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Beyond the First Year of MU in 2014 Clinical Quality Measures and the Physician Quality Reporting System Presenters: Randy Marsden – Chief Client Officer.

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Presentation on theme: "Beyond the First Year of MU in 2014 Clinical Quality Measures and the Physician Quality Reporting System Presenters: Randy Marsden – Chief Client Officer."— Presentation transcript:

1 Beyond the First Year of MU in 2014 Clinical Quality Measures and the Physician Quality Reporting System Presenters: Randy Marsden – Chief Client Officer Leo Vilenskiy – Senior Customer Support Representative Rebecca Imhoff – Special Projects Coordinator

2  Please feel free to ask a question at any time via chat  Please include your name and what practice you are from  We will also have a Q and A session at the end of the webinar  The video of the webinar as well as the slides will be available on the Government Regulations in 2014 page on the IO Practiceware Support Website. Any Questions??

3  As of 2014, all providers regardless of whether they are reporting for Stage 1 or Stage 2, will be required to report 2014 CQMs. **Reporting CQM for the entire year electronically, will also satisfy PQRS** 2014 Clinical Quality Measures (CQM) IF beyond your first year in 2014: -Report CQM data electronically -Report for the entire year to satisfy PQRS -If reporting PQRS via claims, you can report CQM in the following periods to coincide with your MU reporting: -April 1 – June 30 -July 1 – September 30 -October 1 – December 31

4 CQM Measures IO Supports DomainMeasures Care CoordinationClosing the Referral Loop; receipt of specialist report CMS #50 / NQF #TBD Clinical Process/EffectivenessDiabetes: Eye Exam CMS #131 / NQF#55 Cataracts: 20/40 or Better Visual Acuity within 90 Days following Cataract Surgery CMS #133 / NQF #565 Documentation of Presence or Absence of Macular Edema and Level of Severity of Retinopathy (CMS #167 /NQF #88) Diabetic Retinopathy: Communication with the Physician Managing Ongoing Diabetes Care CMS # 142 / NQF #89 Primary Open Angle Glaucoma (POAG): Optic Nerve Evaluation CMS #143 / NQF# 86 Controlling High Blood Pressure CMS #143 / NQF #86 Patient SafetyCataracts: Complications within 30 Days Following Cataract Surgery Requiring Additional Surgical Procedures CMS #132 / NQF #564 Use of High Risk Medication in the Elderly CMS #156 / NQF #22 Documentation of Current Medications in the Medical Record CMS #68 / NQF #419 Population and Public HealthPreventative Care and Screening: Tobacco and Cessation Intervention CMS #138 / NQF #28 Preventative Care and Screening: Body Mass Index (BMI) Screening and Follow Up CMS #138 / NQF #28

5  You will need to report 9 of the measures from 3 different domains.  You must send data for all patients seen during the period, however there is no minimum performance goal for each measure.  In this webinar, we are going to give you a description of the previous listed measures. For detailed steps for your users, visit support.iopracticeware.com  https://support.iopracticeware.com/support/iopracticewar einc/ShowHomePage.do?RefererFrom=Google#Solutions/d v/9b51cc23a64d23dfeaea513c2d3e0cdde612657a51fd5fbe https://support.iopracticeware.com/support/iopracticewar einc/ShowHomePage.do?RefererFrom=Google#Solutions/d v/9b51cc23a64d23dfeaea513c2d3e0cdde612657a51fd5fbe CQM Measures IO Supports

6 Closing the referral loop; receipt of specialist report (CMS #50/ NQF # TBD) Percentage of patients with a referral to a specialist, for which your provider receives a consultation report from the specialist. Care Coordination

7 Percentage of patients 18-75 years of age with Diabetes who had a dilated eye exam or a negative retinal exam within 12 months prior to the reporting period Clinical Process / Effectiveness Diabetes Eye Exam (CMS #131 / NQF #55)

8 Cataracts: 20/40 or Better Visual Acuity within 90 Days Following Cataract Surgery (CMS #133 / NQF #565) Percentage of patients 18 years of age and older with a diagnosis of uncomplicated cataract who had cataract surgery within the reporting period and no later than 3 months prior to the end of the reporting period and no significant ocular conditions impacting the visual outcome of surgery and had the best-corrected visual acuity of 20/40 or better (distance of near) achieved within 90 days following the cataract surgery. Clinical Process / Effectiveness

9 Diabetic Retinopathy: Documentation of Presence or Absence of Macular Edema and Level of Severity of Retinopathy (CMS #167 /NQF #88) Percentage of patients aged 18 years or older with a diagnosis of diabetic retinopathy who had a dilated macular or fundus exam performed which included documentation of the level of severity of retinopathy and the presence or absence of macular edema during one or more office visits within 12 months. Clinical Process / Effectiveness

10 Diabetic Retinopathy: Communication with the Physician Managing Ongoing Diabetes Care (CMS #142 / NQF #89) Percentage of patients ages 18 years and older with a diagnosis of diabetic retinopathy who had a dilated macular or fundus exam performed with documented communication to the physician who manages the ongoing care of the patient with diabetes mellitus regarding the findings of the macular or fundus exam at least once within 12 months **For this measure, 2 or more visits** Clinical Process / Effectiveness

11 Primary Open Angle Glaucoma (POAG): Optic Nerve Evaluation (CMS #143 / NQF #86) Percentage of patients aged 18 years and older with a diagnosis of POAG who have an optic nerve head evaluation during one or more office visits within 12 months Clinical Process / Effectiveness

12 Controlling High Blood Pressure (CMS #143 / NQF #86) Percentage of patients age 18-85 who had a diagnosis of hypertension and whose blood pressure was adequately controlled (<140/90mmHg) during the measurement period. Clinical Process / Effectiveness

13 Cataracts: Complications within 30 Days Following Cataract Surgery Requiring Additional Surgical Procedures (CMS #132/ NQF #564) Percentage of patients aged 18 years and older with a diagnosis of uncomplicated cataract who had cataract surgery and had any of a specified list of surgical procedures in the 30 days following cataract surgery which would indicate the occurrence of any of the following major complications: retained nuclear fragments, endophthalmitis, dislocated or wrong power IOL, retinal detachment, or wound dehiscence. **For this measure, lower score indicates better quality** Patient Safety

14 Use of High-Risk Medications in the Elderly (CMS #156/ NQF #22) Percentage of patients 66 years of age and older who were ordered high- risk medications. Two rates are reported. **For this measure, lower score indicates better quality** Patient Safety

15 Documentation of Current Medications in the Medical Record (CMS #68/ NQF #419) Percentage of specified visits for patients aged 18 years and older for which the eligible professional attests to documenting a list of current medications to the best of his/her knowledge and ability. This list must include ALL prescriptions, over-the-counters, herbals, and vitamin/mineral/dietary (nutritional) supplements AND must contain the medications' name, dosage, frequency and route of administration. Patient Safety

16 Preventative care and Screening: Tobacco Uses: Screening and Cessation Intervention (CMS #138/ NQF # 28) Percentage of patients aged 18 years and older who were screened for tobacco use one or more times within 24 months AND who received cessation counseling intervention if identified as a tobacco user Evaluation and Public Health

17 Preventative Care and Screening: BMI Screening and Follow-Up (CMS #138/ NQF #28) Percentage of patients aged 18 years and older with a documented BMI during the encounter or during the previous six months, AND when the BMI is outside of normal parameters, a follow-up plan is documented during the encounter or during the previous six months of the encounter Evaluation and Public Health

18 To participate in PQRS and earn the 0.5% incentive and avoid the 2% penalty in 2016 (if YOU ARE participating in MU): To participate in PQRS and earn the 0.5% incentive and avoid the 2% penalty in 2016 (if YOU ARE NOT participating in MU or you only do CQM for 1 quarter), do 1 of the following: To participate in PQRS and avoid the 2% penalty in 2016 (if YOU ARE NOT participating in MU): Do CQM as per the MU requirements for the entire year, there is no need to additionally do PQRS if you are successfully reporting on CQM. Report 9 PQRS measures in 3 quality domains correctly for 50 percent of the eligible patients from January 1 to December 31 via claims. Report on 3 measures, covering 1 NQS domain correctly for at least 50 percent of each provider's Medicare Part B patients seen during the reporting period (1/1/14-12/31/14) on claims. 2014 PQRS Reporting

19 IO Highly Recommends: reporting CQM for the entire year This will allow you to avoid the 2% penalty and receive the 0.5% incentive Reporting PQRS

20  However, if YOU ARE NOT participating in MU and want to avoid the penalty, you can report PQRS claims based.  **NOTE: Medicare does not allow re-submission of claims for the purpose of sending PQRS codes. The only way to know for sure that Medicare is receiving your PQRS codes on your claims is to check the Medicare Explanation of Benefits (EOBs). It is your responsibility to continue to check these! ** Claims Based Reporting

21 Claims Based Reporting Initial Setup  From the Admin main screen, press Setup, Plans, find your government Medicare plan, double-click to open the setup screen.  Find the Reference field in the upper left quadrant of the screen. Make sure the code is either M, N or [.  Find the box Allow 0 Amt in the upper left quadrant of the screen. Make sure the box is checked.  The PQRS services codes are set up in the list of Services and the Allow 0 Amt box is checked on each PQRS service code if you are reporting Your Medicare plans have a reference code of M, N or [ and the Allow 0 Amt box is checked for all Medicare plans.

22 Initial Set Up in Newest Version

23 Claims Based Reporting Initial Setup  From the Admin main screen, press Setup, Services, find your PQRS code, double-click to open the setup screen.  Find the Allow 0 Amt box and make sure it is checked.  Check your Medicare EOBs frequently to make sure Medicare is receiving your PQRS codes. Your PQRS services must be added and the Allow 0 Amt box needs to be checked.

24  Patient Safety:  130: Documentation of Current Medications in the Medical Record  Communication and Coordination of Care:  141: Primary Open-Angle Glaucoma: Reduction of Intraocular Pressure by 15% or Documentation of a Plan of Care  Efficiency:  224: Melanoma: Over utilization of Imaging Studies  Clinical Process and Effectiveness:  12: Primary Open-Angle Glaucoma: Optic Nerve Evaluation  14: Age-Related Macular Degeneration: Dilated Macular Examination  18: Diabetic Retinopathy: Documentation of Presence or Absence of Macular Edema and Level of Severity of Retinopathy  140: Age-Related Macular Degeneration: Counseling on Antioxidant Supplement  19: Diabetic Retinopathy: Communication with the Physician Managing on-going care  117: Diabetes Mellitus: Dilated Eye Exam in Diabetic Patient  Population Health:  226: Preventive Care and Screening: Tobacco Use: Screening and Cessation Intervention*  Patient and Family Experience:  None Apply to Ophthalmology Claims Based Standard Measures

25  You can find links to the below information on the IO Practiceware Support Page  AAOE PQRS Support Page  CMS PQRS Page  Support Line for PQRS For More Information

26  Stage 1: Beyond the First Year of MU in 2014  Wednesday, February 26 th at 2 PM  Stage 2: Beyond the First Year on MU in 2014  Wednesday, February 26 th at 3 PM  First Year of MU in 2014  Wednesday, March 5 th at 2 PM Follow Up Webinars

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