Physician Quality Reporting System: A Quick Look at the Opportunities and Pitfalls Adele Allison National Director of Government Affairs, SuccessEHS
Physician Quality Reporting System
Aug 20, 2015
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- 1. Physician Quality Reporting System:A Quick Look at theOpportunities and Pitfalls Adele Allison National Director of Government Affairs, SuccessEHS
- 2. Whats Covered
- The Rundown
- The Opportunities & Pitfalls
- The 2011 Incentive
- The Future
- The Helpful Links
- 3. The Rundown
- Started in 2007 originally called PQRI (Physician Quality Reporting Initiative) and had 74 Clinical Measures
- Must report quality measures for Medicare Part B Physician Fee Schedule (PFS) patients
- 4. The Rundown
- No enrollment / registration
- Voluntary today
- 5. The Rundown
- The Evolution of Reporting Methods
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- 2007: Claims-based reporting (Medicare Part B)
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- 2008: Registry-based reporting (Qualified CMS Registry)
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- 2010: EHR-based reporting (Qualified EHR)
- 6. The Rundown
- 2011 PQRS
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- 190 Measures(Claims / Registry)
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- 20 Measures(EHR)
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- Incentive 1% of total estimated PFS allowed charges during reporting period
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- Additional 0.5% incentive available for Maintenance of Certification Program
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- 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. The Pitfalls * Meaningful Use incentives will vary based upon year initiated and EPs 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. The 2011 Incentive
- Who is eligible?
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- Eligible professionals providing services paid based on Physician Fee Schedule
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- Physicians: MD, DO, DPM, OD, Oral Surgeons, DMD/DDS, DC
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- Practitioners: PA, NP, NS, CRNA, Anesthetist Assistant, Midwife, SW, Psychologist, RD, Nutritionist, Audiologist
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- Therapists: PT, OT, Speech
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- 10. The 2011 Incentive
- Who isnt eligible?
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- Providers with Medicare Administration Contractors with no direct bill
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- Providers paid under Medicare fiscal intermediaries or MACs
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- Services payable under fee schedule other than PFS
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- FQHCs and RHCs
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- Independent diagnostic testing / laboratory facilities
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- Ambulatory surgery centers
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- 11. The 2011 Incentive
- What will eligible providers do?
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- Report at least 3 PQRS measures
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- 13 overlap with Meaningful Use
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- Threshold of 80% eligible instances
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- Report during the required 12 months (Jan. 1 Dec. 31, 2011
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- Single submission to CMS
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- 12. The 2011 Incentive
- Receive Individual Authorized Access to CMS Computer Services account (IACS)
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- IACS Quick Reference Guides
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- Clickhere
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- New User Registration Menu for CMS Applications
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- Clickhere
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- Provider PECOS enrollment must be current
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- 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. The Future of PQRS
- Development / Testing underway building upon 2011 PQRS
- 2012 PQRS Proposed Rule:
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- 53 measures includes all 44 HITECH measures (similar in logic and coding as possible for alignment with MU)
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- In 2013, measure specs should be 100% the same between PQRS and MU
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- For EPs doing PQRS & MU if EP reports PQRS successfully, they meet CQM reporting for MU
- 15. The Future of PQRS
- CMS must publish by 1.1.2012
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- Quality of Care and Cost measures for the modifier
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- Modifier implementation dates
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- Initial performance period for value modifier application in 2015
- 2011: Feedback reports to MDs in IA, KS, MO and NE (56,000 physicians)
- 16. The Future of PQRS
- 2012: Feedback reports to 100,000 physicians
- 2012 & 2013: Limited application of an episode grouper
- 2015: Certain practices affected
- 2017: All practices affected
- 17. The Future of PQRS
- Remember: CMS will pay differentially based on quality and cost composites
- 2015 Modifier will be based on CY2013 Performance Period
- 18. The Helpful Links
- For portal passwords, PQRS, IACS registration/login, program and measurement-specific questions
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- QualityNet Help Desk
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- 866.288.8912
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- [email_address]
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- Provider Contact Center :Clickhere
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- CMS PQRS Reporting :Clickhere
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