Nearly 40% of doctors lose Medicare pay for failing to report patient data

Most doctors who did not report data treat fewer than 100 Medicare patients annually

Almost 40% of health care providers who participate in Medicare will see their reimbursements cut by 1.5% this year because they failed to meet CMS's deadlines to submit quality data, according to a CMS report.

Background on the reporting system

To avoid payment reductions under CMS's Physician Quality Reporting system this year, providers in 2013 had to submit quality data on at least one of more than 100 possible measures.

Physicians this year will need to report on at least nine of the measures in order to avoid future payment reductions. According to the Wall Street Journal, physicians who did submit such data most often reported on:

  • The percentage of patients who had blood pressure readings;
  • The share of patients who were offered smoking cessation counseling; and
  • The share of patients who were asked about their current medications.

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Many did not report data

According to CMS, more than 460,000 of the 1.25 million eligible Medicare providers did not meet deadlines to submit data for the Physician Quality Reporting System in 2013. The agency noted that about 70% of those who did not meet the deadlines see fewer than 100 Medicare patients annually.

Meanwhile, nearly 642,000 eligible Medicare providers did comply with the quality reporting deadlines in 2013 and will receive a 0.5% reimbursement increase this year.

Overall, CMS said that provider participation in the program increased from 15% of eligible providers in 2007 to 51% in 2013. According to the report, specialties with the largest percentage of providers failing to participate or meet PQRS requirements included:

  • Psychiatrists, at 67%; and
  • General practitioners, at 65%.

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Those most likely to not incur payment reductions included:

  • Pathologists, with 15% being penalized; and
  • Radiologists, with 20% being penalized.

CMS said that federal officials are working to simplify the quality-reporting requirements to make them less burdensome (Beck, Wall Street Journal, 4/26; Tahir, Modern Healthcare, 4/24 [subscription required]).

The takeaway: More than 460,000 eligible Medicare providers—most of whom see fewer than 100 Medicare patients annually—did not meet deadlines to submit data for the Physician Quality Reporting System in 2013.


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