Excerpts Medicare Physician Fee Schedule Proposed Rule.pdf

7/26/2019 Excerpts Medicare Physician Fee Schedule Proposed Rule.pdf

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41686 Federal Register / Vol. 80, No. 135/ Wednesday, July 15, 2015/ Proposed Rules

DEPARTMENT OF HEALTH ANDHUMAN SERVICES

Centers for Medicare & MedicaidServices

42 CFR Parts 405, 410, 411, 414, 425,495

[CMS1631P]

RIN 0938AS40

Medicare Program; Revisions toPayment Policies Under the PhysicianFee Schedule and Other Revisions toPart B for CY 2016

AGENCY: Centers for Medicare &Medicaid Services (CMS), HHS.ACTION: Proposed rule.

SUMMARY: This major proposed ruleaddresses changes to the physician feeschedule, and other Medicare Part Bpayment policies to ensure that our

payment systems are updated to reflectchanges in medical practice and therelative value of services, as well aschanges in the statute.DATES: Comment date: To be assuredconsideration, comments must bereceived at one of the addressesprovided below, no later than 5 p.m. onSeptember 8, 2015.ADDRESSES: In commenting, please referto file code CMS1631P. Because ofstaff and resource limitations, we cannotaccept comments by facsimile (FAX)transmission.

You may submit comments in one offour ways (please choose only one of theways listed):

1. Electronically. You may submitelectronic comments on this regulationto www.regulations.gov. Follow theinstructions for submitting acomment.

2. By regular mail. You may mailwritten comments to the followingaddress ONLY: Centers for Medicare &Medicaid Services, Department ofHealth and Human Services, Attention:CMS1631P, P.O. Box 8013, Baltimore,MD 212448013.

Please allow sufficient time for mailedcomments to be received before the

close of the comment period.3. By express or overnight mail. Youmay send written comments to thefollowing address ONLY: Centers forMedicare & Medicaid Services,Department of Health and HumanServices, Attention: CMS1631P, MailStop C42605, 7500 SecurityBoulevard, Baltimore, MD 212441850.

4. By hand or courier. If you prefer,you may deliver (by hand or courier)your written comments before the closeof the comment period to either of thefollowing addresses:

a. For delivery in Washington, DCCenters for Medicare & MedicaidServices, Department of Health andHuman Services, Room 445G, HubertH. Humphrey Building, 200Independence Avenue SW.,Washington, DC 20201.

(Because access to the interior of theHubert H. Humphrey Building is not

readily available to persons withoutfederal government identification,commenters are encouraged to leavetheir comments in the CMS drop slotslocated in the main lobby of the

building. A stamp-in clock is availablefor persons wishing to retain a proof offiling by stamping in and retaining anextra copy of the comments being filed.)

b. For delivery in Baltimore, MDCenters for Medicare & MedicaidServices, Department of Health andHuman Services, 7500 SecurityBoulevard, Baltimore, MD 212441850.

If you intend to deliver your

comments to the Baltimore address,please call telephone number (410) 7867195 in advance to schedule yourarrival with one of our staff members.

Comments mailed to the addressesindicated as appropriate for hand orcourier delivery may be delayed andreceived after the comment period.

FOR FURTHER INFORMATION CONTACT:Donta Henson, (410) 7861947 for any

physician payment issues not identifiedbelow.

Gail Addis, (410) 7864522, for issuesrelated to the refinement panel.

Chava Sheffield, (410) 7862298, forissues related to practice expensemethodology, impacts, conversionfactors, target, and phase-in provisions.

Jessica Bruton, (410) 7865991, forissues related to potentially misvaluedcode lists.

Geri Mondowney, (410) 7864584, forissues related to geographic practicecost indices and malpractice RVUs.

Ken Marsalek, (410) 7864502, forissues related to telehealth services.

Ann Marshall, (410) 7863059, forissues related to advance care planning,and for primary care and caremanagement services.

Michael Soracoe, (410) 7866312, forissues related to the valuation andcoding of the global surgical packages.

Roberta Epps, (410) 7864503, forissues related to PAMA section 218(a)policy.

Regina Walker-Wren, (410) 7869160,for issues related to the incident toproposals.

Lindsey Baldwin, (410) 7861694, forissues related to valuation of moderatesedation and colonoscopy services andportable x-ray transportation fees.

Emily Yoder, (410) 7861804, forissues related to valuation of radiationtreatment services.

Amy Gruber, (410) 7861542, forissues related to ambulance paymentpolicy.

Corinne Axelrod, (410) 7865620, forissues related to rural health clinics orfederally qualified health centers and

payment to grandfathered tribal FQHCs.Simone Dennis, (410) 7868409, for

issues related to rural health clinicsHCPCS reporting.

Edmund Kasaitis (410) 7860477, forissues related to Part B drugs,

biologicals, and biosimilars.Alesia Hovatter, (410) 7866861, for

issues related to Physician Compare.Christine Estella, (410) 7860485, for

issues related to the physician qualityreporting system and the merit-basedincentive payment system.

Alexandra Mugge (410) 7864457, forissues related to EHR Incentive Program.

Sarah Arceo, (410) 7862356) orPatrice Holtz, (4107865663) for issuesrelated to EHR Incentive Program-CPCinitiative and meaningful use alignedreporting.

Christiane LaBonte, (410) 7867237,for issues related to comprehensiveprimary care initiative.

Rabia Khan, (410) 7869328 or TerriPostma, (410) 7864169, for issuesrelated to Medicare Shared SavingsProgram.

Kimberly Spalding Bush, (410) 7863232, or Sabrina Ahmed (410) 7867499, for issues related to value-basedPayment Modifier and PhysicianFeedback Program.

Frederick Grabau, (410) 7860206, forissues related to changes to opt-outregulations.

Lisa Ohrin Wilson (410) 7868852, forissues related to physician self-referralupdates.

SUPPLEMENTARY INFORMATION:Inspection of Public Comments: All

comments received before the close ofthe comment period are available forviewing by the public, including anypersonally identifiable or confidential

business information that is included in

a comment. We post all commentsreceived before the close of thecomment period on the following Website as soon as possible after they have

been received: http://www.regulations.gov. Follow the searchinstructions on that Web site to viewpublic comments.

Comments received timely will alsobe available for public inspection asthey are received, generally beginningapproximately 3 weeks after publicationof a document, at the headquarters ofthe Centers for Medicare & Medicaid

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41807Federal Register / Vol. 80, No. 135/ Wednesday, July 15, 2015/ Proposed Rules

qualified provider-led entities will beposted to our Web site by the following

June 30 at which time all AUCdeveloped or endorsed by that provider-led entity will be considered to bespecified AUC. All qualified provider-led entities must re-apply every 6 yearsand their applications must be received

by January 1 during the 5th year of their

approval. Note that the application isnot a CMS form; rather it is created bythe applicant entity.

d. Identifying Priority Clinical Areas

Section 1834(q)(4) of the Act requiresthat, beginning January 1, 2017,ordering professionals must consultapplicable AUC using a qualified CDSmechanism when ordering applicableimaging services for which payment ismade under applicable paymentsystems, and that furnishingprofessionals must report the results ofthis consultation on Medicare claims.Section 1834(q)(5) of the Act furtherprovides for the identification of outlierordering professionals based on a lowadherence to applicable AUC. We areproposing to identify priority clinicalareas of AUC that we will use inidentifying outlier orderingprofessionals. Although there is noconsequence to being identified as anoutlier ordering professional until

January 2020, it is important to allowordering and furnishing professionals asmuch time as possible to use andfamiliarize themselves with thespecified applicable AUC that willeventually become the basis for

identifying outlier orderingprofessionals.

To identify these priority clinicalareas, we may consider incidence andprevalence of diseases, as well as thevolume, variability of utilization, andstrength of evidence for imagingservices. We may also considerapplicability of the clinical area to avariety of care settings, and to theMedicare population. We are proposingto annually solicit public comment andfinalize clinical priority areas throughthe PFS rulemaking process beginningin CY 2017. To further assist us in

developing the list of proposed priorityclinical areas, we are proposing toconvene the Medicare EvidenceDevelopment and Coverage AdvisoryCommittee (MEDCAC), a CMS FACAcompliant committee, as needed toexamine the evidence surroundingcertain clinical areas.

Specified applicable AUC fallingwithin priority clinical areas may factorinto the low-adherence calculationwhen identifying outlier orderingprofessionals for the prior authorizationcomponent of this statute, which is

slated to begin in 2020. Futurerulemaking will address further details.

e. Identification of Non-Evidence BasedAUC

Despite our proposed provider-ledentity qualification process that shouldensure evidence-based AUCdevelopment, we remain concerned that

non-evidence based criteria may bedeveloped or endorsed by qualifiedprovider-led entities. Therefore, we areproposing a process by which we wouldidentify and review potentially non-evidence-based criteria that fall withinone of our identified priority clinicalareas. We are proposing to accept publiccomment through annual PFSrulemaking so that the public can assistin identifying AUC that potentially arenot evidence-based. We foresee this

being a standing request for commentsin all future rules regarding AUC. Weare proposing to use the MEDCAC to

further review the evidentiary basis ofthese identified AUC, as needed. TheMEDCAC has extensive experience inreviewing, interpreting, and translatingevidence. If through this process, anumber of criteria from an AUC libraryare identified as being insufficientlyevidence-based, and the provider-ledentity that produced the library does notmake a good faith attempt to correctthese in a timely fashion, thisinformation could be considered whenthe provider-led entity applies for re-qualification.

6. Summary

Section 1834(q) of the Act includesrapid timelines for establishing a newMedicare AUC program for advancedimaging services. The number ofclinicians impacted by the scope of thisprogram is massive as it will apply toevery physician and practitioner whoorders applicable diagnostic imagingservices. This crosses almost everymedical specialty and could have aparticular impact on primary carephysicians since their scope of practicecan be quite vast.

We believe the best implementation

approach is one that is diligent,maximizes the opportunity for publiccomment and stakeholder engagement,and allows for adequate advance noticeto physicians and practitioners,

beneficiaries, AUC developers, and CDSmechanism developers. It is for thesereasons we are proposing a stepwiseapproach, adopted through rulemaking,to first define and lay out the process forthe Medicare AUC program. However,we also recognize the importance ofmoving expeditiously to accomplish afully implemented program.

In summary, we are proposingdefinitions of terms necessary toimplement the AUC program. We areparticularly seeking comment on theproposed definition of provider-ledentity as these are the organizations thathave the opportunity to becomequalified to develop, modify or endorsespecified AUC. We are also proposing

an AUC development process whichallows some flexibility for provider-ledentities but sets standards including anevidence-based development processand transparency. In addition, we areproposing the concept and definition ofpriority clinical areas and how they maycontribute to the identification of outlierordering professionals. Lastly, we areproposing to develop a process bywhich non-evidence-based AUC will beidentified and discussed in the publicdomain. We invite the public to submitcomments on these proposals.

H. Physician Compare Web Site

1. Background and Statutory Authority

As required by section 10331(a)(1) ofthe Affordable Care Act, by January 1,2011, we developed a PhysicianCompare Internet Web site withinformation on physicians enrolled inthe Medicare program under section1866(j) of the Act, as well as informationon other eligible professionals (EPs)who participate in the Physician QualityReporting System (PQRS) under section1848 of the Act. We launched the firstphase of Physician Compare onDecember 30, 2010 (http://

www.medicare.gov/physiciancompare).In the initial phase, we posted thenames of EPs that satisfactorilysubmitted quality data for the 2009PQRS, as required by section1848(m)(5)(G) of the Act.

We also implemented, consistent withsection 10331(a)(2) of the AffordableCare Act, a plan for making publiclyavailable through Physician Compareinformation on physician performancethat provides comparable informationon quality and patient experiencemeasures for reporting periods

beginning no earlier than January 1,

2012. We met this requirement inadvance of the statutory deadline of

January 1, 2013, as outlined below, andplan to continue addressing elements ofthe plan through rulemaking.

To the extent that scientifically soundmeasures are developed and areavailable, we are required to include, tothe extent practicable, the followingtypes of measures for public reporting:

Measures collected under thePhysician Quality Reporting System(PQRS).



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An assessment of patient healthoutcomes and functional status ofpatients.

An assessment of the continuityand coordination of care and caretransitions, including episodes of careand risk-adjusted resource use.

An assessment of efficiency. An assessment of patient

experience and patient, caregiver, andfamily engagement.

An assessment of the safety,effectiveness, and timeliness of care.

Other information as determinedappropriate by the Secretary.

In developing and implementing theplan, section 10331(b) requires that weinclude, to the extent practicable, thefollowing:

Processes to ensure that data madepublic are statistically valid, reliable,and accurate, including risk adjustmentmechanisms used by the Secretary.

Processes for physicians and EPs

whose information is being publiclyreported to have a reasonableopportunity, as determined by theSecretary, to review their results beforeposting to Physician Compare. We haveestablished a 30-day preview period forall measurement performance data thatwill allow physicians and other EPs toview their data as it will appear on theWeb site in advance of publication onPhysician Compare (77 FR 69166, 78 FR74450, and 79 FR 67770). Details of thepreview process will be communicateddirectly to those with measures topreview and will also be published on

the Physician Compare Initiative page(http://www.cms.gov/Medicare/Quality-Initiatives-Patient-Assessment-Instruments/physician-compare-initiative/) in advance of the previewperiod.

Processes to ensure the datapublished on Physician Compareprovides a robust and accurate portrayalof a physicians performance.

Data that reflects the care providedto all patients seen by physicians, under

both the Medicare program and, to theextent applicable, other payers, to theextent such information would providea more accurate portrayal of physicianperformance.

Processes to ensure appropriateattribution of care when multiplephysicians and other providers areinvolved in the care of the patient.

Processes to ensure timelystatistical performance feedback isprovided to physicians concerning thedata published on Physician Compare.

Implementation of computer anddata infrastructure and systems used tosupport valid, reliable and accuratereporting activities.

Section 10331(d) of the AffordableCare Act requires us to consider inputfrom multi-stakeholder groups,consistent with sections 1890(b)(7) and1890A of the Act, when selectingquality measures for PhysicianCompare. We also continue to getgeneral input from stakeholders onPhysician Compare through a variety of

means, including rulemaking anddifferent forms of stakeholder outreach(for example, Town Hall meetings, OpenDoor Forums, webinars, education andoutreach, Technical Expert Panels, etc.).

We submitted a report to the Congressin advance of the January 1, 2015deadline, as required by section 10331(f)of the Affordable Care Act, on PhysicianCompare development, includinginformation on the efforts and plans tocollect and publish data on physicianquality and efficiency and on patientexperience of care in support of value-

based purchasing and consumer choice.We believe section 10331 of the

Affordable Care Act supports ouroverarching goals of providingconsumers with quality of careinformation that will help them makeinformed decisions about their healthcare, while encouraging clinicians toimprove the quality of care they provideto their patients. In accordance withsection 10331 of the Affordable CareAct, we plan to continue to publiclyreport physician performanceinformation on Physician Compare.

2. Public Reporting of Performance andOther Data

Since the initial launch of the Website, we have continued to build on andimprove Physician Compare, includinga full redesign in 2013. Currently, Website users can view information aboutapproved Medicare professionals suchas name, primary and secondaryspecialties, practice locations, groupaffiliations, hospital affiliations that linkto the hospitals profile on HospitalCompare as available, MedicareAssignment status, education,residency, and American Board ofMedical Specialties (ABMS) boardcertification information. In addition,

for group practices, users can viewgroup practice names, specialties,practice locations, Medicare assignmentstatus, and affiliated professionals.

In addition, there is a section on eachMedicare professionals profile pageindicating with a green check mark thequality programs under which the EPsatisfactorily or successfully reported.The Web site will continue to postannually the names of individual EPswho satisfactorily report under PQRS,EPs who successfully participate in theMedicare Electronic Health Record

(EHR) Incentive Program as authorizedby section 1848(o)(3)(D) of the Act, andEPs who report PQRS measures insupport of Million Hearts (79 FR 67763).A proposed change to the Million Heartsindicator for 2016 data is discussed

below.With the 2013 redesign of the

Physician Compare Web site, we added

a quality programs section to each grouppractice profile page, as well. We willcontinue to indicate which grouppractices are satisfactorily reporting inthe Group Practice Reporting Option(GPRO) under PQRS (79 FR 67763). ThePhysician Compare Web site alsocontains a link to the PhysicianCompare downloadable database(https://data.medicare.gov/data/physician-compare), includinginformation on this quality programparticipation.

We continue to implement our planfor a phased approach to publicreporting performance information onthe Physician Compare Web site. Underthe first phase of this plan, weestablished that GPRO measurescollected under PQRS through the WebInterface for 2012 would be publiclyreported on Physician Compare (76 FR73419 through 73420). We furtherexpanded the plan by including on thePhysician Compare Web site the 2013group practice-level PQRS measures forDiabetes Mellitus (DM) and CoronaryArtery Disease (CAD) reported via theWeb Interface, and planned to reportcomposite measures for DM and CAD in2014, as well (77 FR 69166).

The 2012 GPRO measures werepublicly reported on Physician Comparein February 2014. The 2013 PQRS GPRODM and GPRO CAD measures collectedvia the Web Interface that met theminimum sample size of 20 patients andproved to be statistically valid andreliable were publicly reported onPhysician Compare in December 2014.The composite measures were notreported, however, as some itemsincluded in the composites were nolonger clinically relevant. If theminimum threshold is not met for aparticular measure, or the measure is

otherwise deemed not to be suitable forpublic reporting, the performance rateon that measure is not publiclyreported. On the Physician CompareWeb site, we only publish thosemeasures that are statistically valid andreliable, and therefore, most likely tohelp consumers make informeddecisions about the Medicareprofessionals they choose to meet theirhealth care needs. In addition, we donot publicly report first year measures,meaning new PQRS and non-PQRSmeasures that have been available for



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2By statistically comparable, CMS means that thequality measures are analyzed and proven tomeasure the same phenomena in the same wayregardless of the mechanism through which theywere collected.

reporting for less than one year,regardless of reporting mechanism.After a measures first year in use, wewill evaluate the measure to see if andwhen the measure is suitable for publicreporting.

Measures must be based on reliableand valid data elements to be useful toconsumers. Therefore, for all proposed

measures available for public reporting,including both group and individual EPlevel measuresregardless of reportingmechanism, only those proposedmeasures that prove to be valid, reliable,and accurate upon analysis and reviewat the conclusion of data collection andthat meet the established publicreporting criteria of a minimum samplesize of 20 patients will be included onPhysician Compare. For information onhow we determine the validity andreliability of data and other statisticalanalyses we perform, refer to the CY2015 PFS final rule with comment

period (79 FR 67764 through 79 FR67765).We will also continue to include an

indicator of which reporting mechanismwas used and to only include on the sitemeasures deemed statisticallycomparable.2 We will continue topublicly report all measures submittedand reviewed and found to bestatistically valid and reliable in thePhysician Compare downloadable file.However, not all of these measureswould necessarily be included on thePhysician Compare profile pages.Consumer testing has shown profilepages with too much information and

measures that are not well understoodby consumers can negatively impact aconsumers ability to make informeddecisions. Our analysis of the collectedmeasure data, along with consumertesting and stakeholder feedback, willdetermine specifically which measuresare published on Web site profile pages.Statistical analyses, like those specifiedabove, will ensure the measuresincluded are statistically valid andreliable and comparable across datacollection mechanisms. Stakeholderfeedback will help us to ensure that allpublicly reported measures meet current

clinical standards. When measures arefinalized in advance of the time periodin which they are collected, it ispossible that clinical guidelines canchange rendering a measure no longerrelevant. Publishing that measure canlead to consumer confusion regardingwhat best practices their health careprofessional should be subscribing to.

We will continue to reach out tostakeholders in the professionalcommunity, such as specialty societies,to ensure that the measures underconsideration for public reportingremain clinically relevant and accurate.

The primary goal of PhysicianCompare is to help consumers makeinformed health care decisions. If a

consumer does not properly interpret aquality measure and thusmisunderstands what the quality scorerepresents, the consumer cannot usethis information to make an informeddecision. Through concept testing, wewill test with consumers how well theyunderstand measures presented usingplain language. Such consumer testingwill help us gauge how measures areunderstood and the kinds of measuresthat are most relevant to consumers.This will be done to help ensure that theinformation included on PhysicianCompare is as consumer friendly and

consumer focused as possible.As is the case for all measurespublished on Physician Compare,individual EPs and group practices will

be given a 30-day preview period toview their measures as they will appearon Physician Compare prior to themeasures being published. As inprevious years, we will fully explain theprocess for the 30-day preview andprovide a detailed timeline andinstructions for preview in advance ofthe start of the preview period.

We also report certain AccountableCare Organization (ACO) qualitymeasures on Physician Compare (76 FR

67802, 67948). Because EPs that billunder the TIN of an ACO participant areconsidered to be a group practice forpurposes of qualifying for a PQRSincentive under the Medicare SharedSavings Program (Shared SavingsProgram), we publicly report ACOperformance on quality measures on thePhysician Compare Web site in the sameway as we report performance onquality measures for group practicesparticipating under PQRS. Publicreporting of performance on thesemeasures is presented at the ACO levelonly. The first subset of ACO measures

was also published on the Web site inFebruary 2014. ACO measures can beviewed by following the AccountableCare Organization (ACO) Quality Datalink on the homepage of the PhysicianCompare Web site (http://medicare.gov/physiciancompare/aco/search.html).

ACOs will be able to preview theirquality data that will be publiclyreported on Physician Compare throughthe ACO Quality Reports, which will bemade available to ACOs for review atleast 30 days prior to the start of publicreporting on Physician Compare. The

quality reports will indicate themeasures that are available for publicreporting. ACO measures will bepublicly reported in plain language, soa crosswalk linking the technicallanguage included in the Quality Reportand the plain language that will bepublicly reported will be provided toACOs at least 30 days prior to the start

of public reporting.As part of our public reporting plan

for Physician Compare, we also haveavailable for public reporting patientexperience measures, specificallyreporting the CAHPS for PQRSmeasures, which relate to the Clinicianand Group Consumer Assessment ofHealthcare Providers and Systems (CGCAHPS) data, for group practices of 100or more EPs reporting data in 2013under PQRS and for ACOs participatingin the Shared Savings Program (77 FR69166 and 69167). The 2013 CAHPSdata for ACOs were publicly reported on

Physician Compare in December 2014.We continued to expand our plan for

publicly reporting data on PhysicianCompare in 2015. We plan to make allgroup practice-level measures collectedthrough the Web Interface for groups of25 or more EPs participating in 2014under the PQRS and for ACOsparticipating in the Shared SavingsProgram available for public reportingin CY 2015 (78 FR 74449). We also planto publicly report performance oncertain measures that group practicesreport via registries and EHRs for the2014 PQRS GPRO (78 FR 74451).

Specifically, we finalized a decision tomake available for public reporting onPhysician Compare performance on 16registry measures and 13 EHR measuresin CY 2015 (78 FR 74451). Thesemeasures are consistent with themeasures available for public reportingvia the Web Interface.

In CY 2015, CAHPS measures forgroup practices of 100 or more EPs whoparticipate in PQRS, regardless of datasubmission method, and for SharedSavings Program ACOs reportingthrough the Web Interface or other CMS-approved tool or interface are available

for public reporting (78 FR 74452). Inaddition, twelve 2014 summary surveymeasures for groups of 25 to 99 EPscollected via any certified CAHPSvendor regardless of PQRS participationare available for public reporting (78 FR74452). For ACOs participating in theShared Savings Program, the patientexperience measures that are includedin the Patient/Caregiver Experiencedomain of the Quality PerformanceStandard under the Shared SavingsProgram will be available for publicreporting in CY 2015 (78 FR 74452).



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In late CY 2015, certain 2014individual PQRS measure data reported

by individual EPs are also available forpublic reporting. Specifically, we willmake available for public reporting 20individual measures collected through aregistry, EHR, or claims (78 FR 74453through 74454). These are measures thatare in line with those measures reported

by groups via the Web Interface.Finally, in support of the HHS-wide

Million Hearts initiative, performancerates on measures in the PQRSCardiovascular Prevention measuresgroup at the individual EP level for datacollected in 2014 for the PQRS areavailable for public reporting in CY2015 (78 FR 74454).

We continue to expand publicreporting on Physician Compare bymaking an even broader set of qualitymeasures available for publication onthe Web site in CY 2016. All 2015group-level PQRS measures across all

group reporting mechanismsWebInterface, registry, and EHRareavailable for public reporting onPhysician Compare in CY 2016 forgroups of 2 or more EPs (79 FR 67769).

Similarly, we decided that all measuresreported by ACOs participating in theShared Savings Program will beavailable for public reporting onPhysician Compare.

Understanding the value of patientexperience data for Physician Compare,CMS decided to report twelve 2015CAHPS for PQRS summary survey

measures for all group practices of twoor more EPs, who meet the specifiedsample size requirements and collectdata via a CMS-specified certifiedCAHPS vendor, are available for publicreporting in CY 2016 (79 FR 67772).

To provide the opportunity for moreEPs to have measures included onPhysician Compare, and to providemore information to consumers to makeinformed decisions about their healthcare, we will make available for publicreporting in CY 2016 on PhysicianCompare all 2015 PQRS measures forindividual EPs collected through a

registry, EHR, or claims (79 FR 67773).Furthermore, in support of the HHS-wide Million Hearts initiative, we willpublicly report the performance rates onthe four, 2015 PQRS measures reported

by individual EPs in support of MillionHearts with a minimum sample size of20 patients.

To further support the expansion ofquality measure data available forpublic reporting on Physician Compareand to provide more quality data toconsumers to help them make informed

decisions, CMS finalized 2015 QualifiedClinical Data Registry (QCDR) PQRS andnon-PQRS measure data collected at theindividual EP level are available forpublic reporting. The QCDR is requiredto declare during their self-nominationif they plan to post data on their ownWeb site and allow Physician Compareto link to it or if they will provide datato CMS for public reporting onPhysician Compare. Measures collectedvia QCDRs must also meet theestablished public reporting criteria.Both PQRS and non-PQRS measuresthat are in their first year of reporting bya QCDR will not be available for public

reporting (79 FR 67774 through 67775).See Table 18 for a summary of our

previously finalized policies for publicreporting data on Physician Compare.

TABLE 18SUMMARY OF PREVIOUSLY FINALIZED POLICIES FOR PUBLIC REPORTING ON PHYSICIAN COMPARE

Datacollection

yearPublic reporting year Reporting mechanism(s) Quality measures and data for public reporting

2012 ........... 2013 ............................... Web Interface (WI),EHR, Registry, Claims.

Include an indicator for satisfactory reporters under PQRS, successful e-prescribers under eRx Incentive Program, and participants in the EHRIncentive Program.

2012 ........... February 2014 ............... WI ................................... 5 Diabetes Mellitus (DM) and Coronary Artery Disease (CAD) measurescollected via the WI for group practices reporting under PQRS with a

minimum sample size of 25 patients and Shared Savings ProgramACOs.

2013 ........... 2014 ............................... WI, EHR, Registry,Claims.

Include an indicator for satisfactory reporters under PQRS, successful e-prescribers under eRx Incentive Program, and participants in the EHRIncentive Program. Include an indicator for EPs who earn a PQRS Main-tenance of Certification Incentive and EPs who report the PQRS Cardio-vascular Prevention measures group in support of Million Hearts.

2013 ........... December 2014 ............. WI ................................... 3 DM and 1 CAD measures collected via the WI for groups of 25 or moreEPs with a minimum sample size of 20 patients.

2013 ........... December 2014 ............. Survey Vendor ............... 6 CAHPS for ACO summary survey measures for Shared Savings Pro-gram ACOs.

2014 ........... Expected to be 2015 ..... WI, EHR, Registry,Claims.

Include an indicator for satisfactory reporters under PQRS and participantsin the EHR Incentive Program. Include an indicator for EPs who earn aPQRS Maintenance of Certification Incentive and EPs who report thePQRS Cardiovascular Prevention measures group in support of MillionHearts.

2014 ........... Expected to be late 2015 WI, EHR, Registry ......... All measures reported via the WI, 13 EHR, and 16 registry measures for

group practices of 2 or more EPs reporting under PQRS with a minimumsample size of 20 patients.

Include composites for DM and CAD, if available.2014 ........... Expected to be late 2015 WI, Survey Vendor Ad-

ministrative Claims.All measures reported by Shared Savings Program ACOs, including

CAHPS for ACO and claims based measures.2014 ........... Expected to be late 2015 WI, Certified Survey

Vendor.Up to 12 CAHPS for PQRS summary measures for groups of 100 or more

EPs reporting via the WI and group practices of 25 to 99 EPs reportingvia a CMS-approved certified survey vendor.

2014 ........... Expected to be late 2015 Registry, EHR, or Claims A sub-set of 20 PQRS measures submitted by individual EPs that alignwith those available for group reporting via the WI and that are collectedthrough registry, EHR, or claims with a minimum sample size of 20 pa-tients.

2014 ........... Expected to be late 2015 Registry .......................... Measures from the Cardiovascular Prevention measures group reported byindividual EPs in support of Million Hearts with a minimum sample sizeof 20 patients.



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3http://www.hhs.gov/strategic-plan/goal1.html.

TABLE 18SUMMARY OF PREVIOUSLY FINALIZED POLICIES FOR PUBLIC REPORTING ON PHYSICIAN COMPAREContinued

Datacollection

yearPublic reporting year Reporting mechanism(s) Quality measures and data for public reporting

2015 ........... Expected to be late 2016 WI, EHR, Registry,Claims.

Include an indicator for satisfactory reporters under PQRS and participantsin the EHR Incentive Program. Include an indicator for EPs who report 4individual PQRS measures in support of Million Hearts.

2015 ........... Expected to be late 2016 WI, EHR, Registry ......... All PQRS measures for group practices of 2 or more EPs.

2015 ........... Expected to be late 2016 WI, Survey Vendor Ad-ministrative Claims.

All measures reported by Shared Savings Program ACOs, includingCAHPS for ACOs and claims based measures.

2015 ........... Expected to be late 2016 Certified Survey Vendor All CAHPS for PQRS measures reported for groups of 2 or more EPs whomeet the specified sample size requirements and collect data via aCMS-specified certified CAHPS vendor.

2015 ........... Expected to be late 2016 Registry, EHR, or Claims All PQRS measures for individual EPs collected through a registry, EHR,or claims.

2015 ........... Expected to be late 2016 Registry, EHR, or Claims 4 PQRS measures reported by individual EPs in support of Million Heartswith a minimum sample size of 20 patients.

2015 ........... Expected to be late 2016 QCDR ............................ All individual EP QCDR measures, including PQRS and non-PQRS meas-ures.

3. Proposed Policies for Public DataDisclosure on Physician Compare

We are expanding public reporting onPhysician Compare by continuing tomake a broad set of quality measuresavailable for publication on the Website. We started the phased approachwith a small number of possible PQRSGPRO Web Interface measures for 2012and have been steadily building on thisto provide Medicare consumers withmore information to help them makeinformed health care decisions. As aresult, we are now proposing to addnew data elements to the individual EPand/or group practice profile pages andto continue to publicly report a broadset of quality measures on the Web site.

a. Value Modifier

We propose to expand the section oneach individual EP and group practiceprofile page that indicates Medicarequality program participation with agreen check mark to include the namesof those individual EPs and grouppractices who received an upwardadjustment for the Value Modifier (VM).We propose to include this on PhysicianCompare annually. For the 2018 VM,this information would be based on2016 data and included on the site noearlier than late 2017. The VM upward

adjustment indicates that a physician orgroup has achieved one of the following:higher quality care at a lower cost;higher quality care at an average cost; oraverage quality care at a lower cost. Thefirst goal of the HHS Strategic Plan is tostrengthen health care. One of the waysto do this is to reduce the growth ofhealth care costs while promoting high-value, effective care (Objective D,Strategic Goal 1).3 This VM indicatorcan help consumers identify higher

quality care provided at a lower cost.This means this type of qualityinformation may be very useful to

consumers as they work to choose thebest possible health care available tothem. Including the check mark is a wayto share what can be a very complexconcept in a user-friend, easy-to-understand format. We believe this is apositive first step in making thisimportant information available to thepublic in a way that is most likely to beaccurately interpreted and beneficial.We solicit comments on this proposal.

b. Million Hearts

In support of the HHS-wide MillionHearts initiative, we include an

indicator for individual EPs who chooseto report on specific ABCS(Appropriate Aspirin Therapy for thosewho need it, Blood Pressure Control,Cholesterol Management, and SmokingCessation) measures (79 FR 67764).Based on available measures the criteriafor this indicator have evolved overtime. In 2015, an indicator was includedif EPs satisfactorily reported fourindividual PQRS CardiovascularPrevention measures. In previous years,the indicator was based on satisfactoryreporting of the CardiovascularPrevention measures group, which was

not available via PQRS for 2015. Tofurther support this initiative, we nowpropose to include on PhysicianCompare annually in the year followingthe year of reporting (for example, 2016data will be included on PhysicianCompare in 2017) an indicator forindividual EPs who satisfactorily reportthe new Cardiovascular Preventionmeasures group being proposed underPQRS, should this measures group befinalized. The Million Hearts initiativesprimary goal is to improvecardiovascular heart health, and

therefore, we believe it is important tocontinue supporting the program andacknowledging those physicians and

other health care professionals workingto excel in performance on the ABCS.We solicit comments on this proposal.

c. PQRS GPRO and ACO Reporting

Understanding the importance ofincluding quality data on PhysicianCompare to support the goals of section10331(a) of the Affordable Care Act, wefinalized in the CY 2015 PFS final rulewith comment period (79 FR 67547) adecision to publicly report on PhysicianCompare all PQRS GPRO measurescollected in 2015 via the Web Interface,registry, or EHR. We propose to

continue to make available for publicreporting on Physician Compare on anannual basis all PQRS GPRO measuresacross all PQRS group practice reportingmechanismsWeb Interface, registry,and EHR for groups of 2 or more EPsavailable in the year following the yearthe measures are reported. Similarly, allmeasures reported by Shared SavingsProgram ACOs, including CAHPS forACO measures, would be available forpublic reporting on Physician Compareannually in the year following the yearthe measures are reported. For grouppractice and ACO measures, the

measure performance rate will berepresented on the Web site. We solicitcomments on this proposal.

d. Individual EP PQRS Reporting

Consumer testing indicates thatconsumers are looking for measuresregarding individual doctors and otherhealth care professionals. As a result,we plan to make available for publicreporting on Physician Compare all2015 PQRS measures for individual EPscollected through a registry, EHR, orclaims (79 FR 67773). Through



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4Kiefe CI, Weissman NW, Allison JJ, Farmer R,Weaver M, Williams OD. Identifying achievablebenchmarks of care: concepts and methodology.International Journal of Quality Health Care. 1998Oct; 10(5):4437.

stakeholder outreach and consumertesting we have learned that these PQRSquality data provide the public withuseful information to help consumersmake informed decisions about theirhealth care. As a result, we propose tocontinue to make all PQRS measuresacross all individual EP reportingmechanisms available for public

reporting on Physician Compareannually in the year following the yearthe measures are reported (for example,2016 data will be included on PhysicianCompare in 2017). For individual EPmeasures, the measure performance ratewill be represented on the Web site. Wesolicit comments on this proposal.

e. Individual EP and Group PracticeQCDR Measure Reporting

Stakeholder outreach and consumertesting have repeatedly shown thatconsumers find individual EP qualitymeasures valuable and helpful whenmaking health care decisions.Consumers want to know more aboutthe individual EPs they can make anappointment to see for their health careneeds. And expanding group practice-level public reporting ensures that morequality data are available to assistconsumers with their decision making.We do appreciate, however, that not allspecialties have a full complement ofavailable quality measures specific tothe work they do currently availablethrough PQRS. As a result, we decidedto make individual EP level QualifiedClinical Data Registry (QCDR)measuresboth PQRS and non-PQRS

measuresavailable for public reportingstarting with 2015 data (79 FR 67774through 67775). To further support theavailability of quality measure data mostrelevant for all specialties, we proposeto continue to make available for publicreporting on Physician Compare allindividual EP level QCDR PQRS andnon-PQRS measure data that have beencollected for at least a full year. Inaddition, we are now proposing to alsomake group practice level QCDR PQRSand non-PQRS measure data that have

been collected for at least a full yearavailable for public reporting.

Previously, the PQRS program onlyincluded QCDR data at the individualEP level. In this proposed rule, CMS isproposing, under the PQRS, to expandQCDR data to be available to grouppractices as well. In this case, grouppractice refers to a group of 2 or moreEPs billing under the same TaxIdentification Number (TIN). Wepropose to publicly report these dataannually in the year following the yearthe measures are reported. For both EPand group level measures, the measureperformance rate will be represented on

the Web site. We solicit comments onthese proposals.

The QCDR would be required todeclare during its self-nomination if itplans to post data on its own Web siteand allow Physician Compare to link toit or if the QDCR will provide data tous for public reporting on PhysicianCompare. After a QCDR declares a

public reporting method, that decisionis final for the reporting year. If adeclaration is not made, the data would

be considered available for publicreporting on Physician Compare.

f. Benchmarking

We previously proposed (79 FR40389) a benchmark that aligned withthe Shared Savings Program ACO

benchmark methodology finalized in theNovember 2011 Shared Savings Programfinal rule (76 FR 67898) and amendedin the CY 2014 PFS final rule withcomment period (78 FR 74759).Benchmarks are important to ensuringthat the quality data published onPhysician Compare are accuratelyunderstood. A benchmark will allowconsumers to more easily evaluate theinformation published by providing apoint of comparison between groupsand between individuals. However,given shortcomings when trying toapply the Shared Savings Programmethodology to the group practice orindividual EP setting, this proposal wasnot finalized. We noted we woulddiscuss more thoroughly potential

benchmarking methodologies with ourstakeholders and evaluate other

programs methodologies to identify thebest possible option for a benchmark forPhysician Compare (79 FR 67772). Toaccomplish this, we reached out tostakeholders, including specialtysocieties, consumer advocacy groups,physicians and other health careprofessionals, measure experts, andquality measure specialists, as well asother CMS Quality Programs. Based onthis outreach and the recommendationof our Technical Expert Panel (TEP), wepropose to publicly report on PhysicianCompare an item or measure-level

benchmark derived using the

Achievable Benchmark of Care(ABCTM) 4 methodology annually basedon the PQRS performance rates mostrecently available. For instance, in 2017we would publicly report a benchmarkderived from the 2016 PQRSperformance rates. The specificmeasures the benchmark would bederived for would be determined once

the data are available and analyzed. Thebenchmark would only be applied tothose measures deemed valid andreliable and that are reported by enoughEPs or group practices to produce avalid result (see 79 FR 67764 through 79FR 67765 for a more detailed discussionregarding the types of analysis done toensure data are suitable for public

reporting). We solicit comments on thisproposal.

ABCTM is a well-tested, data-drivenmethodology that allows us to accountfor all of the data collected for a qualitymeasure, evaluate who the topperformers are, and then use that to seta point of comparison for all of thosegroups or individual EPs who report themeasure.

ABCTM starts with the pared-mean,which is the mean of the bestperformers on a given measure for atleast 10 percent of the patientpopulationnot the population of

reporters. To find the pared-mean, wewill rank order physicians or groups (asappropriate per the measure beingevaluated) in order from highest tolowest performance score. We will thensubset the list by taking the bestperformers moving down from best toworst until we have selected enoughreporters to represent 10 percent of allpatients in the denominator across allreporters for that measure.

We will derive the benchmark bycalculating the total number of patientsin the highest scoring subset receivingthe intervention or the desired level of

care, or achieving the desired outcome,and dividing this number by the totalnumber of patients that were measured

by the top performing doctors. Thisproduces a benchmark that representsthe best care provided to the top 10percent of patients.

An Example: A doctor reports whichof her patients with diabetes havemaintained their blood pressure at ahealthy level. There are four steps toestablishing the benchmark for thismeasure.

(1) We look at the total number ofpatients with diabetes for all doctorswho reported this diabetes measure.

(2) We rank doctors that reported thisdiabetes measure from highestperformance score to lowestperformance score to identify the set oftop doctors who treated at least 10percent of the total number of patientswith diabetes.

(3) We count how many of thepatients with diabetes who were treated

by the top doctors also had bloodpressure at a healthy level.

(4) This number is divided by thetotal number of patients with diabetes



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5Kiefe CI, Weissman NW, Allison JJ, Farmer R,Weaver M, Williams OD. Identifying achievablebenchmarks of care: concepts and methodology.International Journal of Quality Health Care. 1998Oct; 10(5):4437.

6Kiefe CI, Allison JJ, Williams O, Person SD,Weaver MT, Weissman NW. Improving QualityImprovement Using Achievable Benchmarks ForPhysician Feedback: A Randomized ControlledTrial. JAMA. 2001;285(22):28712879.

7Wessell AM, Liszka HA, Nietert PJ, Jenkins RG,Nemeth LS, Ornstein S. Achievable benchmarks ofcare for primary care quality indicators in apractice-based research network. American Journalof Medical Quality 2008 JanFeb;23(1):3946.

8Top Box score refers to the most favorableresponse category for a given measure. If themeasure has a scale of always, sometimes,never, the Top Box score is always if thisrepresents the most favorable response. For theCAHPS for PQRS doctor rating, the Top Box scoreis a rating of 9 or 10.

who were treated by the top doctors,producing the ABCTMbenchmark.

To account for low denominators,ABCTM calls for the calculation of anadjusted performance fraction (AFP), aBayesian Estimator. The AFP iscalculated by dividing the actualnumber of patients receiving theintervention or the desired level of careplus 1 by the total number of patientsin the total sample plus 2. This ensuresthat very small sample sizes do not overinfluence the benchmark and allows alldata to be included in the benchmarkcalculation. To ensure that a sufficientnumber of cases are included by meanperformance percent, ABCTM provides aminimum sufficient denominator (MSD)for each performance level. Togetherthis ensures that all cases areappropriately accounted for andadequately figured in to the benchmark.

The ABCTM methodology for apublicly reported benchmark onPhysician Compare would be based onthe current years data, so the

benchmark would be appropriateregardless of the unique circumstancesof data collection or the measuresavailable in a given reporting year. Wealso propose to use the ABCTMmethodology to generate a benchmarkwhich can be used to systematicallyassign stars for the Physician Compare5 star rating. ABCTM has beenhistorically well received by the healthcare professionals and entities it ismeasuring because the benchmarkrepresents quality while being both

realistic and achievable; it encouragescontinuous quality improvement; and, itis shown to lead to improved quality ofcare.5 6 7

To summarize, we propose to publiclyreport on Physician Compare an item ormeasure-level benchmark derived usingthe Achievable Benchmark of Care(ABCTM) methodology annually basedon the PQRS performance rates mostrecently available (that is, in 2017 wewould publicly report a benchmarkderived from the 2016 PQRSperformance rates), and use this

benchmark to systematically assign stars

for the Physician Compare 5 star rating.We solicit comments on this proposal.

g. Patient Experience of Care Measures

In the CY 2015 PFS final rule withcomment period (79 FR 67547), weadopted a policy to publicly reportpatient experience data for all grouppractices of two or more EPs. Consumer

testing shows that other patientsassessments of their experience resonatewith consumers because it is importantto them to hear about positive andnegative experiences others have withphysicians and other health careprofessionals. As a result, consumersreport these patient experience datahelp them make an informed health caredecision. Understanding the valueconsumers place on patient experiencedata and our commitment to reportingthese data on Physician Compare, wepropose to continue to make availablefor public reporting all patientexperience data for all group practicesof two or more EPs, who meet thespecified sample size requirements andcollect data via a CMS-specifiedcertified CAHPS vendor, annually in theyear following the year the measures arereported (for example, 2016 PQRSreported data will be included on theWeb site in 2017). The patientexperience data available that wepropose to make available for publicreporting are the CAHPS for PQRSmeasures, which include the CGCAHPS core measures. For grouppractices, we propose to annually makeavailable for public reporting a

representation of the top boxperformance rate 8 for these 12 summarysurvey measures:

Getting Timely Care, Appointments,and Information.

How Well Providers Communicate. Patients Rating of Provider. Access to Specialists. Health Promotion & Education. Shared Decision Making. Health Status/Functional Status. Courteous and Helpful Office Staff. Care Coordination. Between Visit Communication. Helping You to Take Medication as

Directed.

Stewardship of Patient Resources.We solicit comments on this proposal.

h. Downloadable Database

(a) Addition of VM Information

To further aid in transparency, wealso propose to add new data elements

to the Physician Compare downloadabledatabase (https://data.medicare.gov/data/physician-compare). Currently, thedownloadable database includes allquality information publicly reported onPhysician Compare, including qualityprogram participation, and all measuressubmitted and reviewed and found to bestatistically valid and reliable. We

propose to add to the PhysicianCompare downloadable database forgroup practices and individual EPs the2018 VM quality tiers for cost andquality, based on the 2016 data, notingif the group practice or EP is high, low,or average on cost and quality per theVM. We also propose to include anotation of the payment adjustmentreceived based on the cost and qualitytiers, and an indication if the individualEP or group practice was eligible to butdid not report quality measures to CMS.The profile pages on Physician Compareare meant to provide information to

average Medicare consumers that canhelp them identify quality health careand choose a quality clinician, whilethis database is geared toward healthcare professionals, industry insiders,and researchers who are more able toaccurately use more complex data.Therefore, adding this information tothe downloadable database promotestransparency and provides useful datato the public while we conductconsumer testing to ensure VM data

beyond the indication for an upwardadjustment discussed above can bepackaged and explained in such a waythat it is accurately interpreted,

understood, and useful to averageconsumers. We solicit comments on thisproposal.

(b) Addition of Utilization Data

In addition, we propose to addutilization data to the PhysicianCompare downloadable database.Utilization data is information generatedfrom Medicare Part B claims on servicesand procedures provided to Medicare

beneficiaries by physicians and otherhealth care professionals; and arecurrently available at (http://www.cms.gov/Research-Statistics-Data-and-

Systems/Statistics-Trends-and-Reports/Medicare-Provider-Charge-Data/Physician-and-Other-Supplier.html). Itprovides counts of services andprocedures rendered by health careprofessionals by Healthcare CommonProcedure Coding System (HCPCS)code. Under section 104(e) of theMedicare Access and CHIPReauthorization Act of 2015 (MACRA),Pub. L. 11410, 104, signed into lawApril 16, 2015; beginning with 2016, theSecretary shall integrate utilization datainformation on Physician Compare. This



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section of the law discusses data thatcan help empower people enrolled inMedicare by providing access toinformation about physician services.These data are very useful to the healthcare industry and to health careresearchers and other stakeholders whocan accurately interpret these data anduse them in meaningful analysis. These

data are less immediately useable intheir raw form by the average Medicareconsumer. As a result, we propose thatthe data be added to the downloadabledatabase versus the consumer-focusedWeb site profile pages. Including thesedata in the Physician Comparedownloadable database providestransparency without taking away fromthe information of most use toconsumers on the main Web site. Wesolicit comments on this proposal.

(i) Board Certification

Finally, we propose adding additional

Board Certification information to thePhysician Compare Web site. BoardCertification is the process of reviewingand certifying the qualifications of aphysician or other health careprofessional by a board of specialists inthe relevant field. We currently include

American Board of Medical Specialties(ABMS) data as part of individual EPprofiles on Physician Compare. Weappreciate that there are additional, wellrespected boards that are not includedin the ABMS data currently available onPhysician Compare that represent EPsand specialties represented on the Website. Such board certification

information is of interest to consumersas it provides additional information touse to evaluate and distinguish betweenEPs on the Web site, which can help inmaking an informed health caredecision. The more data of immediateinterest that is included on PhysicianCompare, the more users will come tothe Web site and find quality data thatcan help them make informed decisions.Specifically, we are now proposing toadd to the Web site board certificationinformation from the American Board ofOptometry (ABO) and AmericanOsteopathic Association (AOA). Please

note we are not endorsing any particularboards. These two specific boardsshowed interest in being added to theWeb site and have demonstrated thatthey have the data to facilitate inclusionof this information on the Web site.These two boards also fill a gap, as the

ABMS does not certify Optometrists andonly certain types of DOs are covered byAMBS Osteopathic certification. Ingeneral, we will review interest from

boards as it is brought to our attention,and if the necessary data are availableand appropriate arrangements andagreements can be made to share theneeded information with Physician

Compare, additional board informationcould be added to the Web site infuture. At this time, however, we arespecifically proposing to include ABOand AOA Board Certificationinformation on Physician Compare. Wesolicit comments on this proposal.

We solicit comments on all proposals.Increasing the measures and dataelements for public reporting onPhysician Compare at both theindividual and group level will helpaccomplish the Web sites twofoldpurpose:

To provide more information for

consumers to encourage informedpatient choice. To create explicit incentives for

physicians to maximize performance.Table 19 summarizes the Physician

Compare measure and participation dataproposals detailed in this section.

TABLE 19SUMMARY OF PROPOSED MEASURE AND PARTICIPATION DATA FOR PUBLIC REPORTING

Data collectionyear *

Publicationyear *

Data type Reporting mechanism Proposed quality measures and data for public reporting

2016 .................. 2017 PQRS, PQRS,GPRO, EHR, andMillion Hearts.

Web Interface, EHR, Reg-istry, Claims.

Include an indicator for satisfactory reporters underPQRS, participants in the EHR Incentive Program, andEPs who satisfactorily report the Cardiovascular Pre-vention measures group proposed under PQRS in sup-port of Million Hearts.

2016 .................. 2018 PQRS, PQRS,GPRO.

Web Interface, EHR, Reg-istry, Claims.

Include an indicator for individual EPs and group prac-tices who receive an upward adjustment for the VM.

2016 .................. 2017 PQRS, GPRO ........ Web Interface, EHR, Reg-istry.

All PQRS GPRO measures reported via the Web Inter-face, EHR, and registry that are available for public re-porting for group practices of 2 or more EPs.

Publicly report an item-level benchmark, as appropriate.2016 .................. 2017 ACO ....................... Web Interface, Survey Ven-

dor Claims.All measures reported by Shared Savings Program

ACOs, including CAHPS for ACOs.2016 .................. 2017 CAHPS for PQRS .. CMS-Specified Certified

CAHPS Vendor.All CAHPS for PQRS measures for groups of 2 or more

EPs who meet the specified sample size requirementsand collect data via a CMS-specified certified CAHPSvendor.

2016 .................. 2017 PQRS ..................... Registry, EHR, or Claims ..... All PQRS measures for individual EPs collected through aregistry, EHR, or claims.

Publicly report an item-level benchmark, as appropriate.2016 .................. 2017 QCDR data ............ QCDR ................................... All individual EP and group practice QCDR measures.2016 .................. 2017 Utilization data ....... Claims .................................. Utilization data for individual EPs in the downloadable

database.2016 .................. 2017 PQRS, PQRS,

GPRO.Web Interface, EHR, Reg-

istry, Claims.The following data for group practices and individual EPs

in the downloadable database: The VM quality tiers for cost and quality, noting if the

group practice or EP is high, low, or neutral on costand quality per the VM.

A notation of the payment adjustment received basedon the cost and quality tiers.

An indication if the individual EP or group practice waseligible to but did not report quality measures to CMS.

* Note that these data are proposed to be reported annually. The table only provides the first year in which these proposals would begin on anannual basis, and such dates also serve to illustrate the data collection year in relation to the publication year. Therefore, after 2016, 2017 datawould be publicly reported in 2018, 2018 data would be publicly reported in 2019, etc.



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Excerpts Medicare Physician Fee Schedule Proposed Rule.pdf

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Transcript of Excerpts Medicare Physician Fee Schedule Proposed Rule.pdf