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PQRS – Provider Quality Reporting System
(formerly known as PQRI)
September 13th, 2012
Webinar
Objectives
• Timeline for reporting programs (incentives/disincentives)
• Future basis for value based purchasing
• PQRS overview / How to report ?
• I was in Medicare Care Management Performance (MCMP) – now what?? (UT, MA, CA, AR)
• Meaningful Use Quality Measures/PQRS pilot
• Central Utah Informatics – Data Submission Vendor (DSV) and Registry
2012 2013 2014 2015 2016 2017 2018 2019 2020
Programs Requiring Provider
Reporting for Participation or by Law
Federal
House Bill 128 begins
reporting clinic-level
measure results
(currently based on
claims data for clinics
with five or more
physicians)2
Accountable
Care
Organization
Formation
(Shared
Savings)9,10$$
Continued E-
Prescribing7
$$ (initial
penalties)
Meaningful
Use
Stage 2$6
Meaningful
Use
Stage 36,11$$
Utah Health
Insurance
Exchange4
Utah Medicaid
Accountable Care
Organization3
$=incentive payments
$=penalties
---future
Utah
Meaningful
Use
Stage 4
(TBD)11
House Bill 128
adds 5 new
measures
yearly2
Continued
Meaningful
Use
Stage 1$6
Continued
PQRS5$
PQRS5 $$
(initial penalties –
penalty assessed
in 2015 for 2013
reporting)
Meaningful
Use
Stage 26,11$$
(initial penalties)
CMS Value Based Purchasing
References
1) http://selecthealth.org/findadoctor/pages/providerreporting.aspx
2) http://le.utah.gov/~2011/bills/hbillamd/hb0128s02.htm
3) http://health.utah.gov/medicaid/stplan/1115%20Waivers/1115%20Waiver%20Payment%20and%20Servi
ce%20Delivery%20Reform%20Document_Jun%2029%202011v2.pdf (July 1, 2011)
4) http://www.exchange.utah.gov/images/stories/The_Utah_Health_Exchange_-
_A_Brief_Overview.pdf
5) https://www.cms.gov/PQRS/
6) https://www.cms.gov/EHRIncentivePrograms/30_Meaningful_Use.asp
7) https://www.cms.gov/ERxIncentive/10_Analysis%20and%20Payment.asp
8) http://www.medicare.gov/find-a-doctor/staticpages/data/note/Overview.aspx
9) http://www.ftc.gov/opp/aco/cms-proposedrule.PDF
10) https://www.cms.gov/sharedsavingsprogram/
11) Penalty timeline described http://www.gpo.gov/fdsys/pkg/FR-2012-03-07/pdf/2012-4443.pdf
Updated 8/2012
www.cms.gov/pqrs
What is PQRS?
• The Physician Quality Reporting System
– Pay-for-reporting program established in 2007
– Combination of incentives and payment adjustments (dis-incentives) to eligible professionals and selected group practices
– Report data on defined quality measures
• The Physician Quality Reporting System will be the basis for the Value-Based Modifier
Polling
• Will you report to CMS on Physician Quality Reporting System (PQRS) for year 2012?
– Yes
– No
– Undecided
PQRS Program Progression
Incentives and Payment Adjustments
• Federal legislation authorized incentive payments through 2014
• Payment Adjustments (Dis-incentives) are proposed for 2015 and beyond (-1.5% in 2015 and -2.0% in 2016 and beyond). The 2015 dis-incentive is based on the 2013 calendar year. Report in 2013 to avoid dis-incentive!!!
• Additional incentive of 0.5% by working with a Maintenance of Certification entity
• 2011 - 1.0% incentive • 2012 - 0.5% incentive
• 2013 - 0.5% incentive • 2014 - 0.5% incentive
Who Can Participate?
• Medicare Eligible Professionals (EPs) include physicians, practitioners, and therapists
• For details on participants see http://www.cms.gov/PQRS/Downloads/EligibleProfessionals.pdf
• These professionals must meet the minimum number or percentage of Medicare Part B Fee-for-Service patients for the measures they choose
Reporting
• Five methods to report PQRS measures:
– Claims Based Reporting
– External Registry
– EHR Data Submission Vendor Reporting
– Direct EHR Based Reporting
– Group Practice Reporting Option
• Validation steps required with all methods
• Six- (Jul-Dec) or 12- (Jan-Dec) month time periods are used based on reporting method
Polling
• If you answered yes to the first question, which method of reporting will you use for 2012 ?
– Claims
– EHR – Direct
– EHR – Data Submission Vendor
– External Registry
– GPRO
Method #1 – Claims Based Reporting
• CPT and G-Codes are added to Medicare claims that include clinical information on a subset of patients
• Medicare does the measure calculation and sends a feedback report and incentive check annually
• Providers must report on at least 3 measures of 211
Method #2 – External Registry
• Provider submits data on 3 measures electronically to a registry.
• The external certified registry then captures, stores, calculates, and submits to Medicare the measure related data.
• Registries must be certified with Medicare and starting in 2012 cannot be EHR based data. Claims or Web based.
• Select from over 200 measures
Method #3 – EHR Data Submission Vendor Reporting
• New in 2012
• Similar to registry reporting only done by EHR vendor
• The vendor captures, stores, calculates, and submits to Medicare the measure related data
• Select from over 50 measures
• Report on 80% of applicable Medicare Part B FFs patients
Method #4 – Direct EHR Based Reporting
• Provider chooses 3 measures to report
• Provider must be using a qualified EHR to report to Medicare patient level data
• Report on 80% of applicable Medicare Part B FFs patients
• List of qualified EHR products is published on the Medicare website
I was in MCMP-now what ??
• MCMP was a Medicare pilot for four years in states of UT, AR, MA, CA from 2007-2011
• Combination of claims and clinical data
• Participants received a free waiver on PQRS
• The GPRO option is very similar to MCMP. GPRO uses the same software tool as MCMP.
• More measures in GPRO than there were in MCMP.
Method #5 – Group Practice Reporting Option (GPRO)
• Available for practices of 25 or more NPIs
• Involves claims and clinical data on a larger measure set (around 26 measures)
• Claims databases are compiled by Medicare and sent to the clinics. The database is then completed either electronically or manually and sent back to Medicare. Once a year.
• Very similar to the MCMP P4P pilot program that ended in 2011
Meaningful Use Quality Measures/PQRS pilot program
• EHR-based reporting (Alignment with
Medicare EHR Incentive Program) of all three Medicare EHR Incentive Program core measures OR up to 3 Medicare EHR Incentive Program alternate core measures AND 3 additional measures for the Medicare EHR Incentive Program
• Pilot at this Stage – Beware of Delays!!
PQRS Summary
• 5 Different Ways to Report
• Get involved to avoid dis-incentives and prepare for value-based purchasing
• Contact your EHR vendor to find out which options they have available
Website: http://www.cms.gov/PQRS/
Multiple Incentive Programs
• Providers can get both the EHR-MU incentive and the PQRS incentive money.
• The e-Rx incentive is not available if a provider is receiving the EHR-MU incentive
Programs Timeline
Highlight:
PQRS Data Submission Vendor and Registry in Utah – Central Utah
Informatics
Central Utah Informatics
• Who we are?
• Why we became a registry?
• How do we collect and work with the data?
Central Utah Informatics
• What information can you submit through
our company?
• PQRS - Registry
• eRx
• PQRS - GPRO
• PQRS - DSV
Slides
• The slides are available on the HealthInsight website – under current events
http://www.healthinsight.org/Internal/HI_Events.html
www.healthinsight.org
David R. Cook MBA, C(ASCP)cm, CPEHR
Quality Improvement Team Lead
801-892-6623
www.centralutahinformatics.com
Jamie R. Steck – Director of Information Technologies (Central Utah Informatics)
Q&As
This material was prepared by HealthInsight, the Medicare Quality Improvement Organization for Nevada and Utah, 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.10SOW-UT-2012-PO-23
