The Group Practice Reporting Option (GPRO) allows individual providers within a group to report as one entity for PQRS. A “group” or “group practice” is defined as a single Medicare-billing Taxpayer Identification Number (TIN) with 2 or more individual eligible professionals (EPs) (as identified by their individual NPI) who have reassigned their billing rights to the TIN.
When you report PQRS as a group, everyone in the group must report the same measures and all EPs within the TIN are included. Individual EPs within a group that reports as a GPRO are not eligible to report as individuals, and GPRO reporting overrides any individual PQRS reporting that may be submitted.
What happens to the group, happens to all EPs in the TIN—either all succeed or all fail. Furthermore, the group’s performance rates will be used to calculate the Value-Modifier (VM) for all EPs in the group.
Physicians in groups of all sizes and physician solo practitioners are subject to the Value Modifier payment adjustments in 2018, based on performance in 2016. Successful participation in PQRS is a requirement for participation in the Value Modifier program.
Physician groups with 2 or more EPs that choose not to register as a GPRO must ensure that at least 50% of the EPs in the group successfully report PQRS to avoid a 2018 Value Modifier payment adjustment (-2.0% or -4.0%, depending on the group’s size).
Considering reporting as a group?
- Reporting as a group can streamline PQRS requirements. Staff reports one set of measures on behalf of all EPs in the group, eliminating the need to keep track of individual EP reporting.
- Some providers, such as visiting specialists, locum tenens, or some specialists, may have seen only a few Medicare patients, and it may be difficult to find enough measures when filing as individuals. Under GPRO, all Medicare Part B PFS patients across the TIN are grouped together.
- It is not required that your measures capture services provided by each provider that is part of the TIN. That is, depending on the measures selected, some EPs may not have patients that are part of the measure(s) denominator(s), and that’s okay. But all Medicare patients that were seen are included in the denominator of a measure if they meet the denominator criteria--even if the measure wasn’t applicable to the EP that saw the patient. For example, if you report as a GPRO and select Measure #112, Breast Cancer Screening, then all women age 50-74 that were seen by any EP within the TIN will fall into the denominator, even if they were only seen by a specialist that normally doesn’t screen for breast cancer.
- The group needs a reliable method of identifying all patients that are included in the denominator of the measures selected. This may be a billing module, an EHR, or a combination of the two. Reporting as a group will require cooperation and input from the quality department, billing, IT, medical records/coding and the clinical staff, particularly for large, multi-specialty groups.
- Groups of 100 or more EPs that register as a GPRO must supplement their PQRS reporting with “CAHPS for PQRS”. The group must select a certified vendor and pay for the survey. For groups of 2-99 EPs, CAHPS for PQRS is optional. (Groups of 100+ EPs that report as individuals do not have to report CAHPS for PQRS.) CMS expects to publish the listing of certified survey vendors this summer.
- Groups must register between April 1 and June 30, 2016 to report as a group and select the method of GPRO reporting. The Registration System can be accessed at https://portal.cms.gov using a valid EIDM account. Group size is determined at the time of registration. Registration must be done every year. Groups can cancel or modify their registration until June 30, 2016.
- Results will be published on Physician Compare.
- Groups do not have to report as a GPRO to meet the requirements for the Value Modifier program. If a group does not elect to report as a GPRO, then at least 50% of their individual EPs must successfully report PQRS in 2016 as individuals to avoid an automatic downward payment adjustment in 2018 under the Value Modifier. Individual EPs that do not report will be subject to the PQRS penalty in 2018.
Individual Reporting vs. Group Reporting?
In general, it is easier to report as a GPRO. However, there may be instances where individual reporting is better for you. Those instances may include:
- if you want to report via Claims,
- if some of your providers are using an EHR while others are not and you intend to report using EHR-Direct/DSV,
- if some of your providers participate with a Qualified Clinical Data Registry while others do not,
- if your TIN has multiple different EHRs and you do not intend to report using the GPRO Web Interface,
- and other similar examples.
Want to learn more?
Primaris is hosting a two-part webinar series on the 2016 GPRO measures. Read more about the webinars in "Understanding the 2016 PQRS GPRO Measures". The webinars will cover the 2016 GPRO measures, including abstraction flow and recommendations for improvement. You can register below!
2016 GPRO Measures: Part 1
Tuesday, June 21 @ noon--12:30 p.m. CT
Part 1 presentation will include abstraction information and helpful tips. The following Preventative (PREV) Care Measures will be discussed: PREV-5, PREV-6, PREV-7, PREV-8, PREV-9, PREV-10, PREV-11, PREV-12, and PREV-13 (New Measure for 2016 Reporting).
2016 GPRO Measures: Part 2
Tuesday, June 28 @ noon--12:30 p.m. CT
Part 2 presentation will include abstraction information and helpful tips. The following measures will be discussed: CARE-2, CARE-3, CAD-7, DM-2, DM-7, HF-6, HTN-2, IVD-2, and MH-1.
If you would like to discuss whether GPRO is right for you, please reach out to us at [email protected].