A provider’s fee schedule will be based on their composite score.
Penalties take effect in 2019 but are based on actions taken in 2017.
There are three exceptions. They are:
1. Physicians billing less than or equal to $30,000 in charges to Medicare for 100 or fewer patients
2. Physicians in their first year of enrollment
3. Physicians participating in APMs
For 2017 & 2018 Requirements are for Physicians (MD/DO and DMD/DDS), Physician Assistants, Clinical Nurse Specialists, and Certified Registered Nurse Anesthetists
In 2019 it is expanded to include physical and occupational therapists, speech-language pathologists, audiologists, nurse midwives, clinical social workers, clinical psychologists, and dietitians/nutritional professionals
So mental health, physical therapy, audiologists, and a few others are not affected until 2019
There are 4 performance categories:
1. PQRS – 60%
2. EHR – 25%
3. Clinical Practice Improvement – 15%
4. Resource Use – 0% (not used in 2017, but will be in 2018 and on)
This means that a huge 85% of the score is based on PQRS and EHR.