This Week – November 16, 2013

This Week in Washington DC:

  1. It is not too late to earn a 2013 PQRS incentive or avoid the 2015 Medicare Reimbursement Cut
  2. ACG working with Congress on SGR Repeal Legislation

PQRS 2013 Reporting Options
As ACG members may know, participation in PQRS in 2013 will impact your 2015 Medicare reimbursement. If you participate in GIQuIC, for example, participants will be able to submit their 2013 PQRS Data through the Outcome PQRS Registry as a free benefit of subscribing to the GIQuIC Registry. The Outcome PQRS registry is a CMS qualified registry, offering an easy-to-use, comprehensive tool, to manage your data.

How to earn the PQRS incentive payment:

  • Satisfactorily report 3 individual PQRS measures OR 1 PQRS measures group via the PQRS registry-based and EHR reporting option. (It may be unlikely that you can qualify via claims-based reporting at this juncture.)
  • GIQuIC participants can use the Outcome PQRS registry at no additional cost.

Outcome PQRS Registry features:

  • Choose from 139 measures available through registry reporting
  • Choose from ALL 22 measures groups available through registry reporting including: the Hepatitis C Measures Group and the Inflammatory Bowel Disease Measures Group
  • View measure data for other quality improvement initiatives

Visit the GIQuIC website for more information on PQRS reporting:

It is not too late to avoid a Medicare reimbursement cut for failing to participate in PQRS this year.

How to simply avoid the payment cut:

Eligible professionals can avoid the negative 1.5% payment adjustment in 2015 by reporting just one PQRS measure using any PQRS reporting mechanism (claims, registry, or EHR). This will allow you to avoid 2015 payment cuts but you do not qualify for the payment incentives.

GIQuIC users: can avoid the penalty by reporting 1 PQRS measure via the Outcome PQRS registry-based reporting option.

Claims: anyone can avoid the penalty by reporting 1 PQRS measure using the PQRS claims-based reporting mechanism. You should remember the following: 1 patient, 1 measure, 1 claims form.

  • 1 Applicable Patient: A Medicare fee service patient.
  • 1 Applicable Measure: A service that qualifies for PQRS reporting purposes.
  • 1 Applicable Claims Form: A corresponding PQRS quality data code on the Medicare fee for service claims form.

ACG working with Congress to align quality reporting and practice improvement initiatives
On Tuesday, November 12th, ACG submitted comments to the most recent congressional proposal to repeal the sustainable growth rate (SGR) formula. On October 30th, the Senate Finance and House Ways & Means Committees released a joint-proposal that freezes physician payments for 10 years, and in its place, would implement a reimbursement model that is designed to pay providers a bonus based on the value of care provided to Medicare beneficiaries. “Value” would be measured by both quality reporting and cost metrics. Providers would be paid differently for performing the same services depending on how they scored on the quality and cost metrics. The proposal would also encourage providers to participate in various “alternative payment models” designed to slow Medicare spending (although not designed to increase physician reimbursement). However, since any reimbursement model will likely require some form of quality reporting, ACG chose to focus its comments on the quality measure and not the model.

ACG urged the committees to use this opportunity to align the various and duplicative quality reporting and clinical practice improvement activities GI clinicians must participate in, not only in Medicare, but also via private payer initiatives and board certification requirements. This includes the use of registries, like the GI Quality Improvement Consortium (GIQuIC), as a means to satisfactorily meet the quality reporting programs across the various public/private initiatives. ACG also believes that members should meet other annual “clinical practice improvement activities” requirements under the proposal if ACG members are already going through the ABIM requirements or are actively engaged in other initiatives such as achieving fellowship status in a specialty society, authoring clinical guidelines, or participating in other clinical improvement activities offered by the College. This would reduce duplicative administrative burdens and significant costs borne by busy clinicians who are already engaging in voluntary nationally recognized quality reporting programs and other practice improvement initiatives.

Please click here to view ACG comments.

Please stay tuned for further updates. Please also share and discuss your thoughts with fellow ACG members on the ACG GI Circle. To login and share your comments, go to and sign in as a member. Once you have done so, click here and then click the orange "Visit ACG GI Circle" button to be taken to the GI Circle site. If you have not yet activated your ACG GI Circle account, please email us at

Contact Brad Conway, VP Public Policy, with any questions or for more information.

Brad Conway