Implementing PQRI measures in Two Subspecialty Practices at UT Medicine
|
|
|
- Grace Warner
- 10 years ago
- Views:
Transcription
1 Implementing PQRI measures in Two Subspecialty Practices at UT Medicine Maureen Sheehan, M.D., Vascular Surgery Kent L. Anderson, MD, PhD, Ophthalmology
2 Aim Statement Implementing a method to capture documentation of appropriate PQRI measures in vascular and ophthalmology clinics to allow for reimbursement ( 80% in 3 measures) within the next 4 months.
3 TEAM PQRI Maureen Sheehan, MD Kent Anderson, MD, PhD Marti Pons Finance Jay Collins Administrator Susan Hilgers EPIC Edward Kennerdell UT Medicine Amruta Parekh Facilitator Andrew Krecek IT Services
4 CAUSE and EFFECT DIAGRAM Physicians Time Interest Consensus Mixed input Building codes IT support System Software/Hardware EMR system +/- upgrade Pharmacies not in Complex, unclear implementation instructions & directions Education Burden Coder Review Build/Transmit codes Competing Priorities Education Audit system NO PQRI Data Entry Value? Education Expense Burden Enforcement Time Staff Politics Institution
5 What is PQRI? Voluntary physician quality reporting incentive program Medicare Part B covered professional services (NPI) Became law; 12/2006; Reporting began 07/ : 1.5 % : 2% 2011: 1.0% : 0.5% 2015: -1.5%; ?: -2.9% 179 measures (2010); 13 measure groups Numerator: Clinical Action required Denominator: Eligible cases (Patient population)
6 How do we report PQRI? Report the entire calendar year (may also report 6 months starting in July) Report 3 measures or a single measures group on a specified group of patients HIV, ESRD, CAD, CHF, CABG, Rec, MEL, CA, LBP, CAT Report for 80 % of cases for which measure is reportable Claims or Registry or EHR PQRI CPT II codes, G codes, & P modifiers CMS qualified registry; one submission annually
7 Why must we do PQRI? Our colleagues do it AAO: 2008 (42%); 2009 (52%); 2010 (57%) Success rate in 2008 was 48% 32% use an EMR; 52% E-prescribe Incentives Penalties Quality reporting is becoming more important Political climate to protect the public Patients as customers Business as usual; marketing
8 What is our incentive? Ophthalmology Vascular Surgery UT Medicine Net Collections for Medicare Part B $2,897,390 $1,085,221 $41,612,109 PQRI Bonus % % % % PQRI Bonus $55,375 $20,544 $790,386 Registry: $ per NPI; 10 doctors for 3 years = $18,000
9 PQRI Measures: Ophthalmology PQRI MEASURE ICD-9 CODES CODE & WHEN MODIFIERS 12: Glaucoma: POAG ONH Optic Nerve Head Evaluation 14: Macular Degeneration: DFE Dilated Fundus Exam 18: Diabetic Retinopathy: DFE Severity of DR, CSME 19: Diabetic Retinopathy: PCP Communicate DFE to PCP 117: Diabetes: DFE Dilated Eye Exam in Diabetic Patient , , , F Date of exam 2019F Date of exam F Date of exam F & G8397 Date of exam , F; 2024F 2026F; 3072F Date of exam 1P: Medical 8P: Unspecified 1P; 8P 2P: Patient 1P; 2P; 8P 2P: Patient 8P: Unspecified 8P: Unspecified
10 PQRI Measures: Ophthalmology PQRI MEASURE ICD-9 CODES CODE & WHEN MODIFIERS 139: Cataract: Pre-Op Assess Comprehensive Preoperative 140: AMD: AREDS Recommend AREDS Vitamins 141: POAG: IOP 15% IOP by 15% or have Plan 191: Cataract: PO VA BCVA 20/40 in POD : Cataract: Complications Additional surgery in POD , , , , Lens CPT Codes s comorbidities N: Comp CPTs D: CE CPT code 124. Health Information Technology (HIT): EHR Adoption/Use of Electronic Health Records 125. E-Prescribing: 1 Rx created during encounter was generated & transmitted electronically using qualified erx system 0014F Date of surgery 4177F Date of exam 3284F DOS 0517F & 3285F 4175F POD 1 90 G G8628 >30 G8447 G8448 8P: Unspecified 8P: Unspecified 8P: Unspecified 8P: Unspecified G8553: Report 25 times during reporting period Jan 01 Dec 31
11 Intervention: Encounter Form
12 Results 100 patients 37 patients: 1 PQRI measures apply Mainly DM, DR, POAG, CAT vs. AMD, E-Rx Physician data entry is simple with no significant impact on time Physician education is simple Sheets can be easily implemented into daily practice
13 No of times reported No of times PQRI measures reported 100 No of times reported 95.0% 96.0% 97.0% 100.0% % 90.0% % 80.0% % 70.0% % % 50.0% % 40.0% % % 20.0% F 2012F 5010F G F 3284F 4175F 3285F 0517F Other PQRI measures 10.0% 0.0%
14 PQRI Measures: Vascular Tobacco Use 1000F Tobacco use assessed 1034 F Current tobacco smoker 1035F Current smokeless tobacco user 1036F Current tobacco non-user G8455 Current Tobacco User G8456 Current Smokeless Tobacco User 4000F Tobacco use cessation intervention, counseling 4000F Tobacco use cessation intervention RX Tx
15 PQRI Measures: Vascular Current Medications G8427 List of current meds w/ dosages and verification G8430 Provider documentation that pt not eligible for med assess G8507 Pt not eligible for pt verification of current meds G8428 Documentation of current meds w/dosages w/o verification G8429 Incomplete or no documentation
16 OUTPATIENT PQRI (Vascular Surgery)
17
18 PQRI Claims-Based Process Critical Step Visit Documented in the Medical Record Encounter Form Coding & Billing N-365 NCH Analysis Contractor National Claims History File Carrier/MAC Confidential Report 18 Incentive Payment
19 Number of CPT codes captured by EMR Pareto Chart showing CPT codes documented for June % 97.4% 94.7% % 90.0% % 80.0% % 57.9% 60.0% % % % % 20.0% % 0 G F 1036F 4000F 1034F G8428 G8455 CPT codes 0.0%
20 Grand Total of measures captured Grand Total of PQRI measures captured in the Vascular Surgery Clinic Pre-intervention Post-intervention May-10 Jun-10 Jul-10 Aug-10 Time Period
21 Net Gain Vascular Medicare Collections January to June 2010 $478,501 2% incentive payment - $9,570 Total UT Medicare Collections 2009 $14,754,638 2% incentive payment - $295,092
22 Conclusions Currently benefit is monetary gains Soon to become monetary losses Process possible but needs complex and requires constant surveillance Further implementation throughout UT Medicine system
DEMONSTRATING MEANINGFUL USE STAGE 1 REQUIREMENTS FOR ELIGIBLE PROVIDERS USING CERTIFIED EHR TECHNOLOGY IN 2014
DEMONSTRATING MEANINGFUL USE STAGE 1 REQUIREMENTS FOR ELIGIBLE PROVIDERS USING CERTIFIED EHR TECHNOLOGY IN 2014 The chart below lists the measures (and specialty exclusions) that eligible providers must
DEMONSTRATING MEANINGFUL USE STAGE 1 REQUIREMENTS FOR ELIGIBLE PROVIDERS USING CERTIFIED EHR TECHNOLOGY IN 2015
DEMONSTRATING MEANINGFUL USE STAGE 1 REQUIREMENTS FOR ELIGIBLE PROVIDERS USING CERTIFIED EHR TECHNOLOGY IN 2015 The chart below lists the measures (and specialty exclusions) that eligible providers must
Incentive Programs Update, Quality Reporting and Information Exchange
Incentive Programs Update, Quality Reporting and Information Exchange Dr. Henry and Dr. Gross are affiliated with EHRGURU.NET and have lectured for numerous companies including Topcon, First Insight, RevolutionEHR,
Demonstrating Meaningful Use Stage 1 Requirements for Eligible Providers Using Certified EMR Technology
Demonstrating Meaningful Use Stage 1 Requirements for Eligible Providers Using Certified EMR Technology The chart below lists the measures (and specialty exclusions) that eligible providers must demonstrate
Thank You to Our Sponsors! Game Plan. CMS EHR Incentive Programs. Where to go for Help, Handouts, and Future Updates
Thank You to Our Sponsors! Incentive Programs Update, Quality Reporting and Information Exchange Dr. Henry and Dr. Gross are affiliated with www.ehrguru.net and have lectured for numerous companies including
Ophthalmology Meaningful Use Attestation Guide Stage 1 2013 Edition
Ophthalmology Meaningful Use Attestation Guide Stage 1 2013 Edition Ophthalmologists can register for the Medicare electronic health record (EHR) incentive program on the CMS website: https://ehrincentives.cms.gov
The Physician Quality Reporting Initiative: Using Information Technology to Advance Quality of Care
The Physician Quality Reporting Initiative: Using Information Technology to Advance Quality of Care Joseph Cooke, MD; Chief Quality and Patient Safety Officer Mary Koval, RN; Clinical Quality Program Manager
Meaningful Use - Stage 1. And. Practice Maximus
Meaningful Use - Stage 1 And Practice Maximus The following explains how Practice Maximus certified EHR module allows user to achieve meaningful use objectives for Stage 1. Eligible Professionals (EP)
MEANINGFUL USE STAGE 2 REQUIREMENTS FOR ELIGIBLE PROVIDERS USING CERTIFIED EMR TECHNOLOGY
MEANINGFUL USE STAGE 2 REQUIREMENTS FOR ELIGIBLE PROVIDERS USING CERTIFIED EMR TECHNOLOGY On August 24, the Centers for Medicare & Medicaid Services (CMS) posted the much anticipated final rule for Stage
Meaningful Use Qualification Plan
Meaningful Use Qualification Plan Overview Certified EHR technology used in a meaningful way is one piece of a broader Health Information Technology infrastructure intended to reform the health care system
Ophthalmology Meaningful Use Attestation Guide Stage 2 2014 Edition
Ophthalmology Meaningful Use Attestation Guide Stage 2 2014 Edition Physicians who first participated in meaningful use in 2011 or 2012 must move on to Stage 2 in 2014. For 2014 only, physicians will attest
MEANINGFUL USE STAGE 2 2015 FOR ELIGIBLE PROVIDERS USING CERTIFIED EMR TECHNOLOGY
MEANINGFUL USE STAGE 2 2015 FOR ELIGIBLE PROVIDERS USING CERTIFIED EMR TECHNOLOGY STAGE 2 REQUIREMENTS EPs must meet or qualify for an exclusion to 17 core objectives EPs must meet 3 of the 6 menu measures.
Coding for the Future!
Coding for the Future! American Society of Ophthalmic Registered Nurses November 11, 2012 Presented by Joy Newby, LPN, CPC, PCS Newby Consulting, Inc. 5725 Park Plaza Court Indianapolis, IN 46220 Voice:
Psychiatrists and Reporting on Meaningful Use Stage 1. August 6, 2012
Psychiatrists and Reporting on Meaningful Use Stage 1 August 6, 2012 Quick Overview Functional Measures Providers (tracked by NPI) must report on 15 core objectives and associated measures and 5 objectives
Primary Care in the U.S. Measuring and Improving Primary Care in the United States ISQua Indicators Summit 2012. CMS Measures. Primary Care Measures
Primary Care in the U.S. Measuring and Improving Primary Care in the United States ISQua Indicators Summit 2012 Cliff Fullerton, MD, MS VP Chronic Disease Baylor Health Care System Number of PCPs in the
Electronic Health Record (EHR) Incentive Program. Stage 2 Final Rule Update Part 2
Office of Medical Assistance Programs Electronic Health Record (EHR) Incentive Program Stage 2 Final Rule Update Part 2 November 7, 2012 Medical Assistance HIT Initiative 1 Office of Medical Assistance
Adopting an EHR & Meaningful Use
Adopting an EHR & Meaningful Use Learn how to qualify for the EHR Incentive Program The materials in this presentation, or prepared as part of this presentation, are provided for informational purposes
Meaningful Use - The Basics
Meaningful Use - The Basics Presented by PaperFree Florida 1 Topics Meaningful Use Stage 1 Meaningful Use Barriers: Observations from the field Help and Questions 2 What is Meaningful Use Meaningful Use
Radiology Business Management Association Technology Task Force. Sample Request for Proposal
Technology Task Force Sample Request for Proposal This document has been created by the RBMA s Technology Task Force as a guideline for use by RBMA members working with potential suppliers of Electronic
EHR: The Good, Bad, and Ugly
EHR: The Good, Bad, and Ugly Jonathan W. Lohr President Unibase Healthcare Solutions Kevin J. Corcoran, COE, CPC, CPMA, FNAO President, Corcoran Consulting Group Founder, Corcoran Compliance Connection
Stage 2 June 13, 2014
Stage 2 June 13, 2014 1 General Overview of Idaho Medicaid s EHR Incentive Program Stage 2 Meaningful Use (MU) Overview 2014 Reporting Helpful Resources 2 3 Medicaid can pay certain providers an incentive
ICD-9 CM. ICD-9 9 CM stands for International Classification of Diseases, 9 th revision, clinical modifications
Ophthalmology Coding ICD-9 9 CM & CPT By Alice Landry, Registered Health Information Administrator and Certified Procedural Coder Harvey & Bernice Jones Eye Institute University of Arkansas for Medical
Meaningful Use Stage 1:
Whitepaper Meaningful Use Stage 1: EHR Incentive Program Information -------------------------------------------------------------- Daw Systems, Inc. UPDATED: November 2012 This document is designed to
An Overview of Meaningful Use: FAQs
An Overview of Meaningful Use: FAQs On Feb. 17, 2009, President Obama signed the American Recovery and Reinvestment Act of 2009 (ARRA) into law. This new law includes provisions (known as the HITECH Act)
BCBSTX Bridges to Excellence Diabetes Care Program Guide
BCBSTX Bridges to Excellence Diabetes Care Program Guide Blue Cross and Blue Shield of Texas (BCBSTX) is pleased to offer an innovative program that recognizes Texas physicians who deliver excellent care
Ophthalmic Innovation 2015 A View from the AAO
Ophthalmic Innovation 215 A View from the AAO Ophthalmic Innovation 215: a view from the AAO IRIS David W. Parke II, MD CEO American Academy of Ophthalmology Introduction to AAO s IRIS Registry IRIS Registry
Medicare & Medicaid EHR Incentive Program Meaningful Use Stage 1 Requirements Summary. http://www.cms.gov/ehrincentiveprograms/
Medicare & Medicaid EHR Incentive Program Meaningful Use Stage 1 Requirements Summary 2010 What are the Requirements of Stage 1 Meaningful Use? Basic Overview of Stage 1 Meaningful Use: Reporting period
Meaningful Use - Stage 2 scorecard (in RevolutionEHR: Reports > Administration > Providers > Meaningful Use - Stage 2)!
Process of Attestation The CMS EHR Incentive program continues to require a manual attestation process through the Registration and Attestation system: https://ehrincentives.cms.gov/hitech/login.action.
2012 Physician Quality Reporting System:
DEPARTMENT OF HEALTH AND HUMAN SERVICES Centers for Medicare & Medicaid Services R Official CMS Information for Medicare Fee-For-Service Providers 2012 Physician Quality : Medicare Electronic Health Record
Medicare & Medicaid EHR Incentive Program Specifics of the Program for Eligible Professionals. August 10, 2010
Medicare & Medicaid EHR Incentive Program Specifics of the Program for Eligible Professionals August 10, 2010 Today s Session This training will cover the following topics: EHR Incentive Programs a Background
Unintended Consequences of Electronic Health Records
Financial Disclosure Unintended Consequences of Electronic Health Records Mary Pat Johnson is a Senior Consultant at Corcoran Consulting Group and acknowledges a financial interest in the subject matter
An Introduction to the Medicare EHR Incentive Program for Eligible Professionals
EHR Incentive Programs A program administered by the Centers for Medicare & Medicaid Services (CMS) An Introduction to the Medicare EHR Incentive Program for Eligible Professionals cms.gov/ehrincentiveprograms
An Introduction to the Medicaid EHR Incentive Program for Eligible Professionals
EHR Incentive Programs A program administered by the Centers for Medicare & Medicaid Services (CMS) An Introduction to the Medicaid EHR Incentive Program for Eligible Professionals cms.gov/ehrincentiveprograms
PQRS Cheat Sheet. Occupational Therapy Reporting- Individual Measures
PQRS Cheat Sheet Occupational Therapy Reporting- Individual Measures Medicare requires that practitioners meet certain quality reporting thresholds and collect enough data to assess trends and performance.
Top Medicare Audit problems. Retinal Imaging Technology. Optometric Medical Coding. Unilateral codes. Modifiers
Top Medicare Audit problems Evaluation, Diagnosis, Coding and Reimbursement Associated with Medical Vitreo-Retinal Conditions Kim Castleberry, OD Plano Eye Associates Patient/staff initiated billing complaints!
0 What is Meaningful Use and where are we? 0 What is the Physician Quality Reporting System and where stage are we on?
Outline 0 What is Meaningful Use and where are we? 0 What is the Physician Quality Reporting System and where stage are we on? 0 How can we leverage the EMR to demonstrate the quality of our care? Meaningful
The HIPPA Act of 1996 BILLING & CODING THE MEDICAL EYE EXAMINATION. Federal Government Definition. Optometry School Definition 7/20/2011
BILLING & CODING THE MEDICAL EYE EXAMINATION Craig Thomas, O.D. 3900 West Wheatland Road Dallas, Texas 75237 972-780-7199 [email protected] The HIPPA Act of 1996 Result of law is to establish national standards
EMR Use in the Age of Healthcare Reform. C. Martin Harris, M.D. Chief Information Officer, Cleveland Clinic Executive Director, ecleveland Clinic
EMR Use in the Age of Healthcare Reform C. Martin Harris, M.D. Chief Information Officer, Cleveland Clinic Executive Director, ecleveland Clinic Agenda General Overview Requirements Payments Process to
Meaningful Use: Registration, Attestation, Workflow Tips and Tricks
Meaningful Use: Registration, Attestation, Workflow Tips and Tricks Allison L. Weathers, MD Medical Director, Information Services Rush University Medical Center Gregory J. Esper, MD, MBA Vice Chair, Neurology
FAQs for AMDA Members on the Medicare and Medicaid Electronic Health Record Incentive Programs, Including Medicare Payment Adjustments
FAQs for AMDA Members on the Medicare and Medicaid Electronic Health Record Incentive Programs, Including Medicare Payment Adjustments Long Term Post-Acute Care Providers I am a physician or nurse practitioner
Achieving Meaningful Use in Private Practice. A close examination of Stage 2 requirements
Achieving Meaningful Use in Private Practice A close examination of Stage 2 requirements Abstract As part of the American Recovery and Reinvestment Act of 2009, the Federal Government laid the groundwork
Agenda. What is Meaningful Use? Stage 2 - Meaningful Use Core Set. Stage 2 - Menu Set. Clinical Quality Measures (CQM) Clinical Considerations
AQAF Health Information Technology Forum Meaningful Use Stage 2 Clinical Considerations Marla Clinkscales & Mike Bice Alabama Regional Extension Center (ALREC) August 13, 2013 0 Agenda What is Meaningful
Contact: Barbara J Stout RN, BSC Implementation Specialist University of Kentucky Regional Extension Center 859-323-4895
Contact: Barbara J Stout RN, BSC Implementation Specialist University of Kentucky Regional Extension Center 859-323-4895 $19.2B $17.2B Provider Incentives $2B HIT (HHS/ONC) Medicare & Medicaid Incentives
2013 Physician Quality Reporting System (PQRS): Implementation Guide Claims-Based Reporting for Incentive
2013 Physician Quality Reporting System (PQRS): Implementation Guide Claims-Based Reporting for Incentive CPT only copyright 2012 American Medical Association. All rights reserved. Page 1 of 28 Table of
Meaningful Use: Driving Physicians to eprescribing/emr and Pharma Marketing Opportunities
Meaningful Use: Driving Physicians to eprescribing/emr and Pharma Marketing Opportunities Devin Paullin EVP, New Business Development Physicians Interactive Dan Pucci Director, Informatics Solutions Allscripts
Practice Readiness Assessment
Practice Demographics Practice Name: Tax ID Number: Practice Address: REC Implementation Agent: Practice Telephone Number: Practice Fax Number: Lead Physician: Project Primary Contact: Lead Physician Email
2016 Physician Quality Reporting System (PQRS) Measure Specification and Measure Flow Guide for Claims and Registry Reporting of Individual Measures
2016 Physician Quality Reporting System (PQRS) Measure Specification and Measure Flow Guide for Claims and Registry Reporting of Individual Measures Utilized by Individual Eligible Professionals for Claims
Medicare Physician Reporting: Beyond PQRS. Mary Patton Wheatley Senior Specialist, AAMC August 17, 2011
Medicare Physician Reporting: Beyond PQRS Mary Patton Wheatley Senior Specialist, AAMC August 17, 2011 Who is the AAMC? The Association of American Medical Colleges (AAMC) serves and leads the academic
More Meaningful Meaningful Use Solutions to help providers maximize reimbursements with minimal office disruption
More Meaningful Meaningful Use Solutions to help providers maximize reimbursements with minimal office disruption The information and materials provided and referred to herein are not intended to constitute
ARRA, HITECH Act, and Meaningful Use
ARRA, HITECH Act, and Meaningful Use Overview American Recovery and Reinvestment Act Health Information Technology for Economic and Clinical Health (HITECH) Act Interoperability and Standards Meaningful
Overview of Clinical Quality Measures Reporting in the Centers for Medicare & Medicaid Services (CMS) Final Rule on Meaningful Use
Overview of Clinical Quality Measures Reporting in the Centers for Medicare & Medicaid Services (CMS) Final Rule on Meaningful Use Clinical Quality Measures Clinical quality measures have been defined
Medicare & Medicaid EHR Incentive Program Meaningful Use Stage 1 Requirements Overview. http://www.cms.gov/ehrincentiveprograms/
Medicare & Medicaid EHR Incentive Program Meaningful Use Stage 1 Requirements Overview 2010 What is Meaningful Use? Meaningful Use is using certified EHR technology to Improve quality, safety, efficiency,
A Guide to Understanding and Qualifying for Meaningful Use Incentives
A Guide to Understanding and Qualifying for Meaningful Use Incentives A White Paper by DrFirst Copyright 2000-2012 DrFirst All Rights Reserved. 1 Table of Contents Understanding and Qualifying for Meaningful
Lunch and Learn IFAF 09/24/11. Michael L. Brody, DPM
Lunch and Learn IFAF 09/24/11 Michael L. Brody, DPM Disclaimers Sammy Sponsor of this presentation PICA Biomedix All Pro Imaging The Brave New World of HIT Today s Topics: PQRS E-Rx EMR Health Information
CPT Coding Update And Other Issues
CPT Coding Update And Other Issues Robert E. Smith, M.D. Alison Lynch, M.D. November 13, 2013 1 Disclaimer This information is for educational and informational purposes only, and represents the understanding
Daniel F. Gottlieb, Esq., Partner, McDermott Will & Emery, Chicago Scott A. Weinstein, Esq., Associate, McDermott Will & Emery, Washington, D.C.
Presenting a live 90-minute webinar with interactive Q&A Medicare Value-Based Payment and Quality Reporting for Physician Services: Navigating Recent Changes Leveraging Incentive Payment Opportunities,
Meaningful Use: FAQs for Providers
Meaningful Use: FAQs for Providers On Feb. 17, 2009, President Obama signed the American Recovery and Reinvestment Act of 2009 (ARRA) into law. This law includes provisions (known as the HITECH Act) designed
Preparing for ICD-10 Advance Preparation for Implementation Charles Brownlow, OD [email protected]
Preparing for ICD-10 Advance Preparation for Implementation Charles Brownlow, OD [email protected] International Classification of Diseases (ICD-9, ICD-10) Both include codes for all medical conditions,
Agenda. Government s Role in Promoting EMR Technology. EMR Trends in Health Care. What We Hear as Reasons to Not Implement and EMR
Agenda A 360-Degree Approach to EMR Implementation Environmental Overview Information on the HITECH Stimulus Opportunities Hospitals, Physicians and Interoperability Preparing for an EMR Implementation
ARRA HITECH Programs and Goals Where is Nevada?
ARRA HITECH Programs and Goals Where is Nevada? Regional Extension Center HealthInsight NV and UT $7,151,783 awarded, 50% to NV or $3,575,892 Feb. 2010 Feb. 2014 Approx. 700 NV providers enrolled out of