PQRS NYeC Practice Quality Resources & Registry June 8, 2015

What is this? Provides access to a CMS Qualified PQRS Registry What is PQRS Reporting? PQRS gives participating Practices/ EPs the opportunity to assess the quality of care they are providing to their patients. By reporting PQRS quality measures, providers also can quantify how often they are meeting a particular quality metric. Using the feedback report provided by CMS, EPs can compare their performance on a given measure with their peers. Why use this? Single Source for Practices to access HIT/MU & Quality Information A web based gateway that enables practices / providers a single Access Point to HAPS Services, Education tools, training and support. It offers a CMS Qualified Registry to report PQRS measures NYeC Practice Quality Resources & Registry

Practice Support Resources NYeC Practice Quality Resources & Registry CMS PQRS Registry Advocacy New Regulations MU Audit Support Education Meaningful Use Stage 1 or 2 Practice Transformation All Inclusive Provider Resource

What is PQRS ? PQRS is a quality reporting program that uses negative payment adjustments to promote reporting of quality information by individual EPs and group practices. Those who do not satisfactorily report data on quality measures for covered Medicare Physician Fee Schedule (MPFS) services furnished to Medicare Part B beneficiaries (including Railroad Retirement Board, Medicare Secondary Payer, and Critical Access Hospitals [CAH] method II) will be subject to a negative payment adjustment under PQRS.

National Quality Strategy Domains 1. Patient and Family Engagement 2. Patient Safety 3. Care Coordination 4. Population/Public Health 5. Efficient Use of Healthcare Resources 6. Clinical Process/Effectiveness

Who’s Eligible to Participate Medicare Providers MDs DOs Dr. of Podiatric Medicine Dr. of Optometry Dr. of Oral Surgery Dr. of Dental Medicine Dr. of Chiropractic Practitioners Physician Assistant Nurse Practitioner Clinical Nurse Specialist Certified Registered Nurse Anesthetist (and Anesthesiologists Assistant Certified Nurse Midwife Clinical Social Worker Clinical Psychologist Registered Dietician Nutrition Professional Audiologists Therapists Physical Therapist Occupational Therapist Qualified Speech- Language Therapist

Reporting Options Qualified Registry Reporting electronically using an electronic health record (EHR) Qualified Clinical Data Registry (QCDR) PQRS group practice via GPRO Web Interface CMS-Certified Survey Vendor Claims (CAHPS)

Reporting Criteria Reporting ProtocolConditionsDefined Individual Measures EPs who submit quality data for less than 9 PQRS measures covering 3 NQS domains for at least 50% of the EP’s Medicare Part B FFS patients OR who submit data for 9 or more PQRS measures covering less than 3 domains for at least 50% of the EP’s Medicare Part B FFS patients eligible for each measure OR who do not report on at least 1 cross-cutting measure if had a face-to-face encounter will be subject to Measure-Applicability Validation (MAV). Measures with a 0% performance rate will not be counted An EP who sees at least 1 Medicare patient (face-to-face encounter) must report on 1 cross- cutting measure. Report on at least 9 individual measures covering 3 National Quality Strategy (NQS) domains for at least 50% of the EP’s Medicare Part B FFS patients. Measure Groups For this reporting mechanism, EPs should use the 2015 Physician Quality Reporting System (PQRS) Measures Groups Specifications Manual on the Measures Codes page of the CMS PQRS website at Instruments/PQRS/MeasuresCodes.html to find applicable measures groups. Beginning in 2015, the only reporting period available is 12 months. Report at least 1 measures group on a 20-patient sample, a majority of which (at least 11 out of 20) must be Medicare Part B FFS patients. Group Practices Group practices that submit quality data for less than 9 PQRS measures for at least 50% of their patients or encounters eligible for each measure, OR that submit data for 9 or more PQRS measures covering less than 3 domains for at least 50% of their patients or encounters eligible for each measure OR who do not report on at least 1 cross-cutting measure if had a face-to-face encounter will be subject to MAV. Measures with a 0% performance rate will not be counted An EP who sees at least 1 Medicare patient (face-to-face encounter) must report on 1 crosscutting measure. Report on at least 9 measures covering at least 3 NQS domains for at least 50% of the group’s Medicare Part B FFS patients.

PQRS GPRO Reporting Single Taxpayer Identification (TIN) with 2 or more Providers: All EPs must be billing under the same TIN Once a practice selects its reporting method it is the ONLY PQRS reporting method CMS will analyze for the practice under. If an organization or EP changes TINs, the registration under the old TIN does not carry over to the new TIN If a TIN’s organzition name changes after the GPRO registration period closes. The name used during registration will be used by CMS for reporting analysis. June 30 th is the deadline for GPRO registration

Penalties EPs that fail to report quality measures, eRX or attest to meaningful use could be subject to up to a 6% payment penalty in 2017

Payment Reforms

NYeC PQRS Registry Reporting Services Measures Analysis, Patient Selection, Capture Tool Setup Data Entry Evaluation of EMR Records for compliance Project Management defining the project timeline, reporting setup, data abstraction Guidance on Data collection accuracy Analytics: deliver real time accurate and documented PQRS measure Abstraction Progress Final submission of quality measures to the PQRS Registry

REC|EP2 Program Differences MilestonesDescriptionRECEP2 1Signup $0 2Go-Live/AIU $0 $1350 3MU1 $1500 $1350 $2250 4MU2 $0 $2000 RECEP2 Signup and Go-Live GC Cap reachedNo limit on enrollment 10 Provider Site LimitNo Site Limit Only MU 1 Slots availableAIU, MU1, and MU2 Slots available Program Ends April 7, 2016Program Ends September 30, 2016 Not Likely to be extendedLikely to be extended

EP2 Outreach and Education Required Text to Include: Portions of the information presented today were to support the Medicaid Eligible Professional Expansion Program (EP2) and Meaningful Use activities and adoption of electronic health records (EHR). Related content was presented on behalf of NYeC for the promotion of the EP2 program and Meaningful Use Presentation Details Needed Date: June 8 th, 2015 Presenter: P. Frizzell Presentation Title: NYeC Practice Quality Resources & Registry Conference Name: Presentation File Name: Link to online Materials: