Physician Quality Reporting System (PQRS)

1. Physician)Quality)Repor3ng)System)(PQRS))
Wednesday,)February)5,)2014)
Disclaimer:+Nothing+that+we+are+sharing+is+intended+as+legally+binding+or+prescrip7ve+advice.+This+presenta7on+is+a+
synthesis+of+publically+available+informa7on+and+best+prac7ces.+

2. • Voluntary,+individual+repor1ng+program+
– Quality+measures+for+services++provided+to+Medicare+
beneficiaries+
• Started+in+2007++
– Tax+Relief+and+Health+Care+Act+
• Incen1ve+payments+for+par1cipa1on+through+
2014+
• Financial+penalty+for+nonJpar1cipa1on+aKer+2014+
• Measures+based+on+combina1ons+of+CPT,+ICD+and+
pa1ent+age+at+the+1me+of+the+encounter+
What+is+PQRS?+

3. • +Physicians+
– Doctors+of+Medicine,+Osteopathy,+Podiatric+Medicine,+Optometry,+Oral+Surgery,+Dental+Medicine,+Chiroprac1c+++
• Prac11oners++
– Physician+Assistant+
– Nurse+Prac11oner+
– Clinical+Nurse+Specialist+
– Cer1fied+Registered+Nurse+Anesthe1st+(and+Anesthesiologist+Assistant)+++
– Cer1fied+Nurse+Midwife+
– Clinical+Social+Worker+++
– Clinical+Psychologist+++
– Registered+Die1cian+++
– Nutri1on+Professional++
– +Audiologists+
• Therapists+++
– Physical+Therapist+++
– Occupa1onal+Therapist+++
– Qualified+SpeechJLanguage+Therapist++
Who+is+Eligible?+

4. Provider+Repor1ng+Methods+
• Individual++
– EHR+Direct+Product+that+is+Cer1fied+EHR+Technology+(CEHRT)+
– EHR+data+submission+vendor+that+is+CEHRT+
– Qualified+PQRS+Registry+
– Par1cipa1on+through+a+Qualified+Clinical+Data+Registry+(QCDR)+
– Medicare+Part+B+claims+submiYed+to+CMS+
• Group+Prac1ce+Repor1ng++
– GPRO+Web+Interface+
– Qualified+PQRS+Registry+
– EHR+Direct+Product+that+is+CEHRT+
– EHR+data+submission+vendor+that+is+CERT+
– CMSJcer1fied+survey+vendor+
*Group'prac*ces'repor*ng'via'GPRO'must'register'for'their'selected'repor*ng'method'by'September'30,'2014.'

5. ClaimsJBased+Repor1ng+
• QDCs+must+be+reported+
– On+claim+represen1ng+the+denominator+of+eligible+Medicare+Part+B+
encounters+
– Same+beneficiary+as+encounter+
– Same+date+of+service+as+qualifying+EM+code+
– Same+EP+who+is+rendering+eligible+performed+code+
• QDCs+must+be+submiYed+with+a+lineJitem+charge+of+one+penny+
($0.01)+at+the+1me+the+associated+covered+service+is+
performed+
– SubmiYed+charge+field+cannot+be+blank.+
– Line+item+charge+should+be+$0.01+–+beneficiary+not+liable+for+this+amount+
– En1re+claim+with+$0.01+charge+will+be+rejected.+Claims+for+just+QDC+codes+
are+not+permiYed+
*+Claims+may+NOT+be+resubmi@ed+for+the+sole+purpose+of+adding+or+correc7ng+QDCs++

6. EHRJBased+Repor1ng+
• EHRJbased+repor1ng+op1on+sa1sfies+the+CQM+
component+of+Meaningful+Use+
• Submit+data+by+the+February+28,+2015+
• Direct+EHR+Vendor+
– Must+register+for+an+IACS+account+
• EHR+Data+Submission+Vendor+
– Responsible+for+submicng+PQRS+measures+data+to+
CMS+

7. Qualified+Registry+
• Collects+clinical+data+from+eligible+
professional+or+group+prac1ce+
• Submits+data+to+CMS+on+behalf+of+
par1cipants+
• 2014+Par1cipa1ng+Registry+Vendors+
list+available+on+the+CMS+PQRS+webJ
site+

8. Qualified+Clinical+Data+Registry+(QCDR)+
• CMSJapproved+en1ty+
• Collects+medical+and/or+clinical+data+for+pa1ent+and+disease+tracking++
– Improved+quality+of+care+
• Not+limited+to+PQRS+measures++
• May+submit+measures+from+one+or+more+of+the+following+categories:+
– Clinician+&+Group+Consumer+Assessment+of+Healthcare+Providers+and+Systems+
– Na1onal+Quality+Forum+endorsed+measures+
– Current+2014+PQRS+measures+
– Measures+used+by+boards+or+specialty+socie1es+
– Measures+used+in+regional+quality+collabora1ons+
• Choose+appropriate+QCDR+
• Work+directly+with+QCDR+
– Legal+agreement+for+QCDR+receipt+of+pa1entJspecific+data+and+release+of+quality+measure+data+to+
CMS+on+the+EPs+behalf.++
– Specific+instruc1ons+on+how+to+collect+and+provide+pa1ent+data+for+use+by+the+QCDR+supplied+by+the+
QCDR.+

9. GPRO+Web+Interface+
• Register+and+report+chosen+repor1ng+method+no+later+than+September+30,+2014+if+
repor1ng+for+2014+
• Includes+comple1on+of+preJfilled+beneficiary+sample.++
• 25+–+99+Eligible+Professionals+
– Report+on+all+measures+AND+populate+data+fields+for+the+first+218+consecu1vely+ranked+
and+assigned+beneficiaries+
+++++++Or+
– Have+all+12+CG+CAHPS+summary+survey+modules+reported+via+CMSJcer1fied+survey+
vendor+AND+report+on+6+measures+covering+at+least+2+of+the+NQS+domains++
– Use+a+qualified+registry,+direct+EHR+product,+EHR+data+submission+vendor+or+GPRO+Web+
Interface+as+a+repor1ng+mechanism.+
• 100+++Eligible+Professionals+
– Report+on+all+measures+AND+populate+data+fields+for+the+first+411+ranked+and+assigned+
beneficiaries+
Individual+eligible+professionals+within+a+group+prac1ce+that+sa1sfactorily+completes+the+GPRO+Web+Interface+will+also+
receive+credit+for+the+CQM+component+of+the+EHR+Incen1ve+Program.++

10. Payment+Incen1ve/Penalty+Timeline+

11. Requirements+for+Incen1ve+Payments+
–+Individual+Measures+
• Claims/Qualified+Registry+
– At+least+9+measures+covering+at+least+3+NQS+domains+for+at+least+50%+
Medicare+Part+B+pa1ents+seen+during+repor1ng+period.+
– If+less,+report+1—8+measures+covering+1—3+NQS+domains,+AND+report+
each+measure+for+at+least+50%+Medicare+Part+B+pa1ents+seen+during+
repor1ng+period.+
• Measures+with+a+0%+performance+rate+not+counted.++
• Fewer+than+9+measures+covering+3+NQS+subject+to+the+MAV+process.+++++
• EHR+Report++
– 9+measures+covering+at+least+3+of+the+NQS+domains+
– If+CEHRT+does+not+contain+pa1ent+data+for+at+least+9+measures+covering+at+
least+3+domains,+the+EP+must+report+measures+with+Medicare+pa1ent+data+
– Must+report+on+at+least+1+measure+for+which+there+is+Medicare+pa1ent+
data+

12. Requirements+for+Incen1ve+Payments+
–+Measure+Groups+
• Qualified)Registry))
– Report+at+least+1+measures+group,+AND+report+each+measures+group+
for+at+least+20+pa1ents+
– Majority+must+be+Medicare+Part+B+pa1ents.++
• Qualified)Clinical)Data)Registry))
– Report+at+least+9+measures+covering+at+least+3+NQS+domains+AND+
report+each+measure+for+at+least+50%+eligible+pa1ents+seen+during+the+
repor1ng+period+
– Measures+with+a+0%+performance+rate+not+counted.++++
– At+least+1+outcome+measure.++

13. Requirements+for+Avoiding+Penal1es+in+
2016+–+Individual+Measures+
• Claims/Qualified+Registry/Qualified+Registry+Report+++
– At+least+9+measures+covering+at+least+3+NQS+domains+AND+report+each+measure+for+
at+least+50%++Medicare+Part+B+pa1ents+seen+during+repor1ng+period.++
– If+less+than+requirement+report+1—8+measures+covering+1—3+NQS+domains,+AND+
report+each+measure+for+at+least+50%+Medicare+Part+B++pa1ents+seen+during+the+
repor1ng+period.+
– Measures+with+a+0%+performance+rate+would+not+counted.+++
– Fewer+than+9+measures+covering+3+NQS+domains+via+the+claimsJbased+repor1ng+
mechanism+subject+to+the+MAV+process+
• Claims++
– Report+at+least+3+measures+for+at+least+50%+of+the+eligible++professionals+Medicare+Part+B+
pa1ents+seen+during+the+repor1ng+period.+
– If+less+than+requirement,+report+1—2+measures;+AND+report+each+measure+for+at+least+
50%+Medicare+Part+B+pa1ents+seen+during+the+repor1ng+period+to+which+the+measure+
applies.+
– Measures+with+a+0%+rate+not+counted.+++

14. Avoiding+Penalty+in+2016+J+Individual+
Providers,+Group+Measures++
• Qualified+Registry++
– Report+at+least+1+measures+group,+AND+report+each+measures+group+for+at+least+20+
pa1ents,+a+majority+of+which+must+be+Medicare+Part+B+FFS+pa1ents.++
• Qualified+Clinical+Data+Registry++
– Report+at+least+9+measures+covering+at+least+3+NQS+domains+AND+report+each+
measure+for+at+least+50+percent+of+the+eligible+professional’s+applicable+pa1ents+
seen+during+the+repor1ng+period+to+which+the+measure+applies.+++
– Measures+with+a+0%+performance+rate+would+not+be+counted.+++
– Of+the+measures+reported+via+a+qualified+clinical+data+registry,+the+eligible+
professional+must+report+on+at+least+1+outcome+measure+
• Qualified+Clinical+Data+Registry+
– Report+at+least+3+measures+covering+at+least+1+NQS+domain+AND+report+each+
measure+for+at+least+50+percent+of+the+eligible+professional’s+applicable+pa1ents+
seen+during+the+repor1ng+period+to+which+the+measure+applies.+
– Measures+with+a+0+percent+performance+rate+would+not+be+counted+

15. Avoiding+Penalty+in+2016+J+GPRO+
• GPRO+Web+Interface+Report+on+all+measures+included+in+web+interface.+
– Populate+data+fields+for+the+first+218+(411+for+100+or+more+EPs)+consecu1vely+ranked+and+
assigned+beneficiaries+
– If+less+than+218+eligible+assigned+beneficiaries,+report+on+100%+of+assigned+beneficiaries.+
• Qualified+Registry+
– Report+at+least+9+measures+covering+at+least+3+of+the+NQS+domains+and+report+each+measure+for+at+least+50%+
of+the+group’s+Medicare+Part+B+pa1ents+seen+during+the+repor1ng+period.++
– If+less+than+requirement,+report+1+–+8+measures+covering+1+–+3+domains+with+Medicare+pa1ent+data+AND+
report+each+measure+for+at+least+50%+of+Medicare+Part+B+pa1ents+seen+during+the+repor1ng+period.+
– Measures+with+0%+performance+rate+not+counted.+
– Fewer+than+9+measures+covering+at+least+3+domains,+subjects+the+group+to+the+MAV+process+
• Direct+EHR+/+EHR+Data+Submission+by+Vendor+
– Report+9+measures+covering+at+least+3+domains.+
– If+a+group+prac1ce’s+CEHRT+does+not+contain+pa1ent+data+for+at+least+9+measures+covering+at+least+3+
domains,+then+the+group+prac1ce+must+report+the+measures+for+which+there+is+Medicare+pa1ent+data.+
– A+group+prac1ce+must+report+on+at+least+1+measure+for+which+there+is+Medicare+pa1ent+data.+
• CMS+J+Cer1fied+Survey+Vendor+
– Report+all+CG+CAHPS+survey+measures+AND+report+at+least+6+measures+covering+at+least+2+of+the+NQS+
domains+

16. Measure+Selec1on+
• Individual+Measures+
– 110+Claims+Based+Measures+
– 201+Registry+Based+Measures+
– 64+EHR+Measures+
• Group+Measures+
– 25+Measures+Groups+
• Domains++
– Clinical+Process+/+Effec1veness+
– Pa1ent+Safety+
– Popula1on+/+Public+Health+
– Efficient+Use+of+Healthcare+Resources+
– Care+Coordina1on+
– Pa1ent+and+Family+Engagement+

17. Measure+Selec1on+
• Which+measures+should+you+choose?+
– Difficulty+
– Relevance+
• Clinical+condi1ons+usually+treated+–+Cardiac,+HTN,+Diabetes,+etc.+
• Types+of+care+typically+provided+–+e.g.,+preven1ve,+chronic,+acute+
– Best+performance++
• 200+standardized+quality+measures+
• Meet+50%+threshold+requirement++
– Choose+a+PQRS+quality+measure+for+services+that+are+performed+frequently.+(This+is+the+
minimum+required+to+prevent+penalty)+
• Incen1ve+Payment+or+Avoid+Penalty+

18. PQRS+Resources+
• hYp://www.cms.gov/Medicare/QualityJIni1a1vesJPa1entJAssessmentJ
Instruments/PQRS/MeasuresCodes.html\+
– 2014+Physician+Quality+Repor1ng+System+Implementa1on+Guide+
– 2014+PQRS+Measures+
• QualityNet+Help+Desk:++
– Portal+password+issues+
– PQRS/eRx+feedback+report+availability+and+access++
– IACS+registra1on+ques1ons+–+IACS+login+issues+
– PQRS+and+eRx+Incen1ve+Program+ques1ons+++
• 866J288J8912+(TTY+877J715J6222)++7:00+a.m.–7:00+p.m.+CST+MJF+or+
[email protected]++You+will+be+asked+to+provide+basic+
informa1on+such+as++name,+prac1ce,+address,+phone,+and+eJmail+

19. Q&A+
[email protected]+
[email protected]+