Physician Quality Reporting System

Abstract

Physician Quality Reporting System The Physician Quality Reporting System (PQRS) is a quality reporting program that rewards eligible professionals (EPs) for practicing high quality care. The final year to receive incentive payments is 2014, and in 2015 payment adjustments will apply to all EPs who did not meet PQRS reporting standards in 2013. Payment adjustments are dictated by the reporting two years prior.  2014 Scenarios Receive a 0.5% incentive payment and avoid a payment adjustment in 2016 Report 9 or more measures covering at least 3 National Quality Strategy domains for ≥ 50% of Medicare Part B patients Avoid a payment adjustment of 2% in 2016 Report at least 3 measures covering one National Quality Strategy domain for ≥ 50% of Medicare Part B FFS patients Suffer a payment adjustment of 2% in 2016 Failure to report PQRS measures successfully Reporting The first stage of participating in PQRS is choosing whether to report measures as individuals or as a group. There are several reporting methods for either scenario, with additional information listed below. Individual Reporting Options Certified Electronic Health Record Technology (CEHRT) Reference: EHR Reporting Made Simple Qualified PQRS registry Reference: Registry Reporting Made Simple Qualified Clinical Data Registry Reference: QDR Participation Made Simple Medicare Part B Claims Reference: Claims Reporting Made Simple Group Reporting Options-must register reporting method by September 30, 2014 GPRO Web interface (groups of 25+ EPs) Qualified PQRS Registry CEHRT CMS-certified survey vendor Clinical Measures Once a reporting method is chosen, EPs must then determine which measures to report. Beginning in 2014, EPs are required to report on 9 or more measures covering at least 3 National Quality Strategy (NQS) domains. The NQS domains are: Patient Safety Person and Caregiver-Centered Experience and Outcomes Communication and Care Coordination Effective Clinical Care Community/Population Health Efficiency and Cost Reduction Other GI-related Measures Measure 72: Colon Cancer-Chemotherapy for AJCC Stage III Colon Cancer Patients Measure 100: Colorectal Cancer Resection Pathology Reporting: pT Category (Primary Tumor) and pN Category (Regional Lymph Nodes) with Histologic Grade Measure 185: Endoscopy/Polyp Surveillance: Colonoscopy Interval for Patients with a History of Adenomatous Polyps-Avoidance of Inappropriate Use Measure 249: Barrett’s Esophagus Measure 320: Endoscopy/Polyp Surveillance: Appropriate Follow-Up Interval for Normal Colonoscopy in Average Risk Patients Measure 321: Partcipation by a Hospital, Physcian or Other Clinician in a Systematic Clinical Database Registry that Includes Consensus Endorsed Quality Measure 343: Screening Colonoscopy Adenoma Detection Rate 2012 Most Frequently Reported Measures by Gastroenterologists Measure 113-Colorectal Cancer Screening Percentage of patients 50-75 years who had appropriate screening for colorectal cancer Measure 128-Documentation of Current Medications in the Medical Record Percentage of visits for patients aged 18 years and older for which the eligible professional attests to documenting a list of current medications using all immediate resources available on the date of the encounter. This list must include all known prescriptions, over the counters, herbals, and nutritional supplements and must contain the medications’ name, dosage, frequency and route of administration.  Measure 130-Tobacco Cessation Percentage of patients aged 18 years and older who were screened for tobacco use one of more times within 24 months and who received cessation counseling intervention if identified as a tobacco user. Measure 226-Preventive Care and Screening: BMI Screening and Follow-Up Percentage of patients aged 18 years and older with a documented BMI during the current encounter or during the previous six months and when the BMI is outside of normal parameters, a follow-up plan is documented during the encounter or during the previous six months of the encounter. Measure 124-Health Information Technology *retired* Resources CMS website QualityNet 866-288-8912 or qnetsupport@hcqis.org (Monday-Friday 7:00 a.m. - 7:00 p.m. CT) Medicare Learning Network Provider Compliance ASGE Webinar:  PQRS and the Value-Based Payment Modifier: Preparing for 2014 Reporting Requirements Summary of 2014 Payment Incentives and 2016 Payment Adjustments