2016 PQRS and 2018 Value Modifier Experience Reports

August 23, 2018
Policy Snapshot

Find data from the Physician Quality Reporting System (PQRS) and Value-Based Payment Modifier Programs. Payment adjustments for 2018 are based on 2016 data.

Highlights of this year’s PQRS report include:

  • In 2016, nearly 1.39 million EPs were eligible to participate in PQRS.
  • Of those eligible in 2016, 69% (962,974 EPs) were successful and avoided the 2018 payment adjustment.
  • Of all EPs that were eligible in 2016, 31% (435,111) will receive a payment adjustment of -2% in 2018. Almost 85% of those subject to the adjustment did not attempt to participate in the program (that is, did not submit any data).

Please contact the QualityNet Help Desk at 1-866-288-8912 (TTY: 1-877-715-6222), Monday–Friday, 7 am – 7 pm CT, if you have questions on PQRS.

For questions on Value Modifier and Quality and Resource Use Reports, contact the Physician Value Help Desk at pvhelpdesk@cms.hhs.gov or 1-888-734-6433 (select option 3), Monday–Friday, 7 am – 7 pm CT.

These are the final experience reports for the PQRS and Value Modifier programs; both programs sunset December 31. Many elements of PQRS transitioned to the Quality Performance Category of the Merit-based Incentive Payment System (MIPS). MIPS is one of two paths under the Quality Payment Program. It is designed to update and consolidate previous programs, including Medicare Electronic Health Records Incentive Program, PQRS, and the Value-based Payment Modifier. For more information about MIPS, visit qpp.cms.gov.