VBP. PQRS. ACO. APM. In the alphabet soup of value-based healthcare (under CMS rules), there is one acronym that physician group practices need to be aware of right now—GPRO. Registration to submit using the group provider reporting option, or GPRO, is open until June 30. This registration allows providers to report physician quality reporting system (PQRS) measures as an eligible provider group practice.
PQRS Is Becoming MACRA so Why Should I Go GPRO?
The proposed rule for MACRA came out in May but will not be finalized until later this year which is too late for the 2016 PQRS reporting period. In order for group providers to avoid the negative payment adjustment by CMS for the 2016 reporting year (and Medicare reimbursement in 2018), they must register as a group to submit PQRS GPRO measures in 2016. The reported measures will be figured into the Value Modifier for Medicare reimbursement. To learn more about how the Value Based Modifier works, click here to read our blog about the 2016 Value Modifier.
How Do I Know if My Practice Qualifies for GPRO?
The CMS defines a group practice as a group of two or more individual eligible providers (EPs) who have reassigned their individual National Provider Identifier (NPI) into one single Medicare-billing Taxpayer Identification Number (TIN). Group registration to report PQRS GPRO measures is an annual election so groups who have reported in the past will need to re-register. Additionally, providers who have reported using GPRO in the past are no longer part of the group registration and must work with a CMS-approved PQRS vendor to submit 2016 measures either as a single EP or as part of a group practice registered for the 2016 submission year.
What Happens After MACRA Is Passed?
Because the final rule for MACRA has not been released, it is not yet clear what role PQRS will play for 2017. The importance of lower healthcare costs and quality patient outcomes remains top priority in the coming Quality Payment Program, however, and it is most likely that quality reporting submitted by group practices (as well as individual eligible providers) will provide a foundation for reimbursement comparison putting participating practices and providers ahead of the curve.
Where Can I Go for Help?
The registration period for physician group practices to submit PQRS GPRO measures is April 1 through June 30, 2016. SPH Analytics (SPHA) can submit on behalf of EPs who choose not to register with a group practice in addition to providers who elect to report using the GPRO option. SPHA offers an end-to-end PQRS solution with the ability to measure PQRS metrics and submit them as an approved CMS registry vendor for 2016, as well as a CMS-certified vendor for the CAHPS® for PQRS Survey. In addition, SPHA is an approved Quality Registry, allowing us to help providers transition from PQRS reporting to the updated reporting requirements to help you avoid negative payment adjustment. We are also CMS approved to submit on behalf of EPs for providers who choose not to register with a group.
Our team will help you understand the best measures to optimize your practice’s strengths for value-based performance during the reporting year and, as new acronyms are added to healthcare regulations, to ensure quality outcomes at lower costs as the Quality Payment Program becomes more defined for the changing healthcare market.
Contact SPH Analytics for information about registering your group practice to submit PQRS GPRO measures and working with us to ensure your practice meets changing healthcare requirements.