aligning and succeeding with pqrs and meaningful use · 11/5/2015 · metastar health care quality...

MetaStar Health Care Quality Symposium November 5, 2015

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Aligning and Succeeding

with PQRS and

Meaningful Use

Marni Anderson

Quality Reporting Project Specialist

MetaStar, which represents Wisconsin in the Lake

Superior Quality Innovation Network

[email protected]

608-441-8253


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Lake Superior Quality Innovation Network focuses on

health care quality improvement initiatives that

include:

• Improving prevention coordination through

meaningful us of health information technology

• Improving quality through performance-based

incentives and reporting systems

Ben West

CTO

Health eFilings (DSV)

[email protected]

608-841-1381

mailto:[email protected]

mailto:[email protected]


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Learning Objectives

• Prepare for Pay For Performance (PFP) in the Physician office setting

• Examine how to gain efficiencies related to reporting methods for alignment between Meaningful Use and the Physician Quality Reporting System (PQRS)

• Discuss how electronic reporting can prepare you for the Merit Based Incentive Payment System (MIPS)


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2015 Reporting Year Payment

Adjustments

Who is an Eligible Provider (EP)?

• Medicare EHR Incentive Program EPs Doctors of Medicine or Osteopathy, Dental Surgery or Dental

Medicine, Podiatry, Optometry, and Chiropractors

• PQRS EPs Medicare Physicians, practitioners, and therapists billing

Medicare Physician Fee Schedule (MPFS) Part B or Critical Access Hospital (CAH) Method II

• ACOs and APMs Both Pioneer and the Medicare Shared Savings Program

(MSSP) Accountable Care Organizations (ACOs) are required to use the web interface to report PQRS with a full year of data.


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PQRS Reporting Methods

Method Pros Cons

Claims Doesn’t require CEHRT Not as good at capturing quality actions; Requires manual data entry

Qualified Registry Report on subset of Medicare patients EP must collect and report quality actions; Per provider fees; Requires manual data entry

QCDR Report on more than just PQRS measures Requires membership/fees; manual data entry

Web Interface (25+ EPs only)

Submit a full year of data with all web interface measures

Requires manual data entry

EHR direct Report on all patients and all payers; meet requirements of both programs

Requires use of CEHRT; May require manual data entry or configuration

DSV Report on all patients and all payers; meet requirements of both programs

EHR/DSV Advantages

• Satisfy multiple program reporting

requirements with one submission


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EHR/DSV Advantages

• Avoid risk of human error In 2012, 68% of Providers reporting via Claims

had a mismatch between QDC and required

diagnosis for one measure. – CMS, 2012 Reporting Experience

• Result: Measure disallowed, impacts VBM score and

therefore qualification for incentives

Simple typing errors

EHR/DSV Advantages

• Less complex than Registry & Claims


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EHR/DSV Reporting is the Future

• CMS programs have aligned on electronic reporting eCQMs via QRDA: • Meaningful Use • PQRS/VBM • IQR • Joint Commission ORYX • …

• Mandatory starting in 2018!

Merit-Based Incentive

Payment System

MIPS overlays and re-affirms Meaningful Use, PQRS and the Value-Based Modifier


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How Do I Get Started?

• Decide if you want to use a DSV or EHR

• Determine available measures

• Review eCQM’s available in your CEHRT, or

provided by your DSV

• Work with your CEHRT/DSV vendor to

understand how to properly document patient

care

Example Submission Report


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What if I Have Multiple EHRs?

What if I Can’t Find 9 Measures?

• You only need ONE good measure to do electronic reporting!

• Measures with fewer than 20 relevant patients are ignored for Value Modifier calculations.


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Data Submission Vendor

• Who is a Data Submission Vendor?

• EHR vendor

• QCDR

• Dedicated DSV (e.g. Health eFilings)

Things to Ask a DSV/EHR

• Are you on the HL7 Clinical Quality Informatics Workgroup? • This workgroup manages the standards, so entities

on that group will be more familiar with them.

• Do you participate in the CMS quality reporting kaizens? • Medicare invites leaders in quality reporting to

advise them on their quality programs. Participation indicates that the DSV is thought highly of and participates in making policy.


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Resources

DSV FAQs

http://healthefilings.com/faqs/

2015 How to Report Once for Medicare Quality Reporting Programs

http://www.cms.gov/Medicare/Quality-Initiatives-Patient-Assessment-Instruments/PQRS/Downloads/2015HowtoReportOnce.pdf

2015 PQRS EHR Reporting Made Simple

http://cms.gov/Medicare/Quality-Initiatives-Patient-Assessment-Instruments/PQRS/Downloads/2015_PQRS_EHR_Made_Simple.pdf

2015 Guide for Group Practices Reporting via PQRS GPRO Using an EHR

http://cms.gov/Medicare/Quality-Initiatives-Patient-Assessment-Instruments/PQRS/Downloads/2015_GPRO_EHR_Reporting_forGroups.pdf

Electronic Reporting Using an Electronic Health Record (EHR)

https://www.cms.gov/Medicare/Quality-Initiatives-Patient-Assessment-Instruments/PQRS/Electronic-Health-Record-Reporting.html

eCQM Library

https://www.cms.gov/Regulations-and-Guidance/Legislation/EHRIncentivePrograms/eCQM_Library.html

Resources

Payment Adjustment Information

https://www.cms.gov/Medicare/Quality-Initiatives-Patient-Assessment-Instruments/PQRS/Payment-Adjustment-Information.html

Intro to EHR Incentive program

http://www.cms.gov/Regulations-and-Guidance/Legislation/EHRIncentivePrograms/downloads/Beginners_Guide.pdf

PQRS Eligible Professionals

http://www.cms.gov/Medicare/Quality-Initiatives-Patient-Assessment-Instruments/PQRS/Downloads/2015_PQRSList_of_Eligible_Professionals.pdf

CMS Enterprise Portal

http://portal.cms.gov

CMS Enterprise Identity Management (EIDM) User Guide

https://www.cms.gov/Research-Statistics-Data-and-Systems/CMS-Information-Technology/IACS/Downloads/IACS-EIDM-Migration-User-Guide.pdf

http://healthefilings.com/faqs/











































































http://portal.cms.gov/























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QUESTIONS?

aligning and succeeding with pqrs and meaningful use · 11/5/2015 · metastar health care quality...

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