Tuesday, May 6, :00 Noon EDT Dial In: Meeting ID: No audio available through Webinar

Transcription

1 Aligning PQRS with Meaningful Use CQMs in 2014 Tuesday, May 6, :00 Noon EDT Dial In: Meeting ID: No audio available through Webinar

2 2 Objectives Discuss benefits of aligning clinical quality measure reporting for Stage II Meaningful Use and Physician Quality Reporting System (PQRS) Discuss provider eligibility for aligning programs Discuss options for individual and group reporting Discuss reporting methods for aligning Clinical Quality Measure (CQM) reporting Discuss electronic CQMs (ecqms) and CQM domains

3 Benefits of Aligning PQRS with MU CQMs 3 In order to participate in the 2014 Medicare and Medicaid Electronic Health Record (EHR) Incentive Programs and receive an incentive payment, providers are required to submit 2014 CQM data from certified EHR technology regardless of whether they are in Stage 1 or Stage 2 of meaningful use (MU) This alignment will assist eligible professionals (EPs) who demonstrate MU in 2014 to avoid PQRS penalties Groups greater than 10 EPs satisfy PQRS reporting requirements and avoid the automatic downward payment adjustment under PQRS and Value-Based Payment Modifier (VM)

4 4 Who Can Align the Programs? Available to EPs (individual and part of a group) who are beyond their first year of meaningful use PQRS EHR reporting option for MU is only available to EPs with EHRs certified to the June 2013 version of the ecqms o except for CMS140v1: Breast Cancer: Hormonal Therapy for Stage IC - IIIC Estrogen Receptor/Progesterone Receptor (ER/PR) Positive Breast Cancer where the EHR needs to be certified to the Dec 2012 version

5 Who Cannot Align the 5 Programs? EPs who are in their first year of MU in 2014, including those who are part of a group practice that is participating in the PQRS Group Practice Reporting Option (GPRO), an Medicare Shared Savings Program Accountable Care Organization (MSSP ACO), or a Pioneer ACO, need to report their CQMs via attestation by October 1, 2014 to avoid a Meaningful Use payment adjustment in 2015 EPs whose EHRs are not certified to the version of ecqm required by PQRS will still need to attest their CQMs for MU and select a different reporting method for PQRS reporting Certified systems must meet the 2014 certification requirements

6 Eligibility 6 Eligible for Incentive PQRS Value Modifier EHR Incentive Program Subject to Payment Adjustment Included in Definition of Group Subject to VM Eligible for Medicare Incentive Eligible for Medicaid Incentive Subject to Medicare Payment Adjustment Medicare Physicians Doctor of Medicine X X X X X X X Doctor of Osteopathy X X X X X X X Doctor of Podiatric Medicine X X X X X X Doctor of Optometry X X X X X X Doctor of Oral Surgery X X X X X X X Doctor of Dental Medicine X X X X X X X Doctor of Chiropractic X X X X X X Practitioners Physician Assistant X X X X Nurse Practitioner X X X X Clinical Nurse Specialist X X X Certified Registered Nurse Anesthetist X X X Certified Nurse Midwife X X X X Clinical Social Worker X X X Clinical Psychologist X X X Registered Dietician X X X Nutrition Professional X X X Audiologists X X X Therapists Physical Therapist X X X Occupational Therapist X X X Qualified Speech-Language Therapist X X X

7 Things to Take Into Consideration for Aligning 7 Individual or group reporting? Method of reporting for PQRS? What measures pertain to your practice? Do you have certified electronic health record technology (CEHRT) that is updated to 2014 certification standards? Do you want to report for a full year for MU CQMs? o MU core and menu objectives only require a three-month reporting period in 2014

8 8 Individual vs. Group Reporting EPs can choose to report both PQRS and MU CQMs as individuals or as part of a group for the first time in 2014 Definition of group: A single Tax Identification Number (TIN) with 2 or more individual EPs(as identified by Individual National Provider Identifier [NPI]) who have reassigned their billing rights to the TIN Once a group practice (via their TIN) has registered to participate in PQRS GPRO (no later than Sept. 30, 2014), the reporting method chosen by the group is the only PQRS submission method available to the group and all individual NPIs who bill Medicare under the group's TIN

9 Individual EPs: What Method of PQRS Reporting? 9 In the 2014 PQRS program, individual EPs have 4 ways to report measures Method of PQRS Reporting Individual Claims Qualified Registry Direct EHR product that is CEHRT OR- EHR Data Submission Vendor that is CEHRT Qualified Clinical Data Registry (QCDR) Cannot Align Programs Cannot Align Programs Can Align Programs Can Align Programs

10 Individual Reporting Criteria for Aligning 2014 PQRS with Meaningful Use CQMs 10 Direct EHR product that is CEHRT OR- EHR Data Submission Vendor that is CEHRT Individual Measures What Measure Type? Report 9 measures covering at least 3 of the National Quality Strategy (NQS) domains. If an EP's CEHRT does not contain patient data for at least 9 measures covering at least 3 domains, then the EP must report the measures for which there is Medicare patient data. An EP must report on at least 1 measure for which there is Medicare patient data.

11 11 Certification CMS & Office of National Coordinator (ONC) have established standards and certification criteria for structured data that EHRs must use in order to successfully capture and calculate objectives for Stage 2 of meaningful use These new standards and certification criteria will take effect in 2014 Even if you already have a certified EHR, you will have to adopt or upgrade to the new certification in order to participate in the EHR Incentive Programs beginning in 2014 EHR technology that is certified to the 2014 standards and certification criteria will allow providers to meet both Stage 1 and Stage 2 meaningful use requirements

12 Individual Reporting Criteria for Aligning 2014 PQRS with Meaningful Use CQMs 12 Qualified Clinical Data Registry What Measure Type? Measures selected by Qualified Clinical Data Registry Report at least 9 measures covering at least 3 NQS domains AND report each measure for at least 50 percent of the EP s applicable patients seen during the reporting period to which the measure applies. Measures with a 0 percent performance rate would not be counted. Of the measures reported via a qualified clinical data registry, the EP must report on at least 1 outcome measure.

13 13 Clinical Quality Measures Domains 1. Patient and Family Engagement (4 measures) 2. Patient Safety (6 measures) 3. Care Coordination (1 measure) 4. Population/Public Health (9 measures) 5. Efficient Use of Healthcare Resources (4 measures) 6. Clinical Processes/Effectiveness (40 measures)

14 Patient and Family Engagement 14 CMS emeasure ID NQF# Measure Title CMS157v Oncology: Medical and Radiation Pain Intensity Quantified CMS66v1 TBD Functional status assessment for knee replacement CMS56v1 TBD Functional status assessment for hip replacement CMS90v2 TBD Functional status assessment for complex chronic conditions

15 Patient Safety 15 CMS emeasure ID NQF# Measure Title CMS156v Use of High-Risk Medications in the Elderly CMS139v Falls: Screening for Future Fall Risk CMS68v Documentation of Current Medications in the Medical Record CMS132v Cataracts: Complications within 30 Days Following Cataract Surgery Requiring Additional Surgical Procedures CMS177v Child and Adolescent Major Depressive Disorder: Suicide Risk Assessment CMS179v1 TBD ADE Prevention and Monitoring: Warfarin Time in Therapeutic Range

16 Care Coordination 16 CMS emeasure ID NQF# Measure Title CMS50v Closing the referral loop: receipt of specialist report

17 Population/Public Health 17 CMS emeasure ID NQF# Measure Title CMS155v Weight Assessment and Counseling for Nutrition and Physical Activity for Children and Adolescents CMS138v Preventive Care and Screening: Tobacco Use: Screening and Cessation Intervention CMS153v Chlamydia Screening for Women CMS117v Childhood Immunization Status CMS147v Preventive Care and Screening: Influenza Immunization CMS2v Preventive Care and Screening: Screening for Clinical Depression and Follow-Up Plan CMS69v Preventive Care and Screening: Body Mass Index (BMI) Screening and Follow-Up CMS82v Maternal depression screening CMS22v1 TBD Preventive Care and Screening: Screening for High Blood Pressure and Follow-Up Documented

18 Efficient Use of Healthcare Resources 18 CMS emeasure ID NQF# Measure Title CMS146v Appropriate Testing for Children with Pharyngitis CMS166v Use of Imaging Studies for Low Back Pain CMS154v Appropriate Treatment for Children with Upper Respiratory Infection (URI) CMS129v Prostate Cancer: Avoidance of Overuse of Bone Scan for Staging Low Risk Prostate Cancer Patients

19 19 Clinical Processes/Effectiveness CMS emeasure ID NQF# Measure Title CMS137v Initiation and Engagement of Alcohol and Other Drug Dependence Treatment CMS165v Controlling High Blood Pressure CMS125v Breast Cancer Screening CMS124v Cervical Cancer Screening CMS153v Chlamydia Screening for Women CMS130v Colorectal Cancer Screening CMS126v Use of Appropriate Medications for Asthma CMS127v Pneumonia Vaccination Status for Older Adults CMS131v Diabetes: Eye Exam CMS123v Diabetes: Foot Exam

20 Clinical Processes/Effectiveness (cont d) CMS emeasure ID NQF# Measure Title CMS122v Diabetes: Hemoglobin A1c Poor Control CMS148v Hemoglobin A1c Test for Pediatric Patients CMS134v Diabetes: Urine Protein Screening CMS163v Diabetes: Low Density Lipoprotein (LDL) Management CMS164v Ischemic Vascular Disease (IVD): Use of Aspirin or Another Antithrombotic CMS145v Coronary Artery Disease (CAD): Beta-Blocker Therapy Prior Myocardial Infarction (MI) or Left Ventricular Systolic Dysfunction (LVEF <40%) CMS182v Ischemic Vascular Disease (IVD): Complete Lipid Panel and LDL Control CMS135v Heart Failure (HF): Angiotensin-Converting Enzyme (ACE) Inhibitor or Angiotensin Receptor Blocker (ARB) Therapy for Left Ventricular Systolic Dysfunction (LVSD) CMS144v Heart Failure (HF): Beta-Blocker Therapy for Left Ventricular Systolic Dysfunction (LVSD) CMS143v Primary Open Angle Glaucoma (POAG): Optic Nerve Evaluation 20

21 Clinical Processes/Effectiveness (cont d) 21 CMS emeasure ID NQF# Measure Title CMS167v Diabetic Retinopathy: Documentation of Presence or Absence of Macular Edema and Level of Severity of Retinopathy CMS142v Diabetic Retinopathy: Communication with the Physician Managing Ongoing Diabetes Care CMS161v Major Depressive Disorder (MDD): Suicide Risk Assessment CMS128v Anti-depressant Medication Management CMS136v ADHD: Follow-Up Care for Children Prescribed Attention- Deficit/Hyperactivity Disorder (ADHD) Medication CMS169v Bipolar Disorder and Major Depression: Appraisal for alcohol or chemical substance use CMS141v Colon Cancer: Chemotherapy for AJCC Stage III Colon Cancer Patients CMS140v Breast Cancer: Hormonal Therapy for Stage IC-IIIC Estrogen Receptor/ Progesterone Receptor (ER/PR) Positive Breast Cancer CMS62v HIV/AIDS: Medical Visit CMS52v HIV/AIDS: Pneumocystis jiroveci pneumonia (PCP) Prophylaxis

22 Clinical Processes/Effectiveness (cont d) CMS emeasure ID NQF# Measure Title CMS77v HIV/AIDS: RNA control for Patients with HIV CMS133v Cataracts: 20/40 or Better Visual Acuity within 90 Days Following Cataract Surgery CMS158v Pregnant women that had HBsAg testing CMS159v Depression Remission at Twelve Months CMS160v Depression Utilization of the PHQ-9 Tool CMS75v Children who have dental decay or cavities CMS74v Primary Caries Prevention Intervention as Offered by Primary Care Providers, including Dentists CMS61v2 TBD Preventive Care and Screening: Cholesterol Fasting Low Density Lipoprotein (LDL-C) Test Performed CMS64v2 TBD Preventive Care and Screening: Risk-Stratified Cholesterol Fasting Low Density Lipoprotein (LDL-C) CMS149v1 TBD Dementia: Cognitive Assessment CMS65v2 TBD Hypertension: Improvement in blood pressure 22

23 Individual Satisfactory Reporting for Alignment 23 Direct EHR product that is CEHRT -OR- EHR Data Submission Vendor that is CEHRT Yes Will you satisfactorily report to earn 2014 PQRS incentive? No Earn PQRS incentive of 0.5% Avoid 2016 PQRS payment adjustment Satisfy MU CQM requirements Will not earn PQRS incentive for 2014 Subject to 2016 PQRS payment adjustment of -2.0% Will not satisfy MU CQM requirements * EP must report core and menu MU objectives separately through Attestation module * EP must report CQMs through Attestation module (along with core and measure MU objectives to avoid MU payment adjustment in 2016 of -2.0%

24 Individual Satisfactory Reporting for Alignment 24 Qualified Clinical Data Registry Will you satisfactorily report to earn 2014 PQRS incentive? Yes No Earn PQRS incentive of 0.5% Avoid 2016 PQRS payment adjustment Satisfy MU CQM requirements Will not earn PQRS incentive for 2014 Will not satisfy MU CQM requirements * EP must report core and menu MU objectives separately through Attestation module Can you report at least 3 measures covering at least 1 NQS domain? Yes Avoid the 2016 PQRS payment adjustment by reporting at least 3 measures covering at least 1 NQS domain AND report each measure for at least 50 percent of the eligible professional s applicable patients seen during the reporting period to which the measure applies. Measures with a 0 percent performance rate would not be counted. No Will be subject to the 2016 PQRS payment adjustment of -2.0% EP must report CQMs through Attestation module (along with core and measure MU objectives) to avoid MU payment adjustment in 2016 of -2.0%

25 Group Practice Reporting Option (GPRO): What Method of PQRS Reporting? 25 Options for reporting under the Group Practice Reporting Option (GPRO) depends on the size of the group Group Practice Size? 2-24 EPs 1. Qualified Registry 2. Direct EHR Product that is CEHRT -OR- EHR Data Submission Vendor that is CEHRT EPs 1. Qualified Registry 2. Direct EHR Product that is CEHRT -OR- EHR Data Submission Vendor that is CEHRT 3. GPRO Web Interface CMS-certified survey vendor is optional with choices 1-3 above 100+ EPs 1. Qualified Registry 2. Direct EHR Product that is CEHRT -OR- EHR Data Submission Vendor that is CEHRT 3. GPRO Web Interface AND REQUIRED CG CAHPS survey CMS-certified survey vendor optional with choices 1-2 above *Qualified Registry option not available for alignment with MU CQM reporting

26 GPRO Reporting Criteria for Aligning 2014 PQRS with Meaningful Use CQMs 26 Direct EHR product that is CEHRT -OR- EHR Data Submission Vendor that is CEHRT 2+ EPs Group Practice Size? Report 9 measures covering at least 3 of the NQS domains. If a group practice's CEHRT does not contain patient data for at least 9 measures covering at least 3 domains, then the group practice must report the measures for which there is Medicare patient data. A group practice must report on at least 1 measure for which there is Medicare patient data.

27 GPRO Reporting Criteria for Aligning 2014 PQRS with Meaningful Use CQMs 27 GPRO Web Interface Group Practice Size? EPs 100+ EPs Report on all measures included in the web interface; AND Populate data fields for the first 218 consecutively ranked and assigned beneficiaries in the order in which they appear in the group s sample for each module or preventive care measure. If the pool of eligible assigned beneficiaries is less than 218, then report on 100 percent of assigned beneficiaries. Report on all measures included in the web interface; AND Populate data fields for the first 411 consecutively ranked and assigned beneficiaries in the order in which they appear in the group s sample for each module or preventive care measure. If the pool of eligible assigned beneficiaries is less than 411, then report on 100 percent of assigned beneficiaries. In addition, the group practice must report all CG CAHPS survey measures via certified survey vendor. *Individual EPs within a group practice that satisfactorily completes GPRO Web Interface also receives credit for CQM component of MU

28 GPRO Measure Number CARE-1 CARE-2 GPRO Measure Number CAD-2 CAD GPRO Web Interface Measures Measure Title Care Coordination/Patient Safety (CARE) Measures (2 Measures) Medication Reconciliation Falls: Screening for Future Fall Risk Measure Title Coronary Artery Disease (CAD) Disease Module (2 Components of 1 Composite Measure) CAD Composite: (All or Nothing Scoring) CAD Composite (All or Nothing Scoring): Coronary Artery Disease (CAD): Lipid Control CAD Composite (All or Nothing Scoring): Coronary Artery Disease (CAD): Angiotensin-Converting Enzyme (ACE) Inhibitor or Angiotensin Receptor Blocker (ARB) Therapy - Diabetes or Left Ventricular Systolic Dysfunction (LVEF < 40%) 28

29 GPRO Measure Number DM GPRO Web Interface Measures Measure Title Diabetes Mellitus (DM) Disease Module (1 Individual Measure and 1 Composite Measure) Diabetes: Hemoglobin A1c Poor Control Diabetes Composite: Optimal Diabetes Care (5 Components of 1 Composite Measure) Diabetes Composite: (All or Nothing Scoring) 29 DM-13 DM-14 DM-15 DM-16 DM-17 Diabetes Composite (All or Nothing Scoring): Diabetes Mellitus: High Blood Pressure Control Diabetes Composite (All or Nothing Scoring): Diabetes Mellitus: Low Density Lipoprotein (LDL-C) Control Diabetes Composite (All or Nothing Scoring): Diabetes Mellitus: Hemoglobin A1c Control (< 8%) Diabetes Composite (All or Nothing Scoring): Diabetes Mellitus: Daily Aspirin or Antiplatelet Medication Use for Patients with Diabetes and Ischemic Vascular Disease Diabetes Composite (All or Nothing Scoring): Diabetes Mellitus: Tobacco Non-Use

30 2014 GPRO Web Interface Measures 30 GPRO Measure Number HF-6 GPRO Measure Number HTN-2 Measure Title Heart Failure (HF) Disease Module (1 Measure) Heart Failure (HF): Beta-Blocker Therapy for Left Ventricular Systolic Dysfunction (LVSD) Measure Title Hypertension (HTN) Disease Module (1 Measure) Controlling High Blood Pressure GPRO Measure Number IVD-1 Measure Title Ischemic Vascular Disease (IVD) Disease Module (2 Measures) Ischemic Vascular Disease (IVD): Complete Lipid Panel and LDL Control IVD-2 Ischemic Vascular Disease (IVD): Use of Aspirin or Another Antithrombotic

31 GPRO Measure Number PREV-5 PREV-6 PREV-7 PREV GPRO Web Interface Breast Cancer Screening Colorectal Cancer Screening Measures Measure Title Preventive (PREV) Care Measures (8 Measures Individually Sampled) Preventive Care and Screening: Influenza Immunization Pneumonia Vaccination Status for Older Adults 31 PREV-9 PREV-10 PREV-11 PREV-12 Preventive Care and Screening: Body Mass Index (BMI) Screening and Follow-Up Preventive Care and Screening: Tobacco Use: Screening and Cessation Intervention Preventive Care and Screening: Screening for High Blood Pressure and Follow-Up Documented Preventive Care and Screening: Screening for Clinical Depression and Follow-Up Plan

32 GPRO Reporting Criteria for Aligning 2014 PQRS with Meaningful Use CQMs 32 CMS-certified survey vendor AND ONE OF: 1) direct EHR product -OR- EHR Data Submission Vendor; or 2) GPRO web interface 25+ EPs Group Practice Size? Report all CG CAHPS survey measures via a CMS-certified survey vendor, AND report at least 6 measures covering at least 2 of the NQS domains using a direct EHR product or EHR Data Submission Vendor, or reporting all measures included in the GPRO web interface

33 CG-CAHPS: Summary Survey Modules 33 CG CAHPS will include the following survey modules: 1. Getting timely care, appointments, and information 2. How well providers Communicate 3. Patient s Rating of Provider 4. Access to Specialists 5. Health Promotion & Education 6. Shared Decision Making 7. Health Status/Functional Status 8. Courteous and Helpful Office Staff 9. Care Coordination 10. Between Visit Communication 11. Helping You to Take Medication as Directed 12. Stewardship of Patient Resources Reference For more information on the CG CAHPS survey modules, click here:

34 GPRO Satisfactory Reporting for Alignment 34 All reporting methods available for alignment Will group satisfactorily report to earn 2014 PQRS incentive?* Yes No Earn PQRS incentive of 0.5% Avoid 2016 PQRS payment adjustment Satisfy MU CQM requirements *Groups using these reporting options to align programs must meet the PQRS incentive requirements in order to avoid 2016 PQRS payment adjustment; no additional methods available to groups using these reporting options to avoid payment adjustment. Will not earn PQRS incentive for 2014 Subject to 2016 PQRS payment adjustment of -2.0% Will not satisfy MU CQM requirements * EPs in group must individually report core and menu MU objectives separately through Attestation module * EPs in group must individually report CQMs through Attestation module (along with core and measure MU objectives to avoid MU payment adjustment in 2016 of -2.0%

35 Value-Based Payment Modifier (VM) 35 Section 3007 of the Affordable Care Act mandated that, by 2015, CMS begin applying a value modifier under the Medicare Physician Fee Schedule (MPFS) VM assesses both quality of care furnished and the cost of that care under the Medicare Physician Fee Schedule For CY 2015, CMS will apply the VM to groups of physicians with 100 or more eligible professionals (EPs) For CY 2016, CMS will apply the VM to groups of physicians with 10 or more EPs Phase-in to be completed for all physicians by 2017 Implementation of the VM is based on participation in Physician Quality Reporting System

36 How Aligning PQRS and MU CQMs Affects Value Modifier Groups of 10+ EPs who satisfactorily report using EHR product, EHR Data Submission Vendor, the GPRO Web Interface, or the CG-CAHPS survey (with measures using one of the above reporting options) will avoid the automatic -2.0% downward adjustment for the 2016 VM for non-reporting o o Groups of EPs would be subject to a neutral or upward payment adjustment based on quality-tieirng Groups of 100+ EPs will be subject to a neutral, upward, or downward payment adjustment based on quality-tiering Groups of 10+ EPs who do not satisfactorily report PQRS will receive an automatic 2% downward adjustment for the 2016 VM o o In addition to the -2.0% payment adjustment for non-reporting of PQRS An additional -2.0% payment adjustment for meaningful use if individual EPs do not submit CQMs through the Attestation module 36

37 Reporting Quality Data at the Individual Level - 50% Threshold Option 37 If a group does not seek to report quality measures as a group, CMS will calculate a group quality score if at least 50 percent of the eligible professionals within the group report measures individually. o At least 50% of EPs must successfully avoid the 2016 PQRS payment adjustment o EPs who want to align the PQRS and Meaningful Use programs may report on measures available to individual EPs via the following reporting mechanisms: EHR (direct product or Data Submission Vendor) Qualified Clinical Data Registries (new for CY 2014)

38 Where to Call for Help 38 QualityNet Help Desk: o o o o o Portal password issues PQRS/eRx feedback report availability and access IACS registration questions IACS login issues PQRS and erx Incentive Program questions (TTY ) 7:00 a.m. 7:00 p.m. CST M-F or qnetsupport@hcqis.org You will be asked to provide basic information such as name, practice, address, phone, and Provider Contact Center: o o Questions on status of 2012 PQRS/eRx Incentive Program incentive payment (during distribution timeframe) See Contact Center Directory at EHR Incentive Program Information Center: (TTY )

39 39 CMS Regional Office Contacts Region I: CT, ME, MA, NH, RI, VT Andrew Finnegan ( ) Region II: NJ, NY, PR, VI Angela Adetola ( ) Region III: DE, DC, MD, PA, VA, WV Patrick Hamilton ( ) Barbara Connors, D.O. ( ) Region IV: AL, FL, GA, KY, MS, TN, NC, SC Sabrina Teferi ( ) Region V: IL, IN, MI, MN, OH, WI Jonathan Sanchez-Leos ( ) Region VI: AR, LA, NM, OK, TX Kathy Maris ( ) Region VII: IA, KS, MO, NE Annette Kussmaul ( ) Region VIII: CO, MT, ND, SD, UT, WY Mark Levine ( ) Region IX: AZ, CA, NV, HI, U.S. Pac. Terr. Lolita Jacobe ( ) Betsy Thompson ( ) Region X: AK, ID, OR, WA Lauri Tan ( )