Transcript EM PQRI Open Door Forum PowerPoint Presentation

Emergency Medicine PQRI
(Physician Quality Reporting Initiative)
Open Door Forum
Hosts
CMS, ACEP, & CEP America
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Disclaimers
This presentation was current at the time it was published or uploaded onto the web. Medicare
policy changes frequently so links to the source documents have been provided within the
document for your reference.
This presentation was prepared as a tool to assist providers and is not intended to grant rights
or impose obligations. Although every reasonable effort has been made to assure the accuracy
of the information within these pages, the ultimate responsibility for the correct submission of
claims and response to any remittance advice lies with the provider of services. The Centers
for Medicare & Medicaid Services (CMS) employees, agents, and staff make no representation,
warranty, or guarantee that this compilation of Medicare information is error-free and will bear
no responsibility or liability for the results or consequences of the use of this guide. This
publication is a general summary that explains certain aspects of the Medicare Program, but is
not a legal document. The official Medicare Program provisions are contained in the relevant
laws, regulations, and rulings.
CPT only copyright 2008 American Medical Association. All rights reserved. CPT is a registered
trademark of the American Medical Association. Applicable FARS\DFARS Restrictions Apply to
Government Use. Fee schedules, relative value units, conversion factors and/or related
components are not assigned by the AMA, are not part of CPT, and the AMA is not
recommending their use. The AMA does not directly or indirectly practice medicine or dispense
medical services. The AMA assumes
no liability for data contained or not contained herein.
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Outline
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Introduction
Reason PQRI was developed
Legislative background
How measures are created
Importance
Eligible professionals
Differences b/w PQRI and Core
Requirements for successful PQRI program
Example of successful PQRI program
2009 ED relevant PQRI Measures
Coding and submission of PQRI measures
Current and future challenges
References
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Presenters
 Dennis Beck MD FACEP
 Chair ACEP Quality & Performance Committee
 President and CEO, Beacon Medical Services
 Richard Newell MD MPH
 Member ACEP Quality & Performance Committee
 CMS Program Coordinator, CEP America
 Mike Granovsky MD FACEP
 Member ACEP National Coding and Nomenclature Advisory
Committee
 President of MRSI (Medical Reimbursement Systems, Inc.)
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Value Based Purchasing & PQRI
 VBP key mechanism for transforming Medicare from
passive payer to active purchaser
 Medicare Physician Fee Schedule (PFS) is based on
quantity and resources consumed, NOT quality or
value of services
 Value = Quality ÷ Cost
 Incentives  higher quality +
 Cost containment =
 Enhanced value
 VBP Issue Paper available at
http://www.cms.hhs.gov/center/physician.asp
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Legislative Background
 TRHCA – Tax Relief & Health Care Act, 2006
established 2007 PQRI
 MMSEA - Medicare, Medicaid, and SCHIP
Extension Act of 2007
 MIPPA - Medicare Improvements for Patients
and Providers Act Section 131: 2009 PQRI
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Transition to Value-Based Purchasing
VBP
2007
2008
2009
2010
•TRHCA
•MMSEA
•MIPPA
•74
measures
•119
measures
•153
measures
TBD
through
rulemaking
•Claimsbased only
•Claims
•Claims
•4 Measures
Groups
•7
Measures
Groups
•Registry
•Registry
•EHRtesting
•eRx
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How Are PQRI Measures Developed?
 Created by respected group using a consensus-based
process
 For example the ED relevant measures were developed by:
 AMA-PCPI - American Medical Association-sponsored Physician
Consortium on Performance Improvement
 NCQA - National Committee for Quality Assurance
 ACEP is working on future measures
 After creation there is a public comment period
 Based on comments measures are molded into their
final version
 Measures are submitted to be endorsed or adopted by a
consensus organization such as the National Quality
Forum (NQF)
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ACEP QI Structure
 ACEP Standards Taskforce – 1987
 ACEP Clinical Policies Committee published first
guideline on Chest Pain in 1990
 Over 22 clinical guidelines have been developed, from
which many of ACEP quality measures are derived
 ACEP Quality Improvement and Patient Safety Section
(QIPS), est. 1993
 Task Force on Quality & Performance, est. 2004
 Quality and Performance Committee (QPC) created in
2005
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ACEP Activity: “EM” Measures for PQRI
 ACEP has been a Member of the AMA Physician
Consortium for Performance Improvement since 2000
 ACEP Led Consortium’s Workgroup on Emergency
Medicine
 ACEP/Emergency Medicine Workgroup, developed EM
performance measure set for the clinical areas of:
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Acute Myocardial Infarction (AMI)
Pneumonia
Chest Pain
Syncope
Result: Measures Eligible for EP PQRI Reporting in
2007
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ACEP Activity: “EM” Measures for PQRI
 ACEP is also active at National Quality Forum to help refine “EM”
measures, and other measures that are eventually endorsed
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Median Time from ED Arrival to ED Departure
for Admitted ED Patients. Median time from ED
arrival to time of departure from the emergency
department for patients admitted to the facility
from ED
Median Time from ED Arrival to ED Departure
for Discharged ED Patients. Median time from ED
arrival to time of departure from emergency
department for patients discharged from the ED
Admit Decision Time to ED Departure Time for
Admitted Patients. Median time from admit
decision time to time of departure from the ED
for emergency department patients admitted to
inpatient status
Door to Provider. Time of first contact in the ED
to the time when the patient sees the physician
(provider) for the first time.
Left Without Being Seen. Percent of patients
leaving w/o being seen by physician
Severe Sepsis and Septic Shock: Management
Bundle. Initial steps in management of the
patient presenting with infection (severe sepsis
or septic shock)
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Confirmation of Endotracheal Tube Placement. Any
time an endotracheal tube is placed into an airway in
the Emergency Department or an endotraceal tube is
placed by an outside provider and that patient arrives
already intubated (EMS or hospital transfer) or when
an airway is placed after patients arrives to the ED
there should be some method attempted to confirm
ETT placement
Pregnancy Test for Female Abdominal Pain Patients.
Percent of women, ages 14–50 years old, who present
to ED with chief complaint of abdominal pain who have
a pregnancy test (urine or serum) ordered in ED
Anticoagulation for Acute Pulmonary Embolus
Patients. Percent of patients newly diagnosed with a
pulmonary embolus in the ED or referred to the ED
with a new diagnosis of pulmonary embolus who have
orders for anticoagulation (heparin or low molecular
weight heparin) for pulmonary embolus while in the ED
Pediatric Weight in Kilograms. Percent ED patients <
13 years of age with a current weight in kilograms
documented in ED record
Endorsed by NQF in 2008
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Why Are PQRI Measures Important?
 Surrogate for quality
 Financial implications
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Cost control
Incentives
Pay-for-performance
Framework for other payers
 Public accountability
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Eligible Emergency Professionals
 Emergency Physicians (MD/DO)
 Nurse Practitioners
 Physician Assistants
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Core & PQRI Measure Differences
 Who is accountable for performance?
 Core Measure = Hospital
 PQRI = Provider
 Who reports performance?
 Core Measure = Hospital
 PQRI = Billing company or provider
 What patients are included in the
measures?
 Core Measure = All admitted patients regardless of
payer
 PQRI = Both admitted and discharged Medicare Part
B patients
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Successful PQRI Program Requirements
 Organizational priority
 Collaboration with billing company
 Data collection and reporting
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Successful PQRI Program Requirements
 Dedicated position overseeing program
 Provider education
 Timely feedback
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CEP America’s PQRI Program
 Began in 2007
 CMS Program Coordinator position created
 Provider Education
 Constantly updated web-based education
 In person presentations at partnership regional
meetings and PA/NP meetings
 Development of supplemental practice material for
placement in department (see example)
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CEP America’s Program
 Performance reports
 Semi-Annual reports on organizational, regional level,
& site level
 Program coordinator discusses quarterly performance
with medical directors at site
 Timely feedback to providers (see example)
 Allows for individual provider quality improvement
 Department PI projects designed around PQRI
performance
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Site Feedback Report
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Provider Feedback Report
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Where To Start
www.cms.hhs.gov/pqri
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2009 PQRI Measures
 There are 153 PQRI measures
 There are 10 PQRI Measures relevant to
Emergency Medicine
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ED Provider Quality Measures
1. Aspirin at Arrival for AMI
2. Electrocardiogram Non-Traumatic Chest Pain
3. Electrocardiogram Performed for Syncope
4. Vital Signs for Community-Acquired Bacterial
Pneumonia
5. Assessment of Oxygen Saturation for
Community-Acquired Bacterial Pneumonia
6. Assessment of Mental Status for CommunityAcquired Bacterial Pneumonia
7. Empiric Antibiotic for Community-Acquired
Bacterial Pneumonia
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PQRI Additional ED Measures
8. Prevention of Catheter related Infections
 Procedure trigger- 36556
 Cap, mask, gown, large field, hand washing, full prep
9. Stroke- Patients receiving DVT Prophylaxis
 Cross walks to 99291
10. Stroke- Consideration of TPA
 Cross walks to 99291
 Retired #29: Beta-Blocker for Acute MI
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Measure #28: Aspirin in AMI
 Measure description:
 Percentage of patients, regardless of age, with an ED diagnosis
of AMI who had documentation of receiving aspirin within 24
hours before ED arrival or during ED stay
 If not going to provide ASA, document why
 Applicable E&M Levels: 99281, 99282, 99283, 99284,
99285, 99291
 Applicable ICD-9 diagnosis codes: 410.01, 410.11,
410.21, 410.31, 410.41, 410.51, 410.61, 410.71, 410.81,
410.91
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Measure #31: DVT PPx in Stroke & ICH
 Measure Description:
 Percentage of patients aged 18 years and older with a diagnosis
of ischemic stroke or intracranial hemorrhage who received DVT
prophylaxis by end of hospital day two
 Acute ischemic stroke patients recommend prophylactic low-dose
subcutaneous heparin or low-molecular-weight heparins
 Acute ICH, recommend the initial use of intermittent pneumatic
compression
 If not going to provide document medical or patient
reason why not
 Applicable E&M Level: 99291 only
 Applicable ICD-9 diagnosis codes: 431, 433.01, 433.11,
433.21, 433.31, 433.81, 433.91, 434.01, 434.11, 434.91
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Measure #34: t-PA in Ischemic stroke
 Measure description:
 Percentage of patients aged 18 years and older with a diagnosis
of ischemic stroke whose time from symptom onset to arrival is
less than 3 hours who were considered for t-PA administration
 Includes patients to whom t-PA was given or patients for whom
reasons for not being a candidate for t-PA therapy are documented
 Ensure documentation of reasons why t-PA is not being
administered
 Applicable E&M Levels: 99291 only
 Applicable ICD-9 diagnosis codes: 410.01, 410.11,
410.21, 410.31, 410.41, 410.51, 410.61, 410.71, 410.81,
410.91
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Measure #54: EKG in Chest Pain
 Measure description:
 Percentage of patients aged 40 years and older with an
emergency department discharge diagnosis of non-traumatic
chest pain who had a 12-lead electrocardiogram (ECG)
performed
 If not going to obtain an EKG document medical or
patient reason for not doing so
 Applicable E&M Levels: 99281, 99282, 99283, 99284,
99285, 99291
 Applicable ICD-9 diagnosis codes: 413.0, 413.1, 413.9,
786.50, 786.51, 786.52, 786.59
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Measure #55: EKG in Syncope
 Measure description:
 Percentage of patients aged 60 years and older with an ED
diagnosis of syncope who had a 12-lead ECG performed
 If not going to provide obtain an EKG document medical
or patient reason for not doing so
 Applicable E&M Levels: 99281, 99282, 99283, 99284,
99285, 99291
 Applicable ICD-9 diagnosis code: 780.2
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Measure #56: Vital Signs in CAP
 Measure description:
 Percentage of patients aged 18 years and older with a diagnosis
of community-acquired bacterial pneumonia with vital signs
(temperature, pulse, respiratory rate, and blood pressure)
documented and reviewed
 Definition of documented and reviewed:
 Clinician documentation that vital signs were reviewed
 Dictation by the clinician including vital signs
 Clinician initials in the chart that vital signs were reviewed, or other
indication that vital signs had been reviewed
 Applicable E&M Levels: 99281, 99282, 99283, 99284,
99285, 99291
 Applicable ICD-9 diagnosis code: 481, 482.0, 482.1,
482.2, 482.30, 482.31, 482.32, 482.39, 482.40,
482.41,482.42, 482.49, 482.81, 482.82, 482.83, 482.84,
482.89, 482.9, 483.0, 483.1, 483.8, 485, 486, 487.0
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Measure #57: Oxygenation in CAP
 Measure description:
 Percentage of patients aged 18 years and older with a diagnosis
of community-acquired bacterial pneumonia with oxygen
saturation documented and reviewed
 Definition of documented and reviewed:
 Clinician documentation that oxygen saturation was reviewed
 Dictation by the clinician including oxygen saturation
 Clinician initials in the chart that oxygen saturation was reviewed or
other indication that oxygen saturation had been reviewed
 If not going to document and review, document medical,
patient, or system reason(s) for not doing so
 Applicable E&M Levels: 99281, 99282, 99283, 99284,
99285, 99291
 Applicable ICD-9 diagnosis code: 481, 482.0, 482.1,
482.2, 482.30, 482.31, 482.32, 482.39, 482.40, 482.41,
482.49, 482.81, 482.82, 482.83, 482.84, 482.89, 482.9,
483.0, 483.1, 483.8, 485, 486, 487.0
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Measure #58: Mental Status in CAP
 Measure description:
 Percentage of patients aged 18 years and older with a diagnosis
of community-acquired bacterial pneumonia with mental status
assessed
 Definition of mental status assessment:
 Medical record may include documentation by clinician that patient’s
mental status was noted (e.g., patient is oriented or disoriented)
 Applicable E&M Levels: 99281, 99282, 99283, 99284,
99285, 99291
 Applicable ICD-9 diagnosis code: 481, 482.0, 482.1,
482.2, 482.30, 482.31, 482.32, 482.39, 482.40,
482.41,482.42, 482.49, 482.81, 482.82, 482.83, 482.84,
482.89, 482.9, 483.0, 483.1, 483.8, 485, 486, 487.0
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Measure #59: Abx Selection in CAP
 Measure description:
 Percentage of patients over 18 years old with a diagnosis of CAP
with an appropriate empiric antibiotic prescribed
 Definition of appropriate empiric antibiotic
 Four drug classes: Fluoroquinolones, Macrolides, Doxycycline, Beta
Lactam with Macrolide or Doxycycline
 "Prescribed" includes patients who are currently receiving
medication(s) that follow the treatment plan recommended at an
encounter during the reporting period, even if the prescription for
that medication was ordered prior to the encounter
 If not going to provide appropriate antibiotic, document
medical, patient, or system reason(s) for not doing so
 Applicable E&M Levels: 99281, 99282, 99283, 99284,
99285, 99291
 Applicable ICD-9 diagnosis code: 481, 482.0, 482.1,
482.2, 482.30, 482.31, 482.32, 482.39, 482.40,
482.41,482.42, 482.49, 482.81, 482.82, 482.83, 482.84,
482.89, 482.9, 483.0, 483.1, 483.8, 485, 486, 487.0
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Measure #76: CVC Insertion
 Measure description:
 Percentage of patients, regardless of age, who undergo central
venous catheter (CVC) insertion for whom CVC was inserted with
all elements of maximal sterile barrier technique
 Definition of maximal sterile barrier technique:
 Cap AND mask AND sterile gown AND sterile gloves AND a large
sterile sheet AND hand hygiene AND 2% chlorhexidine for
cutaneous antisepsis) followed
 If not going to use maximal sterile barrier technique
document the patient reason why not
 Acceptable CPT procedure codes: 36555, 36556, 36557,
36558, 36560, 36561, 36563, 36565, 36566, 36568,
36569, 36570, 36571, 36578, 36580, 36581, 36582,
36583, 36584, 36585, 93503
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Measure Submission Overview
 Currently Emergency Medicine relevant PQRI
measures are submitted via a claims based
mechanism.
 Possibly in future via EHR
 Reporting period: January 1, 2009 – December
31, 2009
 Satisfactory reporting:
 > 3 PQRI measures or 1-2 measures if <3 measures
apply
 > 80% of applicable Medicare Part B FFS patient
claims for 1-3 measures
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PQRI Operational Process
 The cohort population for a TIN/NPI is identified. This occurs by
reviewing the denominator of the measure.
 CMS will identify claims with ICD 9 Diagnosis Codes. For example
C/W Acute MI
 i.e. 410 code family
 Then CMS will look for the eligible CPT code for a service provided
for this patient.
 The dual requirement of 9928x and ICD9 code 410.X will trigger the
PQRI reporting requirement
 CMS then requires the physician report the code for the MI quality
measure (if this is one of the measures the EP chooses to report).
 Aspirin for Acute MI
 4084F
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CMS PQRI Data Flow
Critical
Step
Visit Documented in
the Medical Record
Encounter Form
Coding & Billing
N-365
NCH
Analysis Contractor
Confidential
Report
National Claims
History File
Carrier/MAC
Incentive
Payment
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Claims-Based Reporting Principles
 The CPT Category II code(s) and/or G-code(s), which supply
the numerator, must be reported:
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on the same claim
for the same beneficiary
for the same date of service (DOS)
for the same EP (NPI within the holder of the tax ID number - NPI/TIN)
 All diagnoses reported on the base claim will be included in PQRI
analysis.
 Claims may NOT be resubmitted simply to add or correct QDCs.
 QDCs must be submitted with a line-item charge of zero dollars
($0.00) at the time the associated covered service is performed.
 If a system does not allow a $0.00 line-item charge, a nominal amount
can be substituted ($0.01).
 The submitted charge field cannot be blank.
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Claims-Based Reporting Process
 Entire claims with a zero charge will be rejected
 Total charge for the claim cannot be $0.00
 QDC line items will be denied for payment by the carrier, but
are then passed through the claims processing system for
PQRI analysis
 EPs will receive a Remittance Advice (RA) associated with
the claim which contains the PQRI QDC line-item and will
include a standard remark code (N365)
 A message that confirms that the QDCs passed into the
National Claims History (NCH) file. N365 reads: “This
procedure code is not payable. It is for reporting/information
purposes only.”
 The N365 remark code does NOT indicate whether the QDC is
accurate for that claim or for the measure the EP is attempting
to report.
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CMS-1500 Claim Example
Example of an individual NPI reporting on a single CMS-1500 claim. See http://www.cms.hhs.gov/manuals/downloads/clm104c26.pdf for more
information.
Qualified PQRI (Dx) listed in Item 21. Up to 8
QDC codes must be submitted with a
Dx may be entered electronically.
line-item charge of $0.00. Charge field
24D. CPT Codes 9928x
cannot be blank.
Diabetes Mellitus
CAD
Identifies
claim
line-item
DM–PQRI #2
BP<130 mmHg–PQRI #3
AND
CAD–PQRI #6
BP< 80 mmHg–PQRI #3
For group
billing, the
rendering
NPI number
of the
individual
EP who
performed
the service
will be used
from each
line-item in
the PQRI
calculations.
UI Assessed–PQRI #48
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The patient was seen for an office visit (99213). The provider is reporting several measures related to diabetes, coronary artery disease (CAD), and urinary incontinence:
Measure #2 (LDL-C) with QDC 3048F + diabetes line-item diagnosis (24E points to DX 250.00 in Item 21);
Measure #3 (BP in Diabetes) with QDCs 3074F + 3078F + diabetes line-item diagnosis (24E points to Dx 250.00 in Item 21);
Measure #6 (CAD) with QDC 4011F + CAD line-item diagnosis (24E points to Dx 414.00 in Item 21); and
Measure #48 (Assessment - Urinary Incontinence) with QDC 1090F. For PQRI, there is no specific diagnosis associated with this measure. Point to the appropriate diagnosis for the encounter.
Note: All diagnoses listed in Item 21 will be used for PQRI analysis. Measures that require the reporting of two or more diagnoses on claim will be analyzed as submitted in Item 21.
NPI placement: Item 24J must contain the NPI of the individual provider that rendered the service when a group is billing. This includes putting the individual NPI on the QDC line-items as well.
The Tax ID associated with the NPI(s) on this claim is shown in Item 25.
Diag pointer field must
contain ICD 9 PQRI trigger
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PQRI-Scoring
 Scores will be reported as a percentage of
compliance
 Numerator- the number of patients with a
PQRI code/modifier assigned
 Denominator-all Medicare patients with the
diagnosis of acute MI and the level of
services (CPT code) noted in the
specification.
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Meeting The Requirements
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QDCs translate clinical actions so they can be
captured in the administrative claims process –
they describe whether:
 The measure requirement was met
– OR –
 The measure requirement was not met due to
documented allowable performance exclusions (i.e.,
using CPT II performance exclusion modifiers
– OR –
 The measure requirement was not met and the reason is
not documented or is not consistent with an accepted
performance exclusion
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PQRI Modifiers
 The provider documents appropriate
performance of the measure
 Report the unmodified code: i.e.4084F
 What if the quality measure was not achieved?
 Add a P Modifier:
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1P Documentation of Medical reason
2P Documentation of Patient reason
3P Documentation of System reason
8P Reason not otherwise specified in CPT)
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PQRI Coding Process - ASA for AMI
 Aspirin within 24 hours of arrival or during the
ED stay
 CPT 2 Code: 4084F Aspirin received within 24
hours before ED arrival or during ED stay
 Aspirin not received 24 hours before ED arrival
or during ED stay
 1P: Documentation of medical reasons for not
receiving Aspirin
 2P: Documentation of patient reasons for not
receiving Aspirin
 8P: Aspirin not received, reason not specified
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PQRI Aspirin Vignette
 A 72 year old female presents with an Acute MI. The
physician documents giving Aspirin - Report 4084F
 A 68 year old male presents with an Acute MI. The
physician documents not giving ASA due to a Hx of
anaphylaxis - Report 4084F, 1P (medical reason)
 A 26 year old male using Crack presents with an acute
MI and refuses Aspirin - Report 4084F, 2P (patient
reason)
 An 82 year old male is brought in by EMS with an acute
MI. Aspirin is perhaps given by EMS - Report 4084F, 8P
(reason not specified)
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2007 PQRI Experience Report
QDC Submission Attempts
 12.15% Missing NPI
 18.89% Incorrect HCPCS code
 13.93% Incorrect DX code
 7.24% Both incorrect HCPCS code and incorrect DX
code*
 4.97% All line items were QDCs only
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PQRI Results: 2007 Claims Data
 631,110 unique Tax ID/National Provider
Identifiers had an opportunity to participate
 109,000 (15.74%) attempted to participate
 Certain specialties were more successful than
others- emergency medicine, ophthalmology,
and anesthesia
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PQRI Economic Experience
 What does the PQRI bonus mean?
 2007 Total: $36 million
 Average individual payment = $600 at 1.5% for 6
months
 Average group payment = $4,700
 Largest group payment = $205,700
 Opting out vs. Future requirements
 109,000 reported in 2007
 56,700 met reporting requirements
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Common Errors
 Eligible claim without individual NPI
 Eligible claim without QDC(s)
 Eligible claim submitted as a QDC-only claim
(no denominator information on the claim)
 Ineligible claim with QDC for measure
 Diagnosis is incorrect on claim for measure
reported
 Surgical procedure is incorrect on claim for
measure reported
 Age is incorrect for measure reported
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PQRI- The Feedback Reports
 Confidential Feedback Reports today
 Hospital data is public
 Reporting of successful participation may occur
in the future.
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2009 Physician Final Rule
CMS-1403-FC Page 655,664
“We are contemplating a physician compare
website…for the public reporting of quality
data”
“It is our intent to identify the eligible
professionals who satisfactorily submit
data on quality measures for the 2009 PQRI
on the CMS Web site in 2010”
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Getting Your Scores
 Register in the IACS System
 Individual Authorized Access to CMS Computer Services
 First Designate a security officer
 Information required
 Taxpayer Identification Number (TIN);
 Legal Business Name;
 Corporate Address; and
 Internal Revenue Service (IRS) CP-575 hard copy form.
 IACS User Help Desk
 1.866.484.8049
 [email protected]
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Getting Your Scores Without IACS
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Non IACS Score Reports
 CMS has an alternate mechanism for 2008
PQRI feedback reports
 Beginning on October 19, 2009, individual EPs
can call their respective carrier or A/B MAC
Provider Contact Center to request 2007 ReRun and 2008 PQRI feedback reports that will
contain data based on their individual NPI.
 When requesting feedback reports, EPs will be
asked to provide an e-mail address. EPs can
then expect to receive the e-mailed feedback
report within 30 days of the request
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Provider Contact List
 Carrier Provider Contact Centers can answer questions
concerning incentive payment status, such as:
 Was my incentive payment sent?
 What is my incentive payment amount?
 What does my Remittance Advice(s) mean?
 Provider Contact Centers
http://www.cms.hhs.gov/MLNProducts/Downloads/C
allCenterTollNumDirectory.zip
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The Future
 Expansion of reporting options:
 Claims based
 EHR base
 Registry based
Movement away from claims based reporting
“While we propose to retain the claims based reporting
mechanism for 2010, we note that we are considering
significantly limiting the claims-based mechanism…after
2010 .”
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The Future – 2010 Proposed Rule
 PQRI Measure #34 Stroke and Stroke
Rehabilitation: Tissue Plasminogen Activator
 “Analytically challenging”
 Potentially replaced with another measure
 Pneumonia Measures group
 Measures #56,57,58, and 59
 Reportable within the framework of a measures group
58
Resources
 Physician Quality Reporting Initiative:
 https://www.cms.hhs.gov/pqri
 CMS Quality Initiatives – General Information:
 http://www.cms.hhs.gov/QualityInitiativesGenInfo/
 12/9/08 Issues Paper: Development of a Plan to
Transition to a Medicare Value-Based Purchasing
Program for Physician and Other Professional Services
 http://www.cms.hhs.gov/center/physician.asp
 Hospital Quality Reporting:
 www.hospitalcompare.hhs.gov
 Open Door Forums:
 http://www.cms.hhs.gov/OpenDoorForums/
 National Provider Identifier:
 https://nppes.cms.hhs.gov/NPPES/Welcome.do
 Demonstrations:
 http://www.cms.hhs.gov/DemoProjectsEvalRpts/
59
Resources
American Medical Association – Physician Consortium
for Performance Improvement
http://www.ama-assn.org
National Committee on Quality Assurance
http://www.ncqa.org/
National Quality Forum
http://www.qualityforum.org
Medicare Payment Advisory Commission
http://www.medpac.gov
National Academies Press – Pathways to Quality Health
Care series – performance measurement and
improvement
http://www.nap.edu
60
Resources
 American College of Emergency Physicians
 www.ACEP.org
 Angela Franklin, Esq.
 Director of Quality and Health IT
 [email protected]
 David McKenzie, CAE
 Reimbursement Director
 [email protected]
 CEP America
 www.CEP.com
 Richard Newell MD MPH
 [email protected]`
61
Questions?
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