Transcript the webinar Powerpoint

Successfully Navigating the 2016
Physician Quality
Reporting System (PQRS)
Scott Weinberg
Specialist, Quality Care & Patient Access
Objectives
• What is PQRS?
• Why participate?
• Who should participate?
• What are the quality measures?
• How to report the quality measures and avoid
payment reductions?
What is PQRS?
• CMS program (Medicare only)
• Physician Quality Reporting System
– Previously known as PQRI
• Applies a payment reduction to eligible
professionals (EPs) who do not satisfactorily
report data on quality measures for covered
professional services.
Why Report Quality Measures?
• Reporting quality measures in 2016 to avoid a
2.0% PQRS payment reduction in 2018.
• Groups of 10 or more providers will
automatically receive an additional 4% VBM
payment reduction.
• Solo practitioners and groups of 2-9 providers
will automatically receive an additional 2% VBM
payment reduction.
Overall Penalties for 1-9 Provider
Practice
YEAR
EHR PENALTY
Value Based
Modifier
PQRS PENALTY
TOTAL PENALTIES
2016
2%
0%
2%
4%
2017
3%
2%
2%
7%
2018
4%*
2%
2%
8%
Note: Percentages based on Medicare Part B allowed charges.
*EHR penalty will rise to 5% if less than 75% of all Medicare providers are participating in meaningful use by 2017.
Overall Penalties for 10+ Provider
Practice
YEAR
EHR PENALTY
Value Based
Modifier
PQRS PENALTY
TOTAL PENALTIES
2016
2%
2%
2%
6%
2017
3%
4%
2%
9%
2018
4%*
4%
2%
10%
Note: Percentages based on Medicare Part B allowed charges.
*EHR penalty will rise to 5% if less than 75% of all Medicare providers are participating in meaningful use by 2017.
Who Should Participate?
• All MD, DO, PA, NP, CNS, APRN who are
reimbursed under the Medicare physician fee
schedule.
• Providers should report for each TIN that they
work under
• If not reporting as a GPRO, at least 50% of
providers in the group should report, to avoid
automatic VBM payment reduction
How Many Quality Measures in 2016?
• Report at least 9 measures.
• Report at least 50% of applicable patients
for each measure for the full year.
• Measures should cover at least 3 National
Quality Strategy domains.
• Report at least 1 “cross-cutting measure”
(only those who see patients face-to-face)
National Quality Strategy Domains
1) Patient Safety
2) Patient and Caregiver-Centered
Experience and Outcomes
3) Communication and Care Coordination
4) Effective Clinical Care
5) Community/Population Health
6) Efficiency and Cost Reduction
6 Dermatology-specific Measures
1) Measure #137 — Melanoma: Continuity of Care —
Recall System
2) Measure #138 — Melanoma: Coordination of Care
3) Measure #224 — Melanoma: Overutilization of Imaging
Studies
4) Measure #265 — Biopsy Follow-Up
5) Measure #337 — Tuberculosis Prevention for Psoriasis
and Psoriatic Arthritis Patients on a Biological Immune
Response Modifier
6) Measure #410 – Psoriasis: Clinical Response to Oral
Systemic or Biologic
Dermatology-specific Measure Update
#410
Psoriasis: Clinical Response to Oral Systemic or Biologic
Percentage of psoriasis patients receiving oral systemic or
biologic therapy who meet minimal physician-or patientreported disease activity levels. It is implied that
establishment and maintenance of an established minimum
level of disease control as measured by physician-and/or
patient-reported outcomes will increase patient satisfaction
with and adherence to treatment
ICD-10-CM: L40.0
CPT: 99201, 99202, 99203, 99204, 99205, 99212, 99213,
99214, 99215, 99324, 99325, 99326, 99327, 99328, 99334,
99335, 99336, 99337, 99341, 99342, 99343, 99344, 99345,
99347, 99348, 99349, 99350, G0438, G0439
Measure #410
To satisfy this measure, a patient must
achieve any ONE of the following:
– PGA (6-point scale) ≤ 2 (clear to mild skin
disease)
– BSA < 3% (mild disease)
– PASI < 3 (no or minimal disease)
– DLQI ≤ 5 (no effect or small effect on patient’s
quality of life)
Cross-cutting Measures
Measure #
NQS Domain
Measure Name
1
Effective Clinical Care
Diabetes: Hemoglobin
A1c Poor Control
46
Communication and
Care Coordination
Medication
Reconciliation Following
Discharge
47
Communication and
Care Coordination
Care Plan
110
Community/Population
Health
Preventive Care and
Screening: Influenza
Immunization
111
Community/Population
Health
Pneumonia Vaccination
Status for Older Adults
112
Effective Clinical Care
Breast
Cancer Screening
Cross-cutting Measures
Measure #
NQS Domain
Measure Name
128
Community/Population
Health
Preventive Care and
Screening: Body
Mass Index (BMI)
Screening and
Follow Up Plan
130
Patient Safety
Documentation of
Current Medications
in the Medical Record
131
Communication and
Care Coordination
Pain Assessment and
Follow-Up
134
Community/Population
Health
Preventive Care and
Screening:
Screening for Clinical
Depression and
Follow
-Up Plan
Cross-cutting Measures
Measure #
NQS Domain
Measure Name
154
Patient Safety
Falls: Risk Assessment
155
Communication and
Care Coordination
Falls: Plan of Care
182
Communication and
Care Coordination
Functional Outcome
Assessment
226
Community/Population
Health
Preventive Care and
Screening: Tobacco Use:
Screening and Cessation
Intervention
236
Effective Clinical Care
Controlling High Blood
Pressure
240
Community/Population
Health
Childhood Immunization
Status—EMR Only
Cross-cutting Measures
Measure #
NQS Domain
Measure Name
317
Community/Population
Health
Preventive Care and
Screening: Screening for
High Blood Pressure and
Follow-Up Documented
318
Patient Safety
Falls: Screening for Fall
Risk – EMR and GPRO
Web Interface
321
Person and Caregiver Centered Experience
and Outcomes
CAHPS for PQRS
Clinician/Group
Survey—Certified
Survey Vendor only
374
Communication and
Care Coordination
Closing the Referral
Loop: Receipt of
Specialist Report—EMR
only
Cross-cutting Measures
Measure #
NQS Domain
Measure Name
400
Effective Clinical Care
Hepatitis C: One-Time
Screening for Hepatitis C
Virus for Patients at Risk
402
Community/Population
Health
Tobacco Use and Help
with Quitting Among
Adolescents
431
Community/Population
Health
Preventive Care and
Screening: Unhealthy
Alcohol Use: Screening
& Brief Counseling
Other DataDerm PQRS Measures
Measure #
NQS Domain
Measure Name
205
Effective Clinical Care
HIV/AIDS: Sexually
Transmitted Disease
Screening for
Chlamydia, Gonorrhea,
and Syphilis
358
Person and CaregiverCentered Experience
and Outcomes
Patient-Centered
Surgical Risk
Assessment and
Communication
397*
Communication and
Care Coordination
Melanoma Reporting
*Pathology measure. Provider or GPRO must bill an 88305 CPT code to report this measure
How to Report
• DataDerm clinical data registry features
PQRS reporting option:
www.aad.org/DataDerm
– Available March 2016
– Replacing the QRS registry
• Information about other qualified registries
available on: www.cms.gov/pqrs
• GPRO (group reporting) requires
registration with CMS
GPRO (Group Practice Reporting Option)
• 2 or more eligible providers under one TIN
• Registration must be completed by June 30,
2016 (opens April 1)
• One cannot cancel, nor edit the registration
after June 30, 2016
• Once registered as a GPRO, no providers
who bill under the TIN can report individually.
MAV Process
• “Measure-Applicability Validation”
• Allows eligible professionals to get credit
for reporting some measures even if they
cannot report 9 measures
• At least one cross-cutting measure must
be reported.
If one cannot report nine measures
• Successfully report measures 137, 138,
and 224
• Successfully report at least one crosscutting measure
• No guarantee of avoiding payment
reductions
How to get started
1) Choose reporting option (individual vs.
group reporting and which registry).
2) Choose measures.
3) Track and log which Medicare patients
will be applicable to which measures.
Measure Checklist
• Does this measure need to be reported
once per patient, or once per visit?
• Does this measure apply to every
Medicare patient, every Medicare patient
below a certain age, or just certain
diagnoses?
• Do I have at least one eligible Medicare
instance for this measure?
Reporting vs. Performance Rate
Reporting Rate
How many of your
eligible patient visits
(whether the measure
is met, or not) are
reported per measure.
This must be 50% or
greater.
Performance Rate
How often you have met
the measure. Measures
with a 0% performance
rate are not counted.
Example – Measure #226 – Tobacco
Screening and Cessation
“We saw 1,000 Medicare patients this year,
but we only asked the 200 new patients if
they use tobacco. They all said ‘no.’ Can we
still report this measure, and if so, how many
patients do we have to report?”
Example – Measure #226 – Tobacco
Screening and Cessation
“Yes, you can report this measure, even if you
did not perform the measure on every Medicare
patient you saw. You need to report at least 500
of your patients (whether they were asked
about tobacco or not). If you only reported 500
patients, including the 200 that were asked
about tobacco, your performance rate would be
40% (200/500), and your reporting rate would
be 50% (500/1000).”
AAD DataDerm Deadlines
• July 1, 2016 - Last day for EHR-based practices to
enroll in DataDerm for 2016 PQRS reporting
• Dec. 16, 2016 - Last day to purchase the PQRS
submission option – for those enrolled only
• Jan. 13, 2017 - Deadline for reporting 2016 PQRS
Quality Measures for a full reporting period
Questions?
• General PQRS Questions: [email protected]
• DataDerm Questions: [email protected]
• CMS QualityNet Help Desk:
[email protected]
• AAD Member Resource Center: 866-503-7546
• Visit www.aad.org/PQRS to:
•
•
•
•
View online tutorials
FAQ sheets
See coding specifications for reporting these measures
Latest information