PHYSICIAN QUALITY REPORTING SYSTEM REGISTRY
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1 PHYSICIAN QUALITY REPORTING SYSTEM REGISTRY 1
2 Why PQRS? Incentives and Penalties Year PQRS Incentive PQRS Payment Adjustment (penalty) % Penalty, 2016 based on 2014 participation 2015 N/A - 1.5% (based on 2013 participation) 2016 N/A - 2.0% (based on 2014 participation) 2017 N/A - 2.0% (based on 2015 participation) 2
3 How PQRS works Reporting Options CMS will use Most Advantageous Claims-based Individual measures Registry Individual measures, Measures Group, GPRO EHR Individual measures, GPRO 3
4 Why a registry and Why PQRSPRO (for EPs) CMS statistics have demonstrated claims-based PQRS reporting to have only 56% success, whereas registry reporting is 96% and higher Rules are confusing More and more measures are not available through claims reporting Measures groups available PQRSPRO has over a 99% success rate PQRSPRO had no measure calculation errors per CMS validation PQRSPRO staff are available to assist eligible providers and their administrative staff 4
5 Measures for APAPO PQRS Registry ID Measure 110 Preventive Care and Screening: Influenza Immunization 111 Pneumonia Vaccination Status for Older Adults 128 Preventive Care and Screening: Body Mass Index (BMI) Screening and Follow-Up Plan 130 Documentation of Current Medications in the Medical Record 131 Pain Assessment and Follow-Up 134 Preventive Care and Screening: Screening for Clinical Depression and Follow-Up Plan 173 Preventive Care and Screening: Unhealthy Alcohol Use Screening 181 Elder Maltreatment Screen and Follow-Up Plan 226 Preventive Care and Screening: Tobacco Use: Screening and Cessation Intervention 325 Adult Major Depressive Disorder (MDD): Coordination of Care of Patients with Specific Comorbid Conditions 383 Adherence to Antipsychotic Medications for Individuals with Schizophrenia 391 Follow-up After Hospitalization for Mental Illness (FUH) 402 Tobacco Use and Help with Quitting Among Adolescents ALSO: the Dementia Measures Group! 5
6 Dementia Measures Group ID Measure 280 Staging of Dementia 281 Cognitive Assessment 282 Functional Status Assessment 283 Neuropsychiatric Symptom Assessment 284 Management of Neuropsychiatric Symptoms 285 Screening for Depressive Symptoms 286 Counseling Regarding Safety Concerns 287 Counseling Regarding Risks of Driving 288 Caregiver Education and Support 6
7 How the registry works 7
8 How the registry works Measure Selection 8
9 How the registry works Measure Selection 9
10 How the registry works Measure Selection 10
11 How the registry works Measure Selection 11
12 How the registry works Measure Selection Must select: At least nine measures At least three domains Measures where the eligible provider (EP) will report greater than 0% performance At least one cross-cutting measure (EPs with any faceto-face encounters) Or opt for MAV 12
13 How the registry works Measure Selection Measure Applicability Validation (MAV) Applies for those that submit less than nine measures or less than three domains 13
14 How the registry works Dashboard 14
15 How the registry works Chart Entry 15
16 How the registry works Chart Review 16
17 Registry Validation 17
18 Registry Submission 18
19 Other Incentives from Reporting Quality Incentive programs utilizing reporting State-generated quality measures incentives, such as the Minnesota Quality Incentive Payment System (QIPS) & California Pay for Performance Program Payor programs utilizing reports: Aetna - variety of programs Anthem Blue Cross and Blue Shield - variety of programs Blue Cross and Blue Shield variety of programs CIGNA - several programs Geisinger Health Plan Harvard Pilgrim Health Care HealthPartners Integrated Healthcare Association MVP Health Care Rhode Island Department of Human Services, Blue Cross & Blue Shield of Rhode Island, Neighborhood Health Plan of Rhode Island, and UnitedHealthcare of New England Tufts Health Plan UCare UnitedHealthcare/PacifiCare Also consider your PQRS data for use in QI / PI initiatives, MOC, and PI programs 19
20 Reporting / Submission Timing Portal opens March Webinars currently scheduled for: March 24 at 1 pm March 30 at 7 pm Encouraged to report throughout year! Can report through Feb 3,
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