8/12/2013 1 VBM 2015 QRUR 2012 2013 PQRS: Why It’s Important and Tips for Successful Participation Physician Compare 2011 Objectives Participants will be able to: 1. Appreciate the timelines and implications for value- based payment. 2. Understand why it’s important to participate in PQRS. 3. Understand the value-based modifier. 4. Describe the options and methods for successful participation in PQRS in 2013. 5. Determine the best way for you and your practice to participate in PQRS in 2013. 2
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2013 PQRS: Why It's Important and Tips for Successful Participation
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8/12/2013
1
VBM
2015
QRUR
2012
2013 PQRS:
Why It’s Important and Tips for
Successful Participation
Physician Compare
2011
Objectives
Participants will be able to:1. Appreciate the timelines and implications for value-
based payment.2. Understand why it’s important to participate in PQRS.3. Understand the value-based modifier.4. Describe the options and methods for successful
participation in PQRS in 2013.5. Determine the best way for you and your practice to
participate in PQRS in 2013.
2
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2
Timelines and Implications
for Value-Based Payment
Background
� Since 2006, Legislation has called for value-based purchasing
(VBP) to transform Medicare from a passive payer to an active
purchaser by using specific performance measures aimed at
improving quality and reducing overall cost.
� Value-based purchasing involves three major elements for
physicians:
�Confidential feedback on performance and resource use
�Public Reporting
�Payment adjustment /value-based modifier (VBM)
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3
Confidential Feedback on
Performance and Resource Use
Quality and Resource Use Reports (QRURs) provide comparative
information so physicians can view the clinical care their patients
receive in relation to the average care and costs of other
physician’s Medicare patients:
� Physicians in IA, KS, MO, NE received them in March 2012
using 2010 data;
� Physicians in groups with > 25 eligible professionals (EPs)
in CA, IA, IL, KS, MI, MN, MO, NE, WI received them in
December 2012 using 2011 data;
� All groups with > 25 EPs will receive them in Fall 2013
using 2012 data; VBM information is expected to be
included in the reports.
5
Public Reporting
Physician Compare is a CMS website for publicly reporting
physician performance; similar to Hospital Compare
� Physician Compare currently reports that a physician has
successfully participated in quality programs:
�PQRS
�Electronic Prescribing
�Meaningful Use
� In 2014, Physician Compare will publicly report group-level
performance data on groups that participated in 2012 PQRS
using the GPRO web interface
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4
Payment Adjustment / Value Modifier
�CMS is phasing in the use of value-based modifiers
(VBM) to provide differential payments based on
quality and cost of care.
�The QRUR is intended as a precursor to the VBM and
currently includes cost of care measures for patients
seen by the physician and quality information
calculated using claims data and from PQRS.
�For further information on the QRUR, go to:http://www.cardiosource.org/~/media/Files/Advocacy/Physician%20Payment/CMSQu
Register by October 15, 2013 as a group to participate in 2013
PQRS:1) Under the Group Practice Reporting Option (GPRO) OR2) Under the administrative claims option
1% penalty
0% (no bonus or penalty)
Performance/Resource Use/Risk Adjustment
High quality, low cost, high risk ~3% bonus
Average quality, average cost, average risk 0% (no bonus or penalty)
Low quality, high cost, average risk 1% penalty
NO
NO
Opt-in to participate in 2015 value-based modifier (quality-tiering) by October 15, 2013 NO
YES
YES
YES
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Proposed VBM Payment Adjustment Amounts (2016)
In Group with 10 or more eligible professionals
Expect VBPM in 2017
* Meet satisfactory reporting requirements through GPRO in 2014 PQRS OR
* 70% of eligible professionals in practice meet satisfactory reporting requirements for 2014 PQRS
2% penalty
Performance/Resource Use/Risk Adjustment
High quality, low cost = bonus
Average quality, average cost =no bonus or penalty
Low quality/average cost OR average quality/high cost penalty = 1%
Low quality, high cost penalty = 2%
NO
NO
In group of 10-99 eligible professionals
YES
YES
In group of 100+ eligible professionals
High quality, low cost= bonus
Average quality, average cost =no bonus or penalty
Low quality/average cost OR average quality/high cost OR Low quality, high cost = No penalty
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8
15
2015
Quality Domain: PQRS Measure Examples
� Clinical Care
�CAD: Lipid Control
� Patient Experience--CG-CAHPS Measures
�Getting timely care, appointments and information
�How well your doctors communicate
� Patient Safety
�Medication Reconciliation
� Care Coordination
�Advance Care Plan
� Efficiency
�Cardiac Stress Imaging: Not Meeting Appropriate Use Criteria: Pre-Operative Evaluation in
Low-Risk Surgery Patients
� Population Health
�Preventive Care and Screening: Tobacco Use: Screening and Cessation Intervention
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Cardiology Trends in PQRS
18
20,124
22,799 23,28723,768 24,089
4,1435,194
7,083
8,7299,401
1,663 2,075
4,239
6,7988,053
0
5,000
10,000
15,000
20,000
25,000
2007 2008 2009 2010 2011
Cardiologist PQRS Experience
Eligible Participating Qualifying
In 2011: 39% of eligible cardiologists participated in PQRS;
86% of cardiologists who participated qualified for the incentive.
8/12/2013
10
19
9,401
5,794
4,988
8,053
3,967
4,723
0
2,000
4,000
6,000
8,000
10,000
Total Claims Registry
Frequency of PQRS Reporting Method by Cardiologists in 2011
Participating Qualifying
In 2011: 62% of participating cardiologists reported via claims submission;
53% of participating cardiologists reported via registry submission
Note: Some reported via more than one option but were only counted once for total participating.
Frequency of Reporting: Individual Measures of InterestFrequency of Reporting: Individual Measures of InterestFrequency of Reporting: Individual Measures of InterestFrequency of Reporting: Individual Measures of Interest
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PQRS # Measure Name Developer
# of EPs
Reporting in
2010
# of EPs
Reporting in
2011
130 Documentation of Current Medications CMS/QIP 23,502 44,027
226 Tobacco Use: Screen ,Cessation Intervention PCPI NA 38,192
6 CAD: Antiplatelet Rx ACC 17,911 21,362
204 IVD: Use of ASA or Other Antithrombotic NCQA 4,491 8,167
201 IVD: BP Management Control NCQA 4,491 7,898
203 IVD: LDL-C Control NCQA 4,492 6,531
202 IVD: Complete Lipid Profile NCQA 3,164 5,703
7 CAD with prior MI: BB Rx ACC 4,001 5,723
197 CAD: Drug Therapy for Lowering LDL-C ACC 1,778 4,329
5 HF with LVSD: ACE/ARB Rx ACC 3,526 4,161
118 CAD with DM or LVSD: ACE/ARB Rx ACC 1,751 2,189
8 HF with LVSD: BB Rx ACC 2,081 2,379
198 HF: LVF Assessment ACC 927 1,237
8/12/2013
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Performance Performance Performance Performance Rates: Individual Measures of InterestRates: Individual Measures of InterestRates: Individual Measures of InterestRates: Individual Measures of Interest
PQRS # Measure Name
2010 Average
Performance
Rate
2011 Average
Performance
Rate
2011 Mean
Performance
Rate for 54
GPRO Groups
130 Documentation of Current Medications 75% 86% NA
226 Tobacco Use: Screen ,Cessation Intervention NA 98% NA
6 CAD: Antiplatelet Rx 85% 85% 84%
204 IVD: Use of ASA or Other Antithrombotic 75% 80% NA
201 IVD: BP Management Control 76% 78% NA
203 IVD: LDL-C Control 53% 52% NA
202 IVD: Complete Lipid Profile 69% 61% NA
7 CAD with prior MI: BB Rx 71% 82% 86%
197 CAD: Drug Therapy for Lowering LDL-C 75% 82% 89%
5 HF with LVSD: ACE/ARB Rx 86% 80% 86%
118 CAD with DM or LVSD: ACE/ARB Rx 68% 64% 82%
8 HF with LVSD: BB Rx 83% 76% 92%
198 HF: LVF Assessment 46% 61% 81%
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Options and Methods for Successful
Participation in PQRS in 2013
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12
2013 PQRS Reporting Options
�Report as an Individual Eligible Professional
�Report as a Group Practice
Group Practice = a single Tax Identification Number
(TIN) with 2 or more eligible professionals, as
identified by their individual NPI, who have
reassigned their Medicare billing rights to the TIN
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Reporting as an Individual Eligible Professional
�Choose your reporting mechanism:
� Claims
� Registry
� EHR direct product
� EHR data submission vendor
� Administrative Claims
� Choose your measures:
� Individual Measures OR Measures Groups
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Individual Reporting Via Claims
Reporting
Period
Measure
Type
Reporting Criteria
Jan 1, 2013 –
Dec 31, 2013
Individual
Measures
Report at least 3 measures
AND
Report each measure for at least 50% of your Medicare
Part B FFS patients seen during the reporting period to
which the measure applies.
Jan 1, 2013 –
Dec 31, 2013
Measures
Groups
Report at least 1 measures group AND Report each
measures group for at least 20 Medicare Part B FFS
patients.
Measures groups containing a measure with a 0%
performance rate will not be counted.
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Individual Reporting Via Registry
Reporting
Period
Measure
Type
Reporting Criteria
Jan 1, 2013 –
Dec 31, 2013
Individual
Measures
Report at least 3 measures AND Report each measure for at least
80% of your Medicare Part B FFS patients seen during the reporting
period to which the measure applies.
Jan 1, 2013 –
Dec 31, 2013
Measures
Groups
Report at least 1 measures group AND Report each measures group
for at least 20 patients, a majority (11) of which must be Medicare
Part B FFS patients, seen during the reporting period.
Measures groups containing a measure with a 0% performance rate
will not be counted.
July 1, 2013 –
Dec 31, 2013
Measures
Groups
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14
Individual Reporting Via
Direct EHR Product OR
EHR Data Submission Vendor
Reporting
Period
Measure
Type
Reporting Criteria
Jan 1, 2013 –
Dec 31, 2013
Individual
Measures
Option 1: Report on ALL 3 PQRS EHR measures that are also
Medicare EHR Incentive Program core measures.
If the denominator for one or more of the core measures is 0:
Report on up to 3 PQRS EHR measures that are also Medicare
EHR Incentive Program alternate core measures
AND
Report on 3 additional PQRS EHR measures that are also
measures available for the Medicare EHR Incentive Program.