Hosts CMS, ACEP, & CEP America Emergency Medicine PQRI (Physician Quality Reporting Initiative) Open Door Forum Hosts CMS, ACEP, & CEP America

Disclaimers This presentation was current at the time it was published or uploaded onto the web. Medicare policy changes frequently so links to the source documents have been provided within the document for your reference. This presentation was prepared as a tool to assist providers and is not intended to grant rights or impose obligations. Although every reasonable effort has been made to assure the accuracy of the information within these pages, the ultimate responsibility for the correct submission of claims and response to any remittance advice lies with the provider of services. The Centers for Medicare & Medicaid Services (CMS) employees, agents, and staff make no representation, warranty, or guarantee that this compilation of Medicare information is error-free and will bear no responsibility or liability for the results or consequences of the use of this guide. This publication is a general summary that explains certain aspects of the Medicare Program, but is not a legal document. The official Medicare Program provisions are contained in the relevant laws, regulations, and rulings. CPT only copyright 2008 American Medical Association. All rights reserved. CPT is a registered trademark of the American Medical Association. Applicable FARS\DFARS Restrictions Apply to Government Use. Fee schedules, relative value units, conversion factors and/or related components are not assigned by the AMA, are not part of CPT, and the AMA is not recommending their use. The AMA does not directly or indirectly practice medicine or dispense medical services. The AMA assumes no liability for data contained or not contained herein.

Outline Introduction Reason PQRI was developed Legislative background How measures are created Importance Eligible professionals Differences b/w PQRI and Core Requirements for successful PQRI program Example of successful PQRI program 2009 ED relevant PQRI Measures Coding and submission of PQRI measures Current and future challenges References

Presenters Dennis Beck MD FACEP Richard Newell MD MPH Chair ACEP Quality & Performance Committee President and CEO, Beacon Medical Services Richard Newell MD MPH Member ACEP Quality & Performance Committee CMS Program Coordinator, CEP America Mike Granovsky MD FACEP Member ACEP National Coding and Nomenclature Advisory Committee President of MRSI (Medical Reimbursement Systems, Inc.)

Value Based Purchasing & PQRI VBP key mechanism for transforming Medicare from passive payer to active purchaser Medicare Physician Fee Schedule (PFS) is based on quantity and resources consumed, NOT quality or value of services Value = Quality ÷ Cost Incentives  higher quality + Cost containment = Enhanced value VBP Issue Paper available at http://www.cms.hhs.gov/center/physician.asp

Legislative Background TRHCA – Tax Relief & Health Care Act, 2006 established 2007 PQRI MMSEA - Medicare, Medicaid, and SCHIP Extension Act of 2007 MIPPA - Medicare Improvements for Patients and Providers Act Section 131: 2009 PQRI

Transition to Value-Based Purchasing VBP 2007 TRHCA 74 measures Claims-based only 2008 MMSEA 119 measures Claims 4 Measures Groups Registry 2009 MIPPA 153 measures Claims 7 Measures Groups Registry EHR-testing eRx 2010 TBD through rule-making

How Are PQRI Measures Developed? Created by respected group using a consensus-based process For example the ED relevant measures were developed by: AMA-PCPI - American Medical Association-sponsored Physician Consortium on Performance Improvement NCQA - National Committee for Quality Assurance ACEP is working on future measures After creation there is a public comment period Based on comments measures are molded into their final version Measures are submitted to be endorsed or adopted by a consensus organization such as the National Quality Forum (NQF)

ACEP QI Structure ACEP Standards Taskforce – 1987 ACEP Clinical Policies Committee published first guideline on Chest Pain in 1990 Over 22 clinical guidelines have been developed, from which many of ACEP quality measures are derived ACEP Quality Improvement and Patient Safety Section (QIPS), est. 1993 Task Force on Quality & Performance, est. 2004 Quality and Performance Committee (QPC) created in 2005 ACEP Measure Development Overview ACEP has long been focused on quality improvement and patient safety. In 1990 the College’s Clinical Policies Committee published its first evidence based clinical guideline on chest pain. Since that time ACEP has developed more than 18 clinical guidelines from which many of the quality measures are derived. ACEP’s Quality Improvement and Patient Safety Section, or QIPS for short, was established in 1993 and focuses on the improvement of quality patient care. Members of this section participate in quality improvement or patient safety in local hospitals, at the state and national levels, in the ACEP Quality Improvement Committee and on national advisory boards. Responding to the explosion of activity in the measurement of physician performance, in 2004 ACEP appointed a Task Force on Quality and Performance to provide expertise to the College on new congressional and administration level initiatives to establish quality measure and pay for performance requirements for physicians. ACEP also committed to more aggressively develop measures and subsequently created the Board-level Quality and Performance Committee in 2005. The Committee is charged with reviewing measures developed by internal and external entities and recommending quality measures to the ACEP Board of Directors. ACEP has been a member of the AMA Physician Consortium for Performance Improvement since 2000, and ACEP members have served on work groups developing measures related to emergency medicine such as diabetes, cardiac, depression, geriatrics, ESRD, and gastroenteritis. ACEP co-chaired the PCPI Emergency Medicine Workgroup, with significant participation from our QPC, in the development of quality measures for Emergency Medicine in 2006-7. The resulting measures were: Electrocardiogram Performed for Chest Pain Aspirin at Arrival for AMI Electrocardiogram Performed for Syncope Vital Signs for Pneumonia Assessment for Oxygen Saturation for Pneumonia Assessment of Mental Status for Pneumonia Empiric Antibiotic for Pneumonia These measures were identified as a high priority, because they: represent a subset of the most frequent presentations to emergency departments by Medicare patients; represent 100% of practicing emergency physicians treat these conditions or use the procedures; and these measures have applicable ICD-9, CPT and G codes to facilitate data extraction. These measures were approved by the Consortium and by the AQA Alliance (formerly the Ambulatory Care Quality Alliance) and became eligible for reporting in the 2007 Physician Quality Reporting Initiative (formerly the Physician Voluntary Reporting Program). 9

ACEP Activity: “EM” Measures for PQRI ACEP has been a Member of the AMA Physician Consortium for Performance Improvement since 2000 ACEP Led Consortium’s Workgroup on Emergency Medicine ACEP/Emergency Medicine Workgroup, developed EM performance measure set for the clinical areas of: Acute Myocardial Infarction (AMI) Pneumonia Chest Pain Syncope Result: Measures Eligible for EP PQRI Reporting in 2007 NOTE: ACEP developed 7 measures unique to the ED (i.e. CPT 9928x): #’s 28 and 54-59. The Stroke measures: #’s 31 and 34 are denominator 99291 (critical care). Depending on their clinical practice EP’s may elect to report on the other measures. And given some of the POA/HAC conditions, they should have these options. 10

ACEP Activity: “EM” Measures for PQRI ACEP is also active at National Quality Forum to help refine “EM” measures, and other measures that are eventually endorsed Median Time from ED Arrival to ED Departure for Admitted ED Patients. Median time from ED arrival to time of departure from the emergency department for patients admitted to the facility from ED Median Time from ED Arrival to ED Departure for Discharged ED Patients. Median time from ED arrival to time of departure from emergency department for patients discharged from the ED Admit Decision Time to ED Departure Time for Admitted Patients. Median time from admit decision time to time of departure from the ED for emergency department patients admitted to inpatient status Door to Provider. Time of first contact in the ED to the time when the patient sees the physician (provider) for the first time. Left Without Being Seen. Percent of patients leaving w/o being seen by physician Severe Sepsis and Septic Shock: Management Bundle. Initial steps in management of the patient presenting with infection (severe sepsis or septic shock) Confirmation of Endotracheal Tube Placement. Any time an endotracheal tube is placed into an airway in the Emergency Department or an endotraceal tube is placed by an outside provider and that patient arrives already intubated (EMS or hospital transfer) or when an airway is placed after patients arrives to the ED there should be some method attempted to confirm ETT placement Pregnancy Test for Female Abdominal Pain Patients. Percent of women, ages 14–50 years old, who present to ED with chief complaint of abdominal pain who have a pregnancy test (urine or serum) ordered in ED Anticoagulation for Acute Pulmonary Embolus Patients. Percent of patients newly diagnosed with a pulmonary embolus in the ED or referred to the ED with a new diagnosis of pulmonary embolus who have orders for anticoagulation (heparin or low molecular weight heparin) for pulmonary embolus while in the ED Pediatric Weight in Kilograms. Percent ED patients < 13 years of age with a current weight in kilograms documented in ED record Endorsed by NQF in 2008 11

Why Are PQRI Measures Important? Surrogate for quality Financial implications Cost control Incentives Pay-for-performance Framework for other payers Public accountability

Eligible Emergency Professionals Emergency Physicians (MD/DO) Nurse Practitioners Physician Assistants

Core & PQRI Measure Differences Who is accountable for performance? Core Measure = Hospital PQRI = Provider Who reports performance? PQRI = Billing company or provider What patients are included in the measures? Core Measure = All admitted patients regardless of payer PQRI = Both admitted and discharged Medicare Part B patients

Successful PQRI Program Requirements Organizational priority Collaboration with billing company Data collection and reporting

Successful PQRI Program Requirements Dedicated position overseeing program Provider education Timely feedback

CEP America’s PQRI Program Began in 2007 CMS Program Coordinator position created Provider Education Constantly updated web-based education In person presentations at partnership regional meetings and PA/NP meetings Development of supplemental practice material for placement in department (see example)

CEP America’s Program Performance reports Semi-Annual reports on organizational, regional level, & site level Program coordinator discusses quarterly performance with medical directors at site Timely feedback to providers (see example) Allows for individual provider quality improvement Department PI projects designed around PQRI performance

Site Feedback Report

Provider Feedback Report

Where To Start www.cms.hhs.gov/pqri www.cms.hhs.gov/pqri Overview CMS Sponsored Calls Statute/Regulations/Program Instructions Eligible Professionals Measures/Codes Reporting Analysis and Payment Educational Resources FAQ updated daily Specialty societies and associations often give coding advice; as does the carriers

2009 PQRI Measures There are 153 PQRI measures There are 10 PQRI Measures relevant to Emergency Medicine

ED Provider Quality Measures 1. Aspirin at Arrival for AMI 2. Electrocardiogram Non-Traumatic Chest Pain 3. Electrocardiogram Performed for Syncope 4. Vital Signs for Community-Acquired Bacterial Pneumonia 5. Assessment of Oxygen Saturation for Community-Acquired Bacterial Pneumonia 6. Assessment of Mental Status for Community- Acquired Bacterial Pneumonia 7. Empiric Antibiotic for Community-Acquired Bacterial Pneumonia 24

PQRI Additional ED Measures 8. Prevention of Catheter related Infections Procedure trigger- 36556 Cap, mask, gown, large field, hand washing, full prep 9. Stroke- Patients receiving DVT Prophylaxis Cross walks to 99291 10. Stroke- Consideration of TPA Retired #29: Beta-Blocker for Acute MI 25

Measure #28: Aspirin in AMI Measure description: Percentage of patients, regardless of age, with an ED diagnosis of AMI who had documentation of receiving aspirin within 24 hours before ED arrival or during ED stay If not going to provide ASA, document why Applicable E&M Levels: 99281, 99282, 99283, 99284, 99285, 99291 Applicable ICD-9 diagnosis codes: 410.01, 410.11, 410.21, 410.31, 410.41, 410.51, 410.61, 410.71, 410.81, 410.91

Measure #31: DVT PPx in Stroke & ICH Measure Description: Percentage of patients aged 18 years and older with a diagnosis of ischemic stroke or intracranial hemorrhage who received DVT prophylaxis by end of hospital day two Acute ischemic stroke patients recommend prophylactic low-dose subcutaneous heparin or low-molecular-weight heparins Acute ICH, recommend the initial use of intermittent pneumatic compression If not going to provide document medical or patient reason why not Applicable E&M Level: 99291 only Applicable ICD-9 diagnosis codes: 431, 433.01, 433.11, 433.21, 433.31, 433.81, 433.91, 434.01, 434.11, 434.91

Measure #34: t-PA in Ischemic stroke Measure description: Percentage of patients aged 18 years and older with a diagnosis of ischemic stroke whose time from symptom onset to arrival is less than 3 hours who were considered for t-PA administration Includes patients to whom t-PA was given or patients for whom reasons for not being a candidate for t-PA therapy are documented Ensure documentation of reasons why t-PA is not being administered Applicable E&M Levels: 99291 only Applicable ICD-9 diagnosis codes: 410.01, 410.11, 410.21, 410.31, 410.41, 410.51, 410.61, 410.71, 410.81, 410.91

Measure #54: EKG in Chest Pain Measure description: Percentage of patients aged 40 years and older with an emergency department discharge diagnosis of non-traumatic chest pain who had a 12-lead electrocardiogram (ECG) performed If not going to obtain an EKG document medical or patient reason for not doing so Applicable E&M Levels: 99281, 99282, 99283, 99284, 99285, 99291 Applicable ICD-9 diagnosis codes: 413.0, 413.1, 413.9, 786.50, 786.51, 786.52, 786.59

Measure #55: EKG in Syncope Measure description: Percentage of patients aged 60 years and older with an ED diagnosis of syncope who had a 12-lead ECG performed If not going to provide obtain an EKG document medical or patient reason for not doing so Applicable E&M Levels: 99281, 99282, 99283, 99284, 99285, 99291 Applicable ICD-9 diagnosis code: 780.2

Measure #56: Vital Signs in CAP Measure description: Percentage of patients aged 18 years and older with a diagnosis of community-acquired bacterial pneumonia with vital signs (temperature, pulse, respiratory rate, and blood pressure) documented and reviewed Definition of documented and reviewed: Clinician documentation that vital signs were reviewed Dictation by the clinician including vital signs Clinician initials in the chart that vital signs were reviewed, or other indication that vital signs had been reviewed Applicable E&M Levels: 99281, 99282, 99283, 99284, 99285, 99291 Applicable ICD-9 diagnosis code: 481, 482.0, 482.1, 482.2, 482.30, 482.31, 482.32, 482.39, 482.40, 482.41,482.42, 482.49, 482.81, 482.82, 482.83, 482.84, 482.89, 482.9, 483.0, 483.1, 483.8, 485, 486, 487.0

Measure #57: Oxygenation in CAP Measure description: Percentage of patients aged 18 years and older with a diagnosis of community-acquired bacterial pneumonia with oxygen saturation documented and reviewed Definition of documented and reviewed: Clinician documentation that oxygen saturation was reviewed Dictation by the clinician including oxygen saturation Clinician initials in the chart that oxygen saturation was reviewed or other indication that oxygen saturation had been reviewed If not going to document and review, document medical, patient, or system reason(s) for not doing so Applicable E&M Levels: 99281, 99282, 99283, 99284, 99285, 99291 Applicable ICD-9 diagnosis code: 481, 482.0, 482.1, 482.2, 482.30, 482.31, 482.32, 482.39, 482.40, 482.41, 482.49, 482.81, 482.82, 482.83, 482.84, 482.89, 482.9, 483.0, 483.1, 483.8, 485, 486, 487.0

Measure #58: Mental Status in CAP Measure description: Percentage of patients aged 18 years and older with a diagnosis of community-acquired bacterial pneumonia with mental status assessed Definition of mental status assessment: Medical record may include documentation by clinician that patient’s mental status was noted (e.g., patient is oriented or disoriented) Applicable E&M Levels: 99281, 99282, 99283, 99284, 99285, 99291 Applicable ICD-9 diagnosis code: 481, 482.0, 482.1, 482.2, 482.30, 482.31, 482.32, 482.39, 482.40, 482.41,482.42, 482.49, 482.81, 482.82, 482.83, 482.84, 482.89, 482.9, 483.0, 483.1, 483.8, 485, 486, 487.0

Measure #59: Abx Selection in CAP Measure description: Percentage of patients over 18 years old with a diagnosis of CAP with an appropriate empiric antibiotic prescribed Definition of appropriate empiric antibiotic Four drug classes: Fluoroquinolones, Macrolides, Doxycycline, Beta Lactam with Macrolide or Doxycycline "Prescribed" includes patients who are currently receiving medication(s) that follow the treatment plan recommended at an encounter during the reporting period, even if the prescription for that medication was ordered prior to the encounter If not going to provide appropriate antibiotic, document medical, patient, or system reason(s) for not doing so Applicable E&M Levels: 99281, 99282, 99283, 99284, 99285, 99291 Applicable ICD-9 diagnosis code: 481, 482.0, 482.1, 482.2, 482.30, 482.31, 482.32, 482.39, 482.40, 482.41,482.42, 482.49, 482.81, 482.82, 482.83, 482.84, 482.89, 482.9, 483.0, 483.1, 483.8, 485, 486, 487.0

Measure #76: CVC Insertion Measure description: Percentage of patients, regardless of age, who undergo central venous catheter (CVC) insertion for whom CVC was inserted with all elements of maximal sterile barrier technique Definition of maximal sterile barrier technique: Cap AND mask AND sterile gown AND sterile gloves AND a large sterile sheet AND hand hygiene AND 2% chlorhexidine for cutaneous antisepsis) followed If not going to use maximal sterile barrier technique document the patient reason why not Acceptable CPT procedure codes: 36555, 36556, 36557, 36558, 36560, 36561, 36563, 36565, 36566, 36568, 36569, 36570, 36571, 36578, 36580, 36581, 36582, 36583, 36584, 36585, 93503

Measure Submission Overview Currently Emergency Medicine relevant PQRI measures are submitted via a claims based mechanism. Possibly in future via EHR Reporting period: January 1, 2009 – December 31, 2009 Satisfactory reporting: > 3 PQRI measures or 1-2 measures if <3 measures apply > 80% of applicable Medicare Part B FFS patient claims for 1-3 measures 36

PQRI Operational Process The cohort population for a TIN/NPI is identified. This occurs by reviewing the denominator of the measure. CMS will identify claims with ICD 9 Diagnosis Codes. For example C/W Acute MI i.e. 410 code family Then CMS will look for the eligible CPT code for a service provided for this patient. The dual requirement of 9928x and ICD9 code 410.X will trigger the PQRI reporting requirement CMS then requires the physician report the code for the MI quality measure (if this is one of the measures the EP chooses to report). Aspirin for Acute MI 4084F

CMS PQRI Data Flow NCH Visit Documented in the Medical Record Critical Step Visit Documented in the Medical Record Encounter Form Coding & Billing N-365 NCH Analysis Contractor National Claims History File Carrier/MAC Confidential Report Incentive Payment 38

Claims-Based Reporting Principles The CPT Category II code(s) and/or G-code(s), which supply the numerator, must be reported: on the same claim for the same beneficiary for the same date of service (DOS) for the same EP (NPI within the holder of the tax ID number - NPI/TIN) All diagnoses reported on the base claim will be included in PQRI analysis. Claims may NOT be resubmitted simply to add or correct QDCs. QDCs must be submitted with a line-item charge of zero dollars ($0.00) at the time the associated covered service is performed. If a system does not allow a $0.00 line-item charge, a nominal amount can be substituted ($0.01). The submitted charge field cannot be blank. 39

Claims-Based Reporting Process Entire claims with a zero charge will be rejected Total charge for the claim cannot be $0.00 QDC line items will be denied for payment by the carrier, but are then passed through the claims processing system for PQRI analysis EPs will receive a Remittance Advice (RA) associated with the claim which contains the PQRI QDC line-item and will include a standard remark code (N365) A message that confirms that the QDCs passed into the National Claims History (NCH) file. N365 reads: “This procedure code is not payable. It is for reporting/information purposes only.” The N365 remark code does NOT indicate whether the QDC is accurate for that claim or for the measure the EP is attempting to report. 40

CMS-1500 Claim Example Example of an individual NPI reporting on a single CMS-1500 claim. See http://www.cms.hhs.gov/manuals/downloads/clm104c26.pdf for more information. The patient was seen for an office visit (99213). The provider is reporting several measures related to diabetes, coronary artery disease (CAD), and urinary incontinence: Measure #2 (LDL-C) with QDC 3048F + diabetes line-item diagnosis (24E points to DX 250.00 in Item 21); Measure #3 (BP in Diabetes) with QDCs 3074F + 3078F + diabetes line-item diagnosis (24E points to Dx 250.00 in Item 21); Measure #6 (CAD) with QDC 4011F + CAD line-item diagnosis (24E points to Dx 414.00 in Item 21); and Measure #48 (Assessment - Urinary Incontinence) with QDC 1090F. For PQRI, there is no specific diagnosis associated with this measure. Point to the appropriate diagnosis for the encounter. Note: All diagnoses listed in Item 21 will be used for PQRI analysis. Measures that require the reporting of two or more diagnoses on claim will be analyzed as submitted in Item 21. NPI placement: Item 24J must contain the NPI of the individual provider that rendered the service when a group is billing. This includes putting the individual NPI on the QDC line-items as well. The Tax ID associated with the NPI(s) on this claim is shown in Item 25. CAD BP< 80 mmHg–PQRI #3 UI Assessed–PQRI #48 CAD–PQRI #6 BP<130 mmHg–PQRI #3 AND DM–PQRI #2 24D. CPT Codes 9928x For group billing, the rendering NPI number of the individual EP who performed the service will be used from each line-item in the PQRI calcula-tions. QDC codes must be submitted with a line-item charge of $0.00. Charge field cannot be blank. Identifies claim line-item Diag pointer field must contain ICD 9 PQRI trigger Qualified PQRI (Dx) listed in Item 21. Up to 8 Dx may be entered electronically. Diabetes Mellitus 23

PQRI-Scoring Scores will be reported as a percentage of compliance Numerator- the number of patients with a PQRI code/modifier assigned Denominator-all Medicare patients with the diagnosis of acute MI and the level of services (CPT code) noted in the specification.

Meeting The Requirements QDCs translate clinical actions so they can be captured in the administrative claims process – they describe whether: The measure requirement was met – OR – The measure requirement was not met due to documented allowable performance exclusions (i.e., using CPT II performance exclusion modifiers – OR – The measure requirement was not met and the reason is not documented or is not consistent with an accepted performance exclusion

PQRI Modifiers The provider documents appropriate performance of the measure Report the unmodified code: i.e.4084F What if the quality measure was not achieved? Add a P Modifier: 1P Documentation of Medical reason 2P Documentation of Patient reason 3P Documentation of System reason 8P Reason not otherwise specified in CPT)

PQRI Coding Process - ASA for AMI Aspirin within 24 hours of arrival or during the ED stay CPT 2 Code: 4084F Aspirin received within 24 hours before ED arrival or during ED stay Aspirin not received 24 hours before ED arrival or during ED stay 1P: Documentation of medical reasons for not receiving Aspirin 2P: Documentation of patient reasons for not receiving Aspirin 8P: Aspirin not received, reason not specified

PQRI Aspirin Vignette A 72 year old female presents with an Acute MI. The physician documents giving Aspirin - Report 4084F A 68 year old male presents with an Acute MI. The physician documents not giving ASA due to a Hx of anaphylaxis - Report 4084F, 1P (medical reason) A 26 year old male using Crack presents with an acute MI and refuses Aspirin - Report 4084F, 2P (patient reason) An 82 year old male is brought in by EMS with an acute MI. Aspirin is perhaps given by EMS - Report 4084F, 8P (reason not specified)

2007 PQRI Experience Report QDC Submission Attempts 12.15% Missing NPI 18.89% Incorrect HCPCS code 13.93% Incorrect DX code 7.24% Both incorrect HCPCS code and incorrect DX code* 4.97% All line items were QDCs only 47

PQRI Results: 2007 Claims Data 631,110 unique Tax ID/National Provider Identifiers had an opportunity to participate 109,000 (15.74%) attempted to participate Certain specialties were more successful than others- emergency medicine, ophthalmology, and anesthesia

PQRI Economic Experience What does the PQRI bonus mean? 2007 Total: $36 million Average individual payment = $600 at 1.5% for 6 months Average group payment = $4,700 Largest group payment = $205,700 Opting out vs. Future requirements 109,000 reported in 2007 56,700 met reporting requirements

Common Errors Eligible claim without individual NPI Eligible claim without QDC(s) Eligible claim submitted as a QDC-only claim (no denominator information on the claim) Ineligible claim with QDC for measure Diagnosis is incorrect on claim for measure reported Surgical procedure is incorrect on claim for measure reported Age is incorrect for measure reported 50

PQRI- The Feedback Reports Confidential Feedback Reports today Hospital data is public Reporting of successful participation may occur in the future.

2009 Physician Final Rule CMS-1403-FC Page 655,664 “We are contemplating a physician compare website…for the public reporting of quality data” “It is our intent to identify the eligible professionals who satisfactorily submit data on quality measures for the 2009 PQRI on the CMS Web site in 2010” 52

Getting Your Scores Register in the IACS System Information required Individual Authorized Access to CMS Computer Services First Designate a security officer Information required Taxpayer Identification Number (TIN); Legal Business Name; Corporate Address; and Internal Revenue Service (IRS) CP-575 hard copy form. IACS User Help Desk 1.866.484.8049 EUSSupport@cgi.com

Getting Your Scores Without IACS 54

Non IACS Score Reports CMS has an alternate mechanism for 2008 PQRI feedback reports Beginning on October 19, 2009, individual EPs can call their respective carrier or A/B MAC Provider Contact Center to request 2007 Re-Run and 2008 PQRI feedback reports that will contain data based on their individual NPI. When requesting feedback reports, EPs will be asked to provide an e-mail address. EPs can then expect to receive the e-mailed feedback report within 30 days of the request 55

Provider Contact List Carrier Provider Contact Centers can answer questions concerning incentive payment status, such as: Was my incentive payment sent? What is my incentive payment amount? What does my Remittance Advice(s) mean? Provider Contact Centers http://www.cms.hhs.gov/MLNProducts/Downloads/CallCenterTollNumDirectory.zip 56

The Future Expansion of reporting options: Claims based EHR base   Expansion of reporting options: Claims based EHR base Registry based Movement away from claims based reporting “While we propose to retain the claims based reporting mechanism for 2010, we note that we are considering significantly limiting the claims-based mechanism…after 2010 .” 57

The Future – 2010 Proposed Rule PQRI Measure #34 Stroke and Stroke Rehabilitation: Tissue Plasminogen Activator  “Analytically challenging” Potentially replaced with another measure Pneumonia Measures group Measures #56,57,58, and 59 Reportable within the framework of a measures group 58

Resources Physician Quality Reporting Initiative: https://www.cms.hhs.gov/pqri CMS Quality Initiatives – General Information: http://www.cms.hhs.gov/QualityInitiativesGenInfo/ 12/9/08 Issues Paper: Development of a Plan to Transition to a Medicare Value-Based Purchasing Program for Physician and Other Professional Services http://www.cms.hhs.gov/center/physician.asp Hospital Quality Reporting: www.hospitalcompare.hhs.gov Open Door Forums: http://www.cms.hhs.gov/OpenDoorForums/ National Provider Identifier: https://nppes.cms.hhs.gov/NPPES/Welcome.do Demonstrations: http://www.cms.hhs.gov/DemoProjectsEvalRpts/

Resources American Medical Association – Physician Consortium for Performance Improvement http://www.ama-assn.org National Committee on Quality Assurance http://www.ncqa.org/ National Quality Forum http://www.qualityforum.org Medicare Payment Advisory Commission http://www.medpac.gov National Academies Press – Pathways to Quality Health Care series – performance measurement and improvement http://www.nap.edu

Resources American College of Emergency Physicians CEP America www.ACEP.org Angela Franklin, Esq. Director of Quality and Health IT afranklin@acep.org David McKenzie, CAE Reimbursement Director dmckenzie@acep.org CEP America www.CEP.com Richard Newell MD MPH RichardNewell@cep.com`

Questions?