Clinical Quality Measures Physician Quality Reporting System 2014

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1 Clinical Quality Measures Physician Quality Reporting System 2014 Marcela Reyes, CHTS- CP Sevocity Product Manager !!

2 2014 CQMs CQMs are no longer a core objective of the EHR Incentive Programs beginning in 2014, but all providers are required to report on CQMs in order to demonstrate meaningful use.

3 Aligning CQMs Across Programs CMS s commitment to alignment includes finalizing the same CQMs used in multiple quality reporting programs for reporting beginning in 2014 Other programs include Hospital IQR Program, PQRS, CHIPRA, and Medicare SSP and Pioneer ACOs Hospital Inpa<ent Quality Repor<ng Program Physician Quality Repor<ng System Children s Health Insurance Program Reauthoriza<on Act Medicare Shared Savings Program and Pioneer ACOs

4 CQM and Meaningful Use Reporting Periods in 2014 Payment Status EPs will submit their meaningful use data following the end of their reporting period, but no later than February 28, 2015 at 12 a.m. EST. EPs who complete their attestation prior to January 1, 2015 will be placed in a pending status until their 2014 CQM data has been received.

5 Electronic Submission of CQMs Beginning in 2014 Beginning in 2014, all Medicare-eligible providers in their second year and beyond of demonstrating meaningful use must electronically report their CQM data to CMS. Medicaid providers will report their CQM data to their state, which may include electronic reporting.

6 2014 CQMs EPs Report 9 out of 64 CQMs Selected CQMs must cover at least 3 of the 6 NQS domains Recommended core CQMs: 9 for adult populations 9 for pediatric populations

7 Sevocity ecqm Manual 7

8 All providers must select CQMs from at least 3 of the 6 HHS National Quality Strategy domains: Selecting ecqms Patient and Family Engagement Patient Safety Care Coordination Population and Public Health Efficient Use of Healthcare Resources Clinical Processes/ Effectiveness

9 Recommended Core Set For 2014, CMS is not requiring the submission of a core set of electronic CQMs (ecqms). Instead, CMS has identified two recommended core sets of ecqms one for adults and one for children that focus on high-priority health conditions and bestpractices for care delivery. 9 ecqms for adult populations that meet all of the program requirements 9 ecqms for pediatric populations that meet all of the program requirements

10 CQM Reporting Options EHR Reporting Options for Eligible Professionals in 2014 Include: Options that only apply for the EHR Incentive Program Option 1: Attest to CQMs through the EHR Registration & Attestation System Option 2: ereport CQMs through via the PQRS portal Options that Align with Other Quality Programs Option 3: Report individual eligible professionals CQMs through PQRS Portal Option 4: Report group s CQMs through PQRS Portal Option 5: Report group s CQMs through Pioneer ACO participation or Comprehensive Primary Care Initiative participation

11 CQM Reporting Time Periods

12 CQM Quarterly Reporting

13 Important Changes for 2014 PQRS The following are key highlights and changes to the 2014 PQRS: Implemented the 2016 PQRS payment adjustment based on 2014 program year data Additions and deletions of quality measures for a total of 284 measures Implemented new satisfactory reporting requirements for claims, qualified registry, and EHR-based reporting to receive incentive: 9 measures across 3 National Quality Strategy (NQS) domains Eligible professionals (EPs) that are incentive eligible for 2014 PQRS will also avoid the 2016 PQRS payment adjustment Group reporting via the Web Interface must report on all Web Interface measures to avoid the 2016 PQRS payment adjustment

14 Important Changes for 2014 PQRS (con t) New Qualified Clinical Data Registry (QCDR) available for participation New CMS-certified survey vendor method for reporting the Clinician and Group Consumer Assessment of Healthcare Providers and Systems (CG CAHPS) summary survey modules for group practices registered for the group practice reporting option (GPRO) called CAHPS for PQRS Added EHR-based reporting for group practices registered for the GPRO The Measure-Applicability Validation (MAV) process has expanded from claims-based reporting to include qualified registry reporting as well Measures groups can only be reported via qualified registry Eliminated Administrative Claims reporting to avoid a payment adjustment in 2016

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16 PQRS Eligible and Able to Participate Under Physician Quality Reporting System (PQRS), covered professional services are those paid under or based on the Medicare Physician Fee Schedule (PFS). To the extent that eligible professionals are providing services which get paid under or based on the PFS, those services are eligible for PQRS incentive payments and/or payment adjustments. The following professionals are eligible to participate in PQRS: 1. Medicare physicians Doctor of Medicine Doctor of Osteopathy Doctor of Podiatric Medicine Doctor of Optometry Doctor of Oral Surgery Doctor of Dental Medicine Doctor of Chiropractic

17 PQRS Eligible and Able to Participate (con t) 2. Prac<<oners Physician Assistant Nurse Practitioner Clinical Nurse Specialist Certified Registered Nurse Anesthetist (and Anesthesiologist Assistant) Certified Nurse Midwife Clinical Social Worker Clinical Psychologist Registered Dietician Nutrition Professional Audiologists

18 PQRS Eligible and Able to Participate (con t) 3. Therapists Physical Therapist Occupational Therapist Qualified Speech-Language Therapist

19 Eligible But Not Able to Participate Some professionals may be eligible to participate per their specialty, but due to billing method may not be able to participate: Professionals who provide Part B services, but bill Medicare at a facility or institutional (Part A) level. Professionals must bill Medicare at an individual National Provider Identifier (NPI) level, where the rendering provider s individual NPI is entered on CMS-1500 type paper or electronic claims billing, associated with specific line-item services. Professionals who reassign benefits to a Critical Access Hospital (CAH) that bills outpatient services at a facility level, such as CAH Method II billing, cannot participate, since the CAH does not include the individual provider NPI on their Institutional (FI) claims. Services payable under fee schedules or methodologies other than the Medicare Fee Schedule (PFS) are not included in PQRS (for example, services provided in federally qualified health centers, independent diagnostic testing facilities, independent laboratories, hospitals [including method I critical access hospitals], rural health clinics, ambulance providers, and ambulatory surgery center facilities).

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24 Individual PQRS Reporting Individual EPs who meet the criteria for satisfactory submission of PQRS quality measures data via one of the reporting mechanisms above for services furnished during a 2014 reporting period will qualify to earn a PQRS incentive payment equal to 0.5% of their total estimated Medicare Part B Physician Fee Schedule (PFS) allowed charges for covered professional services furnished during that same reporting period. To participate in the 2014 PQRS, individual EPs may choose to report information on individual PQRS quality measures or measures groups using the following methods: Medicare Part B Claims Qualified Registry Direct Electronic Health Record using a certified EHR technology CEHRT via Data Submission Vendor Qualified Clinical Data Registry

25 2014 PQRS Individual Measures 37 new individual quality measures were added for the 2014 program year. 45 measures were retired from PQRS. NOTE: The 2014 PQRS measure specifications for any given individual quality measure may be different from specifications for the quality measure used for EPs should ensure that they are using the most current version of the 2014 PQRS measure specifications. 25

26 Group PQRS Reporting A group practice may also potentially qualify to earn PQRS incentive payments equal to 0.5% of the group practice's total estimated Medicare Part B PFS allowed charges for covered professional services furnished during a 2014 PQRS reporting period based on the group practice meeting the criteria for satisfactory reporting specified by CMS. To participate in the 2014 PQRS, group practices may choose to report information on individual PQRS quality measures using the following methods: Qualified Registry Web Interface (for groups of 25+ only) Direct EHR using CEHRT CEHRT via Data Submission Vendor CMS-Certified survey vendor (for groups of 25+only)

27 2014 PQRS Measures Groups For 2014, measures groups will only be reportable via qualified registry. There are a total of 25 measures groups, 22 measures groups were retained, and three new measures groups were added for The new measures groups are Total Knee Replacement, General Surgery, and Optimizing Patient Exposure to Ionizing Radiation. For specific measures groups changes from 2013 to NOTE: The specifications for measures groups differ from those provided for individual reporting; therefore, the specifications and instructions for measures groups are separate from the specifications and instructions for the 2014 individual measures. The 2014 Physician Quality Reporting System (PQRS) Measures Groups Specifications for any given measures group may be different from specifications for the same measures group used for EPs should ensure that they are using the most current version of the 2014 measures group specifications. 27

28 Resources 2014 CQM Webpage 2014 Physician Quality Repor<ng System (PQRS) 2014 Medicare PQRS Interac<ve Tool 28