1. Six Things You Must Know About Quality to
Keep Your Practice Alive
Sandy Pogones, Primaris
MGMA Joplin Chapter Meeting
March 20, 2012
Publication MO-12-08-PREV March 2012
This material was prepared by Primaris, the Medicare Quality Improvement Organization for Missouri, under contract with the
Centers for Medicare & Medicaid Services (CMS), an agency of the U.S. Department of Health and Human Services. The contents
presented do not necessarily reflect CMS policy

2. Who is Primaris
Founded in 1983 by the Missouri State Medical Association,
Missouri Hospital Association and Missouri Association of
Osteopathic Physicians and Surgeons
Primaris serves as the federally-designated Quality
Improvement Organization (QIO) for the state of Missouri.
– Mission of QIOs: To improve the effectiveness, efficiency,
economy and quality of services delivered to Medicare
beneficiaries.
Subcontractor with the Missouri Health Information Technology
Assistance Center (MO-HIT) to assist providers in reaching
Meaningful Use

3. What do the following have in Common?
Medicare Value-based Modifier
Physician Quality Reporting System
E-Prescribe Incentive Program
Meaningful Use/EHR Incentive Program
Patient Centered Medical Home
Comprehensive Primary Care Initiative
Accountable Care Organizations
Medicare Wellness and Preventive Benefits

4. Answer
QUALITY = $$$

5. Countdown

6. #1: Value-Based Purchasing is a Reality
Medicare Value-Based Purchasing is Required by
Law
―Value‖ will be determined by both Cost and
Quality
– Cost: Total per capita and per capita costs for selected
conditions
– Quality: Medicare focus

7. #2: Quality Will be Measured Using PQRS
Individual Quality Measures
– PQRS Cardiovascular Measures Group
– MU Core and Alternate Core
– Additional Measures for Chronic and Preventive Care
GPRO Measures
Future Measures:
– More measures for Clinical Processes/Effectiveness and
Population/Public Health, specialty
– Functional Status, Care Coordination, Patient Safety, Efficient
Use of health services

8. #3: 2013 is a Pivotal Year for Reporting
Base year for determining the VBM applied in 2015
MU Required to Avoid Penalty in 2015
– Years 2+ : MU for entire year 2013
– Year 1: Attest by 10/1/2014 for 90 day period
PQRS required to avoid penalty in 2015
Performance on measures reported in 2013
 $$$

9. #4: e-Quality Measures are the Future of
Reporting
Measure Development is focused on using EHRs
Data abstraction for manual reporting will become
increasingly difficult
Structured data capture is crucial
Standard vocabularies are being required for use by
all vendors to allow data exchange
Vendors must be ―Qualified‖ to report PQRS or CQMs
directly (―Qualified‖ is not the same as ―Certified‖)

10. Sample e-Quality Measure
Percent of patients age 18+ who were screened for tobacco use
one or more times within 24 months AND who received
cessation counseling intervention if identified as a tobacco User.
Data Elements
– Age (BD) - Visit Date (during reporting period)
– Encounter Code - Tobacco User / Non User (screen done)
– Counseling provided & Type – Date of Counseling
– Pharmacotherapy (drug, dose, order)
Logic—determines denominator & numerator, then combines for
Performance Rate

11. #5: Use Population Management
and Rapid Cycle Improvement to
Close Performance Gaps
Run Population-based reports
– Generate Baseline data and patient lists
– Establish a team to address performance gaps
Apply Rapid Cycle Improvement Methodology
– Determine possible root cause(s) of performance gaps
– Assign responsibility for improvement
– Test small changes and re-measure for improvement
– Implement successful changes practice-wide
– Track your changes and results

12. #6: Take Advantage of Opportunities
to Increase Revenue
Expanded Medicare Coverage for Prevention Services
Annual Wellness Visit
PQRS reporting bonuses through 2014; e-Rx 2013;
Meaningful Use Medicare 2016/Medicaid 2021
Medicare Comprehensive Primary Care Initiative
Patient-Centered Medical Home bonus payments for
Medicaid and Privately-Insured Patients

13. Resources
Primaris—Missouri’s Quality Improvement Organization
– Sandy Pogones: spogones@primaris.org; 573-673-4531
– Primaris.org; PQRSMO.org
CMS INFORMATION RESOURCES: http://www.cms.gov
Medicare Prevention Services Info for Physicians:
http://www.cms.gov/PrevntionGenInfo
Medicare Information for Patients:
http://www.medicare.gov
Million Hearts: http://millionhearts.hhs.gov/index.html

14. Conclusion
―The healthcare organization that seeks
merely to meet minimal standards may
not ever reach any higher, and certainly
will not achieve excellence.‖
(Janet Brown, RN, CPHQ, The Healthcare Quality
Handbook, 2010-2011)

15. QUESTIONS?