Transcript Perioperative Care Measures

American Joint Replacement Registry’s
Orthopaedic Quality Resource Center
a CMS approved Qualified Clinical Data Registry (QCDR)
The AJRR Orthopaedic Quality Resource Center in collaboration with
CECity, is approved by the Centers for Medicare & Medicaid Services
(CMS) as a Qualified Clinical Data Registry (QCDR)
A QCDR is a platform comprised of Physician Quality Reporting
System (PQRS) and/or non PQRS-approved measures which qualifies
as a CMS-approved reporting tool for PQRS
Qualified Clinical Data Registry (QCDR)
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The QCDR method provides a new standard to satisfy PQRS requirements
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A QCDR is a CMS-approved entity (such as a registry, certification board, collaborative, etc.) that
collects medical and/or clinical data for the purpose of patient and disease tracking to foster
improvement in the quality of care furnished to patients
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The data submitted to CMS via a QCDR covers quality measures across multiple payers and is not
limited to Medicare beneficiaries
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Measures are not limited to traditional PQRS measures
– Registries may include up to 30 non-PQRS measures
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Registries may include additional measures that are PQRS measures, in addition to the 30 non-PQRS
measures
QCDR Reporting Requirements
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Individual providers must report at least 9 measures for 50% of the applicable patients per measure
– Of the Nine Required Measures, at least 2 must be Outcome measures
• If less than 2 outcome measures are available to an EP, report on at least 1 outcome measure and also at
least one of the following types of measures:
– Patient Safety
– Resource Use
– Patient Experience of Care
– Efficiency/Appropriate Use
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Measures must cross at least 3 National Quality Strategy (NQS) domains including:
– Communication and Care Coordination, Community/Population Health, Effective Clinical Care,
Efficiency and Cost Reduction, Patient Safety, and Person and Caregiver-Centered Experience
2015 Financial Risk
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PQRS Incentives/Penalties
• 2015 is the first year that there is no longer an incentive payment for PQRS participation
• The PQRS program now carries an automatic 2% penalty for non-participation
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Value-Based Modifier (VBM) Payment Adjustment (Penalty) for 2015 PQRS Non-Reporters
• Groups with 2 - 9 Eligible Providers (EPs) and solo practitioners: automatic-2.0% of the Medicare
Physician Fee Schedule (MPFS) downward adjustment
• Groups with 10+ EPs: Automatic -4.0% of MPFS downward adjustment
• These adjustments are additive to the 2% PQRS penalty
VBM Quality-Tiering Payment Adjustment
• Quality-Tiering (applies to all successful 2015 PQRS Reporters)
• Pay for Performance (P4P) – both quality and cost are assessed
• Budget Neutral (“Quality Tiering”) – rewards for the “high quality/low cost”
practices will be funded by the “low quality/high cost” practices.
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Groups of 2-9 EPs and solo practitioners: Upward or neutral VM adjustment only (+0.0% to +2.0x
of MPFS)
Groups with 10+ EPs: Upward, neutral, or downward VM adjustment (up to -4.0% to or +4.0x of
MPFS)
Groups and solo practitioners receiving an upward adjustment are eligible for an additional +1.0x
(x refers to the payment adjustment factor) if their average beneficiary risk score is in the top 25%
of all beneficiary risk scores nationwide
CMS Quality Agenda
“Transforming Medicare from a passive payer to an
active purchaser of high quality, efficient
healthcare” – CMS
Fee for
Service
Pay for Value
2015 Financial Risk: PQRS & VBM
• VBM penalties are additive to PQRS penalties
• VBM are phasing in by group size, while PQRS penalties apply regardless of group size
Quality-Tiering Effects for 2015
Groups <10 and solo practitioners:
Quality/Cost
Low Quality
Average Quality High Quality
Low Cost
0
+1x*
+2x*
Average Cost
0
0
+1x*
High Cost
0
0
0
Groups 10+:
Quality/Cost
Low Cost
Low Quality
Average Quality High Quality
0
+2x*
+4x*
Average Cost
-2%
0
+2x*
High Cost
-4%
-2%
0
* Eligible for an additional +1.0x if successfully reporting quality measures and average
beneficiary risk score in the top 25% of all beneficiary risk scores.
Quality-Tiering: Quality Measures
Quality Composite is derived from the following measures:
• PQRS measures
• Outcome measures:
• All Cause Readmission
• Composite of Acute Prevention Quality Indicators (bacterial pneumonia, urinary tract infection,
dehydration)
• Composite of Chronic Prevention Quality Indicators (Chronic Obstructive Pulmonary Disease
(COPD) heart failure, diabetes)
• Consumer Assessment of Healthcare Providers and Systems (CAHPS) (reported through PQRS Group
Practice Reporting Option [GPRO])
• Optional for GPROs with 2-99 Eligible Professionals (EPs)
• Mandatory for GPROs with 100+ EPs
Quality-Tiering: Cost Measures
Quality Composite is derived from the following measures:
• Medicare Spending Per Beneficiary measure (3 days prior and 30 days after an inpatient
hospitalization) attributed to the group providing the plurality of Part B services during the
hospitalization
• Total per capita costs measures (Parts A & B) for beneficiaries with 4 chronic conditions:
• Chronic Obstructive Pulmonary Disease (COPD)
• Heart failure
• Coronary Artery Disease
• Diabetes
(All cost measures are payment standardized and risk adjusted, and each group’s cost measures adjusted for
specialty mix of the EPs in the group)
AJRR Orthopaedic Quality Resource Center
• The AJRR Orthopaedic Quality Resource Center, in collaboration with CECity, will
provide will provide participating providers with:
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Timely custom continuous performance monitors related to PQRS measures
Performance gap analysis and patient outlier identification
Access to improvement interventions to close performance gaps including patient care
management tools; targeted education; resources and other evidence-based interventions
Comparison versus registry benchmarks and peer-to-peer comparison
AJRR Orthopaedic Quality Resource Center
• Quality Improvement measures supported are specifically chosen for orthopaedic
practices
• Use measure data to submit to CMS to satisfy PQRS requirements
• Participating in this QCDR registry will allow:
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Eligible professionals to submit their quality measure results to CMS to meet their PQRS quality
reporting requirements
AJRR Orthopaedic Quality Resource Center
-Approved CMS QCDR
• 1 of 50 approved QCDRs will allow eligible professionals to submit their QCDR
quality measure results to CMS to meet their PQRS quality reporting
requirements:
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Avoid the value-based payment modifier negative payment adjustment in 2017
Avoid the 2% PQRS negative payment adjustment in 2017
• 22 total PQRS measures
Measures
• A QCDR is not limited to measures within PQRS
• A QCDR may submit measures from one or more of the following categories with
a maximum of 30 non-PQRS measures allowed:
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Clinician & Group Consumer Assessment of Healthcare Providers and Systems (CGCAHPS)
National Quality Forum (NQF)-endorsed measures
Current 2015 PQRS measures
Measures used by boards or specialty societies
Measures used in regional quality collaborations
AJRR Orthopaedic Quality Resource Center Measures
• Perioperative Care Measures:
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Perioperative Care: Selection of Prophylactic
Antibiotic – First OR Second Generation
Cephalosporin
Perioperative Care: Discontinuation of
Prophylactic Parenteral Antibiotics
Perioperative Care: Venous
Thromboembolism (VTE) Prophylaxis
• Total Knee Replacement Measures:
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Shared Decision-Making: Trial of Conservative
(Non-surgical) Therapy
Venous Thromboembolic and Cardiovascular Risk
Evaluation
Preoperative Antibiotic Infusion with Proximal
Tourniquet
Identification of Implanted Prosthesis in Operative
Report
AJRR Orthopaedic Quality Resource Center Measures
• Diabetes: Hemoglobin A1c Poor
Control
• Osteoarthritis (OA): Function and
Pain Assessment
• Documentation of Current
Medications in the Medical
Record
• Pain Assessment and Follow-Up
• Functional Deficit: Change in RiskAdjusted Functional Status for
Patients with Knee Impairments
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Preventive Care and Screening:
Tobacco Use: Screening and Cessation
Intervention
Patient centered Surgical Risk
Assessment and Communication
Unplanned Hospital Readmission
within 30 day Postoperative period
Unplanned Hospital Readmission
within 30 day of Principal procedure
Surgical Site Infection
AJRR Orthopaedic Quality Resource Center Measures
Eligible Professionals must select two (2) of the following
outcome measures:
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Knee injury and Osteoarthritis Outcome Score (KOOS)
KOOS Shortform (KOOS-PS)
Oxford Knee Score
Knee Society Knee Scoring System
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Short Form 36 Health Survey (SF-36)
Veterans RAND 12 item Health Survey (VR-12)
Patient Reported Outcomes Measurement
Information System (PROMIS)-10
Data Entry
• Data entry and upload tools
are available to manage the
data entry process
• CECity can also automate the
flow of data from your
electronic health record
Performance Monitor
• Quality scores for each
measure will be calculated and
displayed in the performance
monitor (as frequently as daily)
• Other features include:
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Performance measure gaps and a
list of patient outliers
Link to interventions and
improvement tools
Peer comparators
Measure
Name
Provider
Score
Diabetes: Hemoglobin A!c
Poor Control
Performance
Management
Dashboard
Components
Functional Status
Assessment for Knee
Replacement
Perioperative Care:
Selection of Prophylactic
Antibiotic – First OR
Performance
Trending
How do we
improve?
Links to
Interventions
Peer
Comparators
How to Use the AJRR Orthopaedic Quality
Resource Center
Steps for Participation
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STEP 1: Determine if the professional is eligible to participate
• The list of EPs able to participate as individuals is available on the PQRS web page at:
• http://www.cms.gov/Medicare/Quality-Initiatives-Patient-Assessment-Instruments/PQRS/
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STEP 2: Go to the following website to register:
• https://www.medconcert.com/ajrr
2015 PQRS
Once you have completed the registration follow these steps:
– Submit data manually or via upload tool
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Select at least 9 measures for PQRS Reporting
Report on at least 50% of your applicable patients (all payers)
Ensure that at least 3 NQS Domains are covered
Ensure that at least 2 Outcome Measures are selected
– If less than 2 outcome measures are available to an EP, report on at least 1 outcome measure
and also at least one of the following types of measures:
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Patient Safety
Resource Use
Patient Experience of Care
Efficiency/Appropriate Use
– Complete Attestation Module for submission to CMS
AJRR Orthopaedic Quality Resource Center
Pricing for PQRS reporting and access to the AJRR Orthopaedic Quality Resource
Center is $439 (on an individual eligible professional/healthcare professional basis):
DATA MUST BE SUBMITTED BY
February 26, 2016
FOR THE 2015 CALENDAR YEAR REVIEW PERIOD
Questions?
[email protected]
847-292-0530
www.ajrr.net