Publication MO-12-31-PREV December 2012This material was prepared by Primaris, the Medicare Quality Improvement Organization for Missouri, under contract with the Centers for Medicare & Medicaid Services (CMS), an agency of the U.S. Department of Health and Human Services. The contents

presented do not necessarily reflect CMS policy

PQRS: Prepare Now for 2013!MSMA December 2012

Sandy Pogones, Program Manager

Who is Primaris

Founded in 1983 by the Missouri State Medical Association and Missouri Association of Osteopathic Physicians and Surgeons

Federally-designated Quality Improvement Organization (QIO) for the state of Missouri.

Objectives

Identify 2013 quality reporting programs under CMS

Discuss how the Physician Quality Reporting System (PQRS) and Value-Based Payment Modifier will impact practices

Examine reporting options

Develop a plan and action steps for quality reporting

Content on this page is subject to the Notice on the title page of this presentation.

Center for Medicare and Medicaid Services (CMS) Quality Reporting Programs

PQRS

Meaningful Use Incentives &

Penatlies

ACOs/Shared Savings Bonus & Penalties

Patient Medical Homes

Incentives

PQRS Incentives &

Penalties

Public Reporting

Value-Based Modifier Bonus & Penalties

What is PQRS?

A “system” to report clinical quality data to Centers for Medicare & Medicaid Services (CMS)

Allows multiple mechanisms of reporting

Provides variety of clinical measures

Dynamic system, continually updated with new/revised/discontinued measures

Who is eligible?

An eligible provider includes

– Physicians (MD, DO, dentists, podiatrists, chiropractors)

– Practitioners (NP, PA, APN, clinical nurse specialists, psychologists, clinical social workers)

– Therapists (PT, OT, speech, audiologist)

Incentives and payment adjustments based on Medicare Part B PFS allowable charges

What Applies to Me in 2013?Program Incentive if reporting in

2013Payment adjustment if not reporting in 2013

PQRS All EPs. Incentive = 0.5% All EPs. Penalty -1.5% applied in 2015

Value-Based Modifier

Groups with 100+ EPs. If report PQRS as a group, then VBM = 0% (Unless elect quality tiering)

Groups with 100+ EPs. If don’t report PQRS as a group then VBM = -1.0% applied in 2015

Meaningful Use/EHR Incentive

All EPs. Bonus under Medicare or Medicaid. Incentive depends on year and program—$8000 - $21,500)

All EPs. If don’t reach MU, -1.0% applied in 2015 (-2.0% if subject to e-RX penalty in 2014)

E-Prescribe All EPs. Incentive =0.5% unless you earned a MU EHR incentive under Medicare, then 0%

All EPs. Penalty = -2.0% in 2014 unless meet hardship exemption. Report 10 cases Jan-June 2013 or 25 cases in 2012 to avoid.

Performance Improvement=Team Sport

“Social and collaborative activities account for most workplace learning.”

– Informal Survey of Importance of Sources of Learning, Centre for Learning Performance Technology, 2012

Mechanisms of PQRS Reporting

•3 measures, or 1 Measures Group•Submit Quality Data Codes on Bill dailyClaims•3 measures or 1 Measures Group•EP sends data to Registry; Registry submits after year-endRegistry•3 measures•EP generates files from EHR, Uploads to CMS after year-endEHR-Direct•3 measures•Data electronically shared, DSV submits after year-end

EHR-Data Submission Vendor

•17 measures•EP elects, No need to send any data, CMS calculatesAdministrative Claims

•22 measures•Group elects, CMS assigns patients, Group submits year-end

GPRO Web-based Interface

How to Choose a PQRS Submission Method

Practice size

Individual or group

Specialty

Your EHR

Participation

Cost

Satisfactory Reporting for Individuals - 2013

Satisfactory Reporting for Groups - 2013

Successful Strategies

Scenario 1: Provider in a five-provider practice, Practice Management System, no EHR.

– The VBM does not apply in 2013

– Provider does not have an EHR, so will incur a Meaningful Use Penalty of -1.5% effective in 2015

– Provider can participate in PQRS using Claims, Registry, or Administrative Claims

– Measures Group good choice

Measures Groups Reportable through Claims and Registry

Claims and RegistryDiabetes Mellitus (DM) Measures

Group

Chronic Kidney Disease (CKD) Measures Group

Preventive Care Measures Group

Rheumatoid Arthritis (RA) Measures Group

Perioperative Care Measures Group

Back Pain Measures Group

Hepatitis C Measures Group

IVD Measures Group

Asthma Measures Group

COPD Measures Group

Dementia Measures Group

Cardiovascular Prevention Measures Group

Registry OnlyCoronary Artery Bypass Graft (CABG)

Measures Group

Coronary Artery Disease (CAD) Measures Group

Heart Failure (HF) Measures Group

HIV/AIDS Measures Group

Inflammatory Bowel Disease (IBD) Measures Group

Sleep Apnea Measures Group

Parkinson’s Disease Measures Group

Hypertension (HTN) Measures Group

Cataracts Measures Group

Oncology Measures Group

Qualified Registries

2013 Listing Available by Spring of 2013 http://www.cms.gov/Medicare/Quality-Initiatives-Patient-Assessment-Instruments/PQRS/Registry-Reporting.html

“Getting Started with Measures Groups” (Cardiovascular Measures Group)

Claims-Based Individual Measures and Measure Groups

Review the Reporting Guides and Specifications:

– Individual Measures – http://www.cms.gov/apps/ama/license.asp?file=/PQRS/downloads/2013-PQRS-MeasureList-ImplementationGuide-11162012.zip

– Measures Groups – http://www.cms.gov/apps/ama/license.asp?file=/PQRS/downloads/2013-PQRS-MeasuresGroupsSpecs-ReleaseNotes-SupportingDocs-11162012.zip

AMA Participation Tools

Billing system PQRS reporting features

Start Reporting

Insert codes for each measure in the Group on the bill

Submit the Claim

Watch for N365 notice on Remittance Advice

Repeat for at least 20 patients, mostly Medicare Part B

Examples of Successful Strategies

Scenario 2: Providers works in a group practice of 30 providers with an EHR that is PQRS Qualified in 2013. The providers participate in Meaningful Use and PCMH.

– The VBM does not apply in 2013

– Meaningful Use Bonuses

– Individual Providers can participate in PQRS using Claims, Registry, EHR, EHR Data Submission Vendor, or Administrative Claims

Qualified Direct EHR

CMS will qualify EHRs in 2013. By 2014 all Certified EHRs must be able to submit PQRS.

2013 Listing of Qualified EHRs Available Now http://www.cms.gov/Medicare/Quality-Initiatives-Patient-Assessment-Instruments/PQRS/Downloads/2013QualifiedEHRDirectVendors.pdf

Put a plan in placeIdentify

measures and specifications

Identify your team-who, what, when,

where, how

Engage with Vendor Customer

Support

Run monthly reports

Initiate improvement

processes

Update system and submit after 12/31

Example of Successful Strategies

Scenario #3: Specialty practice, 30 cardiologists and NPs. Use an EHR, but it is not qualified to report PQRS in 2013. Participate in the ACC Pinnacle Registry. $8 Million Medicare Part B billings.

– Upload Data

– Feedback reports

– Data submission vendor submits to CMS

Qualified EHR Data Submission VendorCMS will qualify in 2013, but not in 2014

2013 Listing Available Summer/Fall 2013 http://www.cms.gov/Medicare/Quality-Initiatives-Patient-Assessment-Instruments/PQRS/Downloads/2012QualifiedDSVs.pdf

Successful Strategies

Scenario 4: TIN with 150 providers. Multispecialty, use different EHRs, some have participated in PQRS in past, some very resistant. $30 Million Medicare Billings

Option Group Reporting Availability

Qualified Registry 2+ EPs, 2013 and beyond

GPRO Web-based tool 25+ EPs, 2013 and beyond

Administrative Claims 2+ EPs, 2013 only, no incentive

Certified EHR/DSV Not Avail in 2013; Avail for 2+ EPs in 2014 and beyond

Claims Not available

Measure Groups Not available

A Few Other Points about Group Reporting

Must self-nominate by 10/15/2013 and be accepted by CMS.

If Group elects to report PQRS as a Group using Registry or GPRO web-based interface:

– All members use the same reporting mechanism;– All members report on the same measures; – Providers can not participate individually.

If group has >100 providers and wish to report PQRS as individuals to earn PQRS incentive, then MUST elect Administrative Claims option to avoid VBM penalty

PQRS Administrative Claims Option for 2013

New in 2013 & only available in 2013 to avoid the 2015 payment adjustment

Requires providers to “elect” by notifying CMS via the Communications portal

– Portal open December 1, 2012 – January 31, 2013, then again from July – October 15, 2013

No incentive payment!!!

Avoid Penalties Simply by Participating

Individual Providers

•Report 1 PQRS measure through Claims, Registry or EHR, --OR--

•Elect Administrative Claims

Groups:

•Self-nominate as a Group, and Elect and Report 1 PQRS measure via Registry or Web-Based Interface, --OR--

•Self-nominate as a Group and Elect Administrative Claims

Summary: How will PQRS Data Be Used?

PQRS Incentives (0.5% in 2013 and 2014)

PQRS Payment Adjustments (1.5% based on 2013 Reporting, Assessed in 2015; 2.0% thereafter)

Calculate VBM for Groups of 100+ EPs based on 2013 & 2014 reporting; for all physicians thereafter

Clinical Quality Measure to meet Meaningful Use Requirements (2014 and beyond) and as part of current pilot

Quality data reported through a Medicare Shared-Savings Program/ACO to meet PQRS/VBM/MU CQM requirements

Physician Compare

Resources

Recordings of National Provider Calls held by CMS: http://www.cms.gov/Outreach-and-Education/Outreach/NPC/National-Provider-Calls-and-Events.html

Primaris websites: PQRSMO.org and Primaris.org

PQRS CMS Website: http://www.cms.gov/Medicare/Quality-

Initiatives-Patient-Assessment-Instruments/PQRS/index.html?redirect=/pqri/

PQRS Questions--QualityNet Help Desk (866)-288-

8912, Open 7:00 –7:00 CST , M-F, or qnetsupport@sdps.org

Resources (cont)

CMS Communication Support Page (Self-nominate as Group & Elect Administrative Claims Option) https://www.qualitynet.org/portal/server.pt/community/communications_support_system/234

Physician Compare: http://www.medicare.gov/find-a-doctor/provider-search.aspx

Value-Based Payment Modifier: http://www.cms.gov/Medicare/Medicare-Fee-for-Service-Payment/PhysicianFeedbackProgram/index.html

Value-Based Modifier Questions: QRUR@cms.hhs.gov ;

Resources (cont)

QRUR Reports for Groups 25+ to help you see how you might compare in VBM calculations: QRURinfo.com

AMA PQRS Participation Tools: http://www.ama-assn.org/ama/pub/physician-resources/clinical-practice-improvement/clinical-quality/physician-quality-reporting-system.page

Questions?

Sandy PogonesProgram Manager

spogones@primaris.org573-673-4531