Starling Receives PQRS Reports for 2015

Last week we received the 2015 PQRS reports for both GH and CMG.  The tax payer identification or TIN level reported data for 2015 compares each reporting group to all groups nationally and scores based upon costs and quality. A high performing group would have high quality and low costs score (see illustrative graph below).

An average provider would be 0.0 for costs (negative is better) and 0.0 for quality (positive is better). Costs numbers come from Medicare claim data and both groups were near or below the Peer Group Mean with GH costs being at the mean at 0.00 below and CMG being just below -.09.

Quality measures are reported from information obtained from data file submissions from Allscripts for CMG and SRS for GH. For quality, CMG was at -.11 just below the mean of 0.00 and this translated into a 0% value based modifier payment adjustment.  For GH, the quality score was -1.33%, which would have a result in a 2% negative adjustment to GH’s 2017 Medicare fee schedule.  The low quality scores of GH were really a result of the reporting limitations of SRS system more than anything else. This is another reason that moving to Allscripts for all of Starling is a priority.  Results indicate that combined Starling still has much work to do to move from “average” into “high performing” to succeed in the future Medicare incentive payment world. The good news is that PQRS is a TIN level system so since Starling is using the legacy CMG’s TIN, the 2015 results will mean no negative adjustment for 2017 fee schedule for all Starling providers.