Aligning PQRS and Meaningful Use Maximize your Medicare Reimbursement
INTRODUCTION Brux McClellan, MPH, MHA Project Coordinator, HealthInsight
Payment Adjustments Incentive $$ & Payment Adjustments Value Based Payment Modifier MU Attestation CQM PQRS Reporting Measures Goals Tracking Education Feedback
2014 update Objectives EHR Incentive Program or Meaningful Use (MU) Physician Quality Reporting System (PQRS) Value Based Payment Modifier (VM) How can I align these programs? Reduce duplicative work Let your local Regional Extension Center (REC) and Quality Improvement Organization (QIO) help you
Poll In What stage of Meaningful Use is our audience? Stage 1 year 1 Stage 1 year 2 Stage 2 year 1
Payment Adjustments Incentive $$ & Payment Adjustments Value Based Payment Modifier MU Attestation CQM PQRS Reporting Measures Goals Tracking Education Feedback
EHR Incentive Program also known as Meaningful Use Payment adjustments: Start in 2015 and look back two years at whether you attested for MU Start at -1% and increase by -1% each year until they reach the maximum of -5%
EHR Incentive Program (Meaningful Use) $24,000 of Medicare incentives left from 2014 forward October 1 st deadline for 1 st 90 day attestation in 2014 to avoid penalties in 2015 & 2016 and get MU payment Or finish your attestation period by Dec 31 st to avoid 2016 penalties only
EHR Incentive Program (Meaningful Use) In 2014 for Medicare: All attestation periods must be done within a calendar quarter You need a patient portal You need the 2014 certified EHR version Can report Clinical Quality Measures (CQMs) with PQRS for the first time in 2014
Payment Adjustments Incentive $$ & Payment Adjustments Value Based Payment Modifier MU Attestation CQM PQRS Reporting Measures Goals Tracking Education Feedback
Poll Question How many of you are already successfully reporting PQRS? Yes No
Physician Quality Reporting System (PQRS) Quality reporting program with incentives and disincentives for EPs who bill Medicare Incentives 2014: +0.5% applied in 2016 Disincentives 2014: -2.0% applied in 2016 Report 9 measures over 3 domains Report on at least 50% of your Medicare patients for the year
PQRS/CQM Domains 1. Patient and Family Engagement (4 Measures) 2. Patient Safety (6 Measures) 3. Care Coordination (1Measure) 4. Population/Public Health (9 Measures) 5. Efficient Use of Healthcare Resources (4 Measures) 6. Clinical Processes/Effectiveness (40 Measures)
Payment Adjustments Incentive $$ & Payment Adjustments Value Based Payment Modifier MU Attestation CQM PQRS Reporting Measures Goals Tracking Education Feedback
Combining Your PQRS and Meaningful Use Efforts Measures: Combine all measures from both programs Pick the most important first Goals: Thresholds MU PQRS National averages Calculated for group Measures Goals Tracking Education Feedback
Combining Your PQRS and Meaningful Use Efforts Tracking: Which fields? Work with EHR vendor & QIO Education: Providers MAs Front office Measures Goals Tracking Education Feedback
Combining Your PQRS and Meaningful Use Efforts Feedback: Regular Reports One on one meetings Transparency? Measures Goals Tracking Education Feedback
Plan Do Study Act Cycles Plan Do Change for improvement? Carry out the change Study What did we learn? Act Adopt, abandon, adapt
Payment Adjustments Incentive $$ & Payment Adjustments Value Based Payment Modifier MU Attestation CQM PQRS Reporting Measures Goals Tracking Education Feedback
Reporting Meaningful Use CQMs with PQRS Who is not eligible? EPs in their first year of MU (attestation deadline Oct 1, 2014) Includes those reporting via: GPRO, Medicare Shared Savings Program ACO, Pioneer ACO EPs whose EHR is not certified to the June 2013 for PQRS and 2014 for MU Medicaid MU participants
Things to Consider for Reporting Together What is your preferred method for reporting? Claims and registry won t work for alignment What measures do you want to use for reporting? Only 64 measures in Meaningful Use Do you want your CQMs to count toward the Value Modifier
Things to Consider for Reporting Together Have you adopted an EHR that is certified to the 2014 certification standards? Are you reporting individually or as a group? EHR reporting & GPRO (Group Practice Reporting Option)
Reporting PQRS/Meaningful Use CQMs Together Benefits MU CQMs & PQRS requirements are the same starting in 2014 Report CQMs with PQRS (saves about 15-20 minutes) Prepare you for the full year attestation in 2015 and beyond Deterrents / Criticisms Could delay payment in 2014 You still have to report in both programs Reporting CQMs with PQRS only saves about 15 min MU $$ dependent on successful PQRS sumission
Alignment? Even though it doesn t make a lot of cense to align the reporting of PQRS and Meaningful Use, aligning the quality improvement efforts will save your clinic time and money.
Payment Adjustments Incentive $$ & Payment Adjustments Value Based Payment Modifier MU Attestation CQM PQRS Reporting Measures Goals Tracking Education Feedback
Poll Question How many of you are successfully reporting for the Value Modifier program? Yes No
Value Modifier Program You do nothing other than report PQRS Gives each EP a score determined by cost and quality Cost calculated from Medicare billing Quality calculated from PQRS reporting Applied to groups of: 100 or more EPs in 2015 looking back to 2013 10 or more EPs in 2016 looking back to 2014 All EPs in 2017 looking back to 2015
Value Modifier Program Medicare payment adjustments: +2% high score 0% medium score -1% low score (w/ reporting) -2% low score (w/o reporting)
Value Based Payment Modifier
Value Modifier Program (2014) No negative payment adjustments for the first year on the program 100+ EPs: Positive, neutral or negative payment adjustments in 2016 10+ EPs: Positive or neutral payment adjustments only in 2016 (no negative adjustments unless they don t report) 1-9 EPs: VM not applied until 2017
Performance Year/VM Year 2013/2015 100+ 2014/2016 100+ 2014/2016 10+ 2015/2017 Group Size ALL INDIVIDUAL PHYSICIANS Possible VM Outcomes Downward Adjustment (-2.0%) No Adjustment Upward Adjustment (Budget Neutral) of total Medicare Part B FFS Charges Downward Adjustment (-2.0%) No Adjustment Upward Adjustment (Budget Neutral) of total Medicare Part B FFS Charges No Adjustment Upward Adjustment (Budget Neutral) of total Medicare Part B FFS Charges Downward Adjustment (TBD) No Adjustment Upward Adjustment (Budget Neutral) of total Medicare Part B FFS Charges
Payment Adjustments Incentive $$ & Payment Adjustments Value Based Payment Modifier MU Attestation CQM PQRS Reporting Measures Goals Tracking Education Feedback
Payment Adjustments!!! Participation in 2014 MU $12,000 (first year of MU) PQRS +0.5% incentive in 2016 Value Modifier +2% high score in 2016 0% medium score in 2016-1% low score (w/ reporting) in 2016 Total possible = Non-Participation in 2014 MU -2%adjustment in 2016 PQRS -2%adjustment in 2016 Value Modifier -2%adjustment in 2016 Total = -6% payment adjustment in 2016! $12,000 + 2.5% (in 2016)
Conclusion Do not ignore PQRS and MU if you bill a significant amount of Medicare! Can you afford the -6% payment adjustment? Combine efforts from both programs into one quality improvement project Reporting Meaningful Use CQMs with PQRS doesn t necessarily make cense this year
Questions
Questions Brux McClellan bmcclellan@healthinsight.org (801) 892-6618