Overview of PQRS, VM, & the EHR Incentive Programs Angela M McCrea, MT, ASCP Maureen Schwarzer, BSN, RN Lynn Page, BSN, RN

Atlantic Quality innovation network (AQIN) The Carolinas Center for Medical Excellence CCME) is part of AQIN, a Quality Innovation Network (QIN) We serve as the QIN-Quality Improvement organization (QIO) for South Carolina –Known as AQIN South Carolina The CCME mission: “We help people by improving the quality of health care”

Objectives Provide a high level overview of CMS’s incentive payment programs (PQRS, VM, MU EHR incentive program). Review how to earn incentive bonuses under the these programs. Review the payments adjustment associated with not participating in these programs.

What is the Physician Quality Reporting System (PQRS)? CMS quality improvement program that uses a combination of incentive payments and penalties to promote reporting of quality data. The Foundation of Value Based Purchasing

Who is Eligible for PQRS? Eligible providers who bill under the Medicare Physician Fee Schedule (part B). Includes therapist and NP. Excludes FQHC, RHC, independent labs or diagnostic testing centers, etc.

PQRS Overview 2007, Pay for Reporting 2014 was the last incentive year of.05% MOC earn an additional.05% Calendar Year Reporting 2014 Reporting Period – 01/01/15 – 02/28/15 Incentive Payments release in the Fall 2015 Penalty-for-Not-Reporting – (Medicare uses the term Payment Adjustments)

Value Modifier Program The Value Modifier (VM) program assesses both quality of care furnished and the cost of that care under the Medicare Physician Fee Schedule. Implementation of the VM is based on participation in the PQRS Program. Medicare Pay for Performance

Value Modifier Program the VM applies to groups of 100+ EP based on 2013 PQRS reporting – the VM applies to 10 – 99 EPs based on 2014 PQRS reporting – the VM applies to solo practitioners and groups of two or more EPs based on 2015 PQRS reporting.

VBM 2016 (2014 Year of Care) Groups of Submit PQRS NONO YESYES 2% VBM Adjustment VBM Quality Tiering Groups of 100 or More Low Quality Avg Quality High Quality 0+1%+2% Low Cost -1%0+1% Avg Cost -2%-1%0 High Cost Groups of Low Quality Avg Quality High Quality 0+1%+2% Low Cost 00+1% Avg Cost 000 High Cost 2% PQRS Adjustment On Top Of For the 2016 value modifier, quality tiering is mandatory for groups with 10 or more EPs. Physicians in groups of 10 to 99 EPs will be subject to an upward or neutral payment adjustment,

VBM 2017 (2015 Year of Care) Submit PQRS YESYES VBM Quality Tiering Groups of 10 or More Low Quality Avg Quality High Quality 0+1%+4% Low Cost -2%0+2% Avg Cost -4%-2%0 High Cost Groups of Low Quality Avg Quality High Quality 0+1%+2% Low Cost 00+1% Avg Cost 000 High Cost < 10 For the 2017 value modifier, quality tiering is mandatory for all EPs Physicians in groups of 1 to 9 EPs will be subject to an upward or neutral payment adjustment, Group Size 2% PQRS Payment Adjustment NO 4% V BM Payment Adjustment 2% VBM Payment Adjustment > 10

Composite Scores Quality Score Based off PQRS measures reported Cost Score a.Diabetes b.COPD c.Coronary Artery Disease d.Heart Failure

Quality Resource Use Reports (QRURs) Provides physician with their performance scores used in calculating the value-based payment modifier (VBM). Provides physicians with comparative information about the quality and cost of the care delivered to their Medicare fee- for-service patients.

Physician Compare Website Information about physicians and other healthcare professionals who satisfactorily participate in CMS incentive payment programs.

EHR Incentive Programs The Medicare and Medicaid EHR Incentive Programs provide incentive payments to eligible professionals (EPs) who demonstrate meaningful use of electronic health records (EHRs). EPs must demonstrate meaningful use and submit measures for Stage 1, Stage 2, and Stage 3.

MU Goals Use certified EHR technology to improve quality, safety, efficiency, and reduce health disparities. Engage patients and families in their health care. Improve care coordination. Improve population and public health. Maintain privacy and security.

MU Payment Adjustments 2015 for Medicare EPs who decide not to participate in the program. No payment adjustments for providers who are only eligible for the Medicaid program.

It’s not just PQRS Anymore Payment adjustments for not participating in CMS Incentive Programs Year CY DataPQRSValue ModiferMeaningful Use Total Posible Payment Adjustments Groups of Groups of – 5%**TBD Groups of <10(each year – 5%**TBD Groups of > 10(each year ** Penalty amount could increase up to 5% depending on meaningful use success rates

(800) (803) Questions? This material was prepared by the Atlantic Quality Innovation Network (AQIN), the Medicare Quality Innovation Network-Quality Improvement Organization for New York State, South Carolina, and the District of Columbia, under contract with the Centers for Medicare & Medicaid Services (CMS), an agency of the U.S. Department of Health and Human Services. The contents do not necessarily reflect CMS policy. 11SOW-AQINSC- TskB

Sources Instruments/PQRS/index.htmlhttp:// Instruments/PQRS/index.html MLN Connects™ National Provider Call: “CY 2014 Medicare Physician Fee Schedule (PFS) Final Rule,” December 17, National- Provider-Calls-and-Events-Items/ PFS-NPC.html CMS Webinar: “CMS 2014 Physician Quality Reporting System (PQRS) Webinar”, January 7, Presentation pdf.aspx Presentation pdf.aspx CMS Webinar: “2014 Value Modifier,” January 14 and 16,