Getting Started with 2015 PQRS 2015 Physician Quality Reporting System (PQRS)

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Presentation transcript:

Getting Started with 2015 PQRS 2015 Physician Quality Reporting System (PQRS)

What is PQRS? Physician Quality Reporting System PQRS is a quality reporting program that encourages individual Eligible Professionals (EPs) and group practices to report information on patient quality of care to Medicare/CMS. 2 | © 2015 HealthEC, LLC Source: cms.govcms.gov

Why PQRS? Failure to report on quality measures for 2015 data will result in a 2% - 6% penalty in →4% Penalty for individual Eligible Professionals (EPs) and/or group practices with 2 – 9 providers  2% value modifier + 2% PQRS penalty →6% Penalty for group practices with 10+ providers  4% value modifier + 2% PQRS penalty 3 | © 2015 HealthEC, LLC Source: cms.govcms.gov

List of Eligible Professionals (EPs) 4 | © 2015 HealthEC, LLC Physicians Doctor of Medicine Doctor of Osteopathy Doctor of Podiatric Medicine Doctor of Optometry Doctor of Oral Surgery Doctor of Dental Medicine Doctor of Chiropractic Medicine Therapists Physical Therapist Occupational Therapist Qualified Speech-Language Therapist Practitioners Physician Assistant Nurse Practitioner, Nurse (APRN), Certified Registered Nurse Anesthetist, Clinical Nurse Certified Nurse Midwife Clinical Social Worker Clinical Psychologist Registered Dietician Nutrition Professional Audiologist

PQRS Reporting Methodology Group Organization Reporting Deadlines: →First Deadline: June 2015 →Second Deadline: March 2016 To complete Individual EP Reporting: →Individual Measures →Group Measures 5 | © 2015 HealthEC, LLC

INDIVIDUAL ELIGIBLE PROVIDER REPORTING 6 | © 2015 HealthEC, LLC

7 | © 2015 HealthEC, LLC

EMR vs. HealthEC® Registry EMR Reporting Individual Measures Reporting ONLY →Report on:  9 Individual Measures  Covering 3 NQS Domains  For at least 50% of the EP’s Medicare Part B FFS patients Registry Reporting Individual Measure Reporting OR Measures Group Reporting → Report on:  1 Measures Group  On a 20-patient sample  Of which, 11 out of 20 must be Medicare Part B FSS 8 | © 2015 HealthEC, LLC Source: cms.govcms.gov Reporting may be accomplished via the EMR or a Certified Registry (NIHITEC powered by HealthEC®)

Steps to Successful Reporting 9 | © 2015 HealthEC, LLC Enroll & Register Fax or the completed data collection form to F: E: Receive an when the portal is open for data entry (3 rd week of December ) Log into the registry, enter each patient and data from the completed form (system allows you to verify the data and display the results) HealthEC will submit the data to CMS after verification by the practice Avoid CMS Penalty Avoid Penalty EnrollSelect Measures Collect Patient Data Enter Data on Member Portal

Measure Group Process: Next Steps Step 1| Complete Registration Form: →Practice Name/Organization Name →Physician/Provider Name → ID, Contact and Phone per Provider →Specialty per Provider →Send to Step 2| Select Measure Group: →HealthEC Confirmation will send you  List of measure groups specific to your Specialty AND  List of forms for each measure group →Complete Registration for your selected Measure Group Step 3| Identify 20 Patients; at least 11 of which must be Fee- For-Service (FFS) Medicare →Complete & Retain Data Collection Form for each patient Step 4| Enter patient data and track progression to completion for Questions, Comments or Concerns 10 | © 2015 HealthEC, LLC

AsthmaBack PainCardiovascular PreventionCataractsChronic Kidney Disease (CKD)Chronic Obstructive Pulmonary Disease (COPD)Coronary Artery Bypass Graft (CABG)Coronary Artery Disease (CAD)DementiaDiabetesGeneral SurgeryHeart Failure Hepatitis CHIV/AIDSHypertensionInflammatory Bowel Disease (IBD)Ischemic Vascular DiseaseOncology Optimizing Patient Exposure to Ionizing Radiation (OPEIR)Parkinson’s DiseasePreventive CarePerioperative CareRheumatoid ArthritisSleep ApneaTotal Knee Replacement (TKR) Measure Groups Eligible Professionals (EPs) select from among the given list and prepare to report on a sample of 20 patients from their overall patient panel. If no measure group seems appropriate, consult with a HealthEC® Analyst for solutions 11 | © 2015 HealthEC, LLC

EX: PREVENTATIVE CARE REPORTING 12 | © 2015 HealthEC, LLC

Reporting Option Selection 13 | © 2015 HealthEC, LLC

Individual Measures Option HealthEC’s PQRS Dashboard Provides: →Option to Select Measures, Description of Measure Criteria and Tool to Input Patient Data →Choose 9 Measures among 175 Measures across 3 NQS Domains →Individual Measures Option Requires:  Reporting on at least 50% of FFS Medicare Patient Panel for EACH Selected Measure 14 | © 2015 HealthEC, LLC

Measure Group Option 15 | © 2015 HealthEC, LLC

Measure Group: Metric Tracking 16 | © 2015 HealthEC, LLC

Measure Group: Summary Dashboard Upon completion of Patient Data-Entry, PQRS Report can be submitted to CMS on your behalf 17 | © 2015 HealthEC, LLC

PQRS Timeline 18 | © 2015 HealthEC, LLC

Frequently Asked Questions How do I know which measure group to report on? →Select a group that either matches your specialty or any measure group where you may have patient information in your records How do I select the patients to report on? →Select the patients (making sure at least 50% of them are Medicare FFS patients) that have the most information in the medical record How long does PQRS reporting take on average? →We estimate 5 days: 3 days to find and select the best patients and then 1 days to complete the forms and 1 day to do data entry per provider. I am a Hospitalist, do I need to report on PQRS measures? →No. However, if you do billing through an independent organization, then possibly yes. What does CMS do with this information? →CMS determines the application of the penalty and includes this information on the proposed physician compare website. 19 | © 2015 HealthEC, LLC

Contact Us 20 | © 2015 HealthEC, LLC HealthEC for problems, questions and clarifications E: P: F: W:

21 | © 2015 HealthEC, LLC