PQRS: Should You Go GPRO?

Chanda Sundara

Quality Improvement Consultant May 18, 2016

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Qualis Health • A leading national population health

management organization • The Medicare Quality Innovation Network - Quality

Improvement Organization (QIN-QIO) for Idaho and Washington

The QIO Program • One of the largest federal programs dedicated to

improving health quality at the local level

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Today’s Objectives

• Review of PQRS • What is GPRO • Eligibility for GPRO • The Pros and Cons of reporting via

GPRO • The GPRO registration process • Resources to succeed in Value-Based

Reimbursement

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PQRS Basics and Eligibility

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What is the Physician Quality Reporting System (PQRS)?

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Review the PQRS Eligible Provider (EP) List

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2018 Payment Adjustments

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High-Level PQRS Process

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How EPs Can Participate in PQRS

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Group Practice Reporting Option (GPRO)

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What is a Group Practice?

A “group practice” under 2016 PQRS is defined as a: • single Tax Identification Number (TIN) with • 2 or more individual eligible professionals (EPs)

(as identified by their individual National Provider Identifier [NPI])

• who have reassigned their billing rights to the TIN.

• Group practices can register to participate in PQRS via the GPRO to be

• analyzed at the group (TIN) level.

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PQRS GPRO Criteria

A group practice must meet all of the following requirements in order to participate:

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Group Size Requirement

• The group practice will determine its size based on the number of EPs billing under the TIN at the time of registration.

• During registration, group size will be categorized as 2-24 EPs, 25-99 EPs, and 100 or more EPs.

• Reporting requirements and available reporting mechanisms may vary based on the group size.

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Participation Requirement

• Have billed Medicare Part B Physician Fee Schedule (PFS) on or after January 1, 2016 and prior to December 31, 2016

• Agree to have the results of their performance on PQRS measures publicly posted on the Physician Compare website

• Register to participate in PQRS GPRO via the Physician Value-Physician Quality Reporting System (PV-PQRS) between April 1 and June 30, 2016 (11:59 pm ET)

• Provide all requested information through the PV-PQRS Registration System during registration

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Reporting Mechanism Requirement

*Note: CAHPS for PQRS survey is required for PQRS group practices of 100+ EPs and must be reported in conjunction with another reporting mechanism.

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Selecting Measures

2016 Measures List and the PQRS Web-Based Measure Search Tool is on the PQRS Measures Codes webpage Note: The PQRS measure set and resulting specifications change from year to year

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What quality measures do group practices have to report?

GPRO Web Interface

Report all measures in reporting tool (18

measures)

Registry, Direct EHR, Data Submission

Vendor, QCDR, Claims

9 Quality Measures Across

3 Quality Domains

CAHPS for PQRS Certified Survey

Vendor

Vendor will administer and

collect 12 summary survey modules

Depends on submission mechanism

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GPRO Web Interface

• The GPRO Web Interface is a secure internet-based application available in the PQRS Portal to pre-registered users

• CMS pre-populates the GPRO Web Interface with a sample of the group’s patients

• PQRS group practice completes data for the pre-populated patients • CMS calculates reporting and performance rates

• Participation via the GPRO Web Interface is available to: • PQRS group practices of 25-99 EPs • PQRS group practices of 100 or more EPs when reported in

conjunction with CAHPS for PQRS

• 2016 PQRS GPRO Web Interface Reporting Made Simple is available on the PQRS GPRO Web Interface webpage

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CAHPS for PQRS

• CAHPS for PQRS is: • Optional for PQRS group practices of 2-99 EPs

• Required for all PQRS group practices of 100 or more EPs

• CMS-certified survey vendors will be responsible for distributing the CAHPS for PQRS survey to select patients

• CMS-certified survey vendor will submit data collected on behalf of the group practice

• PQRS group practices will be required to select a CMS-certified survey vendor with which to work

• Note: CAHPS for PQRS must be reported in conjunction with the mechanism selected during registration

• Additional resources are available on the PQRS CMS-Certified Survey Vendor webpage

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Registration Requirement

• Registration to participate in PQRS via GPRO must be completed through the online PV-PQRS Registration System during the registration period: April 1, 2016 - June 30, 2016

• Update the group’s Medicare Provider Enrollment, Chain, and Ownership System (PECOS) information before registration

• Indicate the size of their group at the time they register for GPRO -Group size based on the number of EPs billing under the TIN

• Indicate the reporting mechanism for the 12-month period • Obtain an EIDM account with a Security Official (SO) Role or a

Group Representative Role to complete registration • Step-by-step instructions for obtaining these roles may be found in

the “Obtain an EIDM Account to Access the Registration System” section of the PQRS GPRO Registration webpage

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To GPRO or not to GPRO?

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Pros and Cons of GPRO Pros Cons

Measures analyzed at the group (TIN) level

Registration system is not user-friendly

Report once for group rather than for each EP

Registration deadline is fast approaching – June 30, 2016

Groups can report on 50% of the group’s Medicare Part B FFS patients vs. 50% for each Indiv EPs

Stuck with method indicated during registration process

GPRO Web Interface is available for group practices with 25+ EPs

May not be beneficial to groups with few EPs

Multi-specialty groups may benefit from not having to find 9 measures over 3 domains to report

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GPRO Registration Process

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Obtain an EIDM account

• An Enterprise Identity Management (EIDM) account is required to access the PV-PQRS Registration System.

• Contact the QualityNet Help Desk and provide the TIN and name of your group to check if someone already has access

• You can sign up for a new EIDM account, modify an existing EIDM account to add the correct role, or reset an EIDM account password (every 60 days) by visiting the CMS portal at https://portal.cms.gov.

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EIDM Roles for Groups

• Groups are identified in EIDM by their Medicare billing TIN and consist of two or more EPs (as identified by their National Provider Identifier (NPI) that bill under the TIN).

• One person from the group must first sign up for an EIDM account with the Security Official role.

• If additional persons need to register the group for PQRS GPRO, they can request the Security Official role or the Group Representative role in EIDM.

• Please note that if you already have an EIDM account, then you must modify your existing account to sign up for one of the group roles described above.

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EIDM Roles for Groups

• Security Official role allows the user to: 1. Register a group to participate in the PQRS GPRO. 2. Obtain the group’s Mid-Year and Annual QRUR,

Supplemental QRUR, and PQRS Feedback Report. 3. Submit a VM informal review request on behalf of

the group. 4. Approve requests for the “Group Representative”

role in EIDM.

• Group Representative role allows the user to perform tasks 1, 2, and 3 listed above.

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Three Steps to Register for the PQRS GPRO

• Gather all of the required information you need to

submit your group’s registration for participating in the PQRS GPRO in 2016.

• Enter the required information into PV-PQRS Registration System at https://portal.cms.gov by logging in with your EIDM User ID and password.

• Verify that you entered all of the required information correctly and submit your registration to CMS.

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Which Groups Do Not Have to Register?

• Groups that participate in the Medicare Shared Savings Program.

• Groups that only provide care to Medicare beneficiaries who are enrolled in a Medicare Advantage plan.

• EPs that choose to participate in the PQRS as an individual in 2016 via claims, registry, QCDR, or EHR. Note: Groups must ensure that at least 50% of the EPs in the group meet the criteria to avoid the 2018 PQRS payment adjustment as individuals in order for the group to avoid the automatic downward payment adjustment (-2.0% or -4.0% depending on the size and composition of the group) and qualify for adjustments based on performance under the Value Modifier in 2018.

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Next steps

• Meet with the appropriate team members to decide if GPRO is right for your group

• Get a new EIDM account or modify an existing account as soon as possible at https://portal.cms.gov/

• Register to participate between April 1, 2016 – June 30, 2016 (11:59 pm ET) at https://portal.cms.gov

• Register early to avoid missing the deadline! • If a group is not able to report on the selected PQRS

GPRO reporting mechanism, then it is encouraged to report via another GPRO reporting mechanism or have the eligible professionals in the group participate in the PQRS as individuals in 2016.

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Where to call for Help with EIDM

QualityNet Help Desk qnetsupport@hcqis.org 866-288-8912 (TYY 877-715-6222) Monday-Friday 8:00am-8:00pm ET

You will be asked to provide basic information such as name, practice, address, phone, and email.

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Resources

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Framework for Success in Value Based Reimbursement

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Qualis Health Resources

Meaningful Use Readiness Assessment Tool

Medicare Payment

Adjustment Calculator

http://www.medicare.qualishealth.org/MU-Tools http://www.medicare.qualishealth.org/PQRS-Tools

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CMS Resources

• PQRS website • Statute Regulation Program Instructions, Analysis and

Payment, Measure Specifications • Group Practice Reporting Option Web Interface • Medicare FFS Physician Feedback Program/VM

website • VM Information, GPRO Registration, QRUR Information

• PQRS GPRO Registration • PV-PQRS System website • CMS Enterprise Portal

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Q & A

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Online Evaluation:

https://www.surveymonkey.com/r/FFVRWWV

For more information: www.Medicare.QualisHealth.org

This material was prepared by Qualis Health, the Medicare Quality Innovation Network - Quality Improvement Organization (QIN-QIO) for Idaho and Washington, under contract with the Centers for Medicare & Medicaid Services (CMS), an agency of the U.S. Department of Health and Human Services. The contents presented do not necessarily reflect CMS policy. ID/WA-HITC-QH-2402-005-16

Contact Chanda Sundara

Quality Improvement Consultant chandas@qualishealth.org

208-383-5939

Deanna Graham Quality Improvement Consultant

deannag@qualishealth.org 208-383-5951

Kelley Carnwath

Quality Improvement Principal kelleyc@qualishealth.org

206-288-2574