Transcript Quality Reporting for Physicians: PQRS, Physician Compare and More

Quality Reporting for Physicians:
PQRS, Physician Compare and More
Sandra Pogones
Primaris
May 12, 2011
MO-11-06-PC May 2011
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
3 Separate/Distinct CMS Incentive Programs
EHR Incentive Program – “Meaningful Use”
eRX Incentive Program
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1% incentive for Successful e-Prescribers in 2011
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Payment reductions begin in 2012
Physician Quality Reporting Systems (formerly PQRI)
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Started in 2006
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1% Incentive for Satisfactory Reporting in 2011
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Payment reductions begin in 2015
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Today’s topic!
Physician Quality Reporting System
PQRS Rules change slightly every year
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Incentive rates
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Measures—additions and deletions
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Measure Specs: updated codes, new QDCs
Incentives independent of participation in other CMS
programs
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You may draw incentives from PQRS reporting in addition to
EHR Program incentives and e-Prescribe Program incentives
(Note: ePrescribe incentives are NOT independent of the EHR
program incentives under Medicare.)
Eligible Professionals
Eligible professionals include physicians, nurse
practitioners, clinical nurse specialists, physician
assistants, physical therapists, and many others
Incentives based on Medicare Part B Covered
Professional Services delineated in the Physician Fee
Schedule
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Services payable under fee schedules or methodologies other
than the PFS are not included in PQRS: RHCs, FQHCs,
providers that have reassigned benefits to a CAH, Medicare
Advantage
Reporting Mechanisms
Individual eligible professionals may report
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3 individual PQRS measures (194 possible measures), OR
1 measures group (14 different Measures Groups)
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A group consists of 4-9 clinically-related measures
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Reportable through Claims or Registry option—not EHR
Reporting options for individual eligible professionals
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Claims
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Qualified registry
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Qualified EHR—(20 different individual measures)
Participation Options
Providers may participate as:
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Individuals
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Large Groups (GPRO I): >=200 individual NPIs
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Small Groups (GPRO II): 2-99 individual NPIs
Additional incentive (0.5%) for Maintenance of
Certification Program
There is no registration required for individual
reporting
Reporting through Part B Claims
12-month (1/1– 12/31 2011)
6-month (7/1 – 12/31 2011)
3 individual measures for >50%
Medicare Part B PFS patients
Same
1 Measure Group for >=30 Medicare
Part B PFS patients
N/A (As long as you report 30
Medicare Part B PFS patients, you
qualify for full year, regardless of
when claims were submitted)
1 Measure Group for >50% Medicare 1 Measure Group for >50% Medicare
Part B PFS patients (at least 15)
Part B PFS patients (at least 8)
PQRS code must be submitted on same claim as
billing codes—No separate claim just for PQRS
allowed!
Reporting through a Qualified Registry
12-month (1/1 – 12/31 2011
6-month (7/1 – 12/31 2011)
3 individual measures for > 80%
Medicare Part B PFS patients
Same
1 Measures Group for >= 30
Medicare Part B PFS patients
N/A (As long as you report 30
Medicare Part B PFS patients you
qualify for full year)
1 Measure Group for >80% Medicare 1 Measure Group for >80% Medicare
Part B PFS patients (at least 15)
Part B PFS patients (at least 8)
Reporting through a Qualified EHR
12-month (1/1 – 12/31 2011)
6-month (7/1 – 12/31 2011)
3 individual measures for > 80%
Medicare Part B PFS patients
No six month reporting option
There is NO Measures Group Option
Same
EHR must be Qualified by CMS
EHR contains a PQRS module/function which pulls
raw data from the EHR—may be a cost from vendor
EP submits raw data from EHR to CMS, then CMS
calculates performance rate
Deadlines
All claims must be submitted by the end of February
2012
Registry, EHR and GPRO must submit all data by the
end of March 2012
Why Participate?
Affordable Care Act (Sect 10331, March 2010)
provides PQRS incentives through 2014
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2011 : 1% of provider’s allowable Part B PFS incentive
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2012, 2013, 2014: 0.5% incentive
Authorized payment reductions to fee schedule
amount beginning in 2015 for those who do not
satisfactorily report
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2015: 1.5% payment reduction
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2016 and subsequent years: 2.0% payment reduction
Why Participate?
Close scrutiny of health care spending--accountability
Supports public reporting of quality data
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Quality reporting measures are becoming more closely
aligned for all CMS initiatives—Meaningful Use, PQRS,
Medicare Advantage, PCMHs, ACOs, Demonstration projects,
etc.
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CMS website contains a listing of all physicians that
satisfactorily completed PQRI in 2009:
http://www.cms.gov/PQRI
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CMS sends a letter to your patients telling them their
physician is participating in PQRS
Why Participate?
Performance will be the basis for payment in the near
future
Physician Compare beginning in 2013
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http://www.medicare.gov/find-a-doctor/provider-search.aspx
Physician Compare Website
“Physician Compare for 2011 includes information about
physicians and other professionals who participated in the
Physician Quality Reporting System. It does not yet contain
physician and eligible professional performance information. We
expect to have performance information on Physician Compare
starting in 2013. This will be for services those providers
furnished to Medicare beneficiaries during 2012.”
Physician Compare Website
Why Report?
Provides a way to measure and monitor the quality of
care you provide your patients
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Identify gaps in performance and take steps to correct
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Keep your patients healthier and provider better, more
comprehensive care that meets professional standards
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Marketing purposes
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Build trust in your patients
Resources
INFORMATION RESOURCES:
http://www.cms.gov/pqrs
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How to Get Started
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Measure Specifications for individual measure reporting
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Measures Groups Specifications
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EHR Specifications
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GPRO Specifications
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2011 Implementation Guide
Resources (cont)
Also see:
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Frequently Asked Questions
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Supplemental education materials
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National Provider Calls
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Special Open Door Forums
QualityNet Help Desk
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http://www.cms.hhs.gov/PQRI/36_HelpDeskSupport.asp#To
pOfPage
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7:00 a.m. - 7:00 p.m. CST at 866-288-8912 or
[email protected]
Resources (cont)
Primaris
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Primaris has just received funding to assist 100 Missouri physicians
to report PQRS using their EHR as part of our national QIO 10th
Scope of Word (begins August 2011).
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Free onsite and/or remote assistance for reporting Preventive
Care Screening (flu/pneumonia vaccines, Colorectal Cancer
Screens, Mammograms, BP measurement, Tobacco cessation)
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Earn PQRS Incentives for 2012 (and possibly 2011)
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Complete and return Interest Form to reserve your spot today.
Eligibility criteria apply.
Primaris will offer best practices and consultation to any practice
attempting to improve performance on the above measures
Thank You!
Questions? Contact:
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Sandy Pogones
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[email protected]
Your Local Connection to Achieving National Health
Goals