American Joint Replacement Registry’s Orthopaedic Quality Resource Center a CMS approved Qualified Clinical Data Registry (QCDR)

The AJRR Orthopaedic Quality Resource Center in collaboration with CECity, is approved by the Centers for Medicare & Medicaid Services (CMS) as a Qualified Clinical Data Registry (QCDR) A QCDR is a platform comprised of Physician Quality Reporting System (PQRS) and/or non PQRS-approved measures which qualifies as a CMS-approved reporting tool for PQRS

Qualified Clinical Data Registry (QCDR) The QCDR method provides a new standard to satisfy PQRS requirements A QCDR is a CMS-approved entity (such as a registry, certification board, collaborative, etc.) that collects medical and/or clinical data for the purpose of patient and disease tracking to foster improvement in the quality of care furnished to patients The data submitted to CMS via a QCDR covers quality measures across multiple payers and is not limited to Medicare beneficiaries Measures are not limited to traditional PQRS measures – Registries may include up to 30 non-PQRS measures Registries may include additional measures that are PQRS measures, in addition to the 30 non-PQRS measures

QCDR Reporting Requirements Individual providers must report at least 9 measures for 50% of the applicable patients per measure – Of the Nine Required Measures, at least 2 must be Outcome measures If less than 2 outcome measures are available to an EP, report on at least 1 outcome measure and also at least one of the following types of measures: – Patient Safety – Resource Use – Patient Experience of Care – Efficiency/Appropriate Use Measures must cross at least 3 National Quality Strategy (NQS) domains including: – Communication and Care Coordination, Community/Population Health, Effective Clinical Care, Efficiency and Cost Reduction, Patient Safety, and Person and Caregiver-Centered Experience

2015 Financial Risk PQRS Incentives/Penalties 2015 is the first year that there is no longer an incentive payment for PQRS participation The PQRS program now carries an automatic 2% penalty for non-participation Value-Based Modifier (VBM) Payment Adjustment (Penalty) for 2015 PQRS Non-Reporters Groups with Eligible Providers (EPs) and solo practitioners: automatic-2.0% of the Medicare Physician Fee Schedule (MPFS) downward adjustment Groups with 10+ EPs: Automatic -4.0% of MPFS downward adjustment These adjustments are additive to the 2% PQRS penalty

VBM Quality-Tiering Payment Adjustment Quality-Tiering (applies to all successful 2015 PQRS Reporters) Pay for Performance (P4P) – both quality and cost are assessed Budget Neutral (“Quality Tiering”) – rewards for the “high quality/low cost” practices will be funded by the “low quality/high cost” practices. Groups of 2-9 EPs and solo practitioners: Upward or neutral VM adjustment only (+0.0% to +2.0x of MPFS) Groups with 10+ EPs: Upward, neutral, or downward VM adjustment (up to -4.0% to or +4.0x of MPFS) Groups and solo practitioners receiving an upward adjustment are eligible for an additional +1.0x (x refers to the payment adjustment factor) if their average beneficiary risk score is in the top 25% of all beneficiary risk scores nationwide

CMS Quality Agenda “Transforming Medicare from a passive payer to an active purchaser of high quality, efficient healthcare” – CMS Fee for Service Pay for Value

2015 Financial Risk: PQRS & VBM VBM penalties are additive to PQRS penalties VBM are phasing in by group size, while PQRS penalties apply regardless of group size

Quality-Tiering Effects for 2015 Groups <10 and solo practitioners: Quality/CostLow QualityAverage QualityHigh Quality Low Cost0+1x*+2x* Average Cost00+1x* High Cost000 Quality/CostLow QualityAverage QualityHigh Quality Low Cost0+2x*+4x* Average Cost-2%0+2x* High Cost-4%-2%0 Groups 10+: * Eligible for an additional +1.0x if successfully reporting quality measures and average beneficiary risk score in the top 25% of all beneficiary risk scores.

Quality-Tiering: Quality Measures Quality Composite is derived from the following measures: PQRS measures Outcome measures: All Cause Readmission Composite of Acute Prevention Quality Indicators (bacterial pneumonia, urinary tract infection, dehydration) Composite of Chronic Prevention Quality Indicators (Chronic Obstructive Pulmonary Disease (COPD) heart failure, diabetes) Consumer Assessment of Healthcare Providers and Systems (CAHPS) (reported through PQRS Group Practice Reporting Option [GPRO]) Optional for GPROs with 2-99 Eligible Professionals (EPs) Mandatory for GPROs with 100+ EPs

Quality-Tiering: Cost Measures Quality Composite is derived from the following measures: Medicare Spending Per Beneficiary measure (3 days prior and 30 days after an inpatient hospitalization) attributed to the group providing the plurality of Part B services during the hospitalization Total per capita costs measures (Parts A & B) for beneficiaries with 4 chronic conditions: Chronic Obstructive Pulmonary Disease (COPD) Heart failure Coronary Artery Disease Diabetes (All cost measures are payment standardized and risk adjusted, and each group’s cost measures adjusted for specialty mix of the EPs in the group)

AJRR Orthopaedic Quality Resource Center The AJRR Orthopaedic Quality Resource Center, in collaboration with CECity, will provide will provide participating providers with: Timely custom continuous performance monitors related to PQRS measures Performance gap analysis and patient outlier identification Access to improvement interventions to close performance gaps including patient care management tools; targeted education; resources and other evidence-based interventions Comparison versus registry benchmarks and peer-to-peer comparison

AJRR Orthopaedic Quality Resource Center Quality Improvement measures supported are specifically chosen for orthopaedic practices Use measure data to submit to CMS to satisfy PQRS requirements Participating in this QCDR registry will allow : Eligible professionals to submit their quality measure results to CMS to meet their PQRS quality reporting requirements

AJRR Orthopaedic Quality Resource Center -Approved CMS QCDR 1 of 50 approved QCDRs will allow eligible professionals to submit their QCDR quality measure results to CMS to meet their PQRS quality reporting requirements: Avoid the value-based payment modifier negative payment adjustment in 2017 Avoid the 2% PQRS negative payment adjustment in total PQRS measures

Measures A QCDR is not limited to measures within PQRS A QCDR may submit measures from one or more of the following categories with a maximum of 30 non-PQRS measures allowed: Clinician & Group Consumer Assessment of Healthcare Providers and Systems (CGCAHPS) National Quality Forum (NQF)-endorsed measures Current 2015 PQRS measures Measures used by boards or specialty societies Measures used in regional quality collaborations

AJRR Orthopaedic Quality Resource Center Measures Perioperative Care Measures: Perioperative Care: Selection of Prophylactic Antibiotic – First OR Second Generation Cephalosporin Perioperative Care: Discontinuation of Prophylactic Parenteral Antibiotics Perioperative Care: Venous Thromboembolism (VTE) Prophylaxis Total Knee Replacement Measures: Shared Decision-Making: Trial of Conservative (Non-surgical) Therapy Venous Thromboembolic and Cardiovascular Risk Evaluation Preoperative Antibiotic Infusion with Proximal Tourniquet Identification of Implanted Prosthesis in Operative Report

AJRR Orthopaedic Quality Resource Center Measures Diabetes: Hemoglobin A1c Poor Control Osteoarthritis (OA): Function and Pain Assessment Documentation of Current Medications in the Medical Record Pain Assessment and Follow-Up Functional Deficit: Change in Risk- Adjusted Functional Status for Patients with Knee Impairments Preventive Care and Screening: Tobacco Use: Screening and Cessation Intervention Patient centered Surgical Risk Assessment and Communication Unplanned Hospital Readmission within 30 day Postoperative period Unplanned Hospital Readmission within 30 day of Principal procedure Surgical Site Infection

AJRR Orthopaedic Quality Resource Center Measures Eligible Professionals must select two (2) of the following outcome measures : Knee injury and Osteoarthritis Outcome Score (KOOS) KOOS Shortform (KOOS-PS) Oxford Knee Score Knee Society Knee Scoring System Short Form 36 Health Survey (SF-36) Veterans RAND 12 item Health Survey (VR-12) Patient Reported Outcomes Measurement Information System (PROMIS)-10

Data Entry Data entry and upload tools are available to manage the data entry process CECity can also automate the flow of data from your electronic health record

Performance Monitor Quality scores for each measure will be calculated and displayed in the performance monitor (as frequently as daily) Other features include: Performance measure gaps and a list of patient outliers Link to interventions and improvement tools Peer comparators

Performance Management Dashboard Components Performance Trending Diabetes: Hemoglobin A!c Poor Control Functional Status Assessment for Knee Replacement Perioperative Care: Selection of Prophylactic Antibiotic – First OR Provider Score How do we improve? Links to Interventions Peer Comparators Measure Name

How to Use the AJRR Orthopaedic Quality Resource Center Steps for Participation STEP 1: Determine if the professional is eligible to participate The list of EPs able to participate as individuals is available on the PQRS web page at: STEP 2: Go to the following website to register:

2015 PQRS Once you have completed the registration follow these steps: – Submit data manually or via upload tool Select at least 9 measures for PQRS Reporting Report on at least 50% of your applicable patients (all payers) Ensure that at least 3 NQS Domains are covered Ensure that at least 2 Outcome Measures are selected – If less than 2 outcome measures are available to an EP, report on at least 1 outcome measure and also at least one of the following types of measures: » Patient Safety » Resource Use » Patient Experience of Care » Efficiency/Appropriate Use – Complete Attestation Module for submission to CMS

AJRR Orthopaedic Quality Resource Center Pricing for PQRS reporting and access to the AJRR Orthopaedic Quality Resource Center is $439 (on an individual eligible professional/healthcare professional basis): DATA MUST BE SUBMITTED BY February 26, 2016 FOR THE 2015 CALENDAR YEAR REVIEW PERIOD Questions?