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Physician Quality Reporting System (PQRS)
Physician Quality Reporting System (PQRS)
Physician Quality Reporting System (PQRS)
Physician Quality Reporting System (PQRS)
Physician Quality Reporting System (PQRS)
Physician Quality Reporting System (PQRS)
Physician Quality Reporting System (PQRS)
Physician Quality Reporting System (PQRS)
Physician Quality Reporting System (PQRS)
Physician Quality Reporting System (PQRS)
Physician Quality Reporting System (PQRS)
Physician Quality Reporting System (PQRS)
Physician Quality Reporting System (PQRS)
Physician Quality Reporting System (PQRS)
Physician Quality Reporting System (PQRS)
Physician Quality Reporting System (PQRS)
Physician Quality Reporting System (PQRS)
Physician Quality Reporting System (PQRS)
Physician Quality Reporting System (PQRS)
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Physician Quality Reporting System (PQRS)

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  • 1. Physician  Quality  Repor3ng  System  (PQRS)   Wednesday,  February  5,  2014   Disclaimer:  Nothing  that  we  are  sharing  is  intended  as  legally  binding  or  prescrip7ve  advice.  This  presenta7on  is  a   synthesis  of  publically  available  informa7on  and  best  prac7ces.  
  • 2. What  is  PQRS?   •  Voluntary,  individual  repor1ng  program   –  Quality  measures  for  services    provided  to  Medicare   beneficiaries   •  Started  in  2007     –  Tax  Relief  and  Health  Care  Act   •  Incen1ve  payments  for  par1cipa1on  through   2014   •  Financial  penalty  for  non-­‐par1cipa1on  aKer  2014   •  Measures  based  on  combina1ons  of  CPT,  ICD  and   pa1ent  age  at  the  1me  of  the  encounter  
  • 3. Who  is  Eligible?   •   Physicians   –  •  Doctors  of  Medicine,  Osteopathy,  Podiatric  Medicine,  Optometry,  Oral  Surgery,  Dental  Medicine,  Chiroprac1c       Prac11oners     –  –  –  –  –  –  –  –  –  –  •  Physician  Assistant   Nurse  Prac11oner   Clinical  Nurse  Specialist   Cer1fied  Registered  Nurse  Anesthe1st  (and  Anesthesiologist  Assistant)       Cer1fied  Nurse  Midwife   Clinical  Social  Worker       Clinical  Psychologist       Registered  Die1cian       Nutri1on  Professional      Audiologists   Therapists       –  –  –  Physical  Therapist       Occupa1onal  Therapist       Qualified  Speech-­‐Language  Therapist    
  • 4. Provider  Repor1ng  Methods   •  Individual     –  –  –  –  –  EHR  Direct  Product  that  is  Cer1fied  EHR  Technology  (CEHRT)   EHR  data  submission  vendor  that  is  CEHRT   Qualified  PQRS  Registry   Par1cipa1on  through  a  Qualified  Clinical  Data  Registry  (QCDR)   Medicare  Part  B  claims  submiYed  to  CMS   •  Group  Prac1ce  Repor1ng     –  –  –  –  –  GPRO  Web  Interface   Qualified  PQRS  Registry   EHR  Direct  Product  that  is  CEHRT   EHR  data  submission  vendor  that  is  CERT   CMS-­‐cer1fied  survey  vendor   *Group  prac*ces  repor*ng  via  GPRO  must  register  for  their  selected  repor*ng  method  by  September  30,  2014.  
  • 5. Claims-­‐Based  Repor1ng   •  QDCs  must  be  reported   –  On  claim  represen1ng  the  denominator  of  eligible  Medicare  Part  B   encounters   –  Same  beneficiary  as  encounter   –  Same  date  of  service  as  qualifying  EM  code   –  Same  EP  who  is  rendering  eligible  performed  code   •  QDCs  must  be  submiYed  with  a  line-­‐item  charge  of  one  penny   ($0.01)  at  the  1me  the  associated  covered  service  is   performed   –  SubmiYed  charge  field  cannot  be  blank.   –  Line  item  charge  should  be  $0.01  –  beneficiary  not  liable  for  this  amount   –  En1re  claim  with  $0.01  charge  will  be  rejected.  Claims  for  just  QDC  codes   are  not  permiYed   *  Claims  may  NOT  be  resubmi@ed  for  the  sole  purpose  of  adding  or  correc7ng  QDCs    
  • 6. EHR-­‐Based  Repor1ng   •  EHR-­‐based  repor1ng  op1on  sa1sfies  the  CQM   component  of  Meaningful  Use   •  Submit  data  by  the  February  28,  2015   •  Direct  EHR  Vendor   –  Must  register  for  an  IACS  account   •  EHR  Data  Submission  Vendor   –  Responsible  for  submicng  PQRS  measures  data  to   CMS  
  • 7. Qualified  Registry   •  Collects  clinical  data  from  eligible   professional  or  group  prac1ce   •  Submits  data  to  CMS  on  behalf  of   par1cipants   •  2014  Par1cipa1ng  Registry  Vendors   list  available  on  the  CMS  PQRS  web-­‐ site  
  • 8. Qualified  Clinical  Data  Registry  (QCDR)   •  •  CMS-­‐approved  en1ty   Collects  medical  and/or  clinical  data  for  pa1ent  and  disease  tracking     –  Improved  quality  of  care   •  •  Not  limited  to  PQRS  measures     May  submit  measures  from  one  or  more  of  the  following  categories:   –  –  –  –  –  •  •  Clinician  &  Group  Consumer  Assessment  of  Healthcare  Providers  and  Systems   Na1onal  Quality  Forum  endorsed  measures   Current  2014  PQRS  measures   Measures  used  by  boards  or  specialty  socie1es   Measures  used  in  regional  quality  collabora1ons   Choose  appropriate  QCDR   Work  directly  with  QCDR   –  Legal  agreement  for  QCDR  receipt  of  pa1ent-­‐specific  data  and  release  of  quality  measure  data  to   CMS  on  the  EPs  behalf.     –  Specific  instruc1ons  on  how  to  collect  and  provide  pa1ent  data  for  use  by  the  QCDR  supplied  by  the   QCDR.  
  • 9. GPRO  Web  Interface   •  •  •  Register  and  report  chosen  repor1ng  method  no  later  than  September  30,  2014  if   repor1ng  for  2014   Includes  comple1on  of  pre-­‐filled  beneficiary  sample.     25  –  99  Eligible  Professionals   –  Report  on  all  measures  AND  populate  data  fields  for  the  first  218  consecu1vely  ranked   and  assigned  beneficiaries                Or   –  Have  all  12  CG  CAHPS  summary  survey  modules  reported  via  CMS-­‐cer1fied  survey   vendor  AND  report  on  6  measures  covering  at  least  2  of  the  NQS  domains     –  Use  a  qualified  registry,  direct  EHR  product,  EHR  data  submission  vendor  or  GPRO  Web   Interface  as  a  repor1ng  mechanism.   •  100  +  Eligible  Professionals   –  Report  on  all  measures  AND  populate  data  fields  for  the  first  411  ranked  and  assigned   beneficiaries   Individual  eligible  professionals  within  a  group  prac1ce  that  sa1sfactorily  completes  the  GPRO  Web  Interface  will  also   receive  credit  for  the  CQM  component  of  the  EHR  Incen1ve  Program.    
  • 10. Payment  Incen1ve/Penalty  Timeline  
  • 11. Requirements  for  Incen1ve  Payments   –  Individual  Measures   •  Claims/Qualified  Registry   –  At  least  9  measures  covering  at  least  3  NQS  domains  for  at  least  50%   Medicare  Part  B  pa1ents  seen  during  repor1ng  period.   –  If  less,  report  1—8  measures  covering  1—3  NQS  domains,  AND  report   each  measure  for  at  least  50%  Medicare  Part  B  pa1ents  seen  during   repor1ng  period.   •  Measures  with  a  0%  performance  rate  not  counted.     •  Fewer  than  9  measures  covering  3  NQS  subject  to  the  MAV  process.           •  EHR  Report     –  9  measures  covering  at  least  3  of  the  NQS  domains   –  If  CEHRT  does  not  contain  pa1ent  data  for  at  least  9  measures  covering  at   least  3  domains,  the  EP  must  report  measures  with  Medicare  pa1ent  data   –  Must  report  on  at  least  1  measure  for  which  there  is  Medicare  pa1ent   data  
  • 12. Requirements  for  Incen1ve  Payments   –  Measure  Groups   •  Qualified  Registry     –  Report  at  least  1  measures  group,  AND  report  each  measures  group   for  at  least  20  pa1ents   –  Majority  must  be  Medicare  Part  B  pa1ents.     •  Qualified  Clinical  Data  Registry     –  Report  at  least  9  measures  covering  at  least  3  NQS  domains  AND   report  each  measure  for  at  least  50%  eligible  pa1ents  seen  during  the   repor1ng  period   –  Measures  with  a  0%  performance  rate  not  counted.         –  At  least  1  outcome  measure.    
  • 13. Requirements  for  Avoiding  Penal1es  in   2016  –  Individual  Measures   •  Claims/Qualified  Registry/Qualified  Registry  Report       –  At  least  9  measures  covering  at  least  3  NQS  domains  AND  report  each  measure  for   at  least  50%    Medicare  Part  B  pa1ents  seen  during  repor1ng  period.     –  If  less  than  requirement  report  1—8  measures  covering  1—3  NQS  domains,  AND   report  each  measure  for  at  least  50%  Medicare  Part  B    pa1ents  seen  during  the   repor1ng  period.   –  Measures  with  a  0%  performance  rate  would  not  counted.       –  Fewer  than  9  measures  covering  3  NQS  domains  via  the  claims-­‐based  repor1ng   mechanism  subject  to  the  MAV  process   •  Claims     –  Report  at  least  3  measures  for  at  least  50%  of  the  eligible    professionals  Medicare  Part  B   pa1ents  seen  during  the  repor1ng  period.   –  If  less  than  requirement,  report  1—2  measures;  AND  report  each  measure  for  at  least   50%  Medicare  Part  B  pa1ents  seen  during  the  repor1ng  period  to  which  the  measure   applies.   –  Measures  with  a  0%  rate  not  counted.      
  • 14. Avoiding  Penalty  in  2016  -­‐  Individual   Providers,  Group  Measures     •  Qualified  Registry     –  Report  at  least  1  measures  group,  AND  report  each  measures  group  for  at  least  20   pa1ents,  a  majority  of  which  must  be  Medicare  Part  B  FFS  pa1ents.     •  Qualified  Clinical  Data  Registry     –  Report  at  least  9  measures  covering  at  least  3  NQS  domains  AND  report  each   measure  for  at  least  50  percent  of  the  eligible  professional’s  applicable  pa1ents   seen  during  the  repor1ng  period  to  which  the  measure  applies.       –  Measures  with  a  0%  performance  rate  would  not  be  counted.       –  Of  the  measures  reported  via  a  qualified  clinical  data  registry,  the  eligible   professional  must  report  on  at  least  1  outcome  measure   •  Qualified  Clinical  Data  Registry   –  Report  at  least  3  measures  covering  at  least  1  NQS  domain  AND  report  each   measure  for  at  least  50  percent  of  the  eligible  professional’s  applicable  pa1ents   seen  during  the  repor1ng  period  to  which  the  measure  applies.   –  Measures  with  a  0  percent  performance  rate  would  not  be  counted  
  • 15. Avoiding  Penalty  in  2016  -­‐  GPRO   •  GPRO  Web  Interface  Report  on  all  measures  included  in  web  interface.   –  Populate  data  fields  for  the  first  218  (411  for  100  or  more  EPs)  consecu1vely  ranked  and   assigned  beneficiaries   –  If  less  than  218  eligible  assigned  beneficiaries,  report  on  100%  of  assigned  beneficiaries.   •  Qualified  Registry   –  –  –  –  •  Report  at  least  9  measures  covering  at  least  3  of  the  NQS  domains  and  report  each  measure  for  at  least  50%   of  the  group’s  Medicare  Part  B  pa1ents  seen  during  the  repor1ng  period.     If  less  than  requirement,  report  1  –  8  measures  covering  1  –  3  domains  with  Medicare  pa1ent  data  AND   report  each  measure  for  at  least  50%  of  Medicare  Part  B  pa1ents  seen  during  the  repor1ng  period.   Measures  with  0%  performance  rate  not  counted.   Fewer  than  9  measures  covering  at  least  3  domains,  subjects  the  group  to  the  MAV  process   Direct  EHR  /  EHR  Data  Submission  by  Vendor   –  Report  9  measures  covering  at  least  3  domains.   –  If  a  group  prac1ce’s  CEHRT  does  not  contain  pa1ent  data  for  at  least  9  measures  covering  at  least  3   domains,  then  the  group  prac1ce  must  report  the  measures  for  which  there  is  Medicare  pa1ent  data.   –  A  group  prac1ce  must  report  on  at  least  1  measure  for  which  there  is  Medicare  pa1ent  data.   •  CMS  -­‐  Cer1fied  Survey  Vendor   –  Report  all  CG  CAHPS  survey  measures  AND  report  at  least  6  measures  covering  at  least  2  of  the  NQS   domains  
  • 16. Measure  Selec1on   •  Individual  Measures   –  110  Claims  Based  Measures   –  201  Registry  Based  Measures   –  64  EHR  Measures   •  Group  Measures   –  25  Measures  Groups   •  Domains     –  –  –  –  –  –  Clinical  Process  /  Effec1veness   Pa1ent  Safety   Popula1on  /  Public  Health   Efficient  Use  of  Healthcare  Resources   Care  Coordina1on   Pa1ent  and  Family  Engagement  
  • 17. Measure  Selec1on   •  Which  measures  should  you  choose?   –  Difficulty   –  Relevance   •  Clinical  condi1ons  usually  treated  –  Cardiac,  HTN,  Diabetes,  etc.   •  Types  of  care  typically  provided  –  e.g.,  preven1ve,  chronic,  acute   –  Best  performance     •  200  standardized  quality  measures   •  Meet  50%  threshold  requirement     –  Choose  a  PQRS  quality  measure  for  services  that  are  performed  frequently.  (This  is  the   minimum  required  to  prevent  penalty)   •  Incen1ve  Payment  or  Avoid  Penalty  
  • 18. PQRS  Resources   •  hYp://www.cms.gov/Medicare/Quality-­‐Ini1a1ves-­‐Pa1ent-­‐Assessment-­‐ Instruments/PQRS/MeasuresCodes.html   –  2014  Physician  Quality  Repor1ng  System  Implementa1on  Guide   –  2014  PQRS  Measures   •  QualityNet  Help  Desk:     –  Portal  password  issues   –  PQRS/eRx  feedback  report  availability  and  access     –  IACS  registra1on  ques1ons  –  IACS  login  issues   –  PQRS  and  eRx  Incen1ve  Program  ques1ons       •  866-­‐288-­‐8912  (TTY  877-­‐715-­‐6222)    7:00  a.m.–7:00  p.m.  CST  M-­‐F  or   qnetsupport@sdps.org    You  will  be  asked  to  provide  basic   informa1on  such  as    name,  prac1ce,  address,  phone,  and  e-­‐mail  
  • 19. Q&A   dan.holleran@quirkhealthcare.com   tamina.vahidy@quirkhealthcare.com  

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