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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.	
  
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	
  
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	
  	
  
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.	
  
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	
  	
  
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	
  
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	
  
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.	
  
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.	
  	
  
Payment	
  Incen1ve/Penalty	
  Timeline	
  
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	
  
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.	
  	
  
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.	
  	
  	
  
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	
  
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	
  
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	
  
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	
  
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	
  
Q&A	
  
dan.holleran@quirkhealthcare.com	
  
tamina.vahidy@quirkhealthcare.com	
  

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Physician Quality Reporting System (PQRS)

  • 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.    
  • 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