MO PC May 2011 This material was prepared by Primaris, the Medicare Quality Improvement Organization for Missouri, 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 Quality Reporting for Physicians: PQRS, Physician Compare and More Sandra Pogones Primaris May 12, 2011

3 Separate/Distinct CMS Incentive Programs EHR Incentive Program – “Meaningful Use” eRX Incentive Program – 1% incentive for Successful e-Prescribers in 2011 – Payment reductions begin in 2012 Physician Quality Reporting Systems (formerly PQRI) – Started in 2006 – 1% Incentive for Satisfactory Reporting in 2011 – Payment reductions begin in 2015 – Today’s topic!

Physician Quality Reporting System PQRS Rules change slightly every year – Incentive rates – Measures—additions and deletions – Measure Specs: updated codes, new QDCs Incentives independent of participation in other CMS programs – You may draw incentives from PQRS reporting in addition to EHR Program incentives and e-Prescribe Program incentives (Note: ePrescribe incentives are NOT independent of the EHR program incentives under Medicare.)

Eligible Professionals Eligible professionals include physicians, nurse practitioners, clinical nurse specialists, physician assistants, physical therapists, and many others Incentives based on Medicare Part B Covered Professional Services delineated in the Physician Fee Schedule – Services payable under fee schedules or methodologies other than the PFS are not included in PQRS: RHCs, FQHCs, providers that have reassigned benefits to a CAH, Medicare Advantage

Reporting Mechanisms Individual eligible professionals may report – 3 individual PQRS measures (194 possible measures), OR – 1 measures group (14 different Measures Groups) – A group consists of 4-9 clinically-related measures – Reportable through Claims or Registry option—not EHR Reporting options for individual eligible professionals – Claims – Qualified registry – Qualified EHR—(20 different individual measures)

Participation Options Providers may participate as: – Individuals – Large Groups (GPRO I): >=200 individual NPIs – Small Groups (GPRO II): 2-99 individual NPIs Additional incentive (0.5%) for Maintenance of Certification Program There is no registration required for individual reporting

Reporting through Part B Claims 12-month (1/1– 12/ )6-month (7/1 – 12/ ) 3 individual measures for >50% Medicare Part B PFS patients Same 1 Measure Group for >=30 Medicare Part B PFS patients N/A (As long as you report 30 Medicare Part B PFS patients, you qualify for full year, regardless of when claims were submitted) 1 Measure Group for >50% Medicare Part B PFS patients (at least 15) 1 Measure Group for >50% Medicare Part B PFS patients (at least 8) PQRS code must be submitted on same claim as billing codes—No separate claim just for PQRS allowed!

Reporting through a Qualified Registry 12-month (1/1 – 12/ month (7/1 – 12/ ) 3 individual measures for > 80% Medicare Part B PFS patients Same 1 Measures Group for >= 30 Medicare Part B PFS patients N/A (As long as you report 30 Medicare Part B PFS patients you qualify for full year) 1 Measure Group for >80% Medicare Part B PFS patients (at least 15) 1 Measure Group for >80% Medicare Part B PFS patients (at least 8)

Reporting through a Qualified EHR 12-month (1/1 – 12/ )6-month (7/1 – 12/ ) 3 individual measures for > 80% Medicare Part B PFS patients No six month reporting option There is NO Measures Group OptionSame EHR must be Qualified by CMS EHR contains a PQRS module/function which pulls raw data from the EHR—may be a cost from vendor EP submits raw data from EHR to CMS, then CMS calculates performance rate

Deadlines All claims must be submitted by the end of February 2012 Registry, EHR and GPRO must submit all data by the end of March 2012

Why Participate? Affordable Care Act (Sect 10331, March 2010) provides PQRS incentives through 2014 – 2011 : 1% of provider’s allowable Part B PFS incentive – 2012, 2013, 2014: 0.5% incentive Authorized payment reductions to fee schedule amount beginning in 2015 for those who do not satisfactorily report – 2015: 1.5% payment reduction – 2016 and subsequent years: 2.0% payment reduction

Why Participate? Close scrutiny of health care spending--accountability Supports public reporting of quality data – Quality reporting measures are becoming more closely aligned for all CMS initiatives—Meaningful Use, PQRS, Medicare Advantage, PCMHs, ACOs, Demonstration projects, etc. – CMS website contains a listing of all physicians that satisfactorily completed PQRI in 2009: – CMS sends a letter to your patients telling them their physician is participating in PQRS

Why Participate? Performance will be the basis for payment in the near future Physician Compare beginning in 2013 –

Physician Compare Website “Physician Compare for 2011 includes information about physicians and other professionals who participated in the Physician Quality Reporting System. It does not yet contain physician and eligible professional performance information. We expect to have performance information on Physician Compare starting in This will be for services those providers furnished to Medicare beneficiaries during 2012.”

Physician Compare Website

Why Report? Provides a way to measure and monitor the quality of care you provide your patients – Identify gaps in performance and take steps to correct – Keep your patients healthier and provider better, more comprehensive care that meets professional standards – Marketing purposes – Build trust in your patients

Resources INFORMATION RESOURCES: – How to Get Started – Measure Specifications for individual measure reporting – Measures Groups Specifications – EHR Specifications – GPRO Specifications – 2011 Implementation Guide

Resources (cont) Also see: – Frequently Asked Questions – Supplemental education materials – National Provider Calls – Special Open Door Forums QualityNet Help Desk – pOfPage – 7:00 a.m. - 7:00 p.m. CST at or

Resources (cont) Primaris – Primaris has just received funding to assist 100 Missouri physicians to report PQRS using their EHR as part of our national QIO 10 th Scope of Word (begins August 2011). – Free onsite and/or remote assistance for reporting Preventive Care Screening (flu/pneumonia vaccines, Colorectal Cancer Screens, Mammograms, BP measurement, Tobacco cessation) – Earn PQRS Incentives for 2012 (and possibly 2011) – Complete and return Interest Form to reserve your spot today. Eligibility criteria apply. – Primaris will offer best practices and consultation to any practice attempting to improve performance on the above measures

Thank You! Questions? Contact: – Sandy Pogones – Your Local Connection to Achieving National Health Goals