCDR measures during the first quarter of 2016 on behalf of MBSAQIP participants who elect to have their data submitted. One benefit of using the MBSAQIP is that data are already being collected as part of participation in the MBSAQIP, whereas other options to satisfy PQRS may have additional data burdens. Specifications of the approved MBSAQIP QCDR quality measures are available.

Resources for Surgeons

Additional background information and PQRS resources are available, as well as www.cms.gov/PQRS. Resources for the EHR Incentive Program are available from the ACS as well as the CMS.

ACS Advocacy and Health Policy staff have compiled a glossary to help define terms and acronyms consistently used when learning how to avoid Medicare penalties.

ACS staff members are also available to answer questions and assist members participating in the 2016 PQRS program, EHR Incentive Program, and VM, and to facilitate enrollment in the SSR and the MBSAQIP. Surgeons can contact the following ACS staff:

  • General PQRS, EHR Incentive Program, and VM questions: Molly Peltzman, ACS Division of Advocacy and Health Policy, 202-337-2701 or mpeltzman@facs.org
  • Information on the SSR: Joe Bonura, ACS Division of Research and Optimal Patient Care (DROPC), 312-202-5000 or ssr@facs.org
  • Information on the MBSAQIP: Rasa Krapikas, ACS DROPC, 312-202-5000 or rkrapikas@facs.org
  • CMS is also available to answer PQRS-related questions at 1-866-288-8912 or qnetsupport@hcqis.org