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Physician Quality Reporting System
 

Physician Quality Reporting System

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A quick look at the opportunities and pitfalls of the Physician Quality Reporting System.

A quick look at the opportunities and pitfalls of the Physician Quality Reporting System.

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    Physician Quality Reporting System Physician Quality Reporting System Presentation Transcript

    • Physician Quality Reporting System: A Quick Look at the Opportunities and Pitfalls Adele Allison National Director of Government Affairs, SuccessEHS
    • What’s Covered
      • The Rundown
      • The Opportunities & Pitfalls
      • The 2011 Incentive
      • The Future
      • The Helpful Links
    • The Rundown
      • Started in 2007 – originally called “PQRI” (Physician Quality Reporting Initiative) and had 74 Clinical Measures
      • Must report quality measures for Medicare Part B Physician Fee Schedule (PFS) patients
    • The Rundown
      • No enrollment / registration
      • Voluntary today
    • The Rundown
      • The Evolution of Reporting Methods
        • 2007: Claims-based reporting (Medicare Part B)
        • 2008: Registry-based reporting (Qualified CMS Registry)
        • 2010: EHR-based reporting (Qualified EHR)
    • The Rundown
      • 2011 PQRS
        • 190 Measures (Claims / Registry)
        • 20 Measures (EHR)
          • Incentive 1% of total estimated PFS allowed charges during reporting period
          • Additional 0.5% incentive available for Maintenance of Certification Program
    • The Opportunities Potential Incentives 2011 2012 2013 2014 2015 2016 2017 PQRS Only 1.0% 0.5% 0.5% 0.5% PQRS and MOC 1.5% 1.0% 1.0% 1.0% EHR Incentive Program* Up to $18,000 Up to $12,000 Up to $8,000 Up to $4,000 Up to $2,000 Varies ePrescribing** 1.0% 1.0% 0.5%
    • The Pitfalls * Meaningful Use incentives will vary based upon year initiated and EP’s allowable charges. ** EPs cannot receive Medicare EHR Incentives and eRx Incentives, but can received Medicaid EHR Incentives and eRx Incentives. Potential Adjustments 2011 2012 2013 2014 2015 2016 2017 ePrescribing 0 -1% -1.5% -2% PQRS -1.5% -2.0% -2.0% EHR Incentive Program -1.0% -2.0% -3.0% Value Modifier TBD TBD TBD TOTAL POTENTIAL 0 -1% -1.5% -2% -2.5%⁺ -4.0%⁺ -5.0%⁺
    • The 2011 Incentive
      • Who is eligible?
        • Eligible professionals providing services paid based on Physician Fee Schedule
          • Physicians: MD, DO, DPM, OD, Oral Surgeons, DMD/DDS, DC
          • Practitioners: PA, NP, NS, CRNA, Anesthetist Assistant, Midwife, SW, Psychologist, RD, Nutritionist, Audiologist
          • Therapists: PT, OT, Speech
    • The 2011 Incentive
      • Who isn’t eligible?
        • Providers with Medicare Administration Contractors with no direct bill
        • Providers paid under Medicare fiscal intermediaries or MACs
        • Services payable under fee schedule other than PFS
          • FQHCs and RHCs
          • Independent diagnostic testing / laboratory facilities
          • Ambulatory surgery centers
    • The 2011 Incentive
      • What will eligible providers do?
        • Report at least 3 PQRS measures
          • 13 overlap with Meaningful Use
          • Threshold of 80% eligible instances
        • Report during the required 12 months (Jan. 1 – Dec. 31, 2011
          • Single submission to CMS
    • The 2011 Incentive
      • Receive Individual Authorized Access to CMS Computer Services account (IACS)
          • IACS Quick Reference Guides
            • Click here
          • New User Registration Menu for CMS Applications
            • Click here
          • Provider PECOS enrollment must be current
    • MU-PQRS Overlap PQRS Measures Description 1, 2 and 3 Diabetes Measures: A1c Poor control, LDL-C, BP (MU) 5 Heart Failure: ACE Inhibitor (MU) 7 CAD: Beta-Blocker for MI (MU) 39 Screening / Therapy Osteoporosis in Women 47 Advance Care Plan 48 Urinary Incontinence: Assessment or Absence of 110, 112 Preventive: Flu Vaccine and Mammography (MU) 111 Preventive: Pneumonia Vaccination (MU) 113 Preventive: Colorectal Cancer Screening (MU) 124 HIT Measure: EHR Adoption or Use 128 BMI: Screening and F/up (MU) 173 Preventive: Unhealthy Alcohol Use Screening 237 Blood Pressure Measure (MU) NQF 0022 Drugs to be Avoided in the Elderly NQF 0024 BMI Children Measure ages 2 through 18 (MU) 226 Preventive: Tobacco Use Measure Screening and Cessation Intervention (MU) NQF 0038 Childhood Immunization Status (MU)
    • The Future of PQRS
      • Development / Testing underway – building upon 2011 PQRS
      • 2012 PQRS Proposed Rule:
        • 53 measures – includes all 44 HITECH measures (similar in logic and coding as possible for alignment with MU)
        • In 2013, measure specs should be 100% the same between PQRS and MU
        • For EPs doing PQRS & MU – if EP reports PQRS successfully, they meet CQM reporting for MU
    • The Future of PQRS
      • CMS must publish by 1.1.2012
        • Quality of Care and Cost measures for the modifier
        • Modifier implementation dates
        • Initial performance period for value modifier application in 2015
      • 2011: Feedback reports to MDs in IA, KS, MO and NE (56,000 physicians)
    • The Future of PQRS
      • 2012: Feedback reports to 100,000 physicians
      • 2012 & 2013: Limited application of an “episode” grouper
      • 2015: Certain practices affected
      • 2017: All practices affected
    • The Future of PQRS
      • Remember: CMS will pay differentially based on quality and cost composites
      • 2015 Modifier will be based on CY2013 Performance Period
    • The Helpful Links
      • For portal passwords, PQRS, IACS registration/login, program and measurement-specific questions
        • QualityNet Help Desk
          • 866.288.8912
          • [email_address]
        • Provider Contact Center : Click here
        • CMS PQRS Reporting : Click here