Understanding PQRS and why reporting via an anesthesia QCDR is beneficial

PRESENTED BY: MATTHEW T. POPOVICH, PH.D.QUALITY SPECIALISTAMERICAN SOCIETY OF ANESTHESIOLOGISTS

Claims and the QCDR: Avoiding the Payment Adjustment

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Physician Quality Reporting System (PQRS)

• Physician Quality Reporting System

– What is the program?

– Incentives and Payment (Negative) Adjustments

– Reporting Options (Including the QCDR)

• CMS Rulemaking Process

– 2014 Physician Fee Schedule (PFS)

– 2015 Proposed PFS

• Final Rule (est. November 2014)

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Physician Quality Reporting System (PQRS)

• Defining PQRS– “Paid under or based on the Physician Fee Schedule”

– Eligible Professionals (EPs)

– Payment Incentives (ending in 2014) v. Payment Adjustments

• Common Measures Reported by Anesthesiologists– #30 (NQF #0269): Timing of Prophylactic Antibiotic

– #44 (NQF #0236): Preoperative Beta-Blocker in Patients with Isolated CABG Surgery

– #76 (NQF #0464): Prevention of Catheter-Related Bloodstream Infections (CRBSI): Central Venous Catheter (CVC) Insertion Protocol

– #193 (NQF #0454): Perioperative Temperature Management

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Satisfactorily Report = Avoid the Payment Adjustment

• Reporting Options (2014 & Proposed 2015)

– Claims

– Qualified Clinical Data Registry (QCDR)

– “Traditional” Qualified Registry

– Other Reporting Options

• Alignment of Measure Reporting Requirements

– Nine (9) quality measures

– Three (3) National Quality Strategy (NQS) domains

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• National Quality Strategy Domains– Patient Safety– Person and Caregiver-Centered Experience and Outcomes – Communication and Care Coordination– Effective Clinical Care– Community / Population Health– Efficiency and Cost Reduction

• Anesthesia Measures (Claims)– Patient Safety (PQRS #30, #76 and #193)– Effective Clinical Care (PQRS #44)

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• Satisfactorily Reporting – Claims (2014):

– EPs must report ≥ 9 PQRS measures covering ≥ 3 NQS domains to qualify for an incentive payment for 50% of Medicare Part B patients for whom the measure applies

• If fewer than 9 measures, then EP is subject to the Measure-Applicability Validation (MAV) process

– EPs must report ≥ 3 measures in order to avoid the payment adjustment for 2016

• Subject to MAV process

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• Qualified Clinical Data Registry (QCDR)

– Use of Established Specialty Society Registries

– PQRS and non-PQRS Measures

• AQI/NACOR: 8 PQRS and 11 Non-PQRS Measures

• AQI/NACOR: 4 NQS Domains Available

– QCDR Responsibilities

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• Claims-Based Reporting Challenges (Beyond 2014):

– PQRS Measures for Consideration

– PQRS #30, PQRS #109

– Potentially fewer measures to report via claims

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• QCDR Incentive Requirements (2014)

– Report at least 9 measures covering at least 3 NQS domains AND report each measure for at least 50% of EP’s applicable patients seen during reporting period

– One measure must be an outcome measure

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• QCDR Reporting Requirements– Avoid the payment adjustment (2016)

• [For CY 2014] Report at least 3 measures covering at least 1 NQS domain for at least 50 percent of the EP’s applicable patients seen during the participation period

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– Avoid the payment adjustment (2017) • CMS PROPOSED: “For the 12-month reporting period [CY

2015] for the 2017 PQRS payment adjustment, the EP would report at least 9 measures available for reporting under a QCDR covering at least 3 of the NQS domains, AND report each measure for at least 50 percent of the eligible professional’s patients.”

• Report 3 outcome measures or 2 outcome measures and at least 1 resource use, patient experience or efficiency/appropriate use measure

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Resources

• Learn and Understand PQRS– CMS PQRS Website (www.cms.gov/pqrs)– CMS QualityNet Help Desk (866-288-8912 or

[email protected])

• ASA & AQI Member Resources– Quality and Regulatory Affairs ([email protected])– Anesthesia Quality Institute (http://www.aqihq.org/qcdr)– ASA web site (www.asahq.org/qcdr )

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PRESENTED BY:LANCE MUELLERDIRECTOR ANESTHESIA QUALITY INSTITUTE

The Qualified Clinical Data Registry

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The Challenge

• The government wants to know that Ma and Pa are getting the health care they deserve… and that our taxes pay for.

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• Institute of Medicine report published in late 1999

• Highlighted preventable errors in the US healthcare system

• “100,000 lives a year lost to preventable death”

• Anesthesiology cited as leaders in advancing patient safety

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The Physician Quality Reporting System

• Individual physicians

• For public reporting

• Approved measures

– Submitted and maintained by ‘stewards’

– Vetting through National Quality Forum

• “Claims made” reporting

• Scored by CMS

• Incentives >>> penalties

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“Pay for Performance”

• Federal programs to promote quality over quantity in the delivery of healthcare

• Based on measuring outcomes

– Public reporting

– Payment adjustments (penalties) >>> Incentives

• Hospitals

• Physicians

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Key Points

• Pay for Performance programs are evolving over time

• What was true last year will not be true next year

• Complexity is increasing

• ASA (and all physician societies) must seize opportunities to guide this evolution

• ASA has worked hard to provide a solution for the profession

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The Evolution of P4P

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From

To

Outcomes

Process Measures

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From

To

Small hospitals, surgery centers, clinics and offices

Big hospitals

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From

To

ALL patients

Inpatients

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From

To

ALL payers including

Medicare Advantage, Medicaid

Medicare only

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From

To

Penalties

Incentives

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From

To

Patient Centered

Clinical Safety Focused

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From

To

Teams

Individuals

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From

To

Electrons

Paper

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From

To

The way we do business

A demonstration project

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The QCDR

• Qualified Clinical Data Registry

• New in 2014

• A reporting mechanism for registry participants

• Similar to the registry reporting option for PQRS / VM

• Can use PQRS measures

• Can use non-PQRS, specialty specific measures

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Why the QCDR is a big deal

• Measure definition by the specialty, for the specialty

• Data collection and scoring moves from CMS to the registry

• “One stop shop” for all requirements

• Public reporting by the society

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The Anesthesiology Perspective

• The National Anesthesia Clinical Outcomes Registry (NACOR) is certified as a QCDR

• Available measures for perioperative care increased from 4-8 in PQRS to 19

• 4 domains, multiple outcome measures

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Where Did New Anesthesia Measures Come From?

• Existing in PQRS

– Solves the stewardship problem

• Existing in NQF

• New measures mostly developed by ASA’s Committee on Performance and Outcome Measures (CPOM)

– Developed, but never selected

– Developed, but never submitted

• Subspecialty possibilities

• Aspirational measures

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AQI as a QCDR

• The Centers for Medicare and Medicaid Services (CMS) introduced the Qualified Clinical Data Registry (QCDR) as a reporting option in 2014.

• 2015 Medicare Physician Fee Schedule Proposed Rule:

– To avoid future payment adjustments an EP will have to report on 9 measures including 3 outcomes across 3 NQS domains.

• The addition of QCDR reporting allows specialty societies to develop measures that reflect profession-specific priorities.

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Performance Reporting through the QCDR

• 2015 Anesthesia QCDR reporting is a product of ASA in partnership with AQI

– ASA sells the service

– AQI reports to CMS on behalf on the group and it’s EP’s

– AQI provides monthly PQRS feedback reports

• Groups must be participating in AQI and receive all benefits of participation

• Free to ASA members who are participating in AQI’s NACOR registry

• Additional charge for Eligible Professionals (EP) who are non-ASA members

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QCDR Reporting Requirements. You Must:

• Be a NACOR participant

• If you are already participating – see next slide

• If you are not already participating in NACOR steps include:

– Completion of a Business Associate Agreement with the AQI

– Completion of the AQI practice survey

– Transmission of electronic data to the registry beginning in January 2015

– Pay AQI membership dues

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QCDR Reporting – Steps to Report

• Self-nomination with AQI for QCDR reporting in early 2015 (more details forthcoming)

• Work with AQI to ensure proper data is being sent

– AQI has staff to review your data and reports to ensure EP’s are reporting and have a reasonable expectation of satisfactorily reporting

• Approve the final transmission of EP performance data to CMS (early 2016)

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PRESENTED BY:TERRI HOWARD, CAEDIRECTOR OF MEMBER SERVICES

ASA QCDR Service

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ASA QCDR Service

• Definition of the service

• Costs associated with participating in QCDR

• Enrollment and membership processes

• Who to contact if interested in participating

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ASA QCDR

•ASA has partnered with AQI to provide PQRS reporting as a benefit of ASA membership.

•To participate in QCDR, the entire practice enrolls in AQI’s NACOR.

– ASA members: no cost to participate in NACOR

– Non-ASA member independent providers: $1000 annually to participate

– Non-physician providers in the care team: no cost to participate

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ASA Membership / QCDR Purchase

• Group Membership / QCDR Invoice

– One invoice for all participating providers in the practice

– Membership: Both ASA and state component society dues are required

• ASA membership = $665 physicians, $335 CRNAs, AAs; state dues varies

– Non-ASA members purchase QCDR only = $295 per provider annually

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Enrollment Process

• Submit roster template of participating EPs

– Practice may add/subtract providers throughout the year

• Sign AQI & ASA agreements

• Work with AQI to submit data to NACOR

• Submit new ASA member applications, as applicable

• Practice reviews the roster prior to annual renewal of membership and QCDR service

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Questions?

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Getting Started

• Contact ASA

– Sara Moser, Director of Marketing & Corporate Development, [email protected] 847-268-9230

– Terri Howard, Director of Member Services, [email protected] 847-268-9269

– General questions: [email protected]

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Understanding PQRS and why reporting via an anesthesia QCDR is beneficial

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