Physician Quality Reporting System


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

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Physician Quality Reporting System

  1. 1. Physician Quality Reporting System: A Quick Look at the Opportunities and Pitfalls Adele Allison National Director of Government Affairs, SuccessEHS
  2. 2. What’s Covered <ul><li>The Rundown </li></ul><ul><li>The Opportunities & Pitfalls </li></ul><ul><li>The 2011 Incentive </li></ul><ul><li>The Future </li></ul><ul><li>The Helpful Links </li></ul>
  3. 3. The Rundown <ul><li>Started in 2007 – originally called “PQRI” (Physician Quality Reporting Initiative) and had 74 Clinical Measures </li></ul><ul><li>Must report quality measures for Medicare Part B Physician Fee Schedule (PFS) patients </li></ul>
  4. 4. The Rundown <ul><li>No enrollment / registration </li></ul><ul><li>Voluntary today </li></ul>
  5. 5. The Rundown <ul><li>The Evolution of Reporting Methods </li></ul><ul><ul><li>2007: Claims-based reporting (Medicare Part B) </li></ul></ul><ul><ul><li>2008: Registry-based reporting (Qualified CMS Registry) </li></ul></ul><ul><ul><li>2010: EHR-based reporting (Qualified EHR) </li></ul></ul>
  6. 6. The Rundown <ul><li>2011 PQRS </li></ul><ul><ul><li>190 Measures (Claims / Registry) </li></ul></ul><ul><ul><li>20 Measures (EHR) </li></ul></ul><ul><ul><ul><li>Incentive 1% of total estimated PFS allowed charges during reporting period </li></ul></ul></ul><ul><ul><ul><li>Additional 0.5% incentive available for Maintenance of Certification Program </li></ul></ul></ul>
  7. 7. 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%
  8. 8. 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%⁺
  9. 9. The 2011 Incentive <ul><li>Who is eligible? </li></ul><ul><ul><li>Eligible professionals providing services paid based on Physician Fee Schedule </li></ul></ul><ul><ul><ul><li>Physicians: MD, DO, DPM, OD, Oral Surgeons, DMD/DDS, DC </li></ul></ul></ul><ul><ul><ul><li>Practitioners: PA, NP, NS, CRNA, Anesthetist Assistant, Midwife, SW, Psychologist, RD, Nutritionist, Audiologist </li></ul></ul></ul><ul><ul><ul><li>Therapists: PT, OT, Speech </li></ul></ul></ul>
  10. 10. The 2011 Incentive <ul><li>Who isn’t eligible? </li></ul><ul><ul><li>Providers with Medicare Administration Contractors with no direct bill </li></ul></ul><ul><ul><li>Providers paid under Medicare fiscal intermediaries or MACs </li></ul></ul><ul><ul><li>Services payable under fee schedule other than PFS </li></ul></ul><ul><ul><ul><li>FQHCs and RHCs </li></ul></ul></ul><ul><ul><ul><li>Independent diagnostic testing / laboratory facilities </li></ul></ul></ul><ul><ul><ul><li>Ambulatory surgery centers </li></ul></ul></ul>
  11. 11. The 2011 Incentive <ul><li>What will eligible providers do? </li></ul><ul><ul><li>Report at least 3 PQRS measures </li></ul></ul><ul><ul><ul><li>13 overlap with Meaningful Use </li></ul></ul></ul><ul><ul><ul><li>Threshold of 80% eligible instances </li></ul></ul></ul><ul><ul><li>Report during the required 12 months (Jan. 1 – Dec. 31, 2011 </li></ul></ul><ul><ul><ul><li>Single submission to CMS </li></ul></ul></ul>
  12. 12. The 2011 Incentive <ul><li>Receive Individual Authorized Access to CMS Computer Services account (IACS) </li></ul><ul><ul><ul><li>IACS Quick Reference Guides </li></ul></ul></ul><ul><ul><ul><ul><li>Click here </li></ul></ul></ul></ul><ul><ul><ul><li>New User Registration Menu for CMS Applications </li></ul></ul></ul><ul><ul><ul><ul><li>Click here </li></ul></ul></ul></ul><ul><ul><ul><li>Provider PECOS enrollment must be current </li></ul></ul></ul>
  13. 13. 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)
  14. 14. The Future of PQRS <ul><li>Development / Testing underway – building upon 2011 PQRS </li></ul><ul><li>2012 PQRS Proposed Rule: </li></ul><ul><ul><li>53 measures – includes all 44 HITECH measures (similar in logic and coding as possible for alignment with MU) </li></ul></ul><ul><ul><li>In 2013, measure specs should be 100% the same between PQRS and MU </li></ul></ul><ul><ul><li>For EPs doing PQRS & MU – if EP reports PQRS successfully, they meet CQM reporting for MU </li></ul></ul>
  15. 15. The Future of PQRS <ul><li>CMS must publish by 1.1.2012 </li></ul><ul><ul><li>Quality of Care and Cost measures for the modifier </li></ul></ul><ul><ul><li>Modifier implementation dates </li></ul></ul><ul><ul><li>Initial performance period for value modifier application in 2015 </li></ul></ul><ul><li>2011: Feedback reports to MDs in IA, KS, MO and NE (56,000 physicians) </li></ul>
  16. 16. The Future of PQRS <ul><li>2012: Feedback reports to 100,000 physicians </li></ul><ul><li>2012 & 2013: Limited application of an “episode” grouper </li></ul><ul><li>2015: Certain practices affected </li></ul><ul><li>2017: All practices affected </li></ul>
  17. 17. The Future of PQRS <ul><li>Remember: CMS will pay differentially based on quality and cost composites </li></ul><ul><li>2015 Modifier will be based on CY2013 Performance Period </li></ul>
  18. 18. The Helpful Links <ul><li>For portal passwords, PQRS, IACS registration/login, program and measurement-specific questions </li></ul><ul><ul><li>QualityNet Help Desk </li></ul></ul><ul><ul><ul><li>866.288.8912 </li></ul></ul></ul><ul><ul><ul><li>[email_address] </li></ul></ul></ul><ul><ul><li>Provider Contact Center : Click here </li></ul></ul><ul><ul><li>CMS PQRS Reporting : Click here </li></ul></ul>