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
608-441-8253
MetaStar Health Care Quality Symposium November 5, 2015
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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)
608-841-1381
MetaStar Health Care Quality Symposium November 5, 2015
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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)
MetaStar Health Care Quality Symposium November 5, 2015
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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.
MetaStar Health Care Quality Symposium November 5, 2015
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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
MetaStar Health Care Quality Symposium November 5, 2015
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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
MetaStar Health Care Quality Symposium November 5, 2015
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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
MetaStar Health Care Quality Symposium November 5, 2015
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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
MetaStar Health Care Quality Symposium November 5, 2015
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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.
MetaStar Health Care Quality Symposium November 5, 2015
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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.
MetaStar Health Care Quality Symposium November 5, 2015
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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
MetaStar Health Care Quality Symposium November 5, 2015
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QUESTIONS?