Transcript PQRS: Are you ready? - American Academy of Family Physicians

PQRS: Are You Ready?
A guide for last minute 2016
PQRS reporting
Sandy Pogones, MPA, CPHQ
Senior Strategist, Health Care Quality
Conflict of Interest Disclosure
It is the policy of the AAFP that all individuals in a position to
control content disclose any relationships with commercial
interests upon nomination/invitation of participation. Disclosure
documents are reviewed for potential conflicts of interest and, if
identified, conflicts are resolved prior to confirmation of
participation. Only those participants who had no conflict of
interest or who agreed to an identified resolution process prior to
their participation were involved in this CME activity.
All individuals in a position to control content for this activity have
indicated they have no relevant financial relationships to
disclose.
Sandy serves as the American Academy of Family
Physician’s Senior Strategist, Health Care Quality,
with expertise in quality improvement, performance
measurement, federal quality programs, and
advanced primary care transformation. In this role,
she works to assist family physicians in adopting
care delivery capabilities to better prepare them for
success in value-based payment models.
Sandy Pogones, MPA,
CPHQ
Senior, Strategist, Health
Care Quality
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Prior to the AAFP, Sandy was with Primaris
Healthcare Business Solutions where she led the
physician services task providing “hands-on”
technical assistance to physicians to support PQRS,
Meaningful Use, value-based purchasing and patient
medical home transformation. She facilitated
practice improvement using advanced capabilities of
EHRs for population management, care
coordination, health information exchange and
patient engagement.
PQRS: Are You Ready?
A guide for last minute 2016
PQRS reporting
Sandy Pogones, MPA, CPHQ
Senior Strategist, Health Care Quality
Learning Objectives
• List the requirements and available options
for PQRS compliance.
• Explain the benefits of reporting by the
deadline and the implications if reporting is
not completed by the deadline.
• Articulate a plan for improved PQRS
reporting.
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What is PQRS?
• Physician Quality Reporting System
• Quality reporting program for Medicare
• Report quality measures on Part B
Professional FFS patients
• Negative payment adjustments for nonreporting
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When to Report PQRS?
• Eligible
Professionals
(EPs) must report
annually
• Deadline depends
on selected
reporting option
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Why Report?
Avoid payment
adjustments
• -2% payment
adjustment applies
to all Medicare Part
B FFS in 2018
based on 2016
reporting
Value-based
Payment Modifier
• CMS pay-forperformance program
• PQRS measures
used in VBPM
calculation
• VBPM penalties
+- 2% - 4% (depends
on size of practice)
Changing payment
environment
• Medicare Access and
Children’s Health
Insurance Program
(CHIP)
Reauthorization Act
(MACRA)
• Alternative payment
models
• Merit-Based Incentive
Payment System
• 2017 performance
year for 2019 payment
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Develop a PQRS Plan
1. Choose reporting
option
2. Select quality
measures
3. Gather data and
report
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Reporting Options
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Reporting Options
1. Individual reporting
– One physician reports individually
2. Group practice reporting option (GPRO)
– Two or more physicians or providers
– Registration has closed for this option
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Individual Provider Option
• Report at the TIN/NPI
combination Level
• Options available
EHRDSV
– Electronic Health
Record (EHR) Direct
EHRQualified
Registry
– EHR Data Submission Direct
Individual
Vendor (DSV)
EPs
– Qualified Registry
– Medicare Part B Claims
– Qualified Clinical Data
QCDR
Claims
Registry (QCDR)
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Electronic Health Record (EHR) Direct &
Data Submission Vendor (DSV)
• EHR Direct
– Must use Certified Electronic Health Record Technology (CEHRT)
– Upload batch information directly from EHR CEHRT to CMS
• Data Submission Vendor (DSV)
– Contract with outside vendor to submit data to CMS on their behalf
– Vendor extracts data directly from provider’s CEHRT
• Reporting once option
– Report once and satisfactorily meet PQRS requirements and Clinical
Quality Measure (eCQM) component of the EHR Incentive Program
– Must select measures from an approved list of 64 eCQMs
• Reporting deadline: February 28, 2017
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EIDM Accounts for
EHR-Direct Submissions
Solo Practice
Group Practice
(Submit EHR data under (Submit EHR data under a TIN)
SSN or TIN)
REQUIRED: Individual
Practitioner
• Approve other roles
• Access PQRS and QRUR
Feedback Reports
• Submit EHR-Direct PQRS Data
Individual Practitioner
Representative
• Access PQRS and QRUR
Reports
• Submit EHR-Direct PQRS Data
REQUIRED: Security Official
• Approve other Roles
• Access PQRS and QRUR Feedback
Reports
• Self-Nominate as GPRO
Group Representative
• Access PQRS and QRUR Reports
REQUIRED: PQRS Submitter
• Submit EHR-Direct PQRS Data
Qualified Registry
• Submit data to registry – registry uploads to CMS
• Provider must enter into contract with 2016 Qualified
Registry
• Report either Individual Measures or a Measures Group
• Reporting deadline: March 31, 2017, but…
Registry vendors have their own internal deadlines prior
to 3/31/16!
• Example of a Qualified Registry: PQRS Wizard (CE
City)
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Qualified Clinical Data
Registry (QCDR)
• Collects data for patient and disease tracking
• Not limited to PQRS data
• Regular exchange of data
• Analyzes data and provides more frequent
feedback
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Claims-Based
• Select measures from a specified list
• Include qualified-data codes (QDC) on each
claim for eligible patient in denominator
population
• Not an option if you did not document QDC
codes throughout 2016
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Selecting Measures
Selecting Measures
• Reporting method determines measures reported
• In general 9 measures covering at least 3 National Quality
Strategy (NQS) domains
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–
–
–
–
–
Patient Safety
Effective Clinical Care
Community/Population Health
Communication and Care Coordination
Efficiency and Cost Reduction
Person and caregiver-centered Experience Outcomes
• At least one cross-cutting measure for Claims and QR; At
least 2 outcome measures for QCDR
• Reporting period is January 1 – December 31, 2016
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Selecting Measures
• Review the CMS 2016 measure list
• Consider the following factors:
–
–
–
–
–
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Clinical conditions treated
Practice priorities
Quality improvement goals
Other quality programs in use or being considered
Your use of the EHR to collect and report data
Selecting Measures
• Method matters when
selecting measures to
report
• Individual measures
vs Measures Group
• 0% performance does
not count
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Individual Measures:
Reporting Thresholds
• Claims & Qualified Registry
– 9 measures across 3 NQS domains plus 1 crosscutting for 50% of eligible Medicare Part B patients
• EHR-Direct & EHR DSV
– 9 measures across 3 domains for ALL eligible patients
regardless of payer
• QCDR
– 9 measures across 3 domains including 2 outcome
measures for 50% of ALL eligible patients regardless
of payer
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Individual Measure Domains
Communication and care
coordination
Community / population
health
Efficiency and cost
reduction
• BMI screening (#128) (crosscutting)
• Preventive Care and Screening: Tobacco Use: Screening
and Cessation Intervention (#226) (crosscutting)
• Antibiotic Treatment for Adults with Acute Bronchitis:
Avoidance of Inappropriate Use (#116)
Patient Safety
• Documentation of Current Medications in the Medical
Record (#130) (cross cutting)
• Falls Risk Assessment (#154) (crosscutting)
Effective clinical care
• Diabetes HbA1c Poor Control (#1) (crosscutting)
• CAD Antiplatelet Therapy (#006)
• Controlling High Blood Pressure (#236) (crosscutting)
Person- and caregivercentered experience and
outcomes
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• Falls plan of care (#155)
• Functional assessment (#182)
• Medication Reconciliation (#046) (crosscutting)
• Osteoarthritis (OA): Function and Pain Assessment (#050)
Measures Group
• Only available through a Qualified Registry and
only for individual reporting (not GPRO)
• Measures Group include a set of related
measures for a single patient sample
• Report on 20 of your patients seen in 2016, 11 of
which must be Medicare part B patients
• Use same 20 patients for each measure
included in the group
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Measures Groups
Diabetes
Preventive
#1 Diabetes: Hemoglobin A1c
Poor Control
#110 Preventive Care and
Screening: Influenza
Immunization
#39 Screening for Osteoporosis for Women
Aged 65-85 years
#117 Diabetes: Eye Exam
#111 Pneumonia Vaccination for Older Adults
#119 Diabetes: Medical
Attention for Nephropathy
#112 Breast Cancer Screening
#126 Diabetes: Foot and Ankle
Care-Neurological Exam
#128 BMI Screening and Follow-Up Plan
#226 Preventive Care and
Screening: Tobacco Use:
Screening and Cessation
Intervention
#226 Tobacco Use: Screening and Cessation
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#48 Urinary Incontinence women 65+
#110 Influenza Immunization
#113 Colorectal Cancer Screening
#134 Screening for Clinical Depression and
Follow-Up Plan
#431 Unhealthy Alcohol Use Screening and
Brief Counseling
Review Measure Specifications
Diabetes: Hemoglobin A1c Poor Control
Report once per reporting period for patients with diabetes
seen during the reporting period.
Measure Description
Numerator
Denominator
Exclusions
Percentage of patients
18-75 years of age with
diabetes who had
hemoglobin A1c > 9.0%
during the measurement
period
Patients whose
most recent HbA1c
level (performed
during the
measurement
period) is > 9.0%
Patients 18 - 75
years of age with
diabetes with a
visit during the
measurement
period
none
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Additional Considerations
• Not enough individual
measures to report
• Only have measures
across two domains
• Measures Applicability
Process
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Carry Out Your Plan
1. Select method
2. Identify measures
3. Gather data and
report
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Plan for the Future
• 2016 is the last reporting period for the
PQRS and Value Modifier programs
• MACRA—Quality Reporting will continue
under MIPS and APMs
– Six Individual Measures or Web Interface
– QR, QCDR and EHR: 50% patients across all
payers first year and increasing thereafter
– Payment Adjustments on a Sliding Scale
• Plan for Improvement
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Resources
• General PQRS
Resources
– AAFP website
– CMS’ PQRS How to
Get Started
• Measures List
– 2016 Measures List
– PQRS Measure
Search Tool
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• CMS Reporting Guides
– Claims Reporting
– EHR Reporting
– Registry Reporting
• Reporting Options
– List of 2016 Qualified
Registries
– List of Qualified Clinical
Data Registries
– PQRSwizard
Resources
CMS QualityNet Help
Desk
Phone: 1-866-288-8912
[email protected]
• General PQRS
information
• Quality Reporting Portal
• Problems with EIDM
account
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• EIDM Accounts
– CMS Enterprise
Portal
– EIDM Quick
Reference Guides
• MACRA Assistance
– AAFP MACRAready
– CMS Quality
Payment Program
Resources
CMS PQRS Analysis
and Payment
• General Information
PQRS Feedback
Reports
• PQRS Informal Review
• MAV Process
• Negative Payment
Adjustments
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Physician Value Help
Desk:
Phone: 1-888-734-6433
(select option 3)
[email protected]
• Trouble downloading
PQRS Feedback Report
• Information on QRUR,
VBPM
• VBPM Informal Review
Resources
For questions and feedback, contact:
Erin Solis
Regulatory Compliance Strategist
[email protected]
800-274-2237
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QUESTIONS?
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