MGMA Update

The information below is provided by the Medical Group Management (MGMA) Government Affairs staff. 


                See MGMA information below regarding Upcoming federal quality reporting program deadlines.

Last day to submit 2015 PQRS data:

March 11 via Certified EHR Technology or Data Submission Vendor, GPRO Web Interface, Qualified Clinical Data Registry (QCDR) QRDA III format

March 31 via QCDR XML format, Qualified Registry


Last day to attest for 2015 Meaningful Use:

March 11 via the Centers for Medicare & Medicaid Services - attestation portal



Study: Practices spend $15.4 billion annually on quality reporting

According to a Health Affairs study of MGMA member practices, each year physician practices in four common specialties spend, on average, 785 hours per physician and more than $15.4 billion on quality measure reporting programs. As the study cites, the majority of time spent on quality reporting consists of “entering information into the medical record ONLY for the purpose of reporting for quality measures from external entities,” and nearly three-quarters of practices stated that their group was being evaluated on quality measures that are not clinically relevant.


The study results confirm what physician practices have known for many years – that reporting varying quality information across multiple payers runs counter to the stated goals of these programs, which are to improve efficiency and clinical outcomes while reducing waste. “As the largest contributor to the problem, the federal government needs to get out of the business of dictating patient care through wasteful mandates and create simplified systems to support medical practices in improving quality across the country,” challenged Halee Fischer-Wright, MD, MMM, FAAP, CMPE, MGMA's president and CEO.

CMS details 2016 Value Modifier bonus and penalty amounts

In the 2016 payment year, the Medicare Value-Based Payment Modifier (VBPM) applies to 13,813 group practices with 10 or more eligible professionals. According to results released earlier this week by the Centers for Medicare & Medicaid Services (CMS), 1% of these group practices will receive a significant bonus payment for achieving high scores under the VBPM analysis, which compares a group’s cost and quality data against national benchmarks. Fifty-nine practices will be subject to a penalty for poor performance under VBPM metrics, while all other groups who were subject to the VBPM cost and quality analysis will receive no bonus or penalty in 2016. However, 5,418 groups were excluded from the VBPM’s analysis because they did not successfully report PQRS quality data in 2014. As a result, those practices will be subject to an automatic 2% penalty in 2016, in addition to the separate 2% PQRS penalty. MGMA has long advocated that the VBPM’s reliance on the burdensome PQRS reporting program is flawed, as many practices are unable to report clinically-relevant data.


To better understand how the 2016 VBPM results impact your practice, download your 2014 Quality and Resource Use Report. Learn how to obtain these CMS reports here.

Medicare plans to test new payment models for drugs

Yesterday, the Centers for Medicare & Medicaid Services (CMS) released a proposed rule to test different payment models for reimbursing Medicare Part B drugs administered in physician offices and hospital outpatient departments (HOPDs). Currently, CMS pays practices and HOPDs the average sales price (ASP) of the drug plus a 6% “add-on” payment. Beginning in late 2016, Medicare would pay ASP plus 2.5% and a flat payment of $16.80 per day per drug payment to physician practices and HOPDs in certain geographic areas in order to determine whether this change affects prescribing incentives. CMS is also proposing to test additional drug payment models, such as eliminating patient cost-sharing and establishing reference prices, beginning in 2017.


Practices and other stakeholders may submit comments in response through May 9, 2016. Access CMS’ factsheet for more information. 

Medicare Part D prescriber requirements delayed to Aug. 1, 2016

As a result of insufficient outreach by the Centers for Medicare & Medicaid Services to promote provider awareness as well as a backlog from Medicare Administrative Contractors (MACs) to process enrollment applications, the agency announced a delay in the Medicare Part D prescriber enrollment requirements for physicians and eligible prescribers. In order to prescribe under Medicare Part D, those prescribing must be enrolled in Medicare or, for those who have opted out of the program, have a valid affidavit on file with their MAC. Beginning Feb. 1, 2017, Medicare Part D sponsors will deny claims for providers who do not meet this criteria. Prescribers of Part D drugs who are not currently enrolled in Medicare should submit their enrollment as soon as possible to allow sufficient time for processing before the Aug. 1, 2016 deadline. Access more information on these Part D prescriber requirements.

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