Health Services Advisory Group of California, Inc.

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1 Physician Quality Reporting Shanti Wilson, MBA, PMP Health IT Director, California June 25 26, 2013 CPCA Conference 1 Health Services Advisory Group of California, Inc. The Medicare Quality Improvement Organization for California Local Extension Center for CalHIPSO Dedicated to improving quality of care delivery and health outcomes through information, education, and assistance Partners with physicians, health plans, home health agencies, nursing homes, and hospitals 2 Agenda Physician Quality Reporting System (PQRS) Disparities Quality Reporting Meaningful Use Quality Reporting 3 1

2 PQRS Quality Reporting Prevention and Chronic Disease Monitoring and Reporting Prevention Group o Influenza Immunization, Pneumococcal Vaccines for >65, Breast Cancer, Colorectal Cancer, BMI, Alcohol Use and Tobacco Screening, UI Assessment, Osteoporosis Screening Diabetes Group o Hemoglobin A1c Poor Control, LDL-C Control, High Blood Pressure Control, Dilated Eye Exam, Medical Attention for Nephropathy, Foot Exam Other Groups o Chronic Kidney Disease, Rheumatoid Arthritis, Heart Failure, CAD, IVD, HIV/AIDS, others Group or Individual Measure Reporting 4 PQRS: Incentives and Penalties Incentive On successful reporting of PQRS, receive incentive at 0.5 percent of allowable Medicare Fee-for-Service (FFS) charges for Payment adjustment 1.5 percent seen in year 2015, for Eligible Professionals (EPs) that don t successfully report in year Increases to 2 percent in PQRS Reporting Criteria Claims-based Reporting At least three measures At least 50 percent of Medicare Part-B FFS patients of each EP EHR-based Reporting At least three measures At least 80 percent of Medicare Part-B FFS patients Registry-based Reporting At least three measures At least 80 percent of applicable Medicare Part-B FFS patients Group Practice Reporting Option Single TIN with at least 25+ EPs who have reassigned billing rights Report on 29 quality measures within six disease modules via a Web interface 6 2

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4 10 11 Disparities Quality Reporting Reduce Disparities project in support of Million Hearts Campaign Report ABCS via PQRS Monitor your office for baseline and improvements ABCS by gender and race Identify best practices Participate Patient activation Provider activation Community engagement 12 4

5 Meaningful Use Reporting 13 Quality Reporting Resources CMS PQRS Reporting Web page: https://www.cms.gov/medicare/quality-initiatives- Patient-Assessment- Instruments/PQRS/index.html?redirect=/PQRS/30_E ducationalresources.asp Reducing Disparities Information: CMS Stage 2 Web page: Guidance/Legislation/EHRIncentivePrograms/Stage_ 2.html 14 Questions? Shanti Wilson, MBA, PMP Health IT Director, California 15 5

6 We convene providers, practitioners, and patients to build and share knowledge, spread best practices, and achieve rapid, wide-scale improvements in patient care; increases in population health; and decreases in healthcare costs for all Americans. This material was prepared by, the Medicare Quality Improvement Organization for California, 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. Publication No. CA-10SOW

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