Transcript here - Anesthesia Quality Institute

Understanding PQRS and why
reporting via an anesthesia
QCDR is beneficial
Claims and the QCDR:
Avoiding the Payment Adjustment
PRESENTED BY:
MATTHEW T. POPOVICH, PH.D.
QUALITY SPECIALIST
AMERICAN SOCIETY OF ANESTHESIOLOGISTS
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Physician Quality Reporting System
(PQRS)
• Physician Quality Reporting System
– What is the program?
– Incentives and Payment (Negative) Adjustments
– Reporting Options (Including the QCDR)
• CMS Rulemaking Process
– 2014 Physician Fee Schedule (PFS)
– 2015 Proposed PFS
• Final Rule (est. November 2014)
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Physician Quality Reporting System
(PQRS)
• Defining PQRS
– “Paid under or based on the Physician Fee Schedule”
– Eligible Professionals (EPs)
– Payment Incentives (ending in 2014) v. Payment Adjustments
• Common Measures Reported by Anesthesiologists
– #30 (NQF #0269): Timing of Prophylactic Antibiotic
– #44 (NQF #0236): Preoperative Beta-Blocker in Patients with Isolated
CABG Surgery
– #76 (NQF #0464): Prevention of Catheter-Related Bloodstream Infections
(CRBSI): Central Venous Catheter (CVC) Insertion Protocol
– #193 (NQF #0454): Perioperative Temperature Management
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Satisfactorily Report =
Avoid the Payment Adjustment
• Reporting Options (2014 & Proposed 2015)
– Claims
– Qualified Clinical Data Registry (QCDR)
– “Traditional” Qualified Registry
– Other Reporting Options
• Alignment of Measure Reporting Requirements
– Nine (9) quality measures
– Three (3) National Quality Strategy (NQS) domains
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Satisfactorily Report =
Avoid the Payment Adjustment
• National Quality Strategy Domains
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Patient Safety
Person and Caregiver-Centered Experience and Outcomes
Communication and Care Coordination
Effective Clinical Care
Community / Population Health
Efficiency and Cost Reduction
• Anesthesia Measures (Claims)
– Patient Safety (PQRS #30, #76 and #193)
– Effective Clinical Care (PQRS #44)
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Satisfactorily Report =
Avoid the Payment Adjustment
• Satisfactorily Reporting – Claims (2014):
– EPs must report ≥ 9 PQRS measures covering ≥ 3 NQS
domains to qualify for an incentive payment for 50% of
Medicare Part B patients for whom the measure applies
• If fewer than 9 measures, then EP is subject to the
Measure-Applicability Validation (MAV) process
– EPs must report ≥ 3 measures in order to avoid the payment
adjustment for 2016
• Subject to MAV process
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Satisfactorily Report =
Avoid the Payment Adjustment
• Qualified Clinical Data Registry (QCDR)
– Use of Established Specialty Society Registries
– PQRS and non-PQRS Measures
• AQI/NACOR: 8 PQRS and 11 Non-PQRS Measures
• AQI/NACOR: 4 NQS Domains Available
– QCDR Responsibilities
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Satisfactorily Report =
Avoid the Payment Adjustment
• Claims-Based Reporting Challenges (Beyond 2014):
– PQRS Measures for Consideration
– PQRS #30, PQRS #109
– Potentially fewer measures to report via claims
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Satisfactorily Report =
Avoid the Payment Adjustment
• QCDR Incentive Requirements (2014)
– Report at least 9 measures covering at least 3 NQS
domains AND report each measure for at least 50% of EP’s
applicable patients seen during reporting period
– One measure must be an outcome measure
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Satisfactorily Report =
Avoid the Payment Adjustment
• QCDR Reporting Requirements
– Avoid the payment adjustment (2016)
• [For CY 2014] Report at least 3 measures covering at least 1
NQS domain for at least 50 percent of the EP’s applicable
patients seen during the participation period
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Satisfactorily Report =
Avoid the Payment Adjustment
– Avoid the payment adjustment (2017)
• CMS PROPOSED: “For the 12-month reporting period [CY
2015] for the 2017 PQRS payment adjustment, the EP would
report at least 9 measures available for reporting under a
QCDR covering at least 3 of the NQS domains, AND report
each measure for at least 50 percent of the eligible
professional’s patients.”
• Report 3 outcome measures or 2 outcome measures and at
least 1 resource use, patient experience or
efficiency/appropriate use measure
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Resources
• Learn and Understand PQRS
– CMS PQRS Website (www.cms.gov/pqrs)
– CMS QualityNet Help Desk (866-288-8912 or
[email protected])
• ASA & AQI Member Resources
– Quality and Regulatory Affairs ([email protected])
– Anesthesia Quality Institute (http://www.aqihq.org/qcdr)
– ASA web site (www.asahq.org/qcdr )
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The Qualified Clinical Data Registry
PRESENTED BY:
LANCE MUELLER
DIRECTOR
ANESTHESIA QUALITY INSTITUTE
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The Challenge
• The government wants to
know that Ma and Pa are
getting the health care they
deserve… and that our taxes
pay for.
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• Institute of Medicine report
published in late 1999
• Highlighted preventable errors in
the US healthcare system
• “100,000 lives a year lost to
preventable death”
• Anesthesiology cited as leaders
in advancing patient safety
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The Physician Quality Reporting
System
• Individual physicians
• For public reporting
• Approved measures
– Submitted and maintained by ‘stewards’
– Vetting through National Quality Forum
• “Claims made” reporting
• Scored by CMS
• Incentives >>> penalties
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“Pay for Performance”
• Federal programs to promote quality over quantity in the
delivery of healthcare
• Based on measuring outcomes
– Public reporting
– Payment adjustments (penalties) >>> Incentives
• Hospitals
• Physicians
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Key Points
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Pay for Performance programs are evolving over time
What was true last year will not be true next year
Complexity is increasing
ASA (and all physician societies) must seize opportunities
to guide this evolution
• ASA has worked hard to provide a solution for the
profession
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The Evolution of P4P
From
Process Measures
To
Outcomes
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The Evolution of P4P
From
Big hospitals
To
Small hospitals, surgery centers,
clinics and offices
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The Evolution of P4P
From
Inpatients
To
ALL patients
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The Evolution of P4P
From
Medicare only
To
ALL payers including
Medicare Advantage, Medicaid
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The Evolution of P4P
From
Incentives
To
Penalties
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The Evolution of P4P
From
Clinical Safety Focused
To
Patient Centered
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The Evolution of P4P
From
Individuals
To
Teams
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The Evolution of P4P
From
Paper
To
Electrons
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The Evolution of P4P
From
A demonstration project
To
The way we do business
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The QCDR
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Qualified Clinical Data Registry
New in 2014
A reporting mechanism for registry participants
Similar to the registry reporting option for PQRS / VM
Can use PQRS measures
Can use non-PQRS, specialty specific measures
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Why the QCDR is a big deal
• Measure definition by the specialty, for the specialty
• Data collection and scoring moves from CMS to the
registry
• “One stop shop” for all requirements
• Public reporting by the society
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The Anesthesiology Perspective
• The National Anesthesia Clinical Outcomes Registry
(NACOR) is certified as a QCDR
• Available measures for perioperative care increased from
4-8 in PQRS to 19
• 4 domains, multiple outcome measures
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Where Did New Anesthesia Measures
Come From?
• Existing in PQRS
– Solves the stewardship problem
• Existing in NQF
• New measures mostly developed by ASA’s Committee on
Performance and Outcome Measures (CPOM)
– Developed, but never selected
– Developed, but never submitted
• Subspecialty possibilities
• Aspirational measures
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AQI as a QCDR
• The Centers for Medicare and Medicaid Services (CMS)
introduced the Qualified Clinical Data Registry (QCDR) as a
reporting option in 2014.
• 2015 Medicare Physician Fee Schedule Proposed Rule:
– To avoid future payment adjustments an EP will have to
report on 9 measures including 3 outcomes across 3 NQS
domains.
• The addition of QCDR reporting allows specialty societies
to develop measures that reflect profession-specific
priorities.
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Performance Reporting through the
QCDR
• 2015 Anesthesia QCDR reporting is a product of ASA in
partnership with AQI
– ASA sells the service
– AQI reports to CMS on behalf on the group and it’s EP’s
– AQI provides monthly PQRS feedback reports
• Groups must be participating in AQI and receive all
benefits of participation
• Free to ASA members who are participating in AQI’s
NACOR registry
• Additional charge for Eligible Professionals (EP) who are
non-ASA members
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QCDR Reporting Requirements. You
Must:
• Be a NACOR participant
• If you are already participating – see next slide
• If you are not already participating in NACOR steps
include:
– Completion of a Business Associate Agreement with the
AQI
– Completion of the AQI practice survey
– Transmission of electronic data to the registry beginning in
January 2015
– Pay AQI membership dues
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QCDR Reporting – Steps to Report
• Self-nomination with AQI for QCDR reporting in early 2015
(more details forthcoming)
• Work with AQI to ensure proper data is being sent
– AQI has staff to review your data and reports to ensure EP’s
are reporting and have a reasonable expectation of
satisfactorily reporting
• Approve the final transmission of EP performance data to
CMS (early 2016)
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ASA QCDR Service
PRESENTED BY:
TERRI HOWARD, CAE
DIRECTOR OF MEMBER SERVICES
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ASA QCDR Service
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Definition of the service
Costs associated with participating in QCDR
Enrollment and membership processes
Who to contact if interested in participating
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ASA QCDR
• ASA has partnered with AQI to provide PQRS reporting as a
benefit of ASA membership.
• To participate in QCDR, the entire practice enrolls in AQI’s
NACOR.
– ASA members: no cost to participate in NACOR
– Non-ASA member independent providers: $1000 annually to
participate
– Non-physician providers in the care team: no cost to
participate
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ASA Membership / QCDR Purchase
• Group Membership / QCDR Invoice
– One invoice for all participating providers in the practice
– Membership: Both ASA and state component society dues
are required
• ASA membership = $665 physicians, $335
CRNAs, AAs; state dues varies
– Non-ASA members purchase QCDR only = $295 per
provider annually
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Enrollment Process
• Submit roster template of participating EPs
– Practice may add/subtract providers throughout the year
• Sign AQI & ASA agreements
• Work with AQI to submit data to NACOR
• Submit new ASA member applications, as applicable
• Practice reviews the roster prior to annual renewal of
membership and QCDR service
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Questions?
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Getting Started
• Contact ASA
– Sara Moser, Director of Marketing & Corporate
Development, [email protected] 847-268-9230
– Terri Howard, Director of Member Services,
[email protected] 847-268-9269
– General questions: [email protected]
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