An Overview of 2015 CMS Physician Quality Reporting Programs

Transcription

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

2 Presentation Outline HSAG Ohio s Quality Innovation Network-Quality Improvement Organization (QIN-QIO) The Physician Quality Reporting System (PQRS) and the Value Modifier (VM) 2015 incentives and 2017 payment adjustments Quality Resource Use Reports (QRUR) 2

3 HSAG: QIN-QIO HSAG awarded new QIN-QIO contract for Arizona, California, Florida, Ohio, and the U.S. Virgin Islands Contract began August 1, 2014, and runs through 2019 Serves nearly 25 percent of the nation s Medicare beneficiaries Previous state-based QIO contracts held by: Arizona: HSAG California: HSAG of California Florida: FMQAI Ohio: KEPRO U.S. Virgin Islands: Virgin Islands Medical Institute 3

4 QIN-QIO Framework 4

5 Healthy People, Healthy Communities Promote Effective Prevention and Treatment of Chronic Disease Improve cardiac health and reduce cardiac healthcare disparities (Million Hearts in PQRS) Improve prevention coordination through Meaningful Use of health information technology (HIT) in coordination with Regional Extension Centers 5

6 Better Care at Lower Cost Make Care More Affordable Quality Improvement through Value-Based Payment, Quality Reporting and the Physician Feedback Reporting Programs 6

7 Health and Human Services Goals for Value-Based Payment Alternative payment models Fee-for-service (FFS) linked to quality All Medicare FFS 7 Wolfe, Ashby. Understanding PQRS and the Value-Based Modifier: CMS Plan to Achieve High Value Care Through Transforming Payment Systems. Centers for Medicare & Medicaid Services: June 2015.

8 2015 Is an Important Year 8 Wolfe, Ashby. Understanding PQRS and the Value-Based Modifier: CMS Plan to Achieve High Value Care Through Transforming Payment Systems. Centers for Medicare & Medicaid Services: June 2015.

9 PQRS

10 The Evolution of Physician Quality Reporting 2007 Physician Quality Reporting Initiative is voluntary 2014 PQRS is mandatory 2015 PQRS and VM are mandatory (+ or -) through VM Incentives Penalties Penalties PLUS Adjustments 10

11 Two Options for Eligible Providers to Participate As individuals Analyzed by their rendering/individual National Provider Identifier (NPI) As a group* Under the group practice reporting option (GPRO) and analyzed by their tax identification number (TIN) Bill under Part B of the Medicare Physician Fee Schedule (MPFS) 11 *Group registration deadline (June 30, 2015) has passed

12 2015 PQRS Reporting Nine measures across three quality domains Services provided: January December 2015 JAN FEB MAR APR MAY JUN JUL AUG SEPT OCT NOV DEC Data submitted: January February 2016 JAN FEB

13 2015 Reporting Methods 13 Wolfe, Ashby. Understanding PQRS and the Value-Based Modifier: CMS Plan to Achieve High Value Care Through Transforming Payment Systems. Centers for Medicare & Medicaid Services: June 2015.

14 Process for Feedback MAR 2016 APR MAY JUN JUL AUG SEPT OCT NOV DEC Centers for Medicare & Medicaid Services (CMS) completes evaluation Feedback provided via QRUR Payments affected starting January 1,

15 Performance Period -> Adjustment Period Performance Period Adjustment Period

16 The VM

17 What Is the VM? A new per-claim adjustment under the Medicare Physician Fee Schedule that is applied at the group level to physicians billing under the TIN Assesses the quality of care furnished and the cost of that care, based on what is reported in PQRS Timeframe of Implementation 2015: VM for groups of 100+ Eligible Professionals (Eps) based on 2013 performance 2016: VM for groups of 100+ EPs based on 2014 performance 2017: VM for all physicians and groups of physicians based on 2015 performance 17

18 How Does the VM Work? 18 Wolfe, Ashby. Understanding PQRS and the Value-Based Modifier: CMS Plan to Achieve High Value Care Through Transforming Payment Systems. Centers for Medicare & Medicaid Services: June 2015.

19 What You Do in 2015 Is Important! Those who report satisfactorily for the 2015 program year will avoid the 2017 PQRS negative payment adjustment data determines 2017 adjustments Reporting -> 2017 PQRS penalty Performance -> or VM adjustment depending on size of group 19

20 Tying It All Together 20 Wolfe, Ashby. Understanding PQRS and the Value-Based Modifier: CMS Plan to Achieve High Value Care Through Transforming Payment Systems. Centers for Medicare & Medicaid Services: June 2015.

21 21 Wolfe, Ashby. Understanding PQRS and the Value-Based Modifier: CMS Plan to Achieve High Value Care Through Transforming Payment Systems. Centers for Medicare & Medicaid Services: June 2015.

22 QRURs

23 What is a QRUR? Physician feedback report provided twice a year Mid-year Annual Summary of performance on quality and cost measures Comparisons to average cost and care of other physicians' Medicare patients 23

24 2014 Mid-Year QRURs JUL 2013 through JUN 2014 = APR 2015 Calculated directly from Medicare claims billed during this time period Mid-year QRURs include interim information to TINs about performance on three quality outcomes and six cost measures 24

25 2014 Annual QRURs Disseminated in the fall of 2015 Complete information for VM calculation 2014 performance > 2016 payment adjustments TINs with 10 or more eligible providers QRUR will show the VM adjustment for

26 Sample from Annual QRUR 26 Payment/PhysicianFeedbackProgram/Downloads/2013-Sample-QRUR.PDF

27 Accessing QRUR As of July 13, 2015 an EIDM account (CMS Enterprise Identity Management system) is required to access QRURs at Detailed guidance available by visiting: 27

28 What should providers be doing in 2015?

29 Take Action! 1 2 Decide to participate in PQRS for 2015 Choose a PQRS reporting method 3 Choose which quality measures to report under that method 29

30 Start Improving See how performance measures up Generate reports to monitor performance Compare performance to the VM quality benchmarks Access QRURs and learn how to use them 30

31 Get Help QRUR: Physician Value Help Desk (select option 3) Monday Friday from 8 a.m. to 8 p.m. ET PQRS: QualityNet Help Desk qnetsupport@hcqis.org Monday Friday from 8 a.m. to 8 p.m. ET 31

32 Access Technical Assistance from HSAG One-onone assistance HSAG is funded by CMS to provide no-cost assistance to providers. Learning events Expert advice Join Us! 32

33 Thank you! Carol Saavedra

34 This material was prepared by Health Services Advisory Group, the Medicare Quality Improvement Organization for Ohio, 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. OH-11SOW-D