1. July 15, 2014 NATIONAL ANESTHESIA CLINICAL OUTCOMES REGISTRY (NACOR)

2. Successful PQRS Participation PQRS+MOCNot Participating Successfully in PQRS 20130.5%1.0%-1.5% (in 2015) 20140.5%1.0%-2.0% (in 2016) 2015 2016-2.0% (based on 2014 reporting 2017-2.0% (based on 2015 reporting) PQRS Incentive/Penalty Amounts* *% of Total Allowable Medicare Part B FFS Charges No PQRS Incentive, Potential +% with Value Modifier

3. VALUE MODIFIER INCENTIVE/PENALTY Performance year VM YearPhysician Group Size Possible VM Outcomes 20132015100+ EPs VM -2.0% penalty (no PQRS) 0% Up to +2.0x incentive (budget neutral) 20142016 100+EPs -2.0% penalty (no PQRS or low score) 0% Up to 2.0x incentive (budget neutral) 10+EPs VM -2.0% penalty (no PQRS) 0% Up to +2.0x (budget neutral) 20152017 ALL INDIVIDUAL PHYSICIANS Penalty % TBD (no PQRS or low score) 0% Incentive % TBD

4.  Increase reporting requirements  Emphasis on National Quality Strategy domains  New Qualified Clinical Data Registry (QCDR) option  EHR reporting option ok for GPROs  Measures groups registry-only reporting  Measures applicability validation for registry  Eliminate Administrative Claims option

5.  CMS-approved entity that collects clinical data for patient/disease tracking for quality improvement  QCDRs are typically specialty society registries like AQI’s National Anesthesia Clinical Outcomes Registry (NACOR)  Measure data across multiple payers, not limited to Medicare beneficiaries  Allowed to report “non-PQRS” and PQRS measures for successful PQRS reporting

6.  Greater potential to meet the 9/3 reporting requirements; increasing strictness with other reporting mechanisms.  Meeting multiple requirements/needs:  PQRS participation  Maintenance of certification part IV  Quality improvement  Support better outcome under the Value Modifier program; using a QCDR, quality scores:  Are easier to monitor and improve throughout the reporting year  Could be higher because of the frequent feedback/monitoring  Greater choice of measures to report=potential higher quality scores.

7. PQRS Requirements for Individual EPs Gain the 2014 PQRS Incentive (0.5%) Avoid the 2014 PQRS Payment Adjustment (-2.0%) NEW: Qualified Clinical Data Registry (QCDR) Report 9 measures across 3 NQS domains for 50% of all applicable cases (at least one “outcome” measure) Report 3 measures across at least 1 NQS domain for 50% of all applicable cases (at least one “outcome” measure Traditional Qualified Registry Report 9 measures across 3 NQS domains for 50% of applicable Medicare Part B FFS cases OR If < 9 measures apply, report 1- 8 measures for 1+ NQS domains, subject to the Measures Applicability Validation (MAV) process Be 2014 PQRS incentive eligible OR Report ≥ 3 measures for at least 50% of applicable Medicare Part B FFS patients OR If < 3 measures apply, report 1-2 for 1+ NQS domains, subject to the Measures Applicability Validation (MAV) process

8. National Anesthesia Clinical Outcomes Registry (NACOR) NACOR is a clinical data registry approved by CMS as a QCDR for the 2014 PQRS program. ASA and AQI collaborated in developing the measures to be included Proposed Measures

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