quality reporting: difficult to live with it; even more difficult to survive without it! the...

Quality Reporting: Difficult to Live With It; Even More Difficult to Survive Without It!

The Wisconsin Experience

Introductions

• George M. Lange, MD, FACP, OSMAP

• Rick AbramsCEO at Wisconsin Medical Society

• Chris KleineProduct Director at Physician Compass

Medicine’s Challenge

What will our future state look like?“The best way, the only way, to predict the future is to create it!”

- Peter Drucker

Important Fact

• Health Information Technology and Quality Reporting are here to stay–Whether we like it or not

The Badger State’s Response to this Challenge and Future Reality?

• We will embrace it and proactively create a successful future; We will not resist it

Quality Reporting in Wisconsin

History• MD/DO Executive’s 2002

Assessment of the future –Future success will be driven by: • Transparency of information to the

patient• Evidence-based, data driven medical

outcomes

Wisconsin’s Proactive Response

• Wisconsin Collaborative for Healthcare Quality – WCHQ was founded in 2003– Voluntary multi-stakeholder consortium of

physicians, healthcare organizations, payers and business groups

– Committed to publicly reporting performance measures to help improve healthcare

– Currently claims 40 healthcare organizations as members

Taking Quality Reporting to the Next Level

• Necessity of having to do so – April 2015: Enactment of Medicare

Access and CHIP Reauthorization Act (MACRA)• The Good News: SGR is repealed! • The Challenging News: Medicare payment

will transition from a volume-driven to a value-driven payment model• The Challenging News: The majority of

physicians across the nation are woefully unprepared for this future state

Options to Deal with this Future State

• Drop out of Medicare? Retire?– Not much of an option for many physicians

• Accept a reduction in payment that starts at 4% in 2019 and accelerates to 9% in 2022 and beyond? – Again, not much of an option

• Acquire the tools to get out ahead of the transition so that the future will by marked by growth and prosperity; not by anguish and financial ruin

Wisconsin’s Choice? • We have chosen to “tame the beast” • In concert with our county and

specialty medical society colleagues, the Wisconsin Hospital Association, the Collaborative and others, we have chosen to arm our physicians for future success; Here’s how:

Qualified Clinical Data Registry (QCDR)

• The Collaborative sought and received from CMS the QCDR designation in 2014– Significance: Enabled Wisconsin physicians,

individually or as part of their group, to successfully report quality measures to comply with the Physician Quality Reporting Program (PQRS)

– Significance: The Collaborative is one of the few QCDR’s that is not specialty specific

Taking Quality Reporting to the Next Level

• With the enactment of MACRA, we have created a tool that will enable all physicians regardless of specialty, geography or practice environment to successfully comply with current quality reporting requirements and to position physicians to successfully participate in the new world of the Merit-based incentive payment system (MIPS) and Alternate Payment Mechanisms (APM)

Taking Quality Reporting to the Next Level

• That tool is:

Physician Compass!

Physician Compass• Founded in 2015 to utilize the experience

and workflows created by WCHQ• Expand the success realized in Wisconsin

to physician groups at the national level• Enable physician groups to satisfy current

compliance initiatives and align for future quality reporting programs

Physician CompassOverview

• Qualified Clinical Data Repository (QCDR)

• Rich history of clinical integration, quality measure development and reporting

• Created by physicians, for physicians– to improve the health of our patients

Physician Compass Solutions

• Physician Quality Reporting System (PQRS)

• Custom Quality Reporting and Measure Creation

Physician Compass SolutionsPQRS Overview

• Physician Quality Reporting System (PQRS)– PQRS is a reporting program managed

by the Center of Medicare and Medicaid Services (CMS)

– Promotes physicians and other health professionals to submit quality information

– Quality metrics are submitted annually to CMS

Physician Compass SolutionsPQRS

• Incentives and Penalties on Medicare Payments

(Groups of 10+ EPs)

Service Dates

Year of Impact

PQRSPenalty

Value Based Modifier Adjustment

EHRPenalty

Total Penalty for not reporting PQRS

(PQRS Penalty + VBM) Negative Neutral Upward

2015 2017 -2.00% -4.00% 0.00% +4.00% -3.00% -6.00%2016 2018 -2.00% -4.00% 0.00% +4.00% -4.00% -6.00%

Physician Compass SolutionsPQRS

• Service Dates 2017 - 2020

Service Dates

Year of Impact

MIPS (Merit Based Incentive Payment System)

Negative Positive High Performers2017 2019 -4.00% +4.00% +10.00%2018 2020 -5.00% +5.00% +10.00%2019 2021 -7.00% +7.00% +10.00%2020 2022 -9.00% +9.00% +10.00%

GPSGroup Processing System

• Group & Individual Measure Reporting– Group Reporting (Tax ID level) - GPRO

• Data Submission Vendor (DSV)• Registry

– Individual Reporting (Provider level)• Registry• Qualified Clinical Data Registry (QCDR)

• Target market is practices with >25 providers

MAPSManual Abstraction and Processing System

• Individual Measure Reporting using Measure Groups– Manual entry of 20+ patients (>50% must be

Medicare)– Currently available Measure Groups• Preventative Care• Diabetes• Additional groups to be added for 2016

• Target market is small practices (1 – 25 providers)

Custom NavigatorCustom Quality Reporting

• Flexible application to create custom quality measurements

• Target quality measurements to better understand a specialty area or patient population

• Measurements are facility/health system specific

• Fully configurable numerator/denominator criteria

Convenient File Formats• Comma Separated Values (.csv)

format• Standardize data via data mapping• Files available to be extracted from

customerProvider Master List Blood Pressure FileClinic Master List Tobacco FilePatient File Medication FilePatient Header File Procedure (CPT) FileEncounter File Problem List FileClinical Data File Inpatient File

Product Pricing

Provider Count

Annual Fee

Per Provider

FeeAnnual

Minimum

GPS ALL $4,000 $150 $6,000

MAPS0-25 $0 $275 None26-50 $0 $250 None51+ $0 $225 None

Custom Navigator Based on project specifications.

Physician CompassAligning for the Future

• Physician Compass’ products and its ability to measure clinical data will enable physicians to comply with future quality reporting programs

• Nimble, flexible platform can quickly enhance and adapt to complex government quality reporting initiatives such MIPS and APM

Summary and Key Points• Experienced, successful clinical data

registry– Reported PQRS for 4,000+ providers in

2014– Estimated 5,000+ providers in 2015

• Reputable clinical quality measurement reporting

• Simple, affordable PQRS and MU solution for all sizes of physician groups and practice environments

Questions?Thank you!