Transcript Meaningful Use & Physician Quality Reporting System (PQRS) • Phone lines are now muted • Press *4 to increase or decrease sound level • Find.

Meaningful Use &
Physician Quality
Reporting System
(PQRS)
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Missouri’s Federally-designated
Regional Extension Center
University of Missouri:
Department of Health Management and Informatics
Center for Health Policy
Department of Family and Community Medicine
Missouri School of Journalism
Partners:
EHR Pathway
Hospital Industry Data Institute (Critical Access Hospitals)
Missouri Primary Care Association
Missouri Telehealth Network
Primaris
Assist Missouri's health care providers in using
electronic health records to improve the access and
quality of health services; to reduce inefficiencies
and avoidable costs; and to optimize the health
outcomes of Missourians
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For providers who do not have a certified EHR system We help you choose and implement one in your office
For providers who already have a system - We help
eligible providers meet the Medicare or Medicaid criteria
for incentive payments
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Contact MO HIT Assistance
Center for details and pricing
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Instructions provided
after today’s presentation
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The Office of Continuing Education, School of Medicine, University of Missouri is accredited by the
Accreditation Council for Continuing Medical Education (ACCME) to provide continuing medical education for
physicians.

The Office of Continuing Education, School of Medicine, University of Missouri designates this live Internet
educational activity for a maximum of one AMA PRA Category 1 Credit™. Physicians should only claim the
credit commensurate with the extent of their participation in the activity.
The learning objectives of this live Internet educational activity are:
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Choose an appropriate electronic health record for the practice, create a change team, redesign practice
workflow and successfully implement transition to electronic records.
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Appropriately track quality measures in electronic health records and to create accurate reports of quality
indicators; physicians will understand how to use indicators to improve patient outcomes.
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Identify potential privacy and security issues in individual practices that are utilizing electronic health records
and provide tools for practices to use to assess their security measures to see if they are appropriate.
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Measure and track the way individual practices are reporting on the meaningful use requirements in the federal
HI Tech Act; understand additional clinical reporting requirements contained in meaningful use phases two and
three.
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Appropriately design and implement patient portals for patients to access their health care information and
learn how to better take care of their health conditions.
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The planning members for this activity have no commercial relationships to disclose. However, the presenter of
today’s Webinar, Sandy Pogones is a Primaris employee.
This regional extension center is funded
through an award from the Office of the
National Coordinator for Health Information
Technology, Department of Health and Human
Services Award Number 90RC0039/01
Cerner and the University of Missouri Health System have an independent
strategic alliance to provide unique support for the Tiger Institute for Health
Innovation, a collaborative venture to promote innovative health care solutions
to drive down cost and dramatically increase quality of care for the state of
Missouri. The Missouri Health Information Technology Assistance Center at the
University of Missouri, however, is vendor neutral in its support of the adoption
and implementation of EMRs by health care providers in Missouri as they move
toward meaningful use.
Physician Quality Reporting System:
Beyond an Incentive Payment
Sandra Pogones
Program Manager, Physician Services
Primaris – Columbia, MO
Publication MO-11-21-PC
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
Who is Primaris
Primaris was founded in 1983 by the Missouri State Medical
Association, Missouri Hospital Association and Missouri
Association of Osteopathic Physicians and Surgeons
Among other roles, Primaris serves as the federallydesignated Quality Improvement Organization (QIO) for the
state of Missouri.
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Mission of QIOs: To improve the effectiveness, efficiency, economy
and quality of services delivered to Medicare beneficiaries.
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Services provided under the QIO contract are free-of-charge to
providers.
Slide 11 of 33
Objectives
Establish the importance of Physician Quality Reporting to
the physician practice
Identify PQRS program requirements in terms of eligibility,
incentives, reporting mechanisms and requirements
Examine specifications for a sample measure
Propose a workflow plan to incorporate quality
measurement into daily practice
List resources to assist physician practices in successfully
reporting PQRS
Question & Answer
Slide 12 of 33
Quality Reporting is First Step toward “Real
Goals”
Success of Practice
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Sense of Accomplishment/Professional Achievement
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Improved Productivity/Set Practice Priorities
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Move away from Defensive Medicine to Evidence-Based
Service to Patients
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Improved Outcomes, Prevention, Diagnosis, Remediation
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More engaged, self-responsibility
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Improved Satisfaction, Better Coordination
Benefits for the Population
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Efficacious Care and Improved Population Health
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Less waste, right incentives—Drive Change
Slide 13 of 33
Where do PQRS Measures Come From?
National Quality Forum (NQF) measures are at the
center of PQRS.
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Experts in the clinical area and stakeholders are convened to
define quality and standards through consensus process
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Measures are adopted that are important, scientifically
acceptable, useable, relevant, and feasible to track
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Caregivers adopt and apply measures to improve their own
practice
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Measures provide benchmarks and best practices
Slide 14 of 33
Why Participate in PQRS? Financial
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
Penalties 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
Brings money into the practice—Medicare pays for
many preventive services as first-dollar
Slide 15 of 33
Why Participate in PQRS? Financial (cont.)
We are moving away from Fee-for-Service to Value-based
purchasing
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Accountable Care Organizations
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Patient-Centered Medical Homes
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Missouri Foundation for Health/Healthcare Foundation of
Greater KC/BCBS GKC (2011+)
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Missouri HealthNet – Medicaid (2011+)
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CMS “Comprehensive Primary Care Initiative (Sept 2011)
Slide 16 of 33
Why Participate in PQRS? Financial (cont.)
Value-based modifier is required for specific physicians
by 1/1/2015 and all providers by 1/1/2017. Initial
performance data is 2013.
Physicians in IA, KS, MO and NE will receive individual
“Value-based” Reports late in 2011
–
–
–
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PQRS measures reported
Clinical measures derived from Claims data
Compare average per capita costs among physicians
Compare total per capita costs for patients with COPD, heart
failure, CAD and diabetes
Reports will be refined for future Value-based reports
and for public reporting
Slide 17 of 33
Why Participate in PQRS? Accountability
Close scrutiny of health care spending—accountability
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Public outcry toward national spending has brought all
federal programs to the forefront
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Healthcare is the biggest ticket of federal budget & Medicare
largest payer
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PQRS performance can demonstrate that practice met
standard of care
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PQRS measures serve as window for evidence-based
measure of quality upon which payment will be based
Slide 18 of 33
Why Participate in PQRS? Reputation
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, 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
Physician Compare quality reporting begins in 2013 for
Groups; later for individual physicians
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Slide 19 of 33
http://www.medicare.gov/find-a-doctor/provider-search.aspx
Physician Compare Website
Slide 20 of 33
Why Participate in PQRS? Excellence
Provides a way to measure and monitor the quality of
care you provide your patients
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–
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Slide 21 of 33
Identify gaps in performance and take steps to correct
Provide better, more comprehensive care that meets
professional standards
“You improve what you measure”
Build trust in your patients, engage them in care
Three Separate and Distinct CMS Programs
EHR Incentive Program (“Meaningful Use” of an EHR)
E-Prescribe Incentive Program (electronically transmit
prescriptions)
PQRS Incentive Program (“Physician Quality Reporting
System”—formerly PQRI; report quality measures to
CMS via claims, registry or EHR)
EPs may participate in all programs for incentives and MUST
participate to avoid payment penalties.
(Only Medicare EHR incentives and e-prescribe incentives are
mutually exclusive. Otherwise, eligible providers can collect all three.)
Slide 22 of 33
Physician Quality Reporting System
PQRS requires reporting of clinical measures to CMS
Annual program, rules/measures change every year
PQRS incentives are independent of other CMS
programs
Eligible professionals include physicians, NPs, PAs,
therapists
Incentives based on Medicare Part B PFS allowable
charges – incentives smaller/non-existent for
RHC/FQHC providers
Slide 23 of 33
Reporting Mechanisms
Measures--EPs may report:
–
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3 individual PQRS measures (194 possible), OR
1 measures group (14 different Measures Groups)
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A group consists of 4-9 clinically-related measures
Reporting Options
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Claims—traditional option
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Qualified Registry—list not yet available for 2011
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Qualified EHR (20 individual measures—no measures
groups)—28 EHRs are qualified in 2011
Slide 24 of 33
Participation Options
In 2011 Providers may participate as:
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Individuals--No registration is required
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Groups
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Self-nomination by first of the year required and approval
needed
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Groups report 26 measures
Additional incentive (0.5%) for Maintenance of
Certification Program – professional bodies only
Slide 25 of 33
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)
Submit daily on the claim
Designed for paper-based clinical systems
Some practice management systems have alerts to assist
reporting
Slide 26 of 33
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)
Provider submits data to registry, or registry pulls data from EHR
Registry submits aggregate data to CMS on behalf of provider
Done once a year, usually with a cost
Slide 27 of 33
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 pulls raw data from the EHR and submits to CMS
Done once a year – may be a cost from vendor
CMS calculates performance rate
Slide 28 of 33
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
Slide 29 of 33
Quality Measures--Analysis
Each measure has a denominator that defines the
population included. e.g. Pneumococcal Vaccine
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Denominator: All patients greater than or equal to 65 years
at the beginning of the measurement period. Patients must
have at least one face-to-face office visit during the
measurement period.
Each measure has a numerator that defines the
portion of population that met the measure
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Slide 30 of 33
Patients who received a pneumococcal vaccination before
the end of the measurement period
Quality Measure Analysis (continued)
Some measures have exclusions that remove a
patient from both the numerator and
denominator:
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Medical reason for not having the vaccination, such as
Allergy or Adverse effect
Reporting Rate: Accurately identifying all patients
in the denominator
Performance Rate: Numerator/Denominator
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Slide 31 of 33
Currently incentives are based only on Reporting. There
is no threshold for Performance--yet.
2011 and 2012 are “free years” to master the
fundamentals of quality measurement and reporting
using the EHR
What’s Required for Quality Measurement
Structured Data Capture in Defined Fields
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Drop-down Lists
Checkboxes
Numerical values
- Dates
- Positive/Negative
NOT—scanned documents, dictation, narrative notes
May continue to use non-structured data but must be
able to add underlying coding/structured element
–
–
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Slide 32 of 33
Requires change to workflow and documentation habits
Requires team approach to accomplish change efficiently
Find a balance between structured/unstructured
Crosswalk between Prevention PQRS
Measures and MU CQMs
2011
PQRS Description
PQRS-EHR
Based
Measure
Meaningful
Use
Measure
#110
Influenza Vaccination Patient Aged 50+
Alt. Core
#111
Pneumococcal Vaccine for Patients Aged 65+
Menu
#112
Screening Mammogram Women Aged 40-69
Menu
#113
Colorectal Cancer Screen Aged 50-75
Menu
#226
Tobacco Use and Cessation Counsel Aged 18+
Core
#237
Hypertension: BP Measurement
Core
Slide 33 of 33
Workflow for EHR-Based Reporting
Adult Patient Workflow
PreAppt &
Check
in—
Front
Desk
•Results that have come in are scanned and entered structurally
•If patient completed online pre-registration, front desk updates
EHR based on patient-submitted data. If not, registration
completed.
•Registration form asks about preventive screens and front desk
updates EHR
• If mammogram or colonoscopy was done elsewhere, sends
electronic request for a copy of report to specialist using
standard electronic template and secure e-mail. Note made
to provider. (PQRS #112 & 113)
• Updates flu and pneumococcal vaccine if done elsewhere.
Note made to provider. (PQRS #110 and #111)
•Updates smoking status as indicated on registration form
Slide 34 of 33
Workflow (Continued)
Adult Patient Workflow
Nurse
Review
•Nurse takes blood pressure and documents (PQRS #237)
•Nurse reviews allergies and documents from pick list/template
(PQRS #110 and #111)
•Nurse reviews alerts for preventive screens that are overdue (these
must be activated).
•If patient is due for flu or pneumococcal vaccine, nurse review for
allergy/adverse event and administers as per standing order.
Documents via template (PQRS #110 and #111)
•Nurse reviews about tobacco use and provides cessation
counseling. Makes note to doctor and documents all via template
(PQRS #226)
Slide 35 of 33
Workflow (Continued)
Adult Patient Workflow
Physician •After completing entire visit, physician reviews alerts for
preventive screens that are due.
Review
•If mammogram due, physician orders using CPOE and sends
to Referral Coordinator to schedule. Physician makes strong
case for importance of mammograms.
•If colorectal cancer screening due, physician discusses
options, makes strong recommendation and orders using
CPOE.
•If FOBT or FIT, sends order to nurse to provide test kit and
instructions.
•If colonoscopy, sends order to Referral Clerk to schedule.
•Physician addresses other preventive screens that are due but
that patient may have refused.
•Provides educational information and documents
Slide 36 of 33
Workflow (Continued)
Adult Patient Workflow
Referral
Clerk
•Referral Clerk asks patient if have a preference for
where/when to schedule mammogram and/or
colonoscopy (PQRS #112, #113)
•Sends CCD to specialist with explanatory
notes/preferences
•Tells patient specialist will be contacting to
schedule
Front
Desk or
Clinical
Staff
•Reviews open orders daily. If patient has not followedthrough on preventive screening, sends reminder to
patient.
Slide 37 of 33
Workflow (Continued)
Adult Patient Workflow
Scheduled
Tasks
•Monthly: Run PQRS reports. Drill-down into measure
and generate patient lists to determine which patients
are overdue. Send reminders to patients as per patient
preference.
•Discuss quality reports at staff/provider meetings.
Identify root cause of performance rates that are lower
than expected. Suggest strategies for improving
performance. Assign specific responsibilities to staff.
Test strategies and re-measure for next meeting.
Slide 38 of 33
Bottom Line
Quality measures are being aligned
Financial Reasons
Reputation
Accountability
Culture of Excellence
“The healthcare organization that seeks merely to
meet minimal standards may not ever reach any
higher, and certainly will not achieve excellence.”
(Janet Brown, RN, CPHQ, The Healthcare Quality Handbook, 20102011)
Slide 39 of 33
Resources
Primaris
–
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Slide 40 of 33
Primaris has just received funding to assist 74 Missouri physicians
to report PQRS using their EHR as part of our national QIO 10th
Scope of Word (began 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)
–
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
Resources (cont)
Missouri Health Information Technology Assistance
Center
–
–
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Website: http://ehrhelp.missouri.edu
E-Mail: [email protected]
Phone: 877-882-9933
CMS INFORMATION RESOURCES:
http://www.cms.gov/pqrs
–
–
–
–
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Slide 41 of 33
How to Get Started
Measure Specifications for individual measure reporting
Measures Groups Specifications
EHR Specifications
GPRO Specifications
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
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7:00 a.m. - 7:00 p.m. CST at 866-288-8912 or
[email protected]
Slide 42 of 33
Thank You!
Questions? Contact:
–
–
PQRS and Improvement on Quality Measures:
– Sandy Pogones, [email protected]
Cardiac Learning and Action Network:
– Kristen Bird, [email protected]
Websites:
–
–
Primaris.org
PQRSMO.org
Primaris:
Your Local Connection to Achieving National Health
Goals
Slide 43 of 33
Disclaimer
This presentation was prepared as a tool to assist providers.
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.
Primaris employees, agents and staff make no representation,
warranty, or guarantee that this compilation of 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. Medicare policy changes frequently so
links to the source documents have been provided for your
reference to the most up-to-date information.
Slide 44 of 33
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