2014 Physician Quality Reporting System: Group Reporting Requirements

Transcription

1 2014 Physician Quality Reporting System: Group Reporting Requirements Lisa Lentz, MPH, Health Insurance Specialist and LeTonya Smith, CRNP, Health Insurance Specialist Presentation to the American Medical Group Association Tuesday August 5, :00 PM ET

2 Table of Contents 1. Physician Quality Reporting System Overview Group Reporting Options 3. PQRS 2014 Incentive Payment & 2016 Payment Adjustment 4. Physician Value-Based Payment Modifier 5. Physician Compare 6. Help & Resources 2

3 Physician Quality Reporting System (PQRS) Overview PQRS is a reporting program that uses incentive payments and payment adjustments to promote reporting of quality information Incentive payments continue through the 2014 program year Payment adjustments begin in payment adjustments are based on 2013 program year reporting 2016 payment adjustments are based on 2014 program year reporting PQRS is available to practices with eligible professionals (EPs) or group practices participating in the group practice reporting option (GPRO) The creation of the PQRS program was mandated by federal legislation, but participation is voluntary for EPs 3

4 2014 Reporting Options for Groups Options for reporting under the PQRS Group Practice Reporting Option (GPRO) depend on size of group Groups of 2+ can report using: 1. Qualified registry 2. Directly from Electronic Health Record (EHR) using Certified Electronic Health Record Technology (CEHRT) 3. CEHRT using data submission vendor Groups of 25+ can also report using: 1. Web interface 2. CAHPS for PQRS Elective, in addition to selection of one of the previous reporting options, for groups of eligible professionals and groups of 100+ reporting via registry or EHR Required for groups of 100+ reporting via GPRO web interface CMS will partner with a certified survey vendor and pay for the survey to be disseminated on groups behalf for

5 2014 Measure Reporting Changes for Groups Emphasis on 2014 incentive AND avoiding 2016 payment adjustment Elimination of administrative claims-based reporting for purposes of avoiding 2016 PQRS payment adjustment New requirements for qualified registry and EHR-based reporting to receive incentive and avoid adjustment 9 measures across 3 National Quality Strategy (NQS) domains 5

6 2014 Group Practice Reporting Option (GPRO) Changes EHR-based reporting now available for group practices of 2 or more eligible professionals Reporting directly from certified EHR technology (CEHRT) Reporting CEHRT using a data submission vendor CMS-Certified Survey Vendor option now available for groups of 25 or more eligible professionals that are also reporting via registry, EHR, or GPRO web interface This option is used to report Consumer Assessment of Healthcare Providers and Systems (CAHPS for PQRS) summary survey modules CAHPS for PQRS is required, not elective, for groups of 100 or more eligible professionals reporting via GPRO web interface 6

7 CAHPS for PQRS: Summary Survey Modules CAHPS for PQRS will include the following survey modules: Getting timely care, appointments, and information How well providers Communicate Patient s Rating of Provider Access to Specialists Health Promotion & Education Shared Decision Making Health Status/Functional Status Courteous and Helpful Office Staff Care Coordination Between Visit Communication Helping You to Take Medication as Directed Stewardship of Patient Resources Reference for more information on the CAHPS for PQRS 7

8 Measure Count Changes Reporting Method Total 2013 Count New Total 2014 Count Registry Measures Measures Groups EHR Measures GPRO Web Interface Measures 22 (Includes subcomponents of composite measures) 22 (Includes subcomponents of composite measures) Certified Survey Vendor N/A CAHPS for PQRS (12 Summary Survey Modules) 8

9 National Quality Strategy (NQS) Domains Most PQRS reporting options for 2014 requires 9 measures covering at least 3 NQS domains for 2014 incentive purposes: Notes: 1. Patient Safety 2. Person and Caregiver-Centered Experience and Outcomes 3. Communication and Care Coordination 4. Effective Clinical Care 5. Community/Population Health 6. Efficiency and Cost Reduction These same domains apply to clinical quality measures under meaningful use for EHR Incentive Programs Group practices electing to report via the GPRO web interface must report all 22 web interface measures in order to be eligible for the 2014 PQRS incentive payment 9

10 PQRS Incentives for is the last year for incentives Groups that satisfactorily report quality measures data for services furnished in 2014 are: Eligible to earn an incentive payment of 0.5 percent of estimated total allowed charges for covered Medicare Part B Physician Fee Schedule (PFS) services provided in 2014 Additional 0.5 percent available for Maintenance of Certification Program Incentive 10

11 PQRS Payment Adjustments in is performance year for 2016 PQRS payment adjustment Payment adjustment in 2016 is -2.0 percent of Part B covered professional services under Medicare PFS For more information, review the 2014 Physician Quality Reporting System (PQRS): 2016 PQRS Payment Adjustment fact sheet on the PQRS website: Assessment- Instruments/PQRS/Downloads/2014PQRS Avoiding2016PQR S-PaymentAdjustment_F pdf 11

12 Avoiding PQRS Payment Adjustments in 2016 Groups avoid adjustment by satisfactorily reporting*or: Report at least 3 measures covering 1 NQS domain for at least 50% of the group practice s Medicare Part B FFS patients via qualified registry * Group practices reporting via the GPRO web interface must report on all 22 web interface measures in order to avoid the payment adjustment. 12

13 Registry MAV Process Overview 2014 PQRS incentive eligibility and payment adjustment will include validation processes Groups who satisfactorily submit registry quality data for fewer than 9 PQRS measures and/or fewer than 3 domains will be subject to a measure-applicability validation (MAV) process MAV determines whether additional measures or additional measures with additional domains should have been submitted to be considered incentive eligible When fewer than 9 measures and/or fewer than 3 domains are available for reporting, report on all applicable measures and all applicable domains for at least 50% of eligible patient visits 13

14 EHR and PQRS Incentive Payments Eligible professionals who are eligible for both PQRS and Medicare EHR Incentive Program can submit quality measures once for 2014 and satisfy criteria for both programs Groups can use following reporting options for dual credit: 1. Direct using CEHRT 2. CEHRT using data submission vendor 3. Web interface 4. CAHPS for PQRS (supplementary) For more information, review the How to Report Once for 2014 Medicare Quality Reporting Programs fact sheet and interactive tool on PQRS Educational Resources webpage: Instruments/PQRS/EducationalResources.html 14

15 What is the Value Modifier? Value Modifier (VM) assesses both quality of care furnished and the cost of that care under the Medicare Physician Fee Schedule (PFS) 2016 VM does not apply to groups of physicians in which any of the group s physicians participate in the Shared Saving Program, Pioneer ACO or the CPC Initiative during the 2014 performance period. The VM is a per-claim adjustment under the Medicare PFS that is applied at the group (Taxpayer Identification Number or TIN) level and varies by calendar year. VM adjustments are applied two years after the PQRS reporting period. CY 2015 CMS will apply the VM to groups of physicians with 100 or more eligible professionals (EPs) based on 2013 performance. CY CMS will apply the VM to groups of physicians with 10 ore more EPs based on 2014 performance. CMS is required to apply the VM to all physicians and groups of physicians starting in Resource: VM page of the CMS website at Payment/PhysicianFeedbackProgram/ValueBasedPaymentModifier.html 15

16 VM and PQRS VM is based on participation in PQRS Groups of physicians with 10 or more EPs must use one of the PQRS GPRO or individual reporting mechanisms available to them for 2014 quality data reporting. Groups must register and successfully report or ensure at least 50% of the EPs in their group successfully report individually in order to avoid the automatic downward adjustment and to be eligible for upward adjustments. Group practices that have elected or are required to report the CAHPS for PQRS may elect to include their performance on the 2014 CAHPS for PQRS in the calculation of the group s 2016 VM. 16

17 Reporting at Individual Level - 50% Threshold Option Groups who do not seek to report as a group must ensure at least 50% of the EPs in their group successfully report in order to avoid the automatic VM downward adjustment and to be eligible for VM upward adjustments. EPs may report on measures available to individual EPs via the following reporting mechanisms: Claims CMS Qualified Registries EHR Qualified Clinical Data Registries (new for CY 2014) The TIN (group) does NOT have to register for this option. 17

18 Will My Group be Subject to the 2016 VM? For 2014 program year, groups of physicians with 10+ EPs Participate in PQRS (2 Options) Option 1) Report via 2014 GPRO - Register for GPRO Web Interface, qualified registry, or EHR reporting and meet the criteria to avoid the 2016 PQRS payment adjustment ; OR Option 2) Report as an Individual EP for 2014 PQRS at least 50% of EPs under TIN meet the criteria to avoid the PQRS 2016 payment adjustment Groups of physicians with EPs Upward or neutral 2016 VM adjustment based on quality tiering Mandatory Quality Tiering Calculation Groups of physicians with 100+ EPs Upward, neutral, or downward 2016 VM adjustment based on quality tiering 18 Do NOT Participate in PQRS Do not register to participate in the 2014 GPRO and at least 50% of EPs under TIN do not meet the criteria to avoid the PQRS 2016 payment adjustment Groups of physicians with 10+ EPs -2.0% (Automatic 2016 VM downward adjustment) Note: The VM downward adjustment is separate from the PQRS payment adjustment and payment adjustments from other Medicare sponsored programs.

19 What Should a Physician Group Do in 2014? Decide whether and how to participate in the PQRS for 2014 Group reporting- Register by September 30, 2014 For more information on registration please access the following link: ( Payment/PhysicianFeedbackProgram/Self-Nomination-Registration.html) Individual Reporting No registration necessary Decide which PQRS measures to report and understand the measure specifications Review quality measure benchmarks Obtain your Quality and Resource Use Report available late summer of

20 Physician Compare Two-Fold Purpose Encourage consumers to make informed choices Incentivize physicians to maximize performance 20

21 Physician Compare Overview Physician Compare was mandated as part of the Affordable Care Act of 2010 Physician Compare is a CMS website that allows users to find and choose physicians and other health care professionals enrolled in Medicare programs Physician profiles indicate participation in CMS quality programs, including PQRS Users can now search for Medicare physicians and other health care professionals by defining a location and entering additional information, such as: Medical specialty Health care professional or group practice name Medical condition 21

22 Help Desk QualityNet Help Desk: (TTY ) 7:00 a.m. 7:00 p.m. CT M-F or Portal password issues PQRS/eRx feedback report availability and access IACS registration questions IACS login issues PQRS and erx Incentive Program questions You will be asked to provide basic information such as name, practice, address, phone, and EHR Incentive Program Information Center: (TTY ) VM Help Desk: or ACO Help Desk: or 22

23 Resources PFS Federal Regulation Notices Regulation-Notices.html CMS PQRS Website Medicare Shared Savings Program Payment/sharedsavingsprogram/Quality_Measures_Standards.html CMS Value-based Payment Modifier (VM) Website PhysicianFeedbackProgram/ValueBasedPaymentModifier.html Medicare and Medicaid EHR Incentive Programs EHRIncentivePrograms Frequently Asked Questions (FAQs) Physician Compare 23

24 Questions & Answers 24