Aligning and Succeeding with PQRS and Meaningful Use · 11/5/2015 · MetaStar Health Care Quality...

transcript

MetaStar Health Care Quality Symposium November 5, 2015

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

manderso@metastar.com

608-441-8253

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

Health eFilings (DSV)

Bwest@Healthefilings.com

608-841-1381

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)

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.

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

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

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

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

Example Submission Report

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.

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.

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

QUESTIONS?

Aligning and Succeeding with PQRS and Meaningful Use · 11/5/2015 · MetaStar Health Care Quality...

Documents