PQRS Provider Quality Reporting System (formerly known as PQRI) · 2015-05-12 · The 2015...
Transcript of PQRS Provider Quality Reporting System (formerly known as PQRI) · 2015-05-12 · The 2015...
![Page 1: PQRS Provider Quality Reporting System (formerly known as PQRI) · 2015-05-12 · The 2015 dis-incentive is based on the 2013 calendar year. Report in 2013 to avoid dis-incentive!!!](https://reader034.fdocuments.us/reader034/viewer/2022043020/5f3bfb04a80742204145993b/html5/thumbnails/1.jpg)
PQRS – Provider Quality Reporting System
(formerly known as PQRI)
September 13th, 2012
Webinar
![Page 2: PQRS Provider Quality Reporting System (formerly known as PQRI) · 2015-05-12 · The 2015 dis-incentive is based on the 2013 calendar year. Report in 2013 to avoid dis-incentive!!!](https://reader034.fdocuments.us/reader034/viewer/2022043020/5f3bfb04a80742204145993b/html5/thumbnails/2.jpg)
Objectives
• Timeline for reporting programs (incentives/disincentives)
• Future basis for value based purchasing
• PQRS overview / How to report ?
• I was in Medicare Care Management Performance (MCMP) – now what?? (UT, MA, CA, AR)
• Meaningful Use Quality Measures/PQRS pilot
• Central Utah Informatics – Data Submission Vendor (DSV) and Registry
![Page 3: PQRS Provider Quality Reporting System (formerly known as PQRI) · 2015-05-12 · The 2015 dis-incentive is based on the 2013 calendar year. Report in 2013 to avoid dis-incentive!!!](https://reader034.fdocuments.us/reader034/viewer/2022043020/5f3bfb04a80742204145993b/html5/thumbnails/3.jpg)
2012 2013 2014 2015 2016 2017 2018 2019 2020
Programs Requiring Provider
Reporting for Participation or by Law
Federal
House Bill 128 begins
reporting clinic-level
measure results
(currently based on
claims data for clinics
with five or more
physicians)2
Accountable
Care
Organization
Formation
(Shared
Savings)9,10$$
Continued E-
Prescribing7
$$ (initial
penalties)
Meaningful
Use
Stage 2$6
Meaningful
Use
Stage 36,11$$
Utah Health
Insurance
Exchange4
Utah Medicaid
Accountable Care
Organization3
$=incentive payments
$=penalties
---future
Utah
Meaningful
Use
Stage 4
(TBD)11
House Bill 128
adds 5 new
measures
yearly2
Continued
Meaningful
Use
Stage 1$6
Continued
PQRS5$
PQRS5 $$
(initial penalties –
penalty assessed
in 2015 for 2013
reporting)
Meaningful
Use
Stage 26,11$$
(initial penalties)
CMS Value Based Purchasing
![Page 4: PQRS Provider Quality Reporting System (formerly known as PQRI) · 2015-05-12 · The 2015 dis-incentive is based on the 2013 calendar year. Report in 2013 to avoid dis-incentive!!!](https://reader034.fdocuments.us/reader034/viewer/2022043020/5f3bfb04a80742204145993b/html5/thumbnails/4.jpg)
References
1) http://selecthealth.org/findadoctor/pages/providerreporting.aspx
2) http://le.utah.gov/~2011/bills/hbillamd/hb0128s02.htm
3) http://health.utah.gov/medicaid/stplan/1115%20Waivers/1115%20Waiver%20Payment%20and%20Servi
ce%20Delivery%20Reform%20Document_Jun%2029%202011v2.pdf (July 1, 2011)
4) http://www.exchange.utah.gov/images/stories/The_Utah_Health_Exchange_-
_A_Brief_Overview.pdf
5) https://www.cms.gov/PQRS/
6) https://www.cms.gov/EHRIncentivePrograms/30_Meaningful_Use.asp
7) https://www.cms.gov/ERxIncentive/10_Analysis%20and%20Payment.asp
8) http://www.medicare.gov/find-a-doctor/staticpages/data/note/Overview.aspx
9) http://www.ftc.gov/opp/aco/cms-proposedrule.PDF
10) https://www.cms.gov/sharedsavingsprogram/
11) Penalty timeline described http://www.gpo.gov/fdsys/pkg/FR-2012-03-07/pdf/2012-4443.pdf
Updated 8/2012
www.cms.gov/pqrs
![Page 5: PQRS Provider Quality Reporting System (formerly known as PQRI) · 2015-05-12 · The 2015 dis-incentive is based on the 2013 calendar year. Report in 2013 to avoid dis-incentive!!!](https://reader034.fdocuments.us/reader034/viewer/2022043020/5f3bfb04a80742204145993b/html5/thumbnails/5.jpg)
What is PQRS?
• The Physician Quality Reporting System
– Pay-for-reporting program established in 2007
– Combination of incentives and payment adjustments (dis-incentives) to eligible professionals and selected group practices
– Report data on defined quality measures
• The Physician Quality Reporting System will be the basis for the Value-Based Modifier
![Page 6: PQRS Provider Quality Reporting System (formerly known as PQRI) · 2015-05-12 · The 2015 dis-incentive is based on the 2013 calendar year. Report in 2013 to avoid dis-incentive!!!](https://reader034.fdocuments.us/reader034/viewer/2022043020/5f3bfb04a80742204145993b/html5/thumbnails/6.jpg)
Polling
• Will you report to CMS on Physician Quality Reporting System (PQRS) for year 2012?
– Yes
– No
– Undecided
![Page 7: PQRS Provider Quality Reporting System (formerly known as PQRI) · 2015-05-12 · The 2015 dis-incentive is based on the 2013 calendar year. Report in 2013 to avoid dis-incentive!!!](https://reader034.fdocuments.us/reader034/viewer/2022043020/5f3bfb04a80742204145993b/html5/thumbnails/7.jpg)
PQRS Program Progression
![Page 8: PQRS Provider Quality Reporting System (formerly known as PQRI) · 2015-05-12 · The 2015 dis-incentive is based on the 2013 calendar year. Report in 2013 to avoid dis-incentive!!!](https://reader034.fdocuments.us/reader034/viewer/2022043020/5f3bfb04a80742204145993b/html5/thumbnails/8.jpg)
Incentives and Payment Adjustments
• Federal legislation authorized incentive payments through 2014
• Payment Adjustments (Dis-incentives) are proposed for 2015 and beyond (-1.5% in 2015 and -2.0% in 2016 and beyond). The 2015 dis-incentive is based on the 2013 calendar year. Report in 2013 to avoid dis-incentive!!!
• Additional incentive of 0.5% by working with a Maintenance of Certification entity
• 2011 - 1.0% incentive • 2012 - 0.5% incentive
• 2013 - 0.5% incentive • 2014 - 0.5% incentive
![Page 9: PQRS Provider Quality Reporting System (formerly known as PQRI) · 2015-05-12 · The 2015 dis-incentive is based on the 2013 calendar year. Report in 2013 to avoid dis-incentive!!!](https://reader034.fdocuments.us/reader034/viewer/2022043020/5f3bfb04a80742204145993b/html5/thumbnails/9.jpg)
Who Can Participate?
• Medicare Eligible Professionals (EPs) include physicians, practitioners, and therapists
• For details on participants see http://www.cms.gov/PQRS/Downloads/EligibleProfessionals.pdf
• These professionals must meet the minimum number or percentage of Medicare Part B Fee-for-Service patients for the measures they choose
![Page 10: PQRS Provider Quality Reporting System (formerly known as PQRI) · 2015-05-12 · The 2015 dis-incentive is based on the 2013 calendar year. Report in 2013 to avoid dis-incentive!!!](https://reader034.fdocuments.us/reader034/viewer/2022043020/5f3bfb04a80742204145993b/html5/thumbnails/10.jpg)
Reporting
• Five methods to report PQRS measures:
– Claims Based Reporting
– External Registry
– EHR Data Submission Vendor Reporting
– Direct EHR Based Reporting
– Group Practice Reporting Option
• Validation steps required with all methods
• Six- (Jul-Dec) or 12- (Jan-Dec) month time periods are used based on reporting method
![Page 11: PQRS Provider Quality Reporting System (formerly known as PQRI) · 2015-05-12 · The 2015 dis-incentive is based on the 2013 calendar year. Report in 2013 to avoid dis-incentive!!!](https://reader034.fdocuments.us/reader034/viewer/2022043020/5f3bfb04a80742204145993b/html5/thumbnails/11.jpg)
Polling
• If you answered yes to the first question, which method of reporting will you use for 2012 ?
– Claims
– EHR – Direct
– EHR – Data Submission Vendor
– External Registry
– GPRO
![Page 12: PQRS Provider Quality Reporting System (formerly known as PQRI) · 2015-05-12 · The 2015 dis-incentive is based on the 2013 calendar year. Report in 2013 to avoid dis-incentive!!!](https://reader034.fdocuments.us/reader034/viewer/2022043020/5f3bfb04a80742204145993b/html5/thumbnails/12.jpg)
Method #1 – Claims Based Reporting
• CPT and G-Codes are added to Medicare claims that include clinical information on a subset of patients
• Medicare does the measure calculation and sends a feedback report and incentive check annually
• Providers must report on at least 3 measures of 211
![Page 13: PQRS Provider Quality Reporting System (formerly known as PQRI) · 2015-05-12 · The 2015 dis-incentive is based on the 2013 calendar year. Report in 2013 to avoid dis-incentive!!!](https://reader034.fdocuments.us/reader034/viewer/2022043020/5f3bfb04a80742204145993b/html5/thumbnails/13.jpg)
![Page 14: PQRS Provider Quality Reporting System (formerly known as PQRI) · 2015-05-12 · The 2015 dis-incentive is based on the 2013 calendar year. Report in 2013 to avoid dis-incentive!!!](https://reader034.fdocuments.us/reader034/viewer/2022043020/5f3bfb04a80742204145993b/html5/thumbnails/14.jpg)
Method #2 – External Registry
• Provider submits data on 3 measures electronically to a registry.
• The external certified registry then captures, stores, calculates, and submits to Medicare the measure related data.
• Registries must be certified with Medicare and starting in 2012 cannot be EHR based data. Claims or Web based.
• Select from over 200 measures
![Page 15: PQRS Provider Quality Reporting System (formerly known as PQRI) · 2015-05-12 · The 2015 dis-incentive is based on the 2013 calendar year. Report in 2013 to avoid dis-incentive!!!](https://reader034.fdocuments.us/reader034/viewer/2022043020/5f3bfb04a80742204145993b/html5/thumbnails/15.jpg)
![Page 16: PQRS Provider Quality Reporting System (formerly known as PQRI) · 2015-05-12 · The 2015 dis-incentive is based on the 2013 calendar year. Report in 2013 to avoid dis-incentive!!!](https://reader034.fdocuments.us/reader034/viewer/2022043020/5f3bfb04a80742204145993b/html5/thumbnails/16.jpg)
Method #3 – EHR Data Submission Vendor Reporting
• New in 2012
• Similar to registry reporting only done by EHR vendor
• The vendor captures, stores, calculates, and submits to Medicare the measure related data
• Select from over 50 measures
• Report on 80% of applicable Medicare Part B FFs patients
![Page 17: PQRS Provider Quality Reporting System (formerly known as PQRI) · 2015-05-12 · The 2015 dis-incentive is based on the 2013 calendar year. Report in 2013 to avoid dis-incentive!!!](https://reader034.fdocuments.us/reader034/viewer/2022043020/5f3bfb04a80742204145993b/html5/thumbnails/17.jpg)
![Page 18: PQRS Provider Quality Reporting System (formerly known as PQRI) · 2015-05-12 · The 2015 dis-incentive is based on the 2013 calendar year. Report in 2013 to avoid dis-incentive!!!](https://reader034.fdocuments.us/reader034/viewer/2022043020/5f3bfb04a80742204145993b/html5/thumbnails/18.jpg)
Method #4 – Direct EHR Based Reporting
• Provider chooses 3 measures to report
• Provider must be using a qualified EHR to report to Medicare patient level data
• Report on 80% of applicable Medicare Part B FFs patients
• List of qualified EHR products is published on the Medicare website
![Page 19: PQRS Provider Quality Reporting System (formerly known as PQRI) · 2015-05-12 · The 2015 dis-incentive is based on the 2013 calendar year. Report in 2013 to avoid dis-incentive!!!](https://reader034.fdocuments.us/reader034/viewer/2022043020/5f3bfb04a80742204145993b/html5/thumbnails/19.jpg)
![Page 20: PQRS Provider Quality Reporting System (formerly known as PQRI) · 2015-05-12 · The 2015 dis-incentive is based on the 2013 calendar year. Report in 2013 to avoid dis-incentive!!!](https://reader034.fdocuments.us/reader034/viewer/2022043020/5f3bfb04a80742204145993b/html5/thumbnails/20.jpg)
I was in MCMP-now what ??
• MCMP was a Medicare pilot for four years in states of UT, AR, MA, CA from 2007-2011
• Combination of claims and clinical data
• Participants received a free waiver on PQRS
• The GPRO option is very similar to MCMP. GPRO uses the same software tool as MCMP.
• More measures in GPRO than there were in MCMP.
![Page 21: PQRS Provider Quality Reporting System (formerly known as PQRI) · 2015-05-12 · The 2015 dis-incentive is based on the 2013 calendar year. Report in 2013 to avoid dis-incentive!!!](https://reader034.fdocuments.us/reader034/viewer/2022043020/5f3bfb04a80742204145993b/html5/thumbnails/21.jpg)
Method #5 – Group Practice Reporting Option (GPRO)
• Available for practices of 25 or more NPIs
• Involves claims and clinical data on a larger measure set (around 26 measures)
• Claims databases are compiled by Medicare and sent to the clinics. The database is then completed either electronically or manually and sent back to Medicare. Once a year.
• Very similar to the MCMP P4P pilot program that ended in 2011
![Page 22: PQRS Provider Quality Reporting System (formerly known as PQRI) · 2015-05-12 · The 2015 dis-incentive is based on the 2013 calendar year. Report in 2013 to avoid dis-incentive!!!](https://reader034.fdocuments.us/reader034/viewer/2022043020/5f3bfb04a80742204145993b/html5/thumbnails/22.jpg)
![Page 23: PQRS Provider Quality Reporting System (formerly known as PQRI) · 2015-05-12 · The 2015 dis-incentive is based on the 2013 calendar year. Report in 2013 to avoid dis-incentive!!!](https://reader034.fdocuments.us/reader034/viewer/2022043020/5f3bfb04a80742204145993b/html5/thumbnails/23.jpg)
Meaningful Use Quality Measures/PQRS pilot program
• EHR-based reporting (Alignment with
Medicare EHR Incentive Program) of all three Medicare EHR Incentive Program core measures OR up to 3 Medicare EHR Incentive Program alternate core measures AND 3 additional measures for the Medicare EHR Incentive Program
• Pilot at this Stage – Beware of Delays!!
![Page 24: PQRS Provider Quality Reporting System (formerly known as PQRI) · 2015-05-12 · The 2015 dis-incentive is based on the 2013 calendar year. Report in 2013 to avoid dis-incentive!!!](https://reader034.fdocuments.us/reader034/viewer/2022043020/5f3bfb04a80742204145993b/html5/thumbnails/24.jpg)
PQRS Summary
• 5 Different Ways to Report
• Get involved to avoid dis-incentives and prepare for value-based purchasing
• Contact your EHR vendor to find out which options they have available
Website: http://www.cms.gov/PQRS/
![Page 25: PQRS Provider Quality Reporting System (formerly known as PQRI) · 2015-05-12 · The 2015 dis-incentive is based on the 2013 calendar year. Report in 2013 to avoid dis-incentive!!!](https://reader034.fdocuments.us/reader034/viewer/2022043020/5f3bfb04a80742204145993b/html5/thumbnails/25.jpg)
Multiple Incentive Programs
• Providers can get both the EHR-MU incentive and the PQRS incentive money.
• The e-Rx incentive is not available if a provider is receiving the EHR-MU incentive
![Page 26: PQRS Provider Quality Reporting System (formerly known as PQRI) · 2015-05-12 · The 2015 dis-incentive is based on the 2013 calendar year. Report in 2013 to avoid dis-incentive!!!](https://reader034.fdocuments.us/reader034/viewer/2022043020/5f3bfb04a80742204145993b/html5/thumbnails/26.jpg)
Programs Timeline
![Page 27: PQRS Provider Quality Reporting System (formerly known as PQRI) · 2015-05-12 · The 2015 dis-incentive is based on the 2013 calendar year. Report in 2013 to avoid dis-incentive!!!](https://reader034.fdocuments.us/reader034/viewer/2022043020/5f3bfb04a80742204145993b/html5/thumbnails/27.jpg)
Highlight:
PQRS Data Submission Vendor and Registry in Utah – Central Utah
Informatics
![Page 28: PQRS Provider Quality Reporting System (formerly known as PQRI) · 2015-05-12 · The 2015 dis-incentive is based on the 2013 calendar year. Report in 2013 to avoid dis-incentive!!!](https://reader034.fdocuments.us/reader034/viewer/2022043020/5f3bfb04a80742204145993b/html5/thumbnails/28.jpg)
Central Utah Informatics
• Who we are?
• Why we became a registry?
• How do we collect and work with the data?
![Page 29: PQRS Provider Quality Reporting System (formerly known as PQRI) · 2015-05-12 · The 2015 dis-incentive is based on the 2013 calendar year. Report in 2013 to avoid dis-incentive!!!](https://reader034.fdocuments.us/reader034/viewer/2022043020/5f3bfb04a80742204145993b/html5/thumbnails/29.jpg)
Central Utah Informatics
• What information can you submit through
our company?
• PQRS - Registry
• eRx
• PQRS - GPRO
• PQRS - DSV
![Page 30: PQRS Provider Quality Reporting System (formerly known as PQRI) · 2015-05-12 · The 2015 dis-incentive is based on the 2013 calendar year. Report in 2013 to avoid dis-incentive!!!](https://reader034.fdocuments.us/reader034/viewer/2022043020/5f3bfb04a80742204145993b/html5/thumbnails/30.jpg)
Slides
• The slides are available on the HealthInsight website – under current events
http://www.healthinsight.org/Internal/HI_Events.html
![Page 31: PQRS Provider Quality Reporting System (formerly known as PQRI) · 2015-05-12 · The 2015 dis-incentive is based on the 2013 calendar year. Report in 2013 to avoid dis-incentive!!!](https://reader034.fdocuments.us/reader034/viewer/2022043020/5f3bfb04a80742204145993b/html5/thumbnails/31.jpg)
www.healthinsight.org
David R. Cook MBA, C(ASCP)cm, CPEHR
Quality Improvement Team Lead
801-892-6623
www.centralutahinformatics.com
Jamie R. Steck – Director of Information Technologies (Central Utah Informatics)
![Page 32: PQRS Provider Quality Reporting System (formerly known as PQRI) · 2015-05-12 · The 2015 dis-incentive is based on the 2013 calendar year. Report in 2013 to avoid dis-incentive!!!](https://reader034.fdocuments.us/reader034/viewer/2022043020/5f3bfb04a80742204145993b/html5/thumbnails/32.jpg)
Q&As
This material was prepared by HealthInsight, the Medicare Quality Improvement Organization for Nevada and Utah, 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.10SOW-UT-2012-PO-23