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

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1 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 Director of Endoscopy, Beth Israel Medical Center 1

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4 PQRS: What Is It? 1. A voluntary individual reporting program that provides an incentive payment or adjustment to identified eligible professionals who report data on quality measures for covered Physician Fee Schedule (PFS) services furnished to Medicare Part B beneficiaries (including Railroad Retirement Board and Medicare Secondary Payer) Note: Eligible professionals do not have to sign up or preregister to participate in the Physician Quality Reporting program. 4

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6 Payment Adjustments 1. Future claim payment adjustment amounts for non-participation in the Physician Quality Reporting System program: 1. Yes, you will be penalized for not participating! : 0.5% Incentive : 0.5% Incentive : 1.5 % adjustment and each subsequent year: 2.0 % adjustment 6

7 PENALTIES ARE INCURRED 2 YEARS AFTER REPORTING PERIOD

8 PQRS Reporting Options 1. Individual 2. Group (2+ eligible professionals) EP means: 1) physician; 2) other practitioner (PA, NP, clinical nurse specialist, CRNA/anesthesiologist assistant, nurse midwife, clinical social worker, clinical psychologist, registered dietitian, nutrition professional); 3) physical or occupational therapist, qualified speech-language pathologist; 4) qualified audiologist

9 Individual PQRS Reporting 1. EHR Direct Product that is Certified Electronic Health Record Technology (CEHRT) 2. EHR data submission vendor that is CEHRT 3. A qualified PQRS registry 4. Participation through a Qualified Clinical Data Registry (QCDR) 5. Medicare Part B claims submitted to CMS

10 GPRO Reporting 1. GPRO was introduced in 2010 as a reporting method for group practices to qualify to earn a PQRS incentive. PQRS defines a group practice as a single Tax Identification Number (TIN) with 2 or more individual EPs (as identified by Individual National Provider Identifier [NPI]) that have reassigned their billing rights to the TIN. 2. Group practices may choose to report PQRS quality data via: 3. GPRO Web Interface 4. Qualified PQRS Registry 5. EHR Direct Product that is CEHRT 6. EHR data submission vendor that is CERT 7. CMS-certified survey vendor

11 Measures 11

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13 Individual Measure Overview 13

14 CLAIMS REPORTING METHODOLOGY 2014 PQRS Report at least 9 measures, covering at least 3 of the NQS domains, AND Report each measure for at least 50% of the EP s Medicare Part B FFS patients seen during the reporting period to which the measure applies. Measures with a 0% performance rate will not be counted. If less than 9 measures apply to the EP, then the eligible professional must report 1-8 measures for at least 50 percent of the EP s Medicare Part B FFS patients seen during the reporting period to which the measure applies. The eligible professional wouldalso be subject to Claims-based Measure- Applicability Validation (MAV).

15 NATIONAL QUALITY STRATEGY DOMAINS 1. Patient Safety 2. Person and Caregiver-Centered Experience and Outcomes 3. Communication and Care Coordination 4. Effective Clinical Care 5. Community/Population Health 6. Efficiency and Cost Reduction

16 PQRS MEASURES GROUPS Can report via Registry Only in Measures Groups (22 in 2014) Advantages Requires only 20 unique Medicare part B patients if reporting via claims Requires 20 patients (11/20 Medicare part B) if reporting via registry Disadvantages Limited number of measure groups Can only report via registry 16

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28 How to Report as a Group Practice First, meet group criteria. Defined as, a single Tax Identification Number (TIN) with 2+ EPs, as identified by their NPI, whose physicians have reassigned their Medicare billing rights to the TIN. The size of the group practice must be established by the time the group is selected to participate in the GPRO. If the practice changes its TIN after being selected, it cannot continue to participate in PQRS through the GPRO. Second, self nominate for GPRO. A group practice must self-nominate via the Web to participate in the PQRS Group Practice Reporting Option (GPRO).

29 IACS Introduction You can sign up for a new IACS account or modify an existing IACS account at https://applications.cms.hhs.gov/. Users are limited to 1 account per person. An existing IACS account cannot be transferred to another individual. An account can be associated with multiple group practices (Taxpayer Identification Number (TIN)) or individual EPs (TIN/National Provider Identifier (NPI). If you have an existing IACS account: Ensure your account is still active Contact the QualityNet Help Desk. Must add a PV-PQRS Registration System role to your account (refer to slides 26-27). You can sign up for a new IACS account or modify an existing IACS account at https://applications.cms.hhs.gov/.

30 Gather, Enter, & Verify Three steps to sign up for an IACS account 1. Gather all of the required information you need to submit your request for an IACS account with a PV-PQRS Registration System role or to modify your existing IACS account to add a PV-PQRS Registration System role 2. Enter the required information into IACS at https://applications.cms.hhs.gov/ 3. Verify that you entered all of the required information correctly and submit your request.

31 How to Report as a Group Practice Third, choose reporting mechanism / criteria. Web-Interface PQRS Qualified Registry CEHRT CMS certified survey vendor + registry Fourth, start reporting.

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