The Centers for Medicare & Medicaid Services introduced the Group Practice Reporting Option for the Physician Quality Reporting System in 2010. Group practices that report data on Medicare beneficiaries through the PQRS may qualify for an incentive payment when they use the GPRO satisfactorily. This incentive is equal to 0.5 percent of the Medicare Part B Physician Fee Schedule for the group practice during the 2013 reporting period. The only way for a group practice to participate in the GPRO is through the practice’s Tax Identification Number. This means that individual healthcare professionals who belong to the group practice aren’t eligible for an individual PQRS incentive if they operate under that practice’s TIN.
The 2013 PQRS defines a group practice as a physician group practice with a single TIN. A group practice must also have at least two eligible professionals with individual National Provider Indicators who have assigned their billing rights to the practice’s TIN. This definition represents a significant change from the 2012 PQRS, which required a group practice to have at least 25 eligible professionals. Another major change for 2013 is that group practices with more than 100 eligible professionals are now subject to the Value-based Payment Modifier.
Group Practices with 2 to 24 Eligible Professionals
These group practices must report three measures for at least 80 percent of the practice’s patients who treated under Medicare Part B during the reporting period. Measures with a performance rate of 0 percent don’t count.
Group Practices with 25 to 99 Eligible Professionals
These group practices have the same basic reporting requirements as practices with 2 to 24 eligible professionals. They also have the option of reporting GPRO preventative measures and modules through a web-based interface. The practice must populate data fields in the interface that will capture information on up to 218 beneficiaries for each preventative care measure or module. The group practice must populate the data fields for all of the eligible beneficiaries in the preventative care measure or module if it contains less than 218 beneficiaries. The practice must provide information in the order in which the patients appear within the sample for each preventative care measure or module.
Group Practices with More than 100 Eligible Professionals
These group practices have the same basic pqrs reporting requirements as practices of other sizes. They can also report GPRO measures or modules through a web-based interface with the same requirements as the web-based interface or module for group practices with 25 to 99 eligible professionals. The only difference is that group practices with more than 100 eligible professionals must report information on up to 411 eligible beneficiaries within each preventative care measure or module.
Web Inferface Requirements
All group practices that use a web-based interface for the GPRO must report the same quality measures regardless of the practice’s size. These measures include 18 individual measures and two composite measures, providing a total of 22 measures. Group practices must also report on the following 7 disease modules:
- Care Coordination/Patient Safety
- Ischemic Vascular Disease
- Coronary Artery Disease
- Diabetes Mellitus
- Preventive Care
- Heart Failure
CMS will assign the beneficiaries of Medicare Part B claims to each group practice according to TIN. The beneficiaries consist of those patients who filed claims in 2013 and for whom Medicare is the primary payer. They don’t include enrollees in the Medicare Advantage program. The methodology used to make the assignments is otherwise the same as that used by the Medicare Shared Savings Program. It differs from the methodology used to populate the web interface for the GPRO in that the GPRO doesn’t require a group practice physician to provide at least one primary care service.
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