Tuesday, January 7, :00 Noon EST Dial In: Meeting ID: No audio available through Webinar

Transcription

1 CMS 2014 Physician Quality Reporting System (PQRS) Webinar Tuesday, January 7, :00 Noon EST Dial In: Meeting ID: No audio available through Webinar

2 Introduction 2 Series of calls will focus on 2014 participation in quality programs to earn incentives and avoid payment adjustments All calls Tuesdays at 12 Noon EST and Thursdays at 6:00 PM EST o o o o January 7 & 9: Physician Quality Reporting System (PQRS) January 14 & 16: Value Modifier January 21 & 23: ICD-10 January 28 & 30: Stage 2 Meaningful Use Planning webinar in February to merge information from all programs

3 Upcoming 2014 Important Dates 3 Date Program Milestone January 1, 2014 EHR Reporting period begins for EPs (90 days for ALL participants) Stage 2 begins for EPs (if they have demonstrated meaningful use for 2 or more years) PQRS/Value Modifier Reporting period begins January 31, 2014 PQRS Deadline for self-nomination statement for Qualified Clinical Data Registries (QCDRs) (Qnetsupport@sdps.org) Deadline for self-nomination for Maintenance of Certification (PQRS_Vetting@mathematica-mpr.com)

4 Upcoming 2014 Important Dates 4 Date Program Milestone February 28, 2014 March 31, 2014 EHR Last day for EPs to register and attest to receive an incentive payment for 2013 PQRS Last day to submit 2013 PQRS data through some reporting methods (deadline for submission of PQRS data varies by reporting method, but all methods require data to be submitted by end of first quarter in 2014) Last day to submit Part B charges to be included in calculation of 2013 PQRS and erx incentive payments erx Deadline to request an informal review of application of erx payment adjustment in 2014 (2014 erx Payment Adjustment Informal Review Made Simple) PQRS Deadline for submission of measures information for QCDRs EHR Last day of quarter for EPs reporting for first quarter of CY 2014

5 Reminder: 2014 erx Payment Adjustment Can Affect 2015 MU Payment Adjustment 5 If you did not earn the 2012 erx incentive or reported during the 6-month reporting period in 2013, you will be subject to a -2.0 percent payment adjustment in 2014 If you are subject to the 2014 erx payment adjustment, and you did not successfully demonstrate meaningful use to avoid the 2015 MU payment adjustment, the 2015 MU adjustment is -2.0 percent (as opposed to -1.0 percent) 2014 is the last year erx payment adjustments will be applied Informal review requests can be submitted to erxinformalreview@cms.hhs.gov no later than February 28,2014.

6 Eligibility 6 Eligible for Incentive PQRS Value Modifier EHR Incentive Program Subject to Payment Adjustment Included in Definition of Group (1) Subject to VM (2) Eligible for Medicare Eligible for Medicaid Incentive (4,5) Subject to Medicare Payment Adjustment (7,8) Incentive(3) Medicare Physicians Doctor of Medicine X X X X X X X Doctor of Osteopathy X X X X X X X Doctor of Podiatric Medicine X X X X X X Doctor of Optometry X X X X X X Doctor of Oral Surgery X X X X X X X Doctor of Dental Medicine X X X X X X X Doctor of Chiropractic X X X X X X Practitioners Physician Assistant X X X X (6) Nurse Practitioner X X X X Clinical Nurse Specialist X X X Certified Registered Nurse Anesthetist (10) X X X Certified Nurse Midwife X X X X Clinical Social Worker X X X Clinical Psychologist X X X Registered Dietician X X X Nutrition Professional X X X Audiologists X X X Therapists Physical Therapist X X X Occupational Therapist X X X Qualified Speech-Language Therapist X X X

7 Eligibility 7 Beginning in 2014, professionals who reassign benefits to a Critical Access Hospital (CAH) that bills professional services at a facility level, such as CAH Method II billing, can now participate (in all reporting methods except for claims-based) o To do so, the CAH must include the individual provider NPI on their Institutional (FI) claims. Some professionals may be eligible to participate per their specialty, but due to billing method may not be able to participate o Professionals who do not bill Medicare at an individual National Provider Identifier (NPI) level, where the rendering provider s individual NPI is entered on CMS-1500 type paper or electronic claims billing, associated with specific lineitem services Services payable under fee schedules or methodologies other than the PFS are not included in PQRS

8 PQRS Updates Emphasis on 2014 Incentive AND avoiding 2016 Payment Adjustment New satisfactorily reporting requirements via claims, registry and EHR to receive incentive and avoid adjustment: 9 measures across 3 National Quality Strategy domains Lowered percentage of patients to be reported on for some reporting options from 80 percent to 50 percent Elimination of Administrative claims or the reporting of one measure for purposes of avoiding the 2016 PQRS payment adjustment EPs may report on ONLY three measures on 50 percent of their patients to avoid the 2016 payment adjustment (applies to only to individual claims or qualified registry reporting options)

9 PQRS Updates All Measures Groups reportable via Registry Only Added EHR Reporting for group practices New Qualified Clinical Data Registry (QCDR) reporting option Certified Survey Vendor Option for purposes of reporting the CG-CAHPS measures, available to group practices that register to participate in the Group Practice Reporting Option (GPRO)

10 Incentives and Payment Adjustments 10 in is the last year for incentives EPs who satisfactorily report quality-measures data for services furnished in 2014 are: o eligible to earn an incentive payment of 0.5 percent of the EP's estimated total allowed charges for covered Medicare Part B Physician Fee Schedule (PFS) services provided in 2014 o Additional 0.5 percent available for Maintenance of Certification 2014 is also the performance year for the 2016 PQRS payment adjustment o Payment Adjustment in 2016 is -2.0 percent of EP s Part B covered professional services under Medicare PFS

11 Incentives and Payment Adjustments in EPs who are eligible for both PQRS and the EHR meaningful use (MU) program may participate in both programs and earn incentives for both Medicare EHR incentive payments for 2014 is based on when the individual EP first demonstrated MU: If first year of MU was: 2011 $4, $8, $12, $12, MU Incentive Is (per EP): 2014 Incentive for EPs participating in the Medicaid MU program is either $21,250 or $8,500

12 2014 Incentives and 2016 Payment Adjustments 12 PQRS Value Modifier EHR Incentive Program EPs 100+ EPs Incentive Pay Adj PQRS- Reporting Non- PQRS Reporting PQRS- Reporting (Up or Neutral Adj) PQRS- Reporting (Down Adj) Non- PQRS Reporting Medicare Inc. Medicaid Inc. Medicare Pay Adj MD & DO DDM Oral Sur Pod. 0.5% of MPFS (1.0% with MOC) -2.0% of MPFS +2.0 (x), +1.0(x), or neutral (reassigned to the billing TIN of the group) -2.0% of MPFS (reassigned to the billing TIN of the group) +2.0 (x), +1.0(x), or neutral (reassigned to the billing TIN of the group) -1.0% or -2.0% of MPFS (reassigned to the billing TIN of the group) -2.0% of MPFS (reassigned to the billing TIN of the group) $4,000- $12,000 (based on when EP 1 st demo MU) $8,500 or $21,250 (based on when EP did A/I/U) $8,500 or $21,250 (based on when EP did A/I/U) N/A -2.0% of MPFS Opt. Chiro.

13 Practitioners Physician Assistant Nurse Practitioner Clinical Nurse Specialist 2014 Incentives and 2016 Payment Adjustments 13 Certified Registered Nurse Anesthetist Certified Nurse Midwife Clinical Social Worker Clinical Psychologist Incentive 0.5% of MPFS PQRS Pay Adj. -2.0% of MPFS Value Modifier Groups of 10+ EPs EPs included in the definition of group to determine group size for application of the value modifier in 2016 (10 or more EPs); VM only applied to reimbursement of physicians in the group Medicare Inc. N/A EHR Incentive Program Medicaid Inc. $8,500 or $21,250 (based on when EP did A/I/U) N/A $8,500 or $21,250 (based on when EP did A/I/U) Medicare Pay Adj. N/A Registered Dietician N/A Nutrition Professional Audiologits Therapists Physical Therapist Occupational Therapist Qualified Speech-Language Therapist 0.5% of MPFS -2.0% of MPFS See above N/A N/A N/A

14 National Quality Strategy 14 (NQS) Domains Most PQRS reporting options require a group or practice to report 9 or measures covering at least 3 NQS domains for incentive purposes: 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 Same domains for MU Clinical Quality Measures

15 15 How Will I Participate? Will you participate as an individual or a group? o If a group: how many EPs are in your group? Individuals can report using 5 methods: 1. Claims (Individual measures) 2. Qualified Registry (Individual measures or measures groups) 3. Direct EHR product that is CEHRT 4. EHR data submission vendor that is CEHRT (Individual Measures) 5. Qualified Clinical Data Registry (Measures selected by QCDR)

16 16 New- Qualified Clinical Data Registries A QCDR is a CMS-approved entity that: collects medical and/or clinical data for the purpose of patient and disease tracking has self-nominated and successfully completed a qualification process A QCDR must perform the following functions: (1) Submit quality measures data or results to CMS Must have in place mechanisms for the transparency of data elements, specifications, risk models, and measures. (2) Submit to CMS quality measures data on multiple payers (3) Provide timely feedback (4) Possess benchmarking capacity

17 New- Qualified Clinical Data Registries 17 Must have at least 9 measures, covering at least 3 of the 6 NQS domains, available for reporting Must have at least 1 outcome measure available for reporting to earn incentive May report on process measures Must provide the appropriate analytical structure (i.e., numerator, denominator, denominator exceptions/exclusions, etc.) Must submit a self-nomination statement no later than January 31, 2014 Must provide to CMS descriptions for the measures for which it will report to CMS by no later than March 31, The descriptions must include: o o o name/title of measures, NQF # (if NQF endorsed) descriptions of the denominator, numerator, and when applicable, denominator exceptions and denominator exclusions of the measure QCDRs must calculate the composite score for CMS and provide the formula used for calculation Also finalized as an additional mechanism to report clinical quality measures in the MU program

18 Individual Reporting Criteria for Earning the 2014 PQRS Incentive Claims 18 What Measure Type? Individual Measures Can you report at least 9 measures covering at least 3 domains? Yes No Report at least 9 measures covering at least 3 NQS domains Report 1 8 measures covering 1 3 NQS domains Report each measure for at least 50 percent of the Medicare Part B FFS patients seen during the reporting period to which the measure applies. Measures with a 0 percent performance rate would not be counted. (Subject to MAV)

19 Individual Reporting Criteria for Earning the 2014 PQRS Incentive Qualified Registry What Measure Type? 19 Individual Measures Can you report at least 9 measures covering 3 domains? Measures Groups Reporting Period? Yes Report at least 9 measures covering at least 3 NQS domains No Report 1 8 measures covering 1 3 NQS domains 12 month 6 month (Jul 1- Dec 31) Report each measure for at least 50 percent of the Medicare Part B FFS patients seen during the reporting period to which the measure applies. Measures with a 0 percent performance rate would not be counted. Report at least 1 measures group, AND report each measures group for at least 20 patients, a majority of which much be Medicare Part B FFS patients (Subject to MAV)

20 Individual Reporting Criteria for Earning the 2014 PQRS Incentive 20 Direct EHR product that is CEHRT OR- EHR data Submission vendor that is CEHRT Individual Measures What Measure Type? Report 9 measures covering at least 3 of the NQS domains. If an EP's CEHRT does not contain patient data for at least 9 measures covering at least 3 domains, then the EP must report the measures for which there is Medicare patient data. An EP must report on at least 1 measure for which there is Medicare patient data.

21 Individual Reporting Criteria for Earning the 2014 PQRS Incentive 21 Qualified Clinical Data Registry What Measure Type? Measures selected by Qualified Clinical Data Registry Report at least 9 measures covering at least 3 NQS domains AND report each measure for at least 50 percent of the EP s applicable patients seen during the reporting period to which the measure applies. Measures with a 0 percent performance rate would not be counted. Of the measures reported via a qualified clinical data registry, the EP must report on at least 1 outcome measure.

22 Individual Reporting Criteria for Avoiding the 2016 PQRS Payment Adjustment 22 Claims What Measure Type? Individual Measures Do you plan to meet 2014 incentive criteria? Yes You will avoid the 2016 PQRS payment adjustment Yes Report at least 3 measures No Can you report at least 3 measures? No If less than 3 measures apply to the EP, report 1 2 measures Report each measure for at least 50 percent of the EP s Medicare Part B FFS patients seen during the reporting period to which the measure applies. Measures with a 0 percent performance rate will not be counted. (Subject to MAV)

23 Individual Reporting Criteria for Avoiding the 2016 PQRS Payment Adjustment Qualified Registry 23 What Measure Type? Individual Measures Do you plan to meet 2014 incentive criteria? Measures Groups Reporting Period? Yes No You will avoid the 2016 PQRS payment adjustment Can you report at least 3 measures? Yes Report at least 3 measures No If less than 3 measures apply to the EP, report 1 2 measures 12 month 6 month Must meet the criteria for successfully reporting for 2014 incentive Report each measure for at least 50 percent of the EP s Medicare Part B FFS patients seen during the reporting period to which the measure applies. Measures with a 0 percent performance rate will not be counted. (Subject to MAV)

24 Individual Reporting Criteria for Avoiding the 2016 PQRS Payment Adjustment 24 Direct EHR product that is CEHRT -OR- EHR data Submission vendor that is CEHRT Individual Measures What Measure Type? Must meet the criteria for successful reporting for the 2014 incentive payment

25 Individual Reporting Criteria for Avoiding the 2016 PQRS Payment Adjustment 25 Qualified Clinical Data Registry Measures selected by Qualified Clinical Data Registry What Measure Type? Yes Do you plan to meet 2014 incentive criteria? No You will avoid the 2016 PQRS payment adjustment Report at least 3 measures covering at least 1 NQS domain AND report each measure for at least 50 percent of the eligible professional s applicable patients seen during the reporting period to which the measure applies. Measures with a 0 percent performance rate would not be counted.

26 How Is a Group Practice Defined? 26 A single Tax Identification Number (TIN) with 2 or more individual EPs(as identified by Individual National Provider Identifier [NPI]) who have reassigned their billing rights to the TIN Once a group practice (TIN) has self-nominated or registered to participate in PQRS GPRO, the method chosen is the only PQRS submission method available to the group and all individual NPIs who bill Medicare under the group's TIN If an organization or eligible professional changes TINs, the participation under the old TIN does not carry over to the new TIN, nor is it combined for final analysis

27 27 Group Practice Reporting Option (GPRO) Options for reporting under the Group Practice Reporting Option (GPRO) depends on the size of the group Claims-based reporting option no longer available for GPRO All reporting periods under GPRO is 12 months Group Practice Size? 2-24 EPs 1. Qualified Registry 2. Direct EHR Product that is CEHRT 3. EHR data submission vendor that is CEHRT EPs 1. Qualified Registry 2. Direct EHR Product that is CEHRT 3. EHR data submission vendor that is CEHRT 4. GPRO Web Interface 5. CMS-certified survey vendor AND ONE OF other four options 100+ EPs 1. Qualified Registry 2. Direct EHR Product that is CEHRT 3. EHR data submission vendor that is CEHRT 4. GPRO Web Interface AND REQUIRED CG CAHPS survey 5. CMS-certified survey vendor AND ONE OF other four options

28 28 Certified Survey Vendor New reporting mechanism available to group practices participating in PQRS under GPRO beginning in This option is available to group practices of 25 or more EP wishing to report the Clinician Group Consumer Assessment of Healthcare Providers and Systems (CG CAHPS) summary survey modules. o o NOTE: CMS will only support survey data collection for groups of 100+ EPs May be a fee for groups of EPs The data collected on these measures will be submitted on behalf of the group practice by the certified survey vendor, the results of which will subsequently be posted on the Physician Compare website.

29 CG-CAHPS: Summary Survey Modules 29 CG CAHPS will include the following survey modules: 1. Getting timely care, appointments, and information 2. How well providers Communicate 3. Patient s Rating of Provider 4. Access to Specialists 5. Health Promotion & Education 6. Shared Decision Making 7. Health Status/Functional Status 8. Courteous and Helpful Office Staff 9. Care Coordination 10. Between Visit Communication 11. Helping You to Take Medication as Directed 12. Stewardship of Patient Resources Reference Survey for more information on the CG CAHPS survey modules

30 GPRO Reporting Criteria for Earning the 2014 PQRS Incentive 30 Qualified Registry Group Practice Size? 2+ EPs Can the group report at least 9 measures covering at least 3 domains? Yes No Report at least 9 measures covering at least 3 NQS domains Report 1 8 measures covering 1 3 NQS domains Report each measure for at least 50 percent of the group practice s Medicare Part B FFS patients seen during the reporting period to which the measure applies. Measures with a 0 percent performance rate would not be counted. (Subject to MAV)

31 GPRO Reporting Criteria for Earning the 2014 PQRS Incentive 31 Direct EHR product that is CEHRT -OR- EHR data submission vendor that is CEHRT 2+ EPs Group Practice Size? Report 9 measures covering at least 3 of the NQS domains. If a group practice's CEHRT does not contain patient data for at least 9 measures covering at least 3 domains, then the group practice must report the measures for which there is Medicare patient data. A group practice must report on at least 1 measure for which there is Medicare patient data.

32 GPRO Reporting Criteria for Earning the 2014 PQRS Incentive 32 GPRO Web Interface Group Practice Size? EPs 100+ EPs Report on all measures included in the web interface; AND Populate data fields for the first 218 consecutively ranked and assigned beneficiaries in the order in which they appear in the group s sample for each module or preventive care measure. If the pool of eligible assigned beneficiaries is less than 218, then report on 100 percent of assigned beneficiaries. Report on all measures included in the web interface; AND Populate data fields for the first 411 consecutively ranked and assigned beneficiaries in the order in which they appear in the group s sample for each module or preventive care measure. If the pool of eligible assigned beneficiaries is less than 411, then report on 100 percent of assigned beneficiaries. In addition, the group practice must report all CG CAHPS survey measures via certified survey vendor. *Individual EPs within a group practice that satisfactorily completes GPRO Web Interface also receives credit for CQM component of MU

33 GPRO Reporting Criteria for Earning the 2014 PQRS Incentive 33 CMS-certified survey vendor AND ONE OF: 1) qualified registry; 2) direct EHR product; 3) EHR data submission vendor; 4) or GPRO web interface 25+ EPs Group Practice Size? Report all CG CAHPS survey measures via a CMS-certified survey vendor, AND report at least 6 measures covering at least 2 of the NQS domains using a qualified registry, direct EHR product, EHR data submission vendor, or GPRO web interface (all measures included on web interface).

34 GPRO Reporting Criteria for Avoiding the 2016 PQRS Payment Adjustment 34 Qualified Registry Group Practice Size? 2+ EPs Does the group plan to meet 2014 incentive criteria? Yes Group will avoid the 2016 PQRS payment adjustment Yes Report at least 3 measures No Can the group report at least 3 measures? No If less than 3 measures apply to the group practice, report 1 2 measures Report each measure for at least 50 percent of the group practice s Medicare Part B FFS patients seen during the reporting period to which the measure applies. Measures with a 0 percent performance rate will not be counted. (Subject to MAV)

35 GPRO Reporting Criteria for Avoiding the 2016 PQRS Payment Adjustment 35 Direct EHR product that is CEHRT -OR- EHR data submission vendor that is CEHRT Group Practice Size? 2+ EPs Must meet the criteria for successful reporting for the 2014 incentive payment

36 GPRO Reporting Criteria for Avoiding the 2016 PQRS Payment Adjustment 36 GPRO Web Interface Group Practice Size? EPs 100+ EPS Must meet the criteria for successful reporting for the 2014 incentive payment

37 GPRO Reporting Criteria for Avoiding the 2016 PQRS Payment Adjustment 37 CMS-certified survey vendor AND ONE OF: 1) qualified registry; 2) direct EHR product; 3) EHR data Submission vendor; 4) or GPRO web interface 25+ EPs Group Practice Size? Must meet the criteria for successful reporting for the 2014 incentive payment

38 Measures Applicability Validation 38 (MAV) Process EPs and groups (of all sizes) could be subject to the MAV process if they choose: o Individual Claims option; or o Qualified Registry option MAV process initiated when: o EP or group satisfactorily reports QDCs for only one to eight PQRS measures across one or more domains, OR o EP or group satisfactorily reports QDCs for nine or more PQRS measures across less than three domains

39 Measures Applicability Validation (MAV) Process 39 Eligible professionals must satisfactorily report for at least 50 percent of their eligible patients or encounters for each measure: o To receive 2014 incentive payment, CMS will analyze claims data to validate if more measures/domains may have been applicable for reporting o To avoid 2016 payment adjustment, if only one or two measures are satisfactorily reported, CMS will analyze claims data to validate if more measures may have been applicable for reporting EPs that satisfactorily report three or more measures across one or more domains will not be subject to MAV for payment adjustment purposes, but will be subject to MAV to determine if more measures/domains could have been submitted for 2014 incentive eligibility.

40 Measures Applicability Validation (MAV) Process 40 Two-Step Process: 1. Clinical Relation/Domain Test, based on presumption: If EP submits data for a measure, then that measure applies to her/his practice, and If one measure in a cluster of measures related to a particular clinical topic or EP service is applicable to an EP s practice, then other closely-related measures (measures in that same cluster) may also be applicable 2. Minimum Threshold Test If the EP treated more than a certain number of Medicare patients with a condition where a measure applied, that EP should be accountable for submitting the QDC(s) for that measure Common minimum threshold will not be less than 15 patients (or encounters) for the 12-month reporting period for each 2014 PQRS measure

41 41 Physician Compare Website For Groups of all size, all measures collected through the GPRO web interface will be posted on Physician Compare. 16 possible Registry measures 13 possible EHR measures We plan to publicly report 2014 data in CY 2015 o For ACOs participating in the Shared Savings Program, all measures collected in 2014 will be published, including: All GPRO measures collected via the web interface. The three claims-based and one administrative measure finalized by the Shared Savings Program for 2014

42 42 Physician Compare Website We will publicly report CG-CAHPS measures for groups of 100 or more EPs who participate in PQRS GPRO, regardless of submission method. We will publically report CG-CAHPS for MSSP ACOs reporting through the GPRO web interface. o We plan to publicly report 2014 data in CY 2015 o CMS continues to support survey data collection in 2014 for PQRS GPROs participating via the web interface (12 summary CAHPS survey measures)

43 43 Physician Compare Website For groups of 25 to 99 EPs, we finalized the proposal to publicly report the CG-CAHPS measures collected via a certified CAHPS vendor. o We plan to report 2014 data in CY o CMS will not support survey data collection in o Same 12 Summary Survey Measures for groups of 100 or more.

44 Where to Call for Help 44 QualityNet Help Desk: o o o o o Portal password issues PQRS/eRx feedback report availability and access IACS registration questions IACS login issues PQRS and erx Incentive Program questions (TTY ) 7:00 a.m. 7:00 p.m. CST M-F or qnetsupport@sdps.org You will be asked to provide basic information such as name, practice, address, phone, and Provider Contact Center: o o Questions on status of 2012 PQRS/eRx Incentive Program incentive payment (during distribution timeframe) See Contact Center Directory at EHR Incentive Program Information Center: (TTY )

45 45 CMS Regional Office Contacts Region I: CT, ME, MA, NH, RI, VT Andrew Finnegan ( ) Region II: NJ, NY, PR, VI Paul Velez ( ) Region III: DE, DC, MD, PA, VA, WV Patrick Hamilton ( ) Barbara Connors, D.O. ( ) Region IV: AL, FL, GA, KY, MS, TN, NC, SC Janerio Farrington ( ) Region V: IL, IN, MI, MN, OH, WI Susan Hahn Reizner ( ) Sarah Ross ( ) Region VI: AR, LA, NM, OK, TX Kathy Maris ( ) Region VII: IA, KS, MO, NE Annette Kussmaul ( ) Region VIII: CO, MT, ND, SD, UT, WY Mark Levine ( ) Region IX: AZ, CA, NV, HI, U.S. Pac. Terr. Lolita Jacobe ( ) Monroe Peoples ( ) Region X: AK, ID, OR, WA Lauri Tan ( )