Things to consider when reporting 2013 PQRS

Dermatologists who report at least three quality measures to Medicare’s Physician Quality Reporting System (PQRS) in 2013 will not only make themselves eligible for a bonus payment of 0.5 percent of their total Medicare Part B allowed charges, but can also avoid a 1.5 percent payment reduction to be assessed in 2015. If a dermatologist wishes to only avoid the 2015 reduction, but not earn a 0.5 percent incentive, then he or she only needs to report one measure during the 2013 reporting year.

There are several factors in deciding how to participate in the 2013 PQRS. One should first calculate his or her expected incentive (0.005 x total Medicare charges) and his or her potential 2015 payment reduction (0.015 x Total Medicare charges). One should then consider the cost of a CMS-qualified registry. The quality measures that are most applicable to dermatologists (PQRS measures 137, 138, 224, and 265) can only be reported via electronic registry. Therefore, if reporting at least three of these measures to earn an incentive, one needs to deduct the cost of the chosen registry from the expected incentive. Finally, a potential participant needs to factor in staff time to input the information. This time will vary based on how many applicable Medicare patients a dermatologist treats in 2013. If one chooses this path, then he or she will have also automatically avoided the 1.5 percent payment reduction to be administered in 2015.

To solely avoid the 2015 payment reduction, a dermatologist can report one measure. This can be done either via registry, or by adding a special quality measure code to a Medicare claim during the 2013 reporting year. Note that one cannot report the dermatology-appropriate measures via claims. If choosing to report via claims, one will need to research the other available measures. Staff time to report one measure using either method should be minimal.

   Benefits   Calculations
to consider
3   Registry  
  • Registry fee
  • Staff time
  • Earn 0.5% incentive
  • Avoid 1.5% payment reduction in 2015
  (0.005 x total Medicare charges) - ($249* + staff time) = incentive
1   Registry
  • Registry fee
  • Avoid 1.5% payment reduction in 2015
  $249 > (0.015 x Total Medicare Charges) or $249 ≤ (0.015 x Total Medicare Charges)

1   Claims  
  • None
  • Avoid 1.5% payment reduction in 2015
  0.015 x total Medicare charges = payment reduction
  • 1.5% payment reduction in 2015
  • None
  0.015 x total Medicare charges = payment reduction

* $249 represents the cost of the 2013 AAD PQRS reporting module only and is being used as an example. Prices of other qualified registries will vary and will need to be substituted in these hypothetical scenarios.