This document provides an overview of the Physician Quality Reporting System (PQRS). It describes PQRS as a voluntary reporting program for quality measures related to services provided to Medicare beneficiaries. Eligible professionals include physicians, practitioners, and therapists. Reporting methods include individual reporting through claims, EHR, registry, or QCDR, as well as group practice reporting through the GPRO Web Interface, registry, EHR, or survey vendor. The document provides details on the requirements and options for each reporting method.
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
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.
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