2015 Physician Quality Reporting System (PQRS) and QRS Scott Weinberg Specialist, Quality Care &...

2015 Physician Quality Reporting System (PQRS) and

QRS

Scott WeinbergSpecialist, Quality Care & Patient Access

Objectives

• What is PQRS?• Why participate?• Who should participate?• What are the quality measures?• How to report the quality measures and

avoid payment reductions?

What is PQRS?

• CMS program (Medicare only)

• Physician Quality Reporting System– Previously known as PQRI

• Applies a payment reduction to eligible professionals (EPs) who do not satisfactorily report data on quality measures for covered professional services.

Why Report Quality Measures?

• Reporting quality measures in 2015 to avoid a 2.0% PQRS payment reduction in 2017.

• Groups of 10 or more physicians will automatically receive a 4% VBPM payment reduction in addition.

• Solo practitioners and groups of 2-9 physicians will receive an automatic 2% VBPM payment reduction.

• There is no longer an incentive available to EPs who satisfactorily report PQRS measures.

Who Should Participate?

• All MD, DO, PA, NP, CNS, APRN who are reimbursed under the Medicare physician fee schedule.

• AAD registry available to members and non-physician clinicians who are employed by AAD members.

Overall Penalties for 1-9 Provider Practice

YEAR EHR PENALTY Value Based Modifier

PQRS PENALTY TOTAL PENALTIES

2015 1% 0% 1.5% 2.5%

2016 2% 0% 2% 4%

2017 3% 2% 2% 7%

2018 4%* TBD** 2% 6% + VBM

2019 5%* TBD** 2% 7% + VBM

Note: Percentages based on Medicare Part B allowed charges.*EHR penalty will rise to 5% if less than 75% of all Medicare providers are participating in meaningful use by 2017.**Scheduled to be announced in final rule for 2016 Medicare fee schedule.

Overall Penalties for 10+ Provider Practice

YEAR EHR PENALTY Value Based Modifier

PQRS PENALTY TOTAL PENALTIES

2015 1% 0% 1.5% 2.5%

2016 2% 2% 2% 6%

2017 3% Up to 4% 2% Up to 9%

2018 4%* TBD** 2% 6% + VBM

2019 5%* TBD** 2% 7% + VBM

Note: Percentages based on Medicare Part B allowed charges.*EHR penalty will rise to 5% if less than 75% of all Medicare providers are participating in meaningful use by 2017.**Scheduled to be announced in final rule for 2016 Medicare fee schedule.

How Many Quality Measures in 2015?

• Report at least 9 measures.• Report at least 50% of applicable patients

for each measure for the full year.• Measures should cover at least 3 National

Quality Strategy domains.• Measures should cover at least 1 “cross-

cutting measure.”

National Quality Strategy Domains

1) Patient Safety

2) Patient and Caregiver-Centered Experience and Outcomes

3) Communication and Care Coordination

4) Effective Clinical Care

5) Community/Population Health

6) Efficiency and Cost Reduction

5 Dermatology-Specific Measures

1) Measure #137 — Melanoma: Continuity of Care — Recall System

2) Measure #138 — Melanoma: Coordination of Care

3) Measure #224 — Melanoma: Overutilization of Imaging Studies

4) Measure #265 — Biopsy Follow-Up

5) Measure #337 — Tuberculosis Prevention for Psoriasis and Psoriatic Arthritis Patients on a Biological Immune Response Modifier

13 Dermatology-Applicable Measures (included in AAD registry)

• Measure #397 – Melanoma Reporting (pathology)• Measure #46 - Medication Reconciliation (cross-cutting)• Measure #47 - Care Plan (cross-cutting)• Measure #110 - Preventive Care and Screening: Influenza

Immunization (cross-cutting)• Measure #111 - Pneumonia Vaccination Status for Older

Adults (cross-cutting)• Measure #128 - Preventive Care and Screening: Body

Mass Index (BMI) Screening and Follow-Up (cross-cutting)• Measure #130 — Documentation of Current Medications

in the Medical Record (cross-cutting)

Included in AAD registry, cont.

• Measure #131 — Pain Assessment and Follow-Up (cross-cutting)

• Measure #173 — Preventive Care and Screening: Unhealthy Alcohol Use – Screening

• Measure #194 — Oncology: Cancer Stage Documented • Measure #205 — HIV/AIDS: Sexually Transmitted Disease

Screening for Chlamydia and Gonorrhea• Measure #226 — Preventive Care and Screening: Tobacco

Use: Screening and Cessation Intervention (cross-cutting)• Measure #358 — Patient-Centered Surgical Risk

Assessment and Communication

Dermatology-Applicable Measure Update

#397

Melanoma ReportingPathology reports for primary malignant cutaneous melanoma that include the pT category and a statement on thickness and ulceration and for pT1, mitotic rate.

Dermatology-Applicable Measure Codes

#397

ICD-9-CM: 172.0, 172.1, 172.2, 172.3, 172.4, 172.5, 172.6, 172.7, 172.8, 172.9 ICD-10-CM: C43.0, C43.20, C43.21, C43.22, C43.30, C43.31, C43.39, C43.4, C43.51, C43.52, C43.59, C43.60, C43.61, C43.62, C43.70, C43.71, C43.72, C43.8, C43.9 CPT: 88305

GPRO

• Group Practice Reporting Option

• 2 or more eligible providers under one TIN

• Registration with CMS must be completed by June 30, 2015

• AAD QRS supports GPRO in 2015

Measure Checklist

• Does this measure need to be reported once per patient, or once per visit?

• Does this measure apply to every Medicare patient, every Medicare patient below a certain age, or just certain diagnoses?

• Do I have at least one eligible Medicare instance for this measure?

Important for Successfully Reporting

• Report at least 50% of applicable patients/visits for each measure.

• No measure can have 0% performance.• Select measures across 3 quality domains

(automated in QRS).• Report at least one cross-cutting measure• Enter NPI and TIN correctly into the

module.

2015 QRS Timeline

Academy to close purchase of QRS December 11, 2015; January 15, 2016 is last day to submit data

In early 2016, validation of all submitted information occurs

If issues with your data arise, you will be contacted to try and remedy

Registry submits all data to CMS in February 2016

MAV Process

• “Measure-Applicability Validation”

• Allows eligible professionals to submit data that does not meet satisfactory reporting requirements, allowing for CMS review to determine validity.

• At least one cross-cutting measure must be reported.

MAV Process for Dermatology

• Successfully report measures 137, 138, and 224 (as many as apply to the provider).

• Successfully report at least one cross-cutting measure.

• No guarantee of avoiding payment reductions.

How to get started

1) Choose reporting option (individual vs. group reporting and which registry).

2) Choose measures.

3) Track and log which Medicare patients will be applicable to which measures.

How to Report

• 2015 AAD QRS now available for members and affiliated non-physician clinicians to purchase at www.aad.org/QRS.

• Information about other qualified registries available on: www.cms.gov/pqrs.

Questions?

• QRS Information: QRSSupport@aad.org, (866) 503-7546• PQRS Questions: sweinberg@aad.org, (866) 503-7546 • CMS QualityNet Help Desk:qnetsupport@hcqis.org, (866) 288-8912• Visit www.aad.org/QRS to:

• Purchase the 2015 AAD QRS Registry • View online tutorials, FAQs, and coding specifications• Latest information on PQRS