Overview of the Development and Implementation of CAHPS for ACOs and PQRS. Sandra Adams, RN, BSN Lauren Fuentes, MPH.

Save this PDF as:
 WORD  PNG  TXT  JPG

Size: px
Start display at page:

Download "Overview of the Development and Implementation of CAHPS for ACOs and PQRS. Sandra Adams, RN, BSN Lauren Fuentes, MPH."

Transcription

1 CAHPS for ACOs and PQRS Overview of the Development and Implementation of CAHPS for ACOs and PQRS Sandra Adams, RN, BSN Lauren Fuentes, MPH July 10-11, 2014

2 Agenda Overview of the Medicare Shared Savings Program Quality Measurement and Reporting CAHPS for ACO Survey Development and Content CAHPS for ACO Survey Administration Timeline Overview of Physician Quality Reporting System (PQRS) and 2014 Requirements CAHPS for PQRS Implementation Public Reporting Resources and Help

3 Medicare Shared Savings Program Goals The Shared Savings Program is an new approach to the delivery of health care aimed at reducing fragmentation, improving population health, and lowering overall growth in expenditures by: Promoting accountability for the care of Original Medicare beneficiaries Improving coordination of care for services provided under Medicare Parts A and B Encouraging investment in infrastructure and redesigned care processes

4 Shared Savings Program Quality Standard Measure Domains Quality measures are separated into the following four key domains that serve as the basis for assessing, benchmarking, rewarding, and improving ACO quality performance: Better Care for Individuals 1. Patient/Caregiver Experience 2. Care Coordination/Patient Safety Better Health for Populations 3. Preventive Health 4. At-Risk Population 4

5 CAHPS for ACOs: Survey Development The Shared Savings Program Rule required that the patient experience survey for the program be based on the CAHPS Clinician & Group Survey (CG-CAHPS) These survey domains are required: o Getting Timely Care, Appointments, & Information o How Well Your Providers Communicate o Patient s Rating of Provider o Access to Specialists o Health Promotion and Education o Shared Decision-making o Health Status & Functional Status To identify relevant items within each of these domains, as well as possible new domains, a Technical Expert Panel (TEP) was convened Focus groups were conducted with fee-for-service Medicare beneficiaries to allow them to share what is important to them when they receive care

6 CAHPS for ACOs: Survey Development (cont.) Combining input from these sources, a draft survey instrument developed Cognitive interviews were conducted with beneficiaries to refine item wording and a field test was conducted in the spring of 2012 We revised the survey based on analyses of the field test data The first national survey administration with all ACOs occurred January April 2013

7 Summary Survey Measures in CAHPS for ACOs Number Summary Survey Measure (SSM) Source 1-7 Getting Timely Care, Appointments, & Information How Well Your Providers Communicate Patient s Rating of Provider Access to Specialists Health Promotion and Education Shared Decision-making Health Status & Functional Status* CG CAHPS Core, CG CAHPS Supplemental, New Items These SSMs are part of the ACO quality performance score, there are 14 possible points for CAHPS 8 Courteous & Helpful Office Staff CG CAHPS Core- Not part of the ACO quality performance score 9-12** Care Coordination CAHPS Supplemental Between Visit Communication and new questions Not Educating Patient about Medication Adherence part of the ACO quality Stewardship of Patient Resources performance score *Remains pay for reporting in 2014 **There are 2 versions of the survey for 2014, these summary survey measures are optional

8 CAHPS Survey Content: Focal Provider Survey asks respondents to describe their experiences with a named focal provider The focal provider provides the most primary care services to the beneficiary based on the number of visits The focal provider can be a primary care provider or a specialist that provided primary care services Other survey questions ask about the health care team and practice staff 8

9 CAHPS for ACOs Key Dates for 2014 Administration of the 2013 survey occurred January March 2014 Survey results will be available this summer and are reported with each ACO s quality report ACOs receive a detailed CAHPS specific report in the fall of 2014 CAHPS data may be reported on Physician Compare in late 2014 or early 2015 ACOs choose survey vendor from a list of CMS-certified vendors by September 22, 2014 for the survey administration period that begins in November

10 Quality Performance Feedback to ACOs ACOs receive an annual quality performance report with their scores on all 33 quality measures for 4 ACO quality domains ACOs receive a comprehensive CAHPS report in the fall that details ACO performance on each summary survey measure

11 Quality Scoring: Total Possible Points by Domain Domain Total Individual Measures Total Measures for Scoring Purposes Total Potential Points per Domain Domain weight (percent) Patient/Caregiver Experience 7 7 measures* Care Coordination/ Patient Safety 6 6 measures; the EHR measure double-weighted (4 points) Preventive Health 8 8 measures At-Risk Population 12 7 measures, including 5- component diabetes composite measure and 2-component CAD composite measure Total * The functional status measure remains pay-for-reporting for the entire agreement period 11

12 Pay for Performance Phase-In Complete and accurate reporting for the first reporting period/first performance year qualifies the ACO to share in the maximum available sharing rate for payment In future program years: Must meet minimum attainment level to receive points for measures Shared savings payments linked to quality performance based on a sliding scale High-performing ACOs receive higher sharing rate for payment Year 1 Year 2 Year 3 Pay for Performance Measures Pay for Reporting Measures Total

13 Physician Quality Reporting System (PQRS) Overview PQRS is a reporting program that uses incentive payments and payment adjustments to promote reporting of quality information Incentive payments continue through the 2014 program year Payment adjustments begin in 2015 and are based on prior years reporting Eligible professionals (EPs) can report individually or as a group practice participating in the group practice reporting option (GPRO) The creation of the PQRS program was mandated by federal legislation, but participation is voluntary for EPs

14 2014 Eligible Professionals The following professionals are eligible to participate in PQRS in 2014: Beginning in 2014, professionals who reassign benefits to Critical Access Hospitals (CAHs) that bill professional services at a facility level, such as CAH Method II billing, can now participate (in all reporting methods except for claims-based)

15 Incentives and Payment Adjustments in is the last year that EPs can earn payment incentives EPs who satisfactorily report quality-measures data for services provided in 2014 are: Eligible to earn an incentive payment of 0.5 percent of the EP's total Medicare Part B Physician Fee Schedule (PFS) covered services provided in is also the performance year for the 2016 PQRS payment adjustment Payment adjustment in 2016 is -2.0 percent of EP s Part B covered professional services under Medicare PFS

16 National Quality Strategy (NQS) Domains Most PQRS reporting options require an EP or group practice to report 9 measures covering at least 3 of 6 NQS domains: Patient Safety Person and Caregiver-Centered Experience and Outcomes Communication and Care Coordination Effective Clinical Care Community/Population Health Efficiency and Cost Reduction Same domains for EHR Incentive Programs Clinical Quality Measures

17 PQRS Reporting: Individuals To participate in the 2014 PQRS program, individual EPs may choose to report quality information to CMS through one of the following methods: 1. Medicare Part B claims 2. Qualified registry 3. Qualified Clinical Data Registry (QCDR) 4. Direct electronic health record (EHR) using certified EHR technology (CEHRT) 5. CEHRT via data submission vendor

18 PQRS Reporting: Groups To participate in the 2014 PQRS program, group practices may choose to report quality information to CMS through one of the following methods: 1. Qualified registry 2. Direct EHR using CEHRT (Certified EHR Technology) 3. CEHRT via data submission vendor 4. Web interface (for groups of 25+ only) 5. CAHPS CMS-certified survey vendor (for groups of 25+ only, supplement to other methods) A group practice under 2014 PQRS consists of a physician group practice, as defined by a single Tax Identification Number (TIN), with 2 or more individual EPs, as identified by individual National Provider Identifier or NPI, who have reassigned their billing rights to the TIN.

19 PY 2014 CAHPS for PQRS Requirements Group practices with 100+ EPs reporting GPRO web interface must: Report all 12 CAHPS for PQRS survey summary modules; AND Complete all 22 PQRS GPRO web interface quality measures CMS to bear cost of administering this required CAHPS for PQRS survey

20 PY 2014 CAHPS for PQRS Requirements Group practices with 25+ EPs can: Report all 12 CAHPS for PQRS survey summary modules; AND report at least 6 measures covering at least 2 of the NQS domains using a qualified registry, a CEHRT direct product, or a CEHRT data submission vendor; OR all 22 PQRS GPRO web interface measures CMS to bear cost of this optional CAHPS for PQRS survey

21 Summary Survey Measures in CAHPS for PQRS Number Summary Survey Measure (SSM) Source 1-7 Getting Timely Care, Appointments, & Information How Well Your Providers Communicate Patient s Rating of Provider Access to Specialists Health Promotion and Education Shared Decision-making Health Status & Functional Status CG CAHPS Core, CG CAHPS Supplemental, New Items 8 Courteous & Helpful Office Staff CG CAHPS 9-12 Care Coordination Between Visit Communication Educating Patient about Medication Adherence Stewardship of Patient Resources CAHPS Supplemental and new questions

22 CAHPS for PQRS Implementation PY 2013 CAHPS Implemented for group practices with 100+ EPs reporting through the GPRO web interface Same survey content as CAHPS for ACOs Data collected April July 2014 Detailed results will be shared with groups in early 2015

23 CAHPS for PQRS Implementation PY 2014 CAHPS Groups have until 9/30/14 to register and make reporting selection online at Option to include 2014 CAHPS data in 2016 physician value modifier calculation Same survey content as CAHPS for ACOs CMS aims to collect CAHPS data in early 2015 CMS aims to provide results to groups in the fall of 2015

24 2014 Sampling Considerations Medicare beneficiaries only Assigned to provider who provides the most primary care services to the beneficiary based on the number of visits Meet minimum number of beneficiaries Groups with 100+ EPs: 416 Groups with EPs: 255

25 Public Reporting on Physician Compare PQRS CMS may publically report 2014 CAHPS data for group practices of 100+ EPs reporting through PQRS GPRO web interface in 2015 CMS may publically report 2014 CAHPS data for groups of 25 to 99 EPs in 2015 ACOs Display of Quality Data for ACOs began with the 2012 reporting period for a subset of quality measures reported via the GPRO web interface ACO CAHPS data may be displayed on Physician Compare for the 2013 reporting period, displayed in late 2014 / early 2015

26 CMS Resources Materials available at CMS.gov/PQRS include: PQRS Overview Factsheet PQRS: What s New for 2014 Factsheet Made Simple Guides on Educational Resources webpage 2014 PQRS Implementation Guide

27 CMS Resources ACO quality website: Payment/sharedsavingsprogram/Quality_Measures_Standards.html ACO CAHPS website: PQRS CAHPS website: Instruments/PQRS/CMS-Certified-Survey-Vendor.html 27

28 Questions? For questions or assistance with PQRS reporting contact the QualityNet Help Desk, the help desk is available Monday Friday; 7:00 AM 7:00 PM CST to assist with: General CMS PQRS information Portal password issues Feedback report availability and access PQRI-IACS registration questions PQRI-IACS login issues Phone: TTY: CAHPS for PQRS Technical Assistance is available by ing

Reporting Once for 2014 Medicare Quality Reporting Programs

Reporting Once for 2014 Medicare Quality Reporting Programs Reporting Once for 2014 Medicare Quality Reporting Programs Use this tool* to learn how to report quality measures one time in 2014 in order to: Become incentive eligible for 2014 Physician Quality Reporting

More information

QUALITY BEGINNER. PQRS Training Module: QUALITY MEASUREMENT 101. Last Updated: August 2014

QUALITY BEGINNER. PQRS Training Module: QUALITY MEASUREMENT 101. Last Updated: August 2014 QUALITY 01 BEGINNER PQRS Training Module: QUALITY MEASUREMENT 101 Last Updated: August 2014 TRAINING MODULE OBJECTIVES Quality Measurement 101 is a training module for providers who are interested in learning

More information

Physician Quality Reporting System (PQRS) And VBM (Value Based Modifier) A Primer on Present and Future Requirements

Physician Quality Reporting System (PQRS) And VBM (Value Based Modifier) A Primer on Present and Future Requirements Physician Quality Reporting System (PQRS) And VBM (Value Based Modifier) A Primer on Present and Future Requirements Brett Bernstein, MD, AGAF Chief Quality Officer, Beth Israel Ambulatory Endoscopy Services

More information

CMS s framework for Value Modifier

CMS s framework for Value Modifier CMS s framework for Value Modifier Relationship between quality of care, cost composites and the Value Modifier Clinical Care Patient Experience Population/ Community Health Patient Safety Care Coordination

More information

Medicare Shared Savings Program Quality Measure Benchmarks for the 2015 Reporting Year

Medicare Shared Savings Program Quality Measure Benchmarks for the 2015 Reporting Year Medicare Shared Savings Program Quality Measure Benchmarks for the 2015 Reporting Year Release Notes/Summary of Changes (February 2015): Issued correction of 2015 benchmarks for ACO-9 and ACO-10 quality

More information

Clinical Quality Measures Physician Quality Reporting System 2014

Clinical Quality Measures Physician Quality Reporting System 2014 Clinical Quality Measures Physician Quality Reporting System 2014 Marcela Reyes, CHTS- CP Sevocity Product Manager 877-777-2298!! www.sevocity.com! 2014 CQMs CQMs are no longer a core objective of the

More information

Medicare Shared Savings Program Quality Measure Benchmarks for the 2014 Reporting Year

Medicare Shared Savings Program Quality Measure Benchmarks for the 2014 Reporting Year Medicare Shared Savings Program Quality Measure Benchmarks for the 2014 Reporting Year Release Notes/Summary of Changes (February 2015): Issued correction of 2014 benchmarks for ACO-9 and ACO-10 quality

More information

12/5/2014. What is PQRS? Performance Measurement Committee Practical Theater. Historical concerns with the program (continued)

12/5/2014. What is PQRS? Performance Measurement Committee Practical Theater. Historical concerns with the program (continued) What is PQRS? Navigating CMS Quality Initiatives: How to Successfully Report and Avoid Payment Adjustments Performance Measurement Committee Practical Theater A federally mandated Medicare Part B quality

More information

Physician Quality Reporting System (PQRS) Qualified Clinical Data Registry (QCDR) QCDR Reporting Overview. Program Year 2014

Physician Quality Reporting System (PQRS) Qualified Clinical Data Registry (QCDR) QCDR Reporting Overview. Program Year 2014 Physician Quality Reporting System (PQRS) Qualified Clinical Data Registry (QCDR) QCDR Reporting Overview Program Year 2014 Disclaimers This presentation was current at the time it was published or uploaded

More information

How to Avoid 2016 Negative Payment Adjustments for CMS Medicare Quality Reporting Programs. September 17, 2014

How to Avoid 2016 Negative Payment Adjustments for CMS Medicare Quality Reporting Programs. September 17, 2014 How to Avoid 2016 Negative Payment Adjustments for CMS Medicare Quality Reporting Programs September 17, 2014 The Medicare Learning Network This MLN Connects National Provider Call (MLN Connects Call)

More information

2015 PQRS Requirements: What Eligible Professionals Need to Know to Avoid the PQRS Penalty in 2017

2015 PQRS Requirements: What Eligible Professionals Need to Know to Avoid the PQRS Penalty in 2017 2015 PQRS Requirements: What Eligible Professionals Need to Know to Avoid the PQRS Penalty in 2017 Presented by: Camille Bonta, MHS Summit Health Care Consulting Physician Quality Reporting System What

More information

2015 Physician Quality Reporting System (PQRS): Implementation Guide

2015 Physician Quality Reporting System (PQRS): Implementation Guide 2015 Physician Quality Reporting System (PQRS): Implementation Guide 1/15/2015; Revised Table of Contents Introduction... 3 PQRS Measure Selection Considerations... 6 Satisfactorily Report Measures...

More information

Clinical Quality Measures (CQMs) What are CQMs?

Clinical Quality Measures (CQMs) What are CQMs? Clinical Quality Measures (CQMs) What are CQMs? What are CQMs? Clinical quality measures, or CQMs, are tools that help eligible providers (EPs) measure and track the quality of health care services provided

More information

Gold Coast Health IT Resource Center. Accountable Care Organization (ACO)

Gold Coast Health IT Resource Center. Accountable Care Organization (ACO) Gold Coast Health IT Resource Center Accountable Care Organization (ACO) August 27, 2013 Copyright 2013 Gold Coast HIT 1 Agenda Upcoming Webinars ACO s Copyright 2013 Gold Coast HIT 2 Upcoming Webinars

More information

Physician Compare. Virtual Office Hour Session. January 22, 2015

Physician Compare. Virtual Office Hour Session. January 22, 2015 Physician Compare Virtual Office Hour Session January 22, 2015 Alesia Hovatter Health Policy Analyst Division of Electronic and Clinician Quality Quality Measurement and Health Assessment Group Center

More information

Physician Compare Virtual Office Hour Questions and Answers

Physician Compare Virtual Office Hour Questions and Answers Physician Compare Virtual Office Hour Questions and Answers The Physician Compare Virtual Office Hour session was held on January 22, 2015 via WebEx. The purpose of the session was to allow the Centers

More information

2015 Physician Quality Reporting System (PQRS): Implementation Guide

2015 Physician Quality Reporting System (PQRS): Implementation Guide 2015 Physician Quality Reporting System (PQRS): Implementation Guide Table of Contents Introduction... 3 PQRS Measure Selection Considerations... 6 Satisfactorily Report Measures... 11 Reporting Electronically

More information

CMS Proposals for Quality Reporting Programs under the 2015 Medicare Physician Fee Schedule Proposed Rule. July 24, 2014

CMS Proposals for Quality Reporting Programs under the 2015 Medicare Physician Fee Schedule Proposed Rule. July 24, 2014 CMS Proposals for Quality Reporting Programs under the 2015 Medicare Physician Fee Schedule Proposed Rule July 24, 2014 Medicare Learning Network This MLN Connects National Provider Call (MLN Connects

More information

Medicare Learning Network

Medicare Learning Network CMS Proposals for the Physician Quality Reporting System (PQRS) and Physician Value-Based Payment Modifier (VM) under the Medicare Physician Fee Schedule 2014 July 25, 2013 Medicare Learning Network This

More information

Changes for Calendar Year 2015 Physician Quality Programs and Other Programs in the Medicare Physician Fee Schedule

Changes for Calendar Year 2015 Physician Quality Programs and Other Programs in the Medicare Physician Fee Schedule DEPARTMENT OF HEALTH & HUMAN SERVICES Centers for Medicare & Medicaid Services Room 352-G 200 Independence Avenue, SW Washington, DC 20201 FACT SHEET FOR IMMEDIATE RELEASE October 31, 2014 Contact: CMS

More information

CMS Initiatives Involving Patient Experience Surveying FAQs

CMS Initiatives Involving Patient Experience Surveying FAQs CMS Initiatives Involving Patient Experience Surveying FAQs Updated October 2013 Prepared by: DSS Research CAHPS is a registered trademark of the Agency for Healthcare Research and Quality (AHRQ). The

More information

How to Report Once for 2015 Medicare Quality Reporting Programs: Individual Eligible Professionals

How to Report Once for 2015 Medicare Quality Reporting Programs: Individual Eligible Professionals Table of Contents How to Report Once for 2015 Medicare Quality Reporting Programs: Individual Eligible Professionals 3 How to Report Once for 2015 Medicare Quality Reporting Programs: Group Practices 5

More information

Improving Quality of Care for Medicare Patients: Accountable Care Organizations

Improving Quality of Care for Medicare Patients: Accountable Care Organizations DEPARTMENT OF HEALTH AND HUMAN SERVICES Centers for Medicare & Medicaid Services Improving Quality of Medicare Patients: Overview The Centers for Medicare & Medicaid Services (), an agency within the Department

More information

Aligning Meaningful Use CQM and PQRS Reporting for 2015

Aligning Meaningful Use CQM and PQRS Reporting for 2015 Aligning Meaningful Use CQM and PQRS Reporting for 2015 August 19, 2015 Introductions Marni Anderson Project Specialist, MetaStar manderso@metastar.com 608-441-8253 Laura Sawyer Clinical Application Coordinator,

More information

CMS PQRS and VBPM Incentive/Penalty Programs. Devin Detwiler Manager Quality Improvement Telligen

CMS PQRS and VBPM Incentive/Penalty Programs. Devin Detwiler Manager Quality Improvement Telligen CMS PQRS and VBPM Incentive/Penalty Programs Devin Detwiler Manager Quality Improvement Telligen Free Resource to you Join our Network Engage providers and stakeholders in improvement initiatives through

More information

2014 Physician Quality Reporting System (PQRS): Implementation Guide 12/13/2013

2014 Physician Quality Reporting System (PQRS): Implementation Guide 12/13/2013 2014 Physician Quality Reporting System (PQRS): Implementation Guide 12/13/2013 CPT only copyright 2013 American Medical Association. All rights reserved. Page 1 of 41 Table of Contents Page Introduction

More information

PQRS Guide for ASA Members Webcast Script

PQRS Guide for ASA Members Webcast Script PQRS Guide for ASA Members Webcast Script Chapter 1 (Slide 1) Hello and welcome to this guide to the Physician Quality Reporting System for ASA members. The Physician Quality Reporting System, or PQRS,

More information

January 2014 Physician Quality Reporting System (PQRS): What s New for 2014 Purpose Important Changes for 2014 PQRS PQRS Incentive Individual EPs

January 2014 Physician Quality Reporting System (PQRS): What s New for 2014 Purpose Important Changes for 2014 PQRS PQRS Incentive Individual EPs January 2014 Physician Quality Reporting System (PQRS): What s New for 2014 Purpose This fact sheet includes important information about changes to the Physician Quality Reporting System (PQRS) for 2014.

More information

Physician Quality Reporting System (PQRS)

Physician Quality Reporting System (PQRS) Physician Quality Reporting System (PQRS) Presenter: Alexandra Mugge 4 PQRS Overview CY2018 payment adjustments, based on PY2016 reporting: -2.0% MPFS Changes to PQRS Definition of eligible professional

More information

An Overview of 2015 CMS Physician Quality Reporting Programs

An Overview of 2015 CMS Physician Quality Reporting Programs An Overview of 2015 CMS Physician Quality Reporting Programs Carol Saavedra, BA Health Informatics Specialist Health Services Advisory Group (HSAG) September 8, 2015 Presentation Outline HSAG Ohio s Quality

More information

Calendar Year 2014 Medicare Physician Fee Schedule Final Rule

Calendar Year 2014 Medicare Physician Fee Schedule Final Rule Calendar Year 2014 Medicare Physician Fee Schedule Final Rule Non-facility Cap after receiving many negative comments on this issue from physician groups along with the House GOP Doctors Caucus letter,

More information

Quality Scores Monitoring and Reporting

Quality Scores Monitoring and Reporting Section 5.1 Maintain Quality Scores Monitoring and Reporting This tool describes potential quality measurement and performance requirements for a communitybased care coordination (CCC) program, the process

More information

Accountable Care Organizations: Importance to Physicians in Value Based Payment June 19, 2014 12:00-1:00pm EST

Accountable Care Organizations: Importance to Physicians in Value Based Payment June 19, 2014 12:00-1:00pm EST Accountable Care Organizations: Importance to Physicians in Value Based Payment June 19, 2014 12:00-1:00pm EST Ahmed Haque, Director of Care Transformation Health IT U.S. Department of Health & Human Services

More information

2016 Physician Quality Reporting System (PQRS) Measure Specification and Measure Flow Guide for Claims and Registry Reporting of Individual Measures

2016 Physician Quality Reporting System (PQRS) Measure Specification and Measure Flow Guide for Claims and Registry Reporting of Individual Measures 2016 Physician Quality Reporting System (PQRS) Measure Specification and Measure Flow Guide for Claims and Registry Reporting of Individual Measures Utilized by Individual Eligible Professionals for Claims

More information

Welcome The AAMC, UHC and FPSC Web Conference on 2014 PQRS Proposed Changes will begin shortly.

Welcome The AAMC, UHC and FPSC Web Conference on 2014 PQRS Proposed Changes will begin shortly. Welcome The AAMC, UHC and FPSC Web Conference on 2014 PQRS Proposed Changes will begin shortly. Please do not place your phones on hold. If you need to leave the event, hang up and dial back into the conference.

More information

CMS is requesting information to aid in the planning and implementation of the MIPS in the following areas:

CMS is requesting information to aid in the planning and implementation of the MIPS in the following areas: Summary of Medicare s Request for Information on the Provisions in MACRA which Allow for Implementation of Alternative Payment Models and a Merit-Based Incentive Payment System On September 28, 2015, the

More information

CMS QCDR (Qualified Clinical Data Registry) and Other Ways PPRNet Can Help with Value-Based Payment

CMS QCDR (Qualified Clinical Data Registry) and Other Ways PPRNet Can Help with Value-Based Payment CMS QCDR (Qualified Clinical Data Registry) and Other Ways PPRNet Can Help with Value-Based Payment Cara Litvin MD, MS Assistant Professor MUSC Department of Medicine Agenda Provide an update of the current

More information

Purdue Research Foundation

Purdue Research Foundation PQRS: Leveraging Technology to Improve Quality and Ease Reporting Burdens Tara Hatfield RN, BSN, CHTS-CP Managing Advisor MU/PQRS Purdue Healthcare Advisors Objectives Understand the impact of the PQRS

More information

Medicare Shared Savings Program

Medicare Shared Savings Program Medicare Shared Savings Program Shared Savings Program http://www.cms.gov/savingsprogram/ Centers for Medicare & Medicaid Services February 2012 Medicare Shared Savings Program (Shared Savings Program)

More information

Major Changes in CY2015 MPFS Quality Provisions. Physician Compare

Major Changes in CY2015 MPFS Quality Provisions. Physician Compare Major Changes in CY2015 MPFS Quality Provisions Physician Compare In addition to previously finalized Physician Quality Reporting System (PQRS) quality measure data to be publicly reported beginning in

More information

Obtaining the PV-PQRS Group Representative Role Quick Reference Guide

Obtaining the PV-PQRS Group Representative Role Quick Reference Guide Introduction The Physician Value-Physician Quality Reporting System (PV-PQRS) Group Representative role allows the user to perform the following tasks on behalf of the group practice: Select/change the

More information

Improving Quality of Care for Medicare Patients: Accountable Care Organizations

Improving Quality of Care for Medicare Patients: Accountable Care Organizations DEPARTMENT OF HEALTH AND HUMAN SERVICES Centers for Medicare & Medicaid Services Improving Quality of Care for Medicare Patients: FACT SHEET Overview http://www.cms.gov/sharedsavingsprogram On October

More information

Background. Requirements

Background. Requirements The Physician Quality Reporting System Maintenance of Certification Program Incentive Requirements for 2013 Background In accordance with section 1848(m) (7) of the Act ( Additional Incentive Payment ),

More information

Allscripts CQS Planning for 2014 Webinar: FAQs

Allscripts CQS Planning for 2014 Webinar: FAQs Allscripts CQS Planning for 2014 Webinar: FAQs Listed below are questions asked by attendees based on the CQS Planning for 2014 Webinars, held on May 8, May 28, and May 30, 2014. Answers are provided below.

More information

2014 Medicare Physician Fee Schedule Proposed Rule Quality Provisions

2014 Medicare Physician Fee Schedule Proposed Rule Quality Provisions 2014 Medicare Physician Fee Schedule Proposed Rule Quality Provisions The 2014 Medicare Physician Fee Schedule (MPFS) Notice of Proposed Rulemaking (NPRM) was published in the Federal Register on July

More information

User Guide: 2015 Interim Feedback Dashboard

User Guide: 2015 Interim Feedback Dashboard User Guide: 2015 Interim Feedback Dashboard 7/10/2015 Disclaimer This information was current at the time it was published or uploaded onto the web. Medicare policy changes frequently links to the source

More information

Physician Quality Reporting System What Neurosurgeons Need to Know for 2015

Physician Quality Reporting System What Neurosurgeons Need to Know for 2015 Physician Quality System What Neurosurgeons Need to Know for 2015 Prepared by the: American Association of Neurological Surgeons Congress of Neurological Surgeons For More Information Contact: Rachel Groman,

More information

OUR ACO QUALITY RESULTS 2012 AND 2013

OUR ACO QUALITY RESULTS 2012 AND 2013 OUR ACO QUALITY RESULTS 2012 AND 2013 2012-2013 Patient and Caregiver Experience Source 2012 2013 ACO - 1 CAHPS: Getting Timely Care, Appointments and Information Survey 81.98 84.47 ACO - 2 CAHPS: How

More information

The Impact of Changing Federal Policies on Physician Reimbursement

The Impact of Changing Federal Policies on Physician Reimbursement The Impact of Changing Federal Policies on Physician Reimbursement Peter Margolis, MD, AGAF Chair elect, AGA Regulatory Work Group AGA Institute Practice Management & Economics Committee University Gastroenterology

More information

Tuesday, May 6, 2014 12:00 Noon EDT Dial In: 1-877-267-1577 Meeting ID: 997 828 367 No audio available through Webinar

Tuesday, May 6, 2014 12:00 Noon EDT Dial In: 1-877-267-1577 Meeting ID: 997 828 367 No audio available through Webinar Aligning PQRS with Meaningful Use CQMs in 2014 Tuesday, May 6, 2014 12:00 Noon EDT Dial In: 1-877-267-1577 Meeting ID: 997 828 367 No audio available through Webinar 2 Objectives Discuss benefits of aligning

More information

Accountable Care Organizations (ACO) Proposed Rule Summary March 31, 2011

Accountable Care Organizations (ACO) Proposed Rule Summary March 31, 2011 Accountable Care Organizations (ACO) Proposed Rule Summary March 31, 2011 On March 31, 2011, the Centers for Medicare & Medicaid Services (CMS) released the longawaited proposed rule on Accountable Care

More information

ACO & Medicare Shared Savings Program

ACO & Medicare Shared Savings Program ACO & Medicare Shared Savings Program Office Manager and Front Desk Staff Training Maureen Pence RN BSN CCM mpence@npnwa.net 253 627 1151 February 2013 Agenda All slides and attachments will be e mailed

More information

Medicare Program; Revisions to Payment Policies Under the Physician Fee. Schedule and Other Revisions to Part B for CY 2016; Corrections

Medicare Program; Revisions to Payment Policies Under the Physician Fee. Schedule and Other Revisions to Part B for CY 2016; Corrections This document is scheduled to be published in the Federal Register on 06/01/2016 and available online at http://federalregister.gov/a/2016-12841, and on FDsys.gov DEPARTMENT OF HEALTH AND HUMAN SERVICES

More information

A Guidebook to the 2012 Physician Quality Reporting System

A Guidebook to the 2012 Physician Quality Reporting System A Guidebook to the 2012 Physician Quality Reporting System Last Updated: February 2, 2012 Getting Started With PQRS The Patient Protection and Affordable Care Act made participation in Medicare s Physician

More information

Medicare Final Accountable Care Organization (ACO) Regulations Effective January 1, 2012 Median Savings of $470 Million over 4 Years

Medicare Final Accountable Care Organization (ACO) Regulations Effective January 1, 2012 Median Savings of $470 Million over 4 Years October 20, 2011 CIT Healthcare, John M. Cousins, SVP Healthcare Intelligence john.cousins@cit.com Tel: 850-668-2907 Cell: 716-867-9965 Medicare Final Accountable Care Organization (ACO) Regulations Effective

More information

Under section 1899 of the Act, CMS has established the Medicare Shared Savings

Under section 1899 of the Act, CMS has established the Medicare Shared Savings CMS-1612-FC 848 M. Medicare Shared Savings Program Under section 1899 of the Act, CMS has established the Medicare Shared Savings program (Shared Savings Program) to facilitate coordination and cooperation

More information

ACO Type Initiatives

ACO Type Initiatives If you proposed an ACO initiative, please fill our this Comparison of Elements for Participation in Medicare Shared Savings Program (MSSP) to State SIM ACO Test Proposal From Funding Opportunity Announcement:

More information

Demystifying Patient Satisfaction Surveys

Demystifying Patient Satisfaction Surveys Demystifying Patient Satisfaction Surveys What you need to know about the H-CAHPS, CG-CAHPS, and PQRS and the benefits of performing patient satisfaction surveys. NCMGMA Lunch and Learn Webinar, June 11,

More information

DETAILED SUMMARY--MEDCIARE SHARED SAVINGS/ACCOUNTABLE CARE ORGANIZATION (ACO) PROGRAM

DETAILED SUMMARY--MEDCIARE SHARED SAVINGS/ACCOUNTABLE CARE ORGANIZATION (ACO) PROGRAM 1 DETAILED SUMMARY--MEDCIARE SHARED SAVINGS/ACCOUNTABLE CARE ORGANIZATION (ACO) PROGRAM Definition of ACO General Concept An ACO refers to a group of physician and other healthcare providers and suppliers

More information

Meaningful Use 2015 and beyond. Presented by: Anna Mrvelj EMR Training Specialist

Meaningful Use 2015 and beyond. Presented by: Anna Mrvelj EMR Training Specialist Meaningful Use 2015 and beyond Presented by: Anna Mrvelj EMR Training Specialist 1 Agenda A look at the CMS Website Finding your EMR version Certification Number Proposed Rule by the Centers for Medicare

More information

2015 Medicare Physician Fee Schedule Final Rule Summary

2015 Medicare Physician Fee Schedule Final Rule Summary 2015 Medicare Physician Fee Schedule Final Rule Summary On October 31, 2014, the Centers for Medicare and Medicaid Services (CMS) released the final Medicare Physician Fee Schedule (MPFS) for 2015. The

More information

Meaningful Use Stage 2: What s Next?

Meaningful Use Stage 2: What s Next? Meaningful Use Stage 2: What s Next? Stage 2 Proposed Rule Lisa Hays, Program Manager Sue Shumate, Implementation Specialist MO-12-02-REC April 2012 Slides adapted from Robert Anthony, CMS Steve Posnack

More information

The Medicare Quality Reporting Programs: What Eligible Professionals Need to Know in 2016

The Medicare Quality Reporting Programs: What Eligible Professionals Need to Know in 2016 The Medicare Quality Reporting Programs: What Eligible Professionals Need to Know in 2016 Modules Module 1: Medicare Access and CHIP Reauthorization Act (MACRA) Preview Module 2: 2016 Incentive Payments

More information

2013 E-Prescribing Incentive Requirements

2013 E-Prescribing Incentive Requirements 2013 E-Prescribing Incentive Requirements The Medicare Improvements for Patients and Providers Act of 2008 (MIPPA) created an e- prescribing reporting incentive that pays successful electronic prescribers

More information

CMS Quality Measurement and Value Based Purchasing Programs Kate Goodrich, MD MHS Director, Quality Measurement and Health Assessment Group, CMS

CMS Quality Measurement and Value Based Purchasing Programs Kate Goodrich, MD MHS Director, Quality Measurement and Health Assessment Group, CMS CMS Quality Measurement and Value Based Purchasing Programs Kate Goodrich, MD MHS Director, Quality Measurement and Health Assessment Group, CMS American Urological Association Quality Improvement Summit

More information

Participating Accountable Care Organizations (ACOs) that meet quality performance standards will be eligible to receive payments for shared savings.

Participating Accountable Care Organizations (ACOs) that meet quality performance standards will be eligible to receive payments for shared savings. Background Sec. 3022 of the Patient Protection and Affordable Care Act (PPACA) requires the Secretary to establish the Medicare Shared Savings Program by Jan. 1, 2012 Program goals: Promote accountability

More information

Entities eligible for ACO participation

Entities eligible for ACO participation On Oct. 20, 2011, the Centers for Medicare & Medicaid Services (CMS) finalized new rules under the Medicare Shared Savings Program (MSSP) to help doctors, hospitals, and other health care providers better

More information

Minnesota EHR Incentive Program (MEIP) 2015 2017 Program Year Timeline for EPs, EHs and CAHs. Updated November 2015

Minnesota EHR Incentive Program (MEIP) 2015 2017 Program Year Timeline for EPs, EHs and CAHs. Updated November 2015 Minnesota EHR Incentive Program (MEIP) 2015 2017 Program Year Timeline for EPs, EHs and CAHs Updated November 2015 Glossary CAH Critical access hospitals CEHRT Certified electronic health record technology

More information

Transforming Healthcare through Data-Driven Solutions. Pay for Performance Solutions

Transforming Healthcare through Data-Driven Solutions. Pay for Performance Solutions Transforming Healthcare through Data-Driven Solutions Pay for Performance Solutions Medicare Access and CHIP Reauthorization Act of 2015 MACRA Enacted April 15, 2015 10/14/2015 Copyright Mingle Analytics

More information

Navigating CMS Incentive Programs for Eligible Professionals Why It Matters and What You Need to Know. Dr. Paul Mulhausen, CMO

Navigating CMS Incentive Programs for Eligible Professionals Why It Matters and What You Need to Know. Dr. Paul Mulhausen, CMO Navigating CMS Incentive Programs for Eligible Professionals Why It Matters and What You Need to Know Dr. Paul Mulhausen, CMO Objectives Better understand CMS Incentive Programs and payment adjustments

More information

MEDICARE EHR: PREPARING FOR 2015. Community Counts Practice Effectiveness Web Series ION June 26, 2014 Risë Marie Cleland Oplinc, Inc.

MEDICARE EHR: PREPARING FOR 2015. Community Counts Practice Effectiveness Web Series ION June 26, 2014 Risë Marie Cleland Oplinc, Inc. MEDICARE EHR: PREPARING FOR 2015 Community Counts Practice Effectiveness Web Series ION June 26, 2014 Risë Marie Cleland Oplinc, Inc. Important to Remember The information provided in this presentation

More information

Georgia Medicaid Electronic Health Records Incentives Program

Georgia Medicaid Electronic Health Records Incentives Program Georgia Medicaid Electronic Health Records Incentives Program A Webinar for Eligible Professionals May 17, 2011 Presenter: Jacqueline Koffi, DCH Agenda EHR Incentive Program Background Vision and Goals

More information

CAHPS Survey for the Medicare Shared Savings Program and Pioneer Model ACOs. Report for: ACCOUNTABLE CARE ORGANIZATION

CAHPS Survey for the Medicare Shared Savings Program and Pioneer Model ACOs. Report for: ACCOUNTABLE CARE ORGANIZATION CAHPS Survey for the Medicare Shared Savings Program and Pioneer Model ACOs Report for: ACCOUNTABLE CARE ORGANIZATION Issued September 2013 Table of Contents Part 1: Executive Summary... iii Part 2: Detailed

More information

Accountable Care Organizations: What Providers Need to Know

Accountable Care Organizations: What Providers Need to Know DEPARTMENT OF HEALTH AND HUMAN SERVICES Centers for Medicare & Medicaid Services Accountable Care Organizations: FACT SHEET Overview http://www.cms.gov/sharedsavingsprogram On October 20, 2011, the Centers

More information

Physician Quality Reporting System (PQRS)

Physician Quality Reporting System (PQRS) Physician Quality Reporting System (PQRS) and the Value-Based Payment Modifier Implementation guide for registry-based reporting for the Hepatitis C (HCV) Measures Group 2015 1 Overview of PQRS 1,2 What

More information

PQRS Quality Reporting System www.mshregistry.com

PQRS Quality Reporting System www.mshregistry.com PQRS Quality Reporting System www.mshregistry.com This Guide is intended for US Oncology Network Members Sections I. How to Access the PQRS Quality Reporting System II. How to Log into the PQRS Quality

More information

2016 Physician Quality Reporting System (PQRS): Implementation Guide

2016 Physician Quality Reporting System (PQRS): Implementation Guide 2016 Physician Quality Reporting System (PQRS): Implementation Guide 2/18/2016; Revised Table of Contents Introduction... 3 PQRS Measure Selection Considerations... 6 Satisfactorily Report Measures...

More information

5/19/2016 MIPS AND MACRA: MAKING SENSE OF THE NEW REGULATIONS AND PAYMENT SYSTEMS. No Disclosures AMERICAN ASSOCIATION OF CLINICAL ENDOCRINOLOGISTS

5/19/2016 MIPS AND MACRA: MAKING SENSE OF THE NEW REGULATIONS AND PAYMENT SYSTEMS. No Disclosures AMERICAN ASSOCIATION OF CLINICAL ENDOCRINOLOGISTS MIPS AND MACRA: MAKING SENSE OF THE NEW REGULATIONS AND PAYMENT SYSTEMS 1 No Disclosures 2 1 To Better Understand the Future.. We must remember the past regarding physician payment. 3 THE SGR SGR=Sustainable

More information

= AUDIO 8/20/2015. e Clinical Quality Reporting for Hospitals and Providers. An Important Reminder. Mission of OFMQ. Ashley Rhude RHIA, CHTS IM

= AUDIO 8/20/2015. e Clinical Quality Reporting for Hospitals and Providers. An Important Reminder. Mission of OFMQ. Ashley Rhude RHIA, CHTS IM e Clinical Quality Reporting for Hospitals and Providers Ashley Rhude RHIA, CHTS IM An Important Reminder For audio, you must use your phone: Step 1: Call (866) 906 0123. Step 2: Enter code 2071585#. Step

More information

Implications for I/T/U

Implications for I/T/U Outpatient CMS Quality Measurement Programs Implications for I/T/U CAPT Michael Toedt, MD, FAAFP Acting Chief Medical Information Officer Office of Information Technology, Indian Health Service NIHB 2015

More information

June 27, 2016. Dear Mr. Slavitt:

June 27, 2016. Dear Mr. Slavitt: Mr. Andrew M. Slavitt Acting Administrator Centers for Medicare & Medicaid Services Department of Health and Human Services Attention: CMS-5517-P Submitted electronically to: http://www.regulations.gov

More information

Health Law Bulletin. provided by: ACOs AND SHARED SAVINGS IN A NUTSHELL Applications to Participate Available Now

Health Law Bulletin. provided by: ACOs AND SHARED SAVINGS IN A NUTSHELL Applications to Participate Available Now Health Law Bulletin provided by: ACOs AND SHARED SAVINGS IN A NUTSHELL Applications to Participate Available Now Earlier this month, the Center for Medicare and Medicaid Services (CMS) published the final

More information

Preparing for Meaningful Use Stage 2 Bill Beighe, CIO Becky Shoemaker, HIE Project Manager

Preparing for Meaningful Use Stage 2 Bill Beighe, CIO Becky Shoemaker, HIE Project Manager SCHIE Mission 1 To improve the quality and efficiency of health care for all stakeholders in the Santa Cruz community. To deliver technology assistance, guidance and information on best practices to providers

More information

OUR ACCOUNTABLE CARE ORGANIZATION (ACO) STRATEGY. Meredith Marsh Director Health Choice Care, LLC

OUR ACCOUNTABLE CARE ORGANIZATION (ACO) STRATEGY. Meredith Marsh Director Health Choice Care, LLC OUR ACCOUNTABLE CARE ORGANIZATION (ACO) STRATEGY Meredith Marsh Director Health Choice Care, LLC HEALTH REFORM The Affordable Care Act (ACA) strives to achieve the Triple AIM: Improving the experience

More information

Medicare & Medicaid EHR Incentive Programs- Past, Present, & Future. Travis Broome, Centers for Medicare & Medicaid Services 12/18/2012

Medicare & Medicaid EHR Incentive Programs- Past, Present, & Future. Travis Broome, Centers for Medicare & Medicaid Services 12/18/2012 Medicare & Medicaid EHR Incentive Programs- Past, Present, & Future Travis Broome, Centers for Medicare & Medicaid Services 12/18/2012 Medicare-only Eligible Professionals Medicaid-only Eligible Professionals

More information

The Physician s Role in Delivery System Reform

The Physician s Role in Delivery System Reform The Physician s Role in Delivery System Reform Dr. Patrick Conway, M.D., MSc Acting Principal Deputy Administrator, CMS Chief Medical Officer and Deputy Administrator for Innovation and Quality Director,

More information

Quality Reporting and Registry Update: Challenges and Strategies for Success. Heather Smith, PT, MPH September 13, 2014

Quality Reporting and Registry Update: Challenges and Strategies for Success. Heather Smith, PT, MPH September 13, 2014 Quality Reporting and Registry Update: Challenges and Strategies for Success Heather Smith, PT, MPH September 13, 2014 1 SETTING THE STAGE FOR TOMORROW 2014 American Physical Therapy Association. All rights

More information

What to Expect in Next Year & Developing Your ACO Action Plan

What to Expect in Next Year & Developing Your ACO Action Plan What to Expect in Next Year & Developing Your ACO Action Plan Welcome The webinar will start at 3:00 pm ET. It is interactive, so please make sure that you have connected via phone with your audio pin.

More information

ACO Program: Quality Reporting Requirements. Jennifer Faerberg Mary Wheatley April 28, 2011

ACO Program: Quality Reporting Requirements. Jennifer Faerberg Mary Wheatley April 28, 2011 ACO Program: Quality Reporting Requirements Jennifer Faerberg Mary Wheatley April 28, 2011 Agenda for Today s Call Overview Quality Reporting Requirements Benchmarks/Thresholds Scoring Model Scoring Methodology

More information

As of January 1, 2014 all EHR certifications are required to meet 2014 Edition Criteria.

As of January 1, 2014 all EHR certifications are required to meet 2014 Edition Criteria. As of January 1, 2014 all EHR certifications are required to meet 2014 Edition Criteria. There will be a new CMS EHR Certification ID number for every EHR product that must be updated in each provider

More information

Auditing PQRS & Meaningful Use To Maintain Compliance. Standard Disclaimer. Learning Objectives 12/2/2014

Auditing PQRS & Meaningful Use To Maintain Compliance. Standard Disclaimer. Learning Objectives 12/2/2014 2014 NAMAS Conference Asheville, NC December 9, 2014 Auditing PQRS & Meaningful Use To Maintain Compliance Presented by David J. Zetter, PHR, CHCC, CPCO, CPC, CPC-H, PCS, FCS, CHBC, CMUP Standard Disclaimer

More information

MACRA MIPS and CME. Working Group 3/17/16

MACRA MIPS and CME. Working Group 3/17/16 MACRA MIPS and CME Working Group 3/17/16 MACRA, MIPS and CME Enacted in April 2015 Eliminates SGR; Requires EHR interoperability by 2018 Creates Two New Payment Paths for Medicare Eligible Provider Reimbursement

More information

A Guidebook to the 2015 Physician Quality Reporting System

A Guidebook to the 2015 Physician Quality Reporting System A Guidebook to the 2015 Physician Quality Reporting System Last Updated: December 22, 2014 What is PQRS? The Physician Quality Reporting System (PQRS), formally known as the Physician Quality Reporting

More information

Effective ACO Compliance

Effective ACO Compliance Effective ACO Compliance HCCA Compliance Institute April 21, 2013 Margaret Hambleton, MBA, CHC, CHPC Sr. Vice President, Chief Compliance Officer St. Joseph Health System 1 Objectives Understand Accountable

More information

Meaningful Use (MU): Determining your Stage and Timeline. Shannon Means, MPA Healthcare Performance Professional SCAN Health Plan

Meaningful Use (MU): Determining your Stage and Timeline. Shannon Means, MPA Healthcare Performance Professional SCAN Health Plan Meaningful Use (MU): Determining your Stage and Timeline Shannon Means, MPA Healthcare Performance Professional SCAN Health Plan Agenda What Stage are you in? September 2014 Flexibility Rule Changes Stage

More information

Obtaining the PV-PQRS Role for Existing IACS User Quick Reference Guide

Obtaining the PV-PQRS Role for Existing IACS User Quick Reference Guide Introduction If you have an existing IACS account: You must first ensure that your account is still active Contact the QualityNet Help Desk; and You must add a Physician Value-Physician Quality Reporting

More information

Medicare & Medicaid EHR Incentive Programs

Medicare & Medicaid EHR Incentive Programs Medicare & Medicaid EHR Incentive Programs Stage 2 NPRM Overview Robert Anthony Office of E-Health Standards and Services Marsha Smith Office of Clinical Standards and Quality March 21, 2012 Proposed Rule

More information

Meaningful Use: Terms & Timelines, Changes to Stage 1, and Stage 2 Overview

Meaningful Use: Terms & Timelines, Changes to Stage 1, and Stage 2 Overview Meaningful Use: Terms & Timelines, Changes to Stage 1, and Stage 2 Overview NYC REACH Primary Care Information Project NYC Department of Health & Mental Hygiene 1 Agenda Terms & Timelines of Meaningful

More information

Regulations Overview

Regulations Overview Meaningful Use - Stage 2 Regulations Overview Brought to you by Presented by: Travis Broome, MPH, MBA September 18, 2012 Objectives Specific regulatory changes and requirements based on the CMS Stage 2

More information