Post on 23-Dec-2015
Physician Quality Reporting InitiativeCSNS Provider UpdateAffordable Care Act Task Force
Dr. Justin Singer, MDDr. Nicholas Bambakidis, MD
What is PQRI?
• Center for Medicare and Medicaid Services (CMS) initiative which began in 2014 to promote physician quality reporting for eligible practitioners.
• Eligible practitioners or group practices who participate in Medicare Physician Fee Schedule (PFS) are mandated to participate in the Physician Quality Reporting System (PQRS).
• Physicians who satisfactorily submit PQRS quality reporting data are eligible for a 0.5 % incentive payment (IP) of their total estimates Medicare Part B PFS.
What’s New in 2015?
• PQRS is initiating negative payment (NP) adjustments to providers who did not satisfy reporting requirements for quality measures in 2014 of 1.5 % of their Medicare PFS.
• In 2016 negative adjustment increases to 2% for non-compliance with reporting for 2015 fiscal year.
What is Reported?
• For a list of currently tracked measures go to:
2015 PQRS Measures List
• Most current measures applicable to Neurosurgeons relate to perioperative measures. A few examples included:– Perioperative parenteral antibiotics prior to incision and
discontinuing prior to 24 hours post op.– Surgical Site Infections.– Unanticipated 30 day readmissions post-operatively.
• CMS is accepting suggestions for new measures.
Why should Neurosurgeons Care about PQRS?
• Reporting is mandatory for Neurosurgeons who participate in the Medicare part B PFS.
• Starting this year failure to adequately participate will results in 1.5% negative adjustment to PFS eligible reimbursement.
• Practicing Neurosurgeons who did not satisfactorily report quality data in 2014 will receive 98% of the fee schedule amount for services rendered starting 2016.
How Can Neurosurgeons Avoid 2016 Negative Adjustments Through PQRS?
• Neurosurgeons will have had to meet 1 of the following criteria during the 2014 PQRS program year– Meet requirement criteria for 2014 PQRS incentive
eligibility– Repeat minimum of 3 measures covering one National
Quality Strategy (NQS) domain for at least 50% eligible Medicare Part B FFS patients via claims or qualified registry.
– Participate through a qualified data registry for which at least 3 measures cover a minimum of 1 NQS domain for 50% of applicable patients.
What you can do in 2015 to avoid Negative Adjustments in 2017?
• Report on Min. 9 individuals measures covering 3 NQS domains for 50% of the practitioners Medicare Part B FFS patients.
• Reports at least 1 measures group from a sample of 20 patients, where majority of patients must be Medicare Part B FFS patients.
• 2015 Reporting Registry Made Simple
How To Report
• Claims base reporting• Registry based reporting
– More On Registry Reporting• Qualified Electronic Health Record (EHR)
– More On EHR Reporting• Qualified Clinical Data Registry (QCDR)
– More On QCDR• Group Practice Reporting Option (GPRO)
– More ON GPRO• 2014 Physician Quality Reporting System Implementa
tion Guide
How To Get Started with PQRS?
One Last Thing!!!
• Proposed Changes via “Medicare Access and CHIP Reauthorization Act”– May eliminate negative adjustments or penalties
under CMS programs (ie. PQRS)– May Consolidates the PQRS, EHR and Value-Base
Payment Modifier (VM) programs– Includes Positive incentives for quality improvement
payment programs to include All physicians
H.R.2 - Medicare Access and CHIP Reauthorization Act of 2015
Stay Tuned For Future Updates Following Passage of H.R. 2
For more information check out
http://www.cms.gov/Medicare/Quality-Initiatives-Patient-Assessment-Instruments/PQRS/index.html
http://cms.gov/Medicare/Quality-Initiatives-Patient-Assessment-Instruments/PQRS/Downloads/2015_PQRS_ImplementationGuide.pdf
http://www.cms.gov/Medicare/Quality-Initiatives-Patient-Assessment-Instruments/PQRS/Downloads/PQRS-Timeline-2014-2016.pdf