TOPIC:All Gain, No Pain PQRS ReportingDec. 19th, 2012: 1:00 p.m. – 2:00 p.m.

Presented by Jim Clifford, Senior Solutions Consultant at Wellcentive

Moderator: Stephanie Gramling, Communications Leader at Physician Sales & Service

Topics of Discussion

• PQRS and CMS

• Eligible Professionals

• Reporting Options

• Wellcentive PQRS

PQRS Overview

Enter Patient

Data

Submit Registry

Data

Incentive Payment

Providers

Wellcentive CMS

Quality

Care

In Your Office

We Submit For YouAfter all your data is entered, sit back and let Wellcentive do the work of submitting to CMS

Enter Data into Wellcentive PQRSOur intuitive application gives you feedback on the data you enter

Choose How You Would Like to Enter DataManual Entry Upload Data Sheets

Gather Patient DataRun EHR Reports Billing Data From PM System Pull Paper Charts

Choose Measures To ReportPick measures that fit your specialty or what services you perform.

Choose Reporting MethodMeasure Groups Individual Measures

Eligible Professionals (EP)Physicians• MD/DO• Podiatrist• Optometrist• Oral Surgeon• Dentist• Chiropractor• Ophthalmologist

Therapists • Physical Therapist• Occupational Therapist• Qualified

Speech/Language Pathologist

Practitioners• Physician Assistant

Nurse Practitioner• Clinical Nurse Specialist• Certified Registered Nurse

Anesthetist• Certified Nurse Midwife• Certified Social Worker• Clinical Psychologist• Registered Dietician• Nutrition Professional• Audiologist

The Reporting Options

Measure Groups Individual Measures

Measure Group Reporting• 22 Diagnosis - Based Group Measures• Must report for at least 1 measure group• Must have a Performance Rate > 0%• The Reporting Period is January 1, 2012 – December 31, 2012 • 3 options for reporting:

Report 30 unique Medicare Part B

FFS patients for at least one

measure group

Report 80% or more applicable Medicare Part B FFS patients for 12 months for at

least one measure groups with a

minimum of 15 patients

Report 80% or more applicable Medicare Part B

FFS patients for 6 months for at

least one measure group with a minimum

of 8 patients

Measure Groups

– Diabetes Mellitus (6 measures)– Chronic Kidney Disease (CKD) (4

measures) – Preventive Care (9 measures)– Coronary Artery Bypass Graft

(CABG) (10 measures)– Rheumatoid Arthritis (6 measures)– Perioperative Care (4 Measures)– Back Pain (4 measures)– Hepatitis C (8 measures)– Heart Failure (5 measures)– Coronary Artery Disease (CAD) (4

measures)– Ischemic Vascular Disease (IVD)

(5 measures) – HIV/AIDS (8 measures)– Community-Acquired Pneumonia

(CAP) (4 measures)– Asthma (4 measures)– Chronic Obstructive Pulmonary

Disease (COPD)(5 measures)– Inflammatory Bowel Disease (IBD)

(8 measures)– Sleep Apnea (4 measures)– Dementia (9 measures)– Parkinson’s (6 measures)– Hypertension (8 measures)– Cardiovascular Disease (6

measures) – Cataracts (4 measures)

Measure Groups (22 measure groups)

Individual Measures

• 208 Individual Measures• Must report on a minimum of 3 measures• Must have a Performance Rate > 0• Eligible Professionals must report at least 80%

of their Medicare Part B FFS patients during the reporting period for whom the measure applies to

• The Reporting Period is January 1, 2012 – December 31, 2012

Note: For 2012 the 6-month reporting option for Individual Measures has been removed

The Bonus Payment• This is a Pay-for-Reporting program• Professionals that report in years 2012-2014 successfully

are eligible for a 0.5% percent bonus payment for PQRS.• Potential bonus payment is calculated using total allowed

charges for services furnished during the reporting period and paid under the Medicare Physician Fee Schedule.

• The penalty for not reporting in 2013 is a 1.5% payment reduction in 2015

|2012

|2013

|2014

|2015

1.5%Penalty

for not reportingin 2013/2014/2015

0.5%Incentivefor reporting

0.5%Incentivefor reporting

0.5%Incentivefor reporting

Why Registry?

2010 Success Rate: 91%*

• Submit 2012 data right up until the CMS deadline in March 2013 (no need to track claims throughout the year)

• Higher potential for meeting reporting criteria and receiving bonus payment

• Measures and measure groups updated automatically each year as information is provided by CMS, which keeps staff from having to become measure experts

2010 Success Rate: 57%*

• Must have someone in the clinic who “owns” PQRS: complete audits, know all the ins/outs, keep record of the % completed, etc.

• Auditing process can be tedious and potentially a productivity loss, especially if you have a large Medicare patient population

• Must complete and submit proper forms in proper format for eligible patients

• No internal automated check/ balance system provided by billing company: submits only what you give them

Registry-Based Claims-Based

*Centers for Medicare and Medicaid Services, 2010 PQRS Reporting Experience, February 2012

Why Wellcentive?The most streamlined, reliable reporting solution available

• Easy registry-based reporting - just provide data on 30 unique Medicare Part B FFS patients for a single measure group

• Data verification prior to submission delivers 99% incentive eligibility

• Maintain staff productivity with fast, simple reporting• Enterprise PQRS solutions available for larger organizations

A leader in PQRS reporting• Comprehensively certified by CMS since 2007• Worked with CMS to test registry submission process in 2007• Charter Founder Member of the CMS Registry Initiative

Summary

• Identify the patients for whom PQRS measures apply

• Capture clinical information• Enter your data electronically to Wellcentive or

enter manually into Wellcentive PQRS data collection tool

• We Submit the data to CMS for you• Integrate the measures into your practice• Improve Quality!

Thank You!For FAQs and to register please visit:

www.PSS-PQRS.comThe goal is improving patient wellness.