1. 1. Physician Quality Reporting System:A Quick Look at theOpportunities and Pitfalls Adele Allison National Director of Government Affairs, SuccessEHS
2. 2. Whats Covered
   • The Rundown
   • The Opportunities & Pitfalls
   • The 2011 Incentive
   • The Future
   • The Helpful Links
3. 3. The Rundown
   • Started in 2007 originally called PQRI (Physician Quality Reporting Initiative) and had 74 Clinical Measures
   • Must report quality measures for Medicare Part B Physician Fee Schedule (PFS) patients
4. 4. The Rundown
   • No enrollment / registration
   • Voluntary today
5. 5. The Rundown
   • The Evolution of Reporting Methods
   • • 2007: Claims-based reporting (Medicare Part B)
   • • 2008: Registry-based reporting (Qualified CMS Registry)
   • • 2010: EHR-based reporting (Qualified EHR)
6. 6. The Rundown
   • 2011 PQRS
   • • 190 Measures(Claims / Registry)
   • • 20 Measures(EHR)
   • • • Incentive 1% of total estimated PFS allowed charges during reporting period
   • • • Additional 0.5% incentive available for Maintenance of Certification Program
7. 7. The Opportunities Potential Incentives 2011 2012 2013 2014 2015 2016 2017 PQRS Only 1.0% 0.5% 0.5% 0.5% PQRS and MOC 1.5% 1.0% 1.0% 1.0% EHR Incentive Program* Up to $18,000 Up to $12,000 Up to $8,000 Up to $4,000 Up to $2,000 Varies ePrescribing** 1.0% 1.0% 0.5%
8. 8. The Pitfalls * Meaningful Use incentives will vary based upon year initiated and EPs allowable charges. ** EPs cannot receive Medicare EHR Incentives and eRx Incentives, but can received Medicaid EHR Incentives and eRx Incentives.Potential Adjustments 2011 2012 2013 2014 2015 2016 2017 ePrescribing 0 -1% -1.5% -2% PQRS -1.5% -2.0% -2.0% EHR Incentive Program -1.0% -2.0% -3.0% Value Modifier TBD TBD TBD TOTAL POTENTIAL 0 -1% -1.5% -2% -2.5% -4.0% -5.0%
9. 9. The 2011 Incentive
   • Who is eligible?
   • • Eligible professionals providing services paid based on Physician Fee Schedule
   • • • Physicians: MD, DO, DPM, OD, Oral Surgeons, DMD/DDS, DC
   • • • Practitioners: PA, NP, NS, CRNA, Anesthetist Assistant, Midwife, SW, Psychologist, RD, Nutritionist, Audiologist
   • • • Therapists: PT, OT, Speech
10. 10. The 2011 Incentive
    • Who isnt eligible?
    • • Providers with Medicare Administration Contractors with no direct bill
    • • Providers paid under Medicare fiscal intermediaries or MACs
    • • Services payable under fee schedule other than PFS
    • • • FQHCs and RHCs
    • • • Independent diagnostic testing / laboratory facilities
    • • • Ambulatory surgery centers
11. 11. The 2011 Incentive
    • What will eligible providers do?
    • • Report at least 3 PQRS measures
    • • • 13 overlap with Meaningful Use
    • • • Threshold of 80% eligible instances
    • • Report during the required 12 months (Jan. 1 Dec. 31, 2011
    • • • Single submission to CMS
12. 12. The 2011 Incentive
    • Receive Individual Authorized Access to CMS Computer Services account (IACS)
    • • • IACS Quick Reference Guides
    • • • • Clickhere
    • • • New User Registration Menu for CMS Applications
    • • • • Clickhere
    • • • Provider PECOS enrollment must be current
13. 13. MU-PQRS Overlap PQRS Measures Description 1, 2 and 3 Diabetes Measures: A1c Poor control, LDL-C, BP(MU) 5 Heart Failure:ACE Inhibitor(MU) 7 CAD:Beta-Blocker for MI(MU) 39 Screening / Therapy Osteoporosis in Women 47 Advance Care Plan 48 Urinary Incontinence:Assessment or Absence of 110, 112 Preventive: Flu Vaccine and Mammography(MU) 111 Preventive:Pneumonia Vaccination(MU) 113 Preventive:Colorectal Cancer Screening(MU) 124 HIT Measure:EHR Adoption or Use 128 BMI:Screening and F/up(MU) 173 Preventive:Unhealthy Alcohol Use Screening 237 Blood Pressure Measure(MU) NQF 0022 Drugs to be Avoided in the Elderly NQF 0024 BMI Children Measure ages 2 through 18(MU) 226 Preventive:Tobacco Use Measure Screening and Cessation Intervention(MU) NQF 0038 Childhood Immunization Status(MU)
14. 14. The Future of PQRS
    • Development / Testing underway building upon 2011 PQRS
    • 2012 PQRS Proposed Rule:
    • • 53 measures includes all 44 HITECH measures (similar in logic and coding as possible for alignment with MU)
    • • In 2013, measure specs should be 100% the same between PQRS and MU
    • • For EPs doing PQRS & MU if EP reports PQRS successfully, they meet CQM reporting for MU
15. 15. The Future of PQRS
    • CMS must publish by 1.1.2012
    • • Quality of Care and Cost measures for the modifier
    • • Modifier implementation dates
    • • Initial performance period for value modifier application in 2015
    • 2011: Feedback reports to MDs in IA, KS, MO and NE (56,000 physicians)
16. 16. The Future of PQRS
    • 2012: Feedback reports to 100,000 physicians
    • 2012 & 2013: Limited application of an episode grouper
    • 2015: Certain practices affected
    • 2017: All practices affected
17. 17. The Future of PQRS
    • Remember: CMS will pay differentially based on quality and cost composites
    • 2015 Modifier will be based on CY2013 Performance Period
18. 18. The Helpful Links
    • For portal passwords, PQRS, IACS registration/login, program and measurement-specific questions
    • • QualityNet Help Desk
    • • • 866.288.8912
    • • • [email_address]
    • • Provider Contact Center :Clickhere
    • • CMS PQRS Reporting :Clickhere