Prepare Now to Avoid Medicare Payment Reductions

Oct 30, 2012

The Centers for Medicare & Medicaid Services (CMS) has adopted new Medicare reporting requirements that may significantly impact oncology practices that treat patients covered by Medicare. Namely, CMS is shifting from offering incentives to providers for participating in certain reporting programs—the current system—to reducing reimbursements to those providers who do not participate. Near-term action is required by practices to prevent payment reductions. The greatest impact of these changes will be felt in 2015, but will be based on participation in CMS reporting programs in the coming year. ASCO is urging practices to begin preparing for the new CMS reporting requirements now to avoid reductions in reimbursement later.

“It is critical that oncologists and their practice staff understand the importance of participation in these CMS reporting programs,” said ASCO CEO Allen S. Lichter, MD. “Gone are the days when a failure to report resulted in the loss of a bonus payment. Now, oncologists will see their Medicare reimbursements decrease as a result of nonparticipation.”

CMS Reporting Programs
Although CMS does not require participation in its designated reporting programs, the federal agency strongly encourages providers to share information on specific quality measures and the use of health information technology through three reporting programs: (1) the Physician Quality Reporting System (PQRS), (2) the Electronic Prescribing (eRx) Incentive Program, and (3) the Electronic Health Records (EHR) Incentive Program (“Meaningful Use”).

Previously, CMS has offered financial bonuses to practices as reporting incentives; these incentives are being phased out and will be eliminated completely within the next few years. If eligible providers don’t participate in the PQRS in 2013, CMS will reduce their Medicare Part B physician fee schedule reimbursements in 2015. Additionally, providers who do not have an electronic prescribing system in place in 2012 (this year) and report to CMS through the eRx Incentive Program will receive reduced reimbursements in 2013. Reductions also occur in 2015 for any provider not participating in the EHR Incentive Program.

Finally, in the 2013 Medicare Physician Fee Schedule proposed rule, CMS has proposed using participation in PQRS as a component of the new “value-based payment modifier” required by the Affordable Care Act. This payment modifier will affect select groups of physicians in 2015 (these groups are to be defined by CMS; in the proposed rule, CMS proposes practices with 25 or more eligible professionals), and will affect most physicians by 2017. ASCO will closely monitor the final rule for details on how CMS will actually implement this payment modifier.

The timing and amount of reimbursement reductions vary depending on the specific CMS reporting program:

* PQRS: Physicians who do not participate in the Physician Quality Reporting System during the 2013 program year will lose the 0.5% bonus for 2013, and receive a 1.5% payment reduction in 2015.

* eRx: Physicians not participating in the Electronic Prescribing Incentive Program in 2012 will lose a possible 1.0% bonus for 2012, and have 1.5% automatically deducted from their reimbursements in 2013. Physicians not participating in Electronic Prescribing Incentive Program in 2013 lose a possible 0.5% bonus for 2013, and face a 2.0% payment reduction in 2014.

* EHR: Eligible professionals who are not meaningfully using electronic health records by 2015 will have their Medicare payments reduced by 1% in 2015, and reduced by an additional 1% every subsequent year for nonparticipation, up to a maximum of 5%.

Past participation rates in the CMS reporting programs have been low in oncology. According to CMS data, only 22% of eligible radiation oncologists and 30% of oncologists/hematologists successfully participated in the PQRS program in 2010.

Nevertheless, with reimbursement cuts looming for most oncology practices that care for Medicare patients but do not participate in these reporting programs, ASCO is ramping up its efforts to inform its membership of the upcoming changes. Participating in the CMS reporting programs requires administrative time and effort, and practices that don’t currently participate will need time to implement internal measures to establish a reliable reporting process.

ASCO in Action

To help practices adapt quickly to the changing CMS reporting requirements, ASCO is increasing communications, outreach, and guidance on these programs, including a new web page with additional details on the impact of the Medicare reimbursement reductions at Additionally, on November 13, 2012, at 4:00 PM–5:30 PM ET, ASCO will conduct a free national webinar on the new CMS reporting program requirements for members (for details, visit During this webinar, ASCO will also review the final CMS proposal on the value-based modifier, if available at that time.

Finally, ASCO continues to promote changes to CMS reporting programs to reduce administrative burdens, align requirements across programs, and reduce penalties on oncology practices. In recent comments on the 2013 Medicare Physician Fee Schedule, for example, ASCO advocated for CMS recognition of participation in the Quality Oncology Practice Initiative (QOPI®) as a substitution for PQRS reporting and a means to conduct efficient and meaningful quality assessment of oncology practice throughout the United States.

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