Are you one? 6,000 optometrists split $3 million in PQRS bonuses

June 7, 2013

pqrs chartAbout one in every five optometrists (18.7 percent) who saw Medicare patients during 2011 received a Medicare Physician Quality Reporting System (PQRS) bonus. Optometrists earned a total of $3,092,574 in payment bonuses through PQRS during 2011, according to a report released last month by the U.S. Centers for Medicare & Medicaid Services (CMS).

Of the 32,404 U.S. optometrists eligible to participate in the PQRS that year, more than a quarter (27.7 percent) – some 8,980 practitioners – took part.

More than two-thirds (67.6 percent) of the optometrists who participated in the program – 6,067 practitioners – earned payment bonuses.

“Without the AOA, many optometrists would not have known about the extra monies available to them, and many would not have known how to qualify for the Physician Quality Reporting System bonus,” noted AOA President Ron Hopping, O.D., M.P.H.

PQRS bonuses for optometrists averaged $509 with the largest totaling $11,367.16. Twenty-two optometrists received PQRS Maintenance of Certification Program (MOCP) incentive bonuses, totaling $12,097. PQRS participation rates for optometrists continue to be slightly higher than for health care practitioners overall.

The CMS found 26.4 percent of all eligible U.S. health care practitioners participated in the PQRS during 2011.

However, optometrists significantly straggled behind ophthalmologists in PQRS participation during 2011.

More than three-quarters (79.4 percent) of the nation’s ophthalmologists – some 7,011 practitioners – reported on at least some PQRS quality measures during 2011, with more than a third (36.9 percent) of ophthalmologists earning bonuses through the program.

Launched in 2006 as the Physician Quality Reporting Initiative (PQRI), the Medicare PQRS is a reporting program that uses a combination of incentive payments and payment adjustments to promote reporting of quality information by eligible professionals, according to the CMS.

The program provides an incentive payment to practices with eligible professionals who satisfactorily report data on quality measures for covered Physician Fee Schedule (PFS) services furnished to Medicare Part B Fee-for-Service (FFS) beneficiaries (including Railroad Retirement Board and Medicare Secondary Payer beneficiaries).

Incentive payments are based on a percentage of the eligible practitioner’s total approved Medicare claims for the year.

The typical optometrist who sees Medicare patients stood to earn an average of $503 through the PQRS during 2011, the CMS noted, citing Medicare billing statistics for the year.

However, beginning this year, participation in the PQRS becomes as important to protecting Medicare revenues in an optometric practice as it has been to potentially increasing them, emphasized Rebecca Wartman, O.D., the AOA Third Party Center Executive Committee member who annually compiles AOA guidance on PQRS participation for optometrists.

In 2015, the CMS will begin reducing Medicare payments to eligible health care professionals who do not satisfactorily report data on quality measures for covered professional services under the PQRS program.

The 2015 payment penalties will be based on PQRS participation during 2013. Practitioners who do not report at least some PQRS quality measures in 2013 will see their Medicare payments reduced 1.5 percent in 2015.

“It is encouraging that roughly a fifth of the nation’s optometrists are now earning bonuses though the Medicare PQRS,” Dr. Wartman said. “However, the remainder of optometrists who have not been participating in the PQRS must begin to take part in the program now in order to avoid the Medicare payment penalties that are coming.”

The full CMS report on PQRS participation is available at http://preview.tinyurl.com/bnv77h.

For additional information, visit www.excelod.com/PQRS.

One comment

  1. I Got Mine! Thanks AOA for getting me in. Woo Hoo.

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