SUMMARY OF 2015 PARTICIPATION REQUIREMENTS
In late October 2014, CMS finalized the requirements for patient experience data collection for the 2015 performance year as follows:
- Mandatory administration of PQRS CAHPS continues for medical groups with at least 100 eligible professionals, and expands from groups using the Group Practice Reporting Option (GPRO) web interface to include those who participate in PQRS as a group using any Group Practice Reporting Option (GPRO).
- Voluntary administration of PQRS CAHPS continues for groups with 25-99 eligible professionals and expands to include groups as small as 2 eligible professionals that participate in PQRS using any GPRO.
In addition to the changes in participation, additional dollars are now at risk. Physicians’ at-risk value-based payment modifier (VBPM) dollars based on performance metrics will increase from 2% to 4%, beginning with 2017 payment year.
CAHPS REPORTING COUNTS FOR PQRS
For the overall PQRS program, most groups are required to collect nine measures representing three National Quality Strategy (NQS) domains. One of the nine measures must be a cross-cutting measure. By selecting the new voluntary certified patient experience vendor reporting option, a group can count reporting of the CAHPS surveys as three measures and one National Quality Strategy (NQS) domain toward PQRS. CAHPS also counts as a cross-cutting measure. Inclusion of CAHPS can streamline the medical groups’ PQRS data collection process.
CAHPS REPORTING COUNTS FOR VBPM
CAHPS participation also counts towards the Physician Value-Based Payment Modifier (VBPM), increasing opportunities to improve performance and potential reimbursement. Under VBPM, Press Ganey anticipates that the highest performers will receive an incentive payment, above and beyond current reimbursement. Payment at risk for those who have low quality and high cost has increased from 2% to 4%. Those who start early and understand how they perform on CAHPS survey themes can make better decisions about which measures to collect for PQRS participation.
ANTICIPATED FUTURE PLANS FOR FURTHER MANDATORY PARTICIPATION EXPANSION
While medical groups with 25+ eligible professionals continue with a voluntary option to participate in PQRS CAHPS in CY 2015, Press Ganey anticipates PQRS CAHPS will become mandatory for the 25+ group in future rule making as proposed.