physician quality reporting initiative csns provider update affordable care act task force dr....

Physician Quality Reporting InitiativeCSNS Provider UpdateAffordable Care Act Task Force

Dr. Justin Singer, MDDr. Nicholas Bambakidis, MD

What is PQRI?

• Center for Medicare and Medicaid Services (CMS) initiative which began in 2014 to promote physician quality reporting for eligible practitioners.

• Eligible practitioners or group practices who participate in Medicare Physician Fee Schedule (PFS) are mandated to participate in the Physician Quality Reporting System (PQRS).

• Physicians who satisfactorily submit PQRS quality reporting data are eligible for a 0.5 % incentive payment (IP) of their total estimates Medicare Part B PFS.

What’s New in 2015?

• PQRS is initiating negative payment (NP) adjustments to providers who did not satisfy reporting requirements for quality measures in 2014 of 1.5 % of their Medicare PFS.

• In 2016 negative adjustment increases to 2% for non-compliance with reporting for 2015 fiscal year.

What is Reported?

• For a list of currently tracked measures go to:

2015 PQRS Measures List

• Most current measures applicable to Neurosurgeons relate to perioperative measures. A few examples included:– Perioperative parenteral antibiotics prior to incision and

discontinuing prior to 24 hours post op.– Surgical Site Infections.– Unanticipated 30 day readmissions post-operatively.

• CMS is accepting suggestions for new measures.

Why should Neurosurgeons Care about PQRS?

• Reporting is mandatory for Neurosurgeons who participate in the Medicare part B PFS.

• Starting this year failure to adequately participate will results in 1.5% negative adjustment to PFS eligible reimbursement.

• Practicing Neurosurgeons who did not satisfactorily report quality data in 2014 will receive 98% of the fee schedule amount for services rendered starting 2016.

How Can Neurosurgeons Avoid 2016 Negative Adjustments Through PQRS?

• Neurosurgeons will have had to meet 1 of the following criteria during the 2014 PQRS program year– Meet requirement criteria for 2014 PQRS incentive

eligibility– Repeat minimum of 3 measures covering one National

Quality Strategy (NQS) domain for at least 50% eligible Medicare Part B FFS patients via claims or qualified registry.

– Participate through a qualified data registry for which at least 3 measures cover a minimum of 1 NQS domain for 50% of applicable patients.

What you can do in 2015 to avoid Negative Adjustments in 2017?

• Report on Min. 9 individuals measures covering 3 NQS domains for 50% of the practitioners Medicare Part B FFS patients.

• Reports at least 1 measures group from a sample of 20 patients, where majority of patients must be Medicare Part B FFS patients.

• 2015 Reporting Registry Made Simple

How To Report

• Claims base reporting• Registry based reporting

– More On Registry Reporting• Qualified Electronic Health Record (EHR)

– More On EHR Reporting• Qualified Clinical Data Registry (QCDR)

– More On QCDR• Group Practice Reporting Option (GPRO)

– More ON GPRO• 2014 Physician Quality Reporting System Implementa

tion Guide

How To Get Started with PQRS?

One Last Thing!!!

• Proposed Changes via “Medicare Access and CHIP Reauthorization Act”– May eliminate negative adjustments or penalties

under CMS programs (ie. PQRS)– May Consolidates the PQRS, EHR and Value-Base

Payment Modifier (VM) programs– Includes Positive incentives for quality improvement

payment programs to include All physicians

H.R.2 - Medicare Access and CHIP Reauthorization Act of 2015

Stay Tuned For Future Updates Following Passage of H.R. 2

For more information check out

http://www.cms.gov/Medicare/Quality-Initiatives-Patient-Assessment-Instruments/PQRS/index.html

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

http://www.cms.gov/Medicare/Quality-Initiatives-Patient-Assessment-Instruments/PQRS/Downloads/PQRS-Timeline-2014-2016.pdf