Using Practice Fusion for PQRS EHR Reporting in 2014

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This presentation is an overview of PQRS requirements in 2014, requirements for PQRS EHR reporting, and measure selection and EHR reporting applicability. The presentation will also give a deep dive into using Practice Fusion for PQRS reporting.

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  • Hello everyone and thank you for joining me today to learn about using Practice Fusion for PQRS EHR Reporting in 2014.
  • This video will address the following items related to PQRS EHR Reporting in 2014:
    An overview of PQRS requirements in 2014
    Requirements for PQRS EHR Reporting
    Measure selection and EHR reporting applicability
    Detailed Deep Dive into Practice Fusion PQRS CQMs
    PQRS FAQs
    Resources
  • The Physician Quality Reporting System, or PQRS, is a CMS quality improvement program that uses a combination of incentive payments and penalties to promote reporting of quality data.
    Providers are eligible for participation in PQRS if they are reimbursed under the Medicare Physician Fee Schedule (PFS) and see Medicare Part B patients.
    This includes physicians, chiropractors, dentists, PAs, NPs, and other eligible practitioners and therapists.
    Under PQRS, payment incentives and penalties are determined based on eligible professional services that are paid under or based on the Medicare Physician Fee Schedule.
  • Your PQRS participation in 2014 determines both your potential payment incentive and possible adjustment penalties that will effect future Medicare reimbursements. Note that 2014 is the last year to earn a PQRS incentive payment, and payment penalties will continue to compound at 2% starting with participation this year.
    As you can see, reporting in 2014 can result in either a 0.5% payment incentive or a 2.0% payment adjustment that would be applied in 2016.
    Note that starting this year, the payment penalty increases to 2.0% of your Medicare Part B reimbursements each year moving forward.
  • PQRS is very complex - PQRS requirements vary based on the reporting mechanism that you choose. The complexities are good in that you have more options, but it also means that you need to become familiar specific requirements that apply to the option that you are using.
    PQRS requirements are specific to each calendar year – eligible PQRS measures, G-codes, reporting requirements, etc. may change from year to year, so make sure you refer to 2014 resources and materials
    PQRS actions don’t roll-over – You may have acted last year for PQRS, but that doesn’t mean you can get out of taking action this year. Reporting this year applies to 2016 reimbursements, reporting last year will be applied to 2015 reimbursements.
  • As reflected in the 2014 Medicare Physician Fee Schedule final rule, which went into effect on January 1, 2014, CMS has greatly increased the reporting requirements for providers who wish to earn the 2014 PQRS payment incentive. To qualify for the 2014 PQRS incentive, you must use one of the following reporting options and report the required number of measures as described:
    Claims-Based Reporting involves reporting quality data codes, or g-codes, on Medicare claims.
    Registry-based reporting is used when a provider registers or connects with a data registry.
    Qualified Clinical Data Registry reporting - New for 2014, the QCDR method provides a new standard to satisfy PQRS requirements based on satisfactory participation. A QCDR is a CMS-approved entity (such as a registry, certification board, collaborative, etc.) that collects medical and/or clinical data for the purpose of patient and disease tracking to foster improvement in the quality of care furnished to patients. The data submitted to CMS via a QCDR covers quality measures across multiple payers and is not limited to Medicare beneficiaries.
    The Group Practice Reporting Option, or GPRO, is available for group practices of two or more providers with a single Tax ID number. Group practices who wish to report via the GPRO web interface or GPRO registry reporting option must register with CMS and reporting is done via a web interface tool or providers can report via a registry as a group. Providers who report via GPRO will have their PQRS measure results posted publically on the CMS Physician Compare website.
    EHR Reporting option is available to providers using an EHR that has been certified to the most recent versions of the quality measures. Practice Fusion’s EHR has been certified to the most recent version of the CQMs, so any of the current CQMs can be used for PQRS if you meet the reporting requirements.

    This video will focus on the requirements related to PQRS EHR Reporting and how providers who wish to use this option with Practice Fusion should move forward.
  • EPs can earn a 2014 PQRS incentive and avoid the 2016 PQRS payment adjustment by meeting the following criteria for satisfactory reporting:
    Using a direct EHR product that is Certified EHR Technology (CEHRT) or EHR data submission vendor that is CEHRT, report on at least 9 measures covering 3 National Quality Strategy (NQS) domains
    If the EP’s CEHRT does not contain patient data for at least 9 measures covering at least 3 domains, then the EP must report the measures for which there is Medicare patient data. An EP must report on at least 1 patient for which there is Medicare patient data.

    If an EP satisfactorily reports for 2014 PQRS using the EHR-based reporting option, (s)he will also satisfy the CQM component of the EHR Incentive program; however, EPs will still be required to meet the other Meaningful Use objectives through the Medicare EHR Incentive Program Registration and Attestation System. Using the 2014 EHR reporting mechanism for PQRS and for MU will result in MU incentive payments being delayed until after the PQRS measures are reporting to CMS in 2015.
  • The measures in 2014 PQRS address various aspects of care, such as prevention, chronic- and acute-care management, procedure-related care, resource utilization, and care coordination. Measure selection should begin with a review of the 2014 Physician Quality Reporting System (PQRS) Measures List to determine which measures, associated domains, and reporting option(s) may be of interest to the practice and applicable to the EP or group practice. Please note, not all measures are available under all of the PQRS reporting options. EPs or group practices should avoid individual measures that do not or may infrequently apply to the services they provide to Medicare patients. The measures list is available as a downloadable document from the Measures Codes section of the CMS PQRS website.

    The following factors should be considered when selecting measures for reporting:
    • Clinical conditions usually treated
    • Types of care typically provided – e.g., preventive, chronic, acute
    • Settings where care is usually delivered – e.g., office, emergency department (ED), surgical suite
    • Quality improvement goals for 2014
    • Other quality reporting programs in use or being considered
  • Diagnosis of hypertension must occur at least 6 months prior to the uncontrolled blood pressure. Providers should not be “dinged” for uncontrolled BP that occurs immediately the diagnosis of hypertension.
  • This timeline is helpful for understanding how this measure looks at hypertension diagnosis and blood pressure. Please note that this CQM is not intended to encompass all potential hypertensive patients, but rather this measure is looking specifically to see that providers can control the blood pressure of their hypertensive patients within the first 6 months of diagnosis.
  • Put in some examples of high-risk medications.
  • This measure looks to see what prescriptions have been written for this patient during the measurement period (or calendar year), even if they have been stopped. Examples of high risk medications as defined by this measure include certain dosages and strengths of:
    Acetaminophen
    Butabarbital sodium
    Diphenhydramine Hydrochloride
    Estrogens

    For a complete list of the medications defined as “high-risk” please refer to the Value Set group called “High Risk Medications for the Elderly” which can be accessed at www.ushik.org
  • More Measure Details
    Examples of smoking cessation interventions that you can choose are “smoking cessation education (procedure)” or “referral to stop smoking clinic (procedure)”
    The smoking cessation intervention that is added to the chart can be “performed” or “ordered” and a result is not needed to receive credit for this measure.
  • Colorectal cancer screenings can be recorded in the patient chart in the Screenings/ Interventions/Assessments section or by receiving structured lab results. Patients are identified as having a visit during the measurement period if they have a signed chart note labeled with an encounter type of “office visit.”

    To record the colorectal cancer screening, search for the screening that the patient received and select the appropriate screening. Use the modal to indicate that the screening was “performed” and the date that the screening occurred.
    For patients given a Fecal Occult Blood Test (FOBT), they will be included in the numerator once a structured lab result is received in the EHR. Only screenings that occur during the appropriate timeframe listed in the numerator description will receive numerator credit for this measure.

  • To record the colorectal cancer screening, search for the screening that the patient received and select the appropriate screening. Use the modal to indicate that the screening was “performed” and the date that the screening occurred. For patients given a Fecal Occult Blood Test (FOBT), they will be included in the numerator once a structured lab result is received in the EHR. Only screenings that occur during the appropriate timeframe listed in the numerator description will receive numerator credit for this measure.

    CMS has created the 2014 electronic clinical quality measures (eCQMs) to have more rigorous data collection requirements than previous Meaningful Use quality measures. As such, there are some limitations in how Practice Fusion can collect data for purposes of CQM calculations and reporting. An example of this is that CMS requires an actual lab result when a measure requires a performed FOBT test (or result). While we are working with our lab partners to increase how many send structured LOINC codes to identify these tests, we are also working with those lab partners to map and identify test results that come in with local laboratory codes so that we can properly give credit when we are able to.
  • More Measure Details
    This measure looks to see if providers are avoiding unnecessary imaging tests for patients with low back pain.
    Examples of eligible diagnoses for “low back pain” include:
    Sciatica, unspecified side
    Low back pain
    Lumbago
    Backache, unspecified
    Because this measure is looking to see whether an imaging test is performed within 28 days of diagnosis, you will not see any values for this numerator until at least 29 days after the encounter where the patient was diagnosed.
  • More Measure Details
    For this measure, the patient must have received the eye exam from an eligible eye professional.
    After determining that the patient has had this exam from a eligible eye professional, search and choose the applicable exam, indicate that it was performed and on what date, and if you choose, include a note about the provider in the comments section.
  • More Measure Details
    The data element “Diabetic foot exam (visual, sensory, and pulse)” has been mapped to the coded values for all three exams required for this measure.
    Instead of adding each exam individually, after confirming or performing the visual, sensory, and pulse foot exams, select the option highlighted in green above to get credit in the numerator.
  • Patients who meet the denominator criteria should be screened for depression using an age-appropriate depression screening instrument. After conducting the appropriate screening record “Adult [or Adolescent] depression screening assessment” in the Screenings /Interventions /Assessments section. If positive, record the appropriate follow-up plan in the same section.
     
    Examples of data elements that meet the requirements for a follow-up plan include “Mental health care education (procedure),” “Referral to psychologist (procedure),” and “Case management follow up (procedure).”
  • Many of our customers have asked us about whether screenings that are suggested using clinical decision support are required for some specialties. If you are a specialist that doesn’t conduct depression screenings, you may see your denominator increase but not your numerator. This is perfectly acceptable as it is a known fact that not all specialties will conduct all preventative screenings. Since zero values are acceptable for MU, this will not prevent you from attesting successfully. If you wish, you can turn off the CDS alerts for depression screening in the clinical decision support settings section of the EHR, but make sure you have the minimum amount of alerts enabled as needed for your stage of MU.
  • More Measure Details
    This measure requires that you attest at each patient encounter that you have checked the patient’s current medication list and that it is up to date.
    Checking this checkbox not only allows you to document this attestation for the purposes of accurate documentation and calculations, it can also be used if you are ever audited to prove that you completed this clinical action.
  • Practice Fusion automatically calculations BMI for patients how have height and weight recorded in the EHR. Note that only BMIs that are less than 6 months old (meaning the patient had an encounter where height and weight were recorded sometime in the past 6 months) are eligible for numerator credit in this measure.
  • Must document the follow-up plan, either ordered or performed, and then provide a REASON for why the follow-up plan is being recorded. This reason will be either because the BMI falls above the normal parameters or because the BMI falls below the normal parameters. This information is entered in the Screenings/Assessments/Interventions section after the appropriate follow-up plan is selected.
  • More Measure Details
    Check the box in the referral tab to indicate that you have received the follow-up report from the specialist.
    This checkbox is tied to the appropriate codes in the database for CQM calculations.
    This measure is primarily targeted to primary care providers who are referring patients to specialty providers, however, providers who are specialists who also refer can track referral loops using this feature and can report on this CQM for PQRS.
  • We will now answer some questions submitted by you all during the course of the presentation.
  • We will now answer some questions submitted by you all during the course of the presentation.
  • We will now answer some questions submitted by you all during the course of the presentation.
  • We will now answer some questions submitted by you all during the course of the presentation.
  • Using Practice Fusion for PQRS EHR Reporting in 2014

    1. 1. Using Practice Fusion for PQRS EHR Reporting in 2014 Presented By: Emily Richmond, MPH Senior Manager, Health Care Quality www.PracticeFusion.com
    2. 2. Agenda • PQRS requirements in 2014 • PQRS EHR reporting requirements • Measure selection and EHR reporting applicability • Detailed deep dive into Practice Fusion PQRS CQMs • Frequently asked questions • Resources 2
    3. 3. What is the Physician Quality Reporting System? PQRS is a CMS quality improvement program that uses a combination of incentive payments and penalties to promote reporting of quality data Who is eligible for PQRS? + Providers who see Medicare Part B patients and are reimbursed under the Medicare Physician Fee Schedule (PFS). + This includes physicians, chiropractors, dentists, PAs, NPs, and other eligible practitioners and therapists. What services are PQRS eligible? + Under PQRS, covered professional services are those paid under or based on the Medicare PFS. + Those services are eligible for PQRS incentive payments and/or payment adjustments.
    4. 4. PQRS Participation in 2014 Your PQRS participation in 2014 determines both your potential payment incentive and possible adjustment penalties that will affect future Medicare reimbursements: Year Year Year Data Collected to Inform Payment/Penalty Year Data Collected to Inform Payment/Penalty Bonus/Adjustment Bonus/Adjustment Incentive Payment Incentive Payment 2014 2014 +0.5% 2014 2014 +0.5% Payment Adjustment Payment Adjustment 2015 2015 2013 2013 -1.5% -1.5% 2016 2016 2014 2014 -2.0% -2.0% 2017+ 2015 -2.0% 2017+ 2015 -2.0%
    5. 5. Important PQRS Facts + PQRS is very complex - PQRS requirements vary based on the reporting mechanism that you choose. The complexities are good in that you have more options, but it also means that you need to become familiar specific requirements that apply to the option that you are using. + PQRS requirements are specific to each calendar year – Eligible PQRS measures, G-codes, reporting requirements, etc. may change from year to year, so make sure you refer to 2014 resources and materials. The 2014 PQRS reporting period is January 1, 2014-December 31, 2014. + PQRS actions don’t roll-over – You may have acted last year for PQRS, but that doesn’t mean you can get out of taking action this year. Reporting this year applies to 2016 reimbursements, reporting last year will be applied to 2015 reimbursements. 5
    6. 6. Earning the 2014 PQRS Incentive + To qualify for the 2014 PQRS incentive, you must use one of the following reporting options. + Note that completing requirements to earn the 2014 PQRS incentive automatically results in avoiding the 2016 PQRS payment penalty. Claims-Based Reporting Registry Reporting Qualified Clinical Data Registry (QCDR) Reporting Group Practice Option (GPRO) EHR Reporting
    7. 7. EHR Reporting for PQRS Providers can earn a 2014 PQRS incentive and avoid the 2016 PQRS payment adjustment by meeting the following criteria for EHR satisfactory reporting: + Report on at least 9 measures covering 3 National Quality Strategy (NQS) domains for all eligible patients during the measurement period. + If the certified EHR does not contain patient data for at least 9 measures covering at least 3 domains, then report the measures for which there is Medicare patient data.  Providers must report on at least 1 CQM for which there is Medicare patient data. + PQRS EHR reporting uses data from all patients, regardless of their insurance status when reporting to CMS. 7
    8. 8. Practice Fusion and PQRS EHR Reporting + Practice Fusion will be acting as a Direct EHR Vendor (EHR Direct), which will allow our providers to use Practice Fusion to directly submit their PQRS measures data to CMS in the CMS specified format on their own behalf. + PQRS reporting for the EHR reporting mechanism will occur between January-February 2015 since the PQRS measurement period runs from January 1, 2014- December 31, 2014. 8
    9. 9. Steps for PQRS EHR Reporting 1. Determine which measures apply to your practice  Review the CQM list & learn about the measure specifications 2. Document all patient care and visit-related information in your EHR system  Ensure you identify and capture all eligible cases per the measure denominator for each measure you choose to report. 3. Select which CQMs you want to report for PQRS using EHR reporting and opt-in to PQRS data submission 4. Complete CQM file generation in Practice Fusion’s 2014 Clinical Quality Measure report and upload file to CMS  Late in 2014, you will be able to select your CQMs that you’d like to report for PQRS and generate a file to upload to CMS. 9
    10. 10. Measure selection and EHR data entry + Practice Fusion currently supports 13 clinical quality measures that are eligible for PQRS reporting. + Providers who wish to report PQRS via EHR reporting will need to select 9 measures to report to CMS.  This selection feature will be available in late Summer 2014. + To meet PQRS requirements, select 9 measures that cover at least 3 National Quality Strategy domains and have a value (not a zero) in the measure denominator.  Make sure at least one of the 9 measures includes at least 1 Medicare patient 10
    11. 11. EHR Reporting Measure Selection Considerations Measure selection should begin with a review of Practice Fusion’s CQM Calculation Guide to determine whether the available measures are applicable to your practice. Avoid individual measures that do not or may infrequently apply to the services you provide to your patients. If PF does not support 9 measures that are applicable to your practice, you should look into other PQRS reporting options. 11 The following factors should be considered when selecting measures for reporting:  Clinical conditions usually treated  Types of care typically provided – e.g., preventive, chronic, acute  Settings where care is usually delivered – e.g., office, emergency department (ED), surgical suite  Quality improvement goals for 2014  Other quality reporting programs in use or being considered
    12. 12. Understanding PQRS Measures + PQRS measures consist of two major components: 1. A denominator that describes the eligible cases for a measure (the eligible patient population associated with a measure’s numerator) 2. A numerator that describes the clinical action required by the measure for reporting and performance + Each component is defined by specific clinical codes described in each measure specification along with reporting instructions. + For measures eligible for EHR reporting, Practice Fusion has implemented the measure according to very specific guidelines (including how data must be collected and how the measure is calculated). 12
    13. 13. Practice Fusion Clinical Quality Measures 13 Measure # Title NQS Domain CMS165v2 Controlling High Blood Pressure Clinical Process & Effectiveness CMS156v2 Use of High-Risk Medications in the Elderly Patient Safety CMS138v2 Preventive Care and Screening: Tobacco Use: Screening and Cessation Intervention Population & Public Health CMS130v2 Colorectal Cancer Screening Clinical Process & Effectiveness CMS166v3 Use of Imaging Studies for Low Back Pain Efficient Use of Healthcare Resource CMS131v2 Diabetes: Eye Exam Clinical Process & Effectiveness CMS123v2 Diabetes: Foot Exam Clinical Process & Effectiveness CMS122v2 Diabetes: Hemoglobin A1c Poor Control Clinical Process & Effectiveness CMS2v3 Preventive Care and Screening: Screening for Clinical Depression and Follow-Up Plan Population & Public Health CMS68v3 Documentation of Current Medications in the Medical Record Patient Safety CMS69v2 Preventive Care and Screening: Body Mass Index (BMI) Screening and Follow-Up Population & Public Health CMS50v2 Closing the referral loop: receipt of specialist report Care Coordination CMS90v3 Functional status assessment for complex chronic conditions Patient & Family Engagement
    14. 14. CMS 165v2 – Controlling High Blood Pressure 14 Denominator Numerator Patients 18-85 years of age who had a diagnosis of essential hypertension within the first six months of the measurement period or any time prior to the measurement period Patients whose blood pressure at the most recent visit is adequately (systolic blood pressure < 140 mmHg diastolic blood pressure < 90 mmHg) during the measurement period. Practice Fusion Suggested Workflow Record blood pressure in the chart note for all patients have a diagnosis for hypertension during each Patients whose blood pressure is uncontrolled should be monitored and have their vital signs updated at each follow-up visit.
    15. 15. CMS 165v2 – Controlling High Blood Pressure CQM Measurement Period More Measure Details + This measure looks to see that providers can control the BP of their hypertensive patients within the first 6 months of diagnosis. 15 1/1/2014 6/1/2014 12/31/2014 Patients diagnosed with hypertension prior to the start of the measurement period whose hypertension is resolved before the start of the measurement period ARE NOT included in the denominator. Patients diagnosed with hypertension prior to the start of the measurement period whose hypertension is still ACTIVE after the start of the measurement period ARE included in the denominator, if they have an encounter during the measurement period. All patients who are diagnosed with hypertension within the first 6 months of the measurement period and have an encounter during that time ARE included in the denominator. All patients with an active diagnoses for hypertension who have an encounter during the measurement period ARE included in the denominator of the measure.
    16. 16. CMS156v2– Use of High-Risk Medications in the Elderly 16 Denominator Numerator Patients 66 years and older who had a visit during the measurement period Numerator 1: Patients with an order for at least one high-risk medication during the measurement Numerator 2: Patients with an order for at least two different high-risk medications during the measurement period. Practice Fusion Suggested Workflow “High-risk” medications are those than can result in adverse or medications that are clinically inappropriate for seniors. This measure is calculated based on the medications that prescribed to patients who meet the denominator criteria. Patients are identified as having a visit during the measurement period if they have a signed chart note labeled with an encounter type of “office visit.”
    17. 17. CMS156v2– Use of High-Risk Medications in the Elderly More Measure Details + Examples of high risk medications as defined by this measure include certain dosages and strengths of:  Acetaminophen  Butabarbital sodium  Diphenhydramine Hydrochloride  Estrogens + Go to www.ushik.org to download the “High risk medications for the elderly” Value Set to see the full list. 17
    18. 18. CMS138v2 Tobacco Use: Screening and Cessation Intervention 18 Denominator Numerator All patients aged 18 years and older Patients who were screened for tobacco use at least within 24 months AND who received tobacco cessation counseling intervention if identified as a tobacco user. Practice Fusion Suggested Workflow Record a smoking status in the Lifestyle section for all patients and the patient’s smoking status indicates they are a tobacco user, document a tobacco cessation counseling intervention in the Screenings/Assessments/Interventions section of the chart note. The smoking statuses that are used to identify if a patient is a “tobacco user” are: Current every day smoker; Current some day smoker; Smoker, current status unknown; Heavy tobacco smoker; smoker; and Light tobacco smoker. The smoking status of Unknown if ever smoked is not used to determine numerator numerator credit for this measure.
    19. 19. CMS138v2–Tobacco Use: Screening and Cessation Intervention More Measure Details + Examples of smoking cessation interventions that you can choose are “smoking cessation education (procedure)” or “referral to stop smoking clinic (procedure)” + The smoking cessation intervention that is added to the chart can be “performed” or “ordered” and a result is not needed to receive credit for this measure. 19 1) 2)
    20. 20. CMS130v2 – Colorectal Cancer Screening 20 Denominator Numerator Patients 50-75 years of age with a visit during the measurement Patients with one or more screenings for colorectal cancer. screenings are defined by any one of the following criteria below: • Fecal occult blood test (FOBT) during the measurement period • Flexible sigmoidoscopy during the measurement period or the years prior to the measurement period • Colonoscopy during the measurement period or the nine years to the measurement period Practice Fusion Suggested Workflow Colorectal cancer screenings can be recorded in the patient chart in the Screenings/ Interventions/Assessments section or by receiving structured results. Patients are identified as having a visit during the measurement they have a signed chart note labeled with an encounter type of “office visit.” To record the colorectal cancer screening, search for the screening that the received and select the appropriate screening. Use the modal to indicate screening was “performed” and the date that the screening occurred.
    21. 21. CMS130v2 – Colorectal Cancer Screening More Measure Details + After selecting the appropriate screening, indicate that it was performed and, if needed, select the date of performance if it occurred in the past by another provider. + You can use the comments section to indicate who completed the screening. + CMS requires an actual lab result when a measure requires a performed FOBT test (or result). 21 1) 2)
    22. 22. CMS166v3 – Use of Imaging Studies for Low Back Pain 22 Denominator Numerator Patients 18-50 years of age with a diagnosis of low back pain during outpatient or emergency visit Patients without an imaging study conducted on the of the outpatient or emergency department visit or in 28 days following the outpatient or emergency department visit Practice Fusion Suggested Workflow The numerator value for this measure is determined after a 28 day following each relevant encounter. Practice Fusion only uses encounters that are labeled with “Office Visit” in the denominator of this measure. Imaging studies that have been performed should be recorded in the Screenings/ Interventions/Assessments section of the chart note. Fusion will also use imaging results that are sent to the EHR for the purposes of calculating this measure.
    23. 23. CMS166v3 – Use of Imaging Studies for Low Back Pain More Measure Details + This measure looks to see if providers are avoiding unnecessary imaging tests for patients with low back pain. + Examples of eligible diagnoses for “low back pain” include:  Sciatica, unspecified side  Low back pain  Lumbago  Backache, unspecified + Because this measure is looking to see whether an imaging test is performed within 28 days of diagnosis, you will not see any values for this numerator until at least 29 days after the encounter where the patient was diagnosed. 23
    24. 24. CMS131v2 – Diabetes: Eye Exam 24 Denominator Numerator Patients 18-75 years of age diabetes with a visit during measurement period Patients with an eye screening for diabetic retinal disease. includes diabetics who had one of the following: • A retinal or dilated eye exam by an eye care the measurement period, or • A negative retinal exam (no evidence of retinopathy) by eye care professional in the year prior to the period. Practice Fusion Suggested After performing the required exam or confirming that the has received the exam from an eye care professional, search record that an “Examination of the retina (procedure)” has been performed in the Screenings/Interventions/Assessments
    25. 25. CMS131v2 – Diabetes: Eye Exam More Measure Details + For this measure, the patient must have received the eye exam from an eligible eye professional. + After determining that the patient has had this exam from a eligible eye professional, search and choose the applicable exam, indicate that it was performed and on what date, and if you choose, include a note about the provider in the comments section. 25
    26. 26. CMS123v2 – Diabetes: Foot Exam 26 Denominator Numerator Patients 18-75 years of age diabetes with a visit during measurement period Patients who received visual, pulse and sensory foot examinations during the measurement period Practice Fusion Suggested This measure requires that the patient receive all three of the exams listed in the numerator description. After performing the required foot exams or confirming that the patient has received exams from another medical professional during the period, search for and record that a “Diabetic foot exam (visual, sensory, and pulse)” has been performed in the Screenings/Interventions/Assessments section of the chart This selection is mapped to the coded values for all three exams.
    27. 27. CMS123v2 – Diabetes: Foot Exam More Measure Details + The data element “Diabetic foot exam (visual, sensory, and pulse)” been mapped to the coded values for all three exams required for this measure. + Instead of adding each exam individually, after confirming or the visual, sensory, and pulse foot exams, select the option green above to get credit in the numerator. 27 1) 2)
    28. 28. CMS122v2 – Diabetes: Hemoglobin A1c Poor Control 28 Denominator Numerator Patients 18-75 years of age diabetes with a visit during measurement period Patients whose most recent HbA1c level (performed during measurement period) is >9.0% or patients who don’t have A1c test result during the measurement period Practice Fusion Suggested This measure uses structured lab results that are received in to determine whether a patient falls into the numerator. This is an inverse measure, which means that patients who fall the numerator do not meet the clinical guidelines. Only HbA1c lab results that are received in the EHR from a lab can be used to calculate this measure.
    29. 29. CMS122v2 – Diabetes: Hemoglobin A1c Poor Control More Measure Details + Only structured lab results that include a valid LOINC code can be used in calculating this measure. Many labs send us local codes for tests, instead of LOINC – which is required for the 2014 CQM specifications. + Practice Fusion is working with our lab partners to map their local codes to official LOINC codes so that we can process results more efficiently. 29
    30. 30. CMS2v3 Screening for Clinical Depression and Follow-Up Plan 30 Denominator Numerator All patients aged 12 years and older before the beginning of the measurement period with at least one eligible encounter during the measurement period. Patients screened for clinical depression on the date the encounter using an age appropriate tool AND if positive, a follow-up plan is documented on the date of the positive screen Practice Fusion Suggested Workflow Patients who meet the denominator criteria should be screened for depression using an age-appropriate depression screening instrument. After conducting the appropriate screening record “Adult [or depression screening assessment” in the Screenings /Interventions /Assessments section. If positive, record the appropriate follow-up plan the same section. Examples of data elements that meet the requirements for a follow-up plan include “Mental health care education (procedure),” “Referral to psychologist (procedure),” and “Case management follow up (procedure).”
    31. 31. More Measure Details + After selecting that the screening was performed, you must select the result of depression screening negative or depression screening positive. + If you are a specialist that doesn’t conduct depression screenings, you may see your denominator increase but not your numerator. CMS2v3 Screening for Clinical Depression and Follow-Up Plan 31 1) 2)
    32. 32. CMS68v3 – Documentation of Current Medications in the Medical Record 32 Denominator Numerator All visits occurring during the 12 month reporting period patients aged 18 years and older before the start of the measurement period Eligible professional attests to documenting, updating or reviewing the patient’s current medications using all immediate resources available on the date of the encounter. This list must include ALL known prescriptions, over-the-counters, herbals vitamin/mineral/dietary (nutritional) supplements AND must contain the medications’ name, dosages, frequency and route administration Practice Fusion Suggested Workflow This measure uses a denominator unit of measurement of all for patients age 18 and older, which means that the numerator criteria must be documented for each encounter labeled “Office Visit” or Visit.” To record your attestation that the patient’s current medication is documented in the chart, select the “Documentation of Current Medications” checkbox under the Quality of Care section.
    33. 33. CMS68v3 – Documentation of Current Medications in the Medical Record More Measure Details + This measure requires that you attest at each patient encounter that you have checked the patient’s current medication list and that it is up to date. + Checking this checkbox not only allows you to document this attestation for the purposes of accurate documentation and calculations, it can also be used if you are ever audited to prove that you completed this clinical action. 33 1) 2)
    34. 34. CMS69v2 Body Mass Index (BMI) Screening and Follow-Up 34 Denominator Numerator Denominator 1: Patients age 65 and older… Denominator 2: Patients age 16 through 64 years of age… before the beginning of the measurement period with at one eligible encounter during the measurement period INCLUDING encounters where the patient is receiving palliative care, refuses measurement of height and/or the patient is in an urgent or emergent medical situation where time is of the essence and to delay treatment would jeopardize the patient’s health status, or there is any other reason documented in the medical record by the provider explaining why BMI measurement was not appropriate Patients with a documented BMI during the encounter or during previous six months, AND when the BMI is outside of normal parameters, a follow-up plan is documented during the or during the previous six of the encounter with the BMI outside of normal parameters.
    35. 35. CMS69v2 – Body Mass Index (BMI) Screening and Follow-Up 35 Practice Fusion Suggested Workflow Record height and weight for all patients during eligible encounters (encounters labeled “Office Visit” or “Home Visit”); Practice Fusion automatically calculates and records the patient’s BMI. Determine whether the patient’s BMI falls above or the normal parameters listed below. Normal Parameters: Age 65 years and older BMI ≥ 23 and < 30 Age 18-64 years BMI ≥ 18.5 and < 25 For patients whose BMI falls outside the normal parameters for their age range, record that an appropriate follow-up plan was either ordered or performed in the Screenings/ Interventions/Assessments section of the chart note. After selecting an appropriate follow-up plan, you will need to record the reason for the follow-up, “overweight” or “underweight” depending on where the patient falls in relation to normal parameters. Examples of follow-up plans for BMI management include: “Dietary counseling surveillance,” “Lifestyle education regarding diet (procedure),” and “Nutrition (regime/therapy).”
    36. 36. CMS69v2 Body Mass Index (BMI) Screening and Follow-Up More Measure Details + After choosing the appropriate counseling or follow-up plan, you can indicate that it was ordered or performed. + You must also select the appropriate reason code – overweight or underweight, to receive credit for this measure. 36 1) 2)
    37. 37. CMS50v2 Closing the referral loop: receipt of specialist report 37 Denominator Numerator All patients aged 12 years and older before the beginning of the measurement period with at least one eligible encounter during the measurement period. Number of patients with a referral, for which the referring provider received a report from the provider to whom the patient was referred. Practice Fusion Suggested Workflow Referrals that occur in the Practice Fusion referral workflow are tracked in the referral tab of the patient chart or the messages section. After receiving a follow-up consultation report from the provider to whom the patient was referred, select the checkbox next to each completed referral to meet the numerator criteria. Referrals that occur outside of Practice Fusion can be recorded by selecting appropriate referral data element from the Screenings/ Interventions/Assessments section of the chart note. When a consultation has been received from the provider to whom the patient was referred, this be logged in a subsequent chart note under the Screenings/ Interventions/Assessments section by recording “Confirmatory consultation report (record artifact).”
    38. 38. CMS50v2 – Closing the referral loop: receipt of specialist report More Measure Details + Check the box in the referral tab to indicate that you have received the follow-up report from the specialist. + This checkbox is tied to the appropriate codes in the database for CQM calculations. 38
    39. 39. CMS90v3 Functional Status Assessment for Complex Chronic Conditions 39 Denominator Numerator Adults aged 65 years and older who had two outpatient encounters during the measurement year and an active diagnosis of heart failure. Patients with patient reported functional status assessment results (e.g., VR-12; VR-36; MLHF-Q; KCCQ; PROMIS-10 Global Health, PROMIS-29) present in the EHR at least two weeks before or during initial encounter and the follow-up encounter during the year. Practice Fusion Suggested Workflow This measure requires that patients with heart failure are given functional status assessments at least twice a year and that the functional status results be recorded the EHR at least two weeks before or during the first and follow-up encounter. Functional status assessment results can be recorded in the chart note by for and selecting the appropriate functional status assessment result in the Screenings/ Interventions/Assessments section. Data elements for functional status assessments can be found by searching for the assessment name as listed in the numerator description above.
    40. 40. CMS90v3 Functional Status Assessment for Complex Chronic Conditions Denominator Criteria Numerator Criteria More Measure Details + Only patients who have at least two encounters (signed chart notes) during the measurement period (after January 1, 2014) and an active diagnosis of heart failure are included in the denominator of this measure. + To be included in the denominator, the patient’s first encounter must have occurred sometime before or within 185 days of the start of the measurement period and the second encounter must be at least 30 days after but no more than 180 days after the first encounter. 40 Encounter A ≤ 185 days from start of measurement period Encounter B ≥ 30 days and ≤ 180 days after Encounter B + Active Diagnosis of Heart Failure + and Functional Status Assessment A ≤ 2 weeks before or during Encounter A Functional Status Assessment B ≤ 2 weeks before or during Encounter B and
    41. 41. Need Individual Help with PQRS? + Practice Fusion is not able to offer individual guidance on choosing PQRS measures. + If you have questions regarding individual measures or how PQRS requirements apply to you, please reach out to the CMS QualityNet Help Desk. 41 CMS QualityNet Help Desk Phone: 866-288-8912, TTY: 877-715-6222 Email: qnetsupport@sdps.org
    42. 42. PQRS Frequently Asked Questions 42
    43. 43. How do I find out if I am eligible for PQRS? A. Most health care providers who are reimbursed under the Medicare Physician Fee Schedule are eligible for PQRS. For additional details and a list of eligible PQRS providers go to: http://www.cms.gov/Medicare/Quality-Initiatives-Patient-Assessment- Instruments/PQRS/How_To_Get_Started.html
    44. 44. Practice Fusion’s CQMs don’t apply to my specialty, how will I participate in PQRS? A. PQRS offers over 300 quality measures, which can be reporting using various reporting mechanisms (although not all measures are available for all reporting options.) If you wish to use Practice Fusion, you only have the measures we support available to use for PQRS reporting. You may report less than 9 measures if you meet the other EHR reporting criteria, but you will be subject to the Measure Applicability Validation process which means you may not earn the incentive (although you could avoid the payment penalty). Practice Fusion recommends that continue to monitor and record patient data in the EHR if you believe the measures apply to you to see how your CQM values adjust over the next few months, If you are a specialty provider who wants to report PQRS measures that are not available for EHR reporting, we suggest looking into how to reporting using other mechanisms (claims, etc.)
    45. 45. Practice Fusion’s quality measures don’t apply to my practice. Do I have to enter in data into the EHR for these CQMs for Meaningful Use or PQRS? A: No. Meaningful Use does not certain values, or any value at all, in order to meet program requirements and successfully attest. In addition, providers who wish to participate in PQRS can choose to use the other available reporting mechanisms (claims, registry reporting, etc.) if they want to report CQMs that are more applicable to their practice.
    46. 46. I’m participating in Meaningful Use this year, will there be penalties if I don’t also participate in PQRS? A. PQRS is a separate and distinct program from Meaningful Use. Providers who do not report for PQRS in 2014 will be subject to a 2% payment penalty – regardless of whether or not they successfully participate in Meaningful Use.
    47. 47. Does PQRS EHR Reporting apply only to Medicare patients? A. The EHR reporting option for PQRS requires that providers report CQM data for all patients, regardless of their insurance status. Providers will report data for all patients whom the CQM applies that have data in the EHR.
    48. 48. For more information on PQRS, include links to CMS resources and other Practice Fusion PQRS materials, go to: http://www.practicefusion.com/blog/resources -and-faqs-on-cqms-and-pqrs/ 48

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