Making Data Count2015 Nevada MGMA Annual Conference

May 12, 2015

Erick Maddox, PMP, CPHITHIE Director, HealthInsight

Ellen DePrat, MSN, RN, NE, CPHQProject Coordinator, HealthInsight

Current Reporting Programs

• Meaningful Use– Summary

• Incentives Almost Over / Payment Adjustments in Effect– Highlights

• Physician Quality Report System (PQRS)– Summary

• Incentive Over / Payment Adjustments In Effect– Highlights

• Value Modifier– Summary– Highlights

• Transitions of Care• Population Health Management• Cost

Current Reporting Programs

• Meaningful Use (MU)Established in 2010 Meaningful Use is an incentives/penalties program to fund installation and use of electronic health records through the American Recovery and Reinvestment Act (ARRA)

Current Reporting Programs

• Physician Quality Report System (PQRS)The 2006 Tax Relief and Health Care Act (TRHCA) authorized a physician quality reporting system, including an incentive payment for EPs who satisfactorily reported data on quality measures for Medicare Part B Physician Fee Schedule (PFS) covered professional services furnished to Medicare Fee-for-Service beneficiaries. CMS named this program the Physician Quality Reporting Initiative (PQRI). In 2011 the PQRI program name changed to Physician Quality Reporting System (PQRS).

Current Reporting Programs

• Value-based Payment Modifier (VM) Value Based Payment was authorized under the Patient Protection and Affordable Care Act of 2010, the Affordable Care Act directed CMS to provide information to physicians and medical practice groups about the resources used and quality of care provided to their Medicare Fee-For-Service patients, including quantification and comparisons of patterns of resource use/cost among physicians and medical practice groups.• Section 3007 of the Affordable Care Act mandated that, by 2015, CMS begin

applying a value modifier under the Medicare Physician Fee Schedule (MPFS). Both cost and quality data are to be included in calculating payments for physicians.

• By 2017, the Value-based Payment Modifier is to be applied to all physicians who bill Medicare for services provided under the physician fee schedule.

• Implementation of the VM is based on participation in Physician Quality Reporting System (PQRS)

Data Collection Strategies

• Reporting Method Identification• Identification of Measures

– What do you need to capture• 9 Measures in 3 Domains

– What are you already capturing• Registries• General Operation

– What CAN you capture• EHR Capability

Reporting Method

What are you Already Capturing

What do you need to capture

What Can you

Capture

Quality Improvement Feedback

• What’s Available– PQRS Feedback reports

• How to get them• Samples

– QRUR Reports• How to get them• Samples

– Internal EHR Reporting– How to reach them/What’s important about

the reports

Feedback – What’s Available

• PQRS Feedback reports– 2013 reports disseminated by CMS in September 2014 – How to get them

Authorized representatives of groups and solo practitioners can access the QRURs at https://portal.cms.gov using an Individuals Authorized Access to the CMS Computer Services (IACS) account with one of the following Physician Value (PV)-PQRS System roles:

– For groups with 2 or more EPs (TINs with 2 or more individual National Provider Identifiers (NPI)):

• PV-PQRS Group Security Official (primary or back-up) • PV-PQRS Group Representative

– For a solo practitioner (TIN with only 1 individual NPI): • PV-PQRS Individual (primary or back-up) • PV-PQRS Individual Representative

Feedback – What’s Available

• PQRS Feedback Reports– Clinical measure performance

Feedback – What’s Available

• Internal EHR Reporting

• 2013 Quality Use and Resource Reports (QRURs) – Confidential feedback reports provided to physicians and groups of physicians nationwide that

include one or more eligible professionals1 who billed for Medicare-covered services under a single taxpayer identification number (TIN) in 2013, and that had at least one eligible case for one or more of the quality or cost measures included in the QRURs. These reports contain exhibits on the quality of the care the physician or group of physicians provided to its attributed Medicare fee-for-service (FFS) beneficiaries and the costs associated with this care. They also indicate how the value-based payment modifier (VM) will impact the TIN’s Physician Fee Schedule payments beginning in 2015.

– Physicians and physician groups should use the data presented to identify opportunities to improve the quality and efficiency of the care they deliver.

Feedback – What’s Available

• QRUR Reports– Performance rate

Feedback – What’s Available

• QRUR Reports– Cost component

Feedback – What’s Available

• QRUR Reports– per capita costs

Feedback – What’s Available

Impact

• Value Based Modifier Elements– Transitions of Care– Population Health

• Solutions to Address the Impact– HIE

• Alerts• Query Based Exchange

– Patient Engagement• Patient Portal• Patient Communication

Impact

• How does your QRUR impact the Value Modifier? • The VM is derived from a quality composite score and a cost

composite score. The quality composite score summarizes a TIN’s performance on quality care for Medicare beneficiaries for as many as six, equally weighted quality domains: – (1) Clinical Process/Effectiveness – (2) Patient and Family Engagement– (3) Population/Public Health– (4) Patient Safety– (5) Care Coordination– (6) Efficient Use of Healthcare Resources.

The cost composite score summarizes a TIN’s performance regarding resource use for its attributed Medicare beneficiaries, across two equally weighted cost domains: Per Capita Costs for All Attributed Beneficiaries and Per Capita Costs for Beneficiaries with Specific Conditions (diabetes, CAD, COPD, and heart failure).

QRUR Scoring Impact

Solutions

• HIE– Alerts– Query Based Exchange

• Patient Engagement– Patient Portal– Patient Communication

Resources & Tools

CMS PQRS Website• http://www.cms.gov/Medicare/Quality-Initiatives-Patient-Assessment-Instruments/PQRS

PFS Federal Regulation Notices• http://

www.cms.gov/Medicare/Medicare-Fee-for-Service-Payment/PhysicianFeeSched/PFS-Federal-Regulation-Notices.html

Medicare and Medicaid EHR Incentive Programs• http://www.cms.gov/Regulations-and-Guidance/Legislation/EHRIncentivePrograms

Medicare Shared Savings Program• http://

cms.gov/Medicare/Medicare-Fee-for-Service-Payment/sharedsavingsprogram/Quality_Measures_Standards.html

CMS Value-based Payment Modifier (VM) Website• http://

www.cms.gov/Medicare/Medicare-Fee-for-Service-Payment/PhysicianFeedbackProgram/ValueBasedPaymentModifier.html

Resources & Tools

Physician Compare• http://www.medicare.gov/physiciancompare/search.html

Frequently Asked Questions (FAQs)• https://questions.cms.gov/

MLN Connects Provider eNews• http://cms.gov/Outreach-and-Education/Outreach/FFSProvPartProg/Index.html

PQRS Listserv • https://public-dc2.govdelivery.com/accounts/USCMS/subscriber/new?topic_id=USCMS_520

QualityNet Help Desk:• 866-288-8912 (TTY 877-715-6222)• 7:00 a.m.–7:00 p.m. CST M-F• qnetsupport@hcqis.org • You will be asked to provide basic information such as name, practice, address, phone, and e-mail

Provider Contact Center:• Questions on status of 2013 PQRS/eRx Incentive Program incentive payment (during distribution

timeframe)

Contact Center Directory - http://www.cms.gov/MLNProducts/Downloads/CallCenterTollNumDirectory.zip

EHR Incentive Program Information Center:• 888-734-6433 (TTY 888-734-6563)

Resources & Tools

ACO Help Desk via the CMS Information Center:• 888-734-6433 Option 2• cmsaco@cms.hhs.gov

PIONEER ACO• Any questions regarding participation in PQRS through the Pioneer ACO should contact the CMS at

PIONEERQUESTIONS@cms.hhs.gov

VM Help Desk:• 888-734-6433 Option 3• pvhelpdesk@cms.hhs.gov

CPC Initiative Help Desk:• E-mail: cpcisupport@telligen.org

Physician Compare Help Desk:• E-mail: PhysicianCompare@Westat.com

Resources & Tools

Questions and Contact Information

Erick Maddox, PMP, CPHITHIE Director, HealthInsight

702-933-7341emaddox@healthinsight.org

Ellen DePrat, MSN, RN, NE, CPHQProject Coordinator, HealthInsight

702-933-7316edeprat@healthinsight.org