understanding pqrs and why reporting via an anesthesia qcdr is beneficial
TRANSCRIPT
Understanding PQRS and why reporting via an anesthesia QCDR is beneficial
PRESENTED BY: MATTHEW T. POPOVICH, PH.D.QUALITY SPECIALISTAMERICAN SOCIETY OF ANESTHESIOLOGISTS
Claims and the QCDR: Avoiding the Payment Adjustment
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Physician Quality Reporting System (PQRS)
• Physician Quality Reporting System
– What is the program?
– Incentives and Payment (Negative) Adjustments
– Reporting Options (Including the QCDR)
• CMS Rulemaking Process
– 2014 Physician Fee Schedule (PFS)
– 2015 Proposed PFS
• Final Rule (est. November 2014)
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Physician Quality Reporting System (PQRS)
• Defining PQRS– “Paid under or based on the Physician Fee Schedule”
– Eligible Professionals (EPs)
– Payment Incentives (ending in 2014) v. Payment Adjustments
• Common Measures Reported by Anesthesiologists– #30 (NQF #0269): Timing of Prophylactic Antibiotic
– #44 (NQF #0236): Preoperative Beta-Blocker in Patients with Isolated CABG Surgery
– #76 (NQF #0464): Prevention of Catheter-Related Bloodstream Infections (CRBSI): Central Venous Catheter (CVC) Insertion Protocol
– #193 (NQF #0454): Perioperative Temperature Management
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Satisfactorily Report = Avoid the Payment Adjustment
• Reporting Options (2014 & Proposed 2015)
– Claims
– Qualified Clinical Data Registry (QCDR)
– “Traditional” Qualified Registry
– Other Reporting Options
• Alignment of Measure Reporting Requirements
– Nine (9) quality measures
– Three (3) National Quality Strategy (NQS) domains
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Satisfactorily Report = Avoid the Payment Adjustment
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• National Quality Strategy Domains– Patient Safety– Person and Caregiver-Centered Experience and Outcomes – Communication and Care Coordination– Effective Clinical Care– Community / Population Health– Efficiency and Cost Reduction
• Anesthesia Measures (Claims)– Patient Safety (PQRS #30, #76 and #193)– Effective Clinical Care (PQRS #44)
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Satisfactorily Report = Avoid the Payment Adjustment
• Satisfactorily Reporting – Claims (2014):
– EPs must report ≥ 9 PQRS measures covering ≥ 3 NQS domains to qualify for an incentive payment for 50% of Medicare Part B patients for whom the measure applies
• If fewer than 9 measures, then EP is subject to the Measure-Applicability Validation (MAV) process
– EPs must report ≥ 3 measures in order to avoid the payment adjustment for 2016
• Subject to MAV process
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Satisfactorily Report = Avoid the Payment Adjustment
• Qualified Clinical Data Registry (QCDR)
– Use of Established Specialty Society Registries
– PQRS and non-PQRS Measures
• AQI/NACOR: 8 PQRS and 11 Non-PQRS Measures
• AQI/NACOR: 4 NQS Domains Available
– QCDR Responsibilities
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Satisfactorily Report = Avoid the Payment Adjustment
• Claims-Based Reporting Challenges (Beyond 2014):
– PQRS Measures for Consideration
– PQRS #30, PQRS #109
– Potentially fewer measures to report via claims
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• QCDR Incentive Requirements (2014)
– Report at least 9 measures covering at least 3 NQS domains AND report each measure for at least 50% of EP’s applicable patients seen during reporting period
– One measure must be an outcome measure
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Satisfactorily Report = Avoid the Payment Adjustment
Satisfactorily Report = Avoid the Payment Adjustment
• QCDR Reporting Requirements– Avoid the payment adjustment (2016)
• [For CY 2014] Report at least 3 measures covering at least 1 NQS domain for at least 50 percent of the EP’s applicable patients seen during the participation period
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– Avoid the payment adjustment (2017) • CMS PROPOSED: “For the 12-month reporting period [CY
2015] for the 2017 PQRS payment adjustment, the EP would report at least 9 measures available for reporting under a QCDR covering at least 3 of the NQS domains, AND report each measure for at least 50 percent of the eligible professional’s patients.”
• Report 3 outcome measures or 2 outcome measures and at least 1 resource use, patient experience or efficiency/appropriate use measure
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Satisfactorily Report = Avoid the Payment Adjustment
Resources
• Learn and Understand PQRS– CMS PQRS Website (www.cms.gov/pqrs)– CMS QualityNet Help Desk (866-288-8912 or
• ASA & AQI Member Resources– Quality and Regulatory Affairs ([email protected])– Anesthesia Quality Institute (http://www.aqihq.org/qcdr)– ASA web site (www.asahq.org/qcdr )
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PRESENTED BY:LANCE MUELLERDIRECTOR ANESTHESIA QUALITY INSTITUTE
The Qualified Clinical Data Registry
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The Challenge
• The government wants to know that Ma and Pa are getting the health care they deserve… and that our taxes pay for.
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• Institute of Medicine report published in late 1999
• Highlighted preventable errors in the US healthcare system
• “100,000 lives a year lost to preventable death”
• Anesthesiology cited as leaders in advancing patient safety
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The Physician Quality Reporting System
• Individual physicians
• For public reporting
• Approved measures
– Submitted and maintained by ‘stewards’
– Vetting through National Quality Forum
• “Claims made” reporting
• Scored by CMS
• Incentives >>> penalties
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“Pay for Performance”
• Federal programs to promote quality over quantity in the delivery of healthcare
• Based on measuring outcomes
– Public reporting
– Payment adjustments (penalties) >>> Incentives
• Hospitals
• Physicians
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Key Points
• Pay for Performance programs are evolving over time
• What was true last year will not be true next year
• Complexity is increasing
• ASA (and all physician societies) must seize opportunities to guide this evolution
• ASA has worked hard to provide a solution for the profession
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The Evolution of P4P
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From
To
Outcomes
Process Measures
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The Evolution of P4P
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From
To
Small hospitals, surgery centers, clinics and offices
Big hospitals
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The Evolution of P4P
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From
To
ALL patients
Inpatients
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The Evolution of P4P
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From
To
ALL payers including
Medicare Advantage, Medicaid
Medicare only
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The Evolution of P4P
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From
To
Penalties
Incentives
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The Evolution of P4P
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From
To
Patient Centered
Clinical Safety Focused
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The Evolution of P4P
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From
To
Teams
Individuals
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The Evolution of P4P
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From
To
Electrons
Paper
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The Evolution of P4P
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From
To
The way we do business
A demonstration project
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The QCDR
• Qualified Clinical Data Registry
• New in 2014
• A reporting mechanism for registry participants
• Similar to the registry reporting option for PQRS / VM
• Can use PQRS measures
• Can use non-PQRS, specialty specific measures
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Why the QCDR is a big deal
• Measure definition by the specialty, for the specialty
• Data collection and scoring moves from CMS to the registry
• “One stop shop” for all requirements
• Public reporting by the society
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The Anesthesiology Perspective
• The National Anesthesia Clinical Outcomes Registry (NACOR) is certified as a QCDR
• Available measures for perioperative care increased from 4-8 in PQRS to 19
• 4 domains, multiple outcome measures
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Where Did New Anesthesia Measures Come From?
• Existing in PQRS
– Solves the stewardship problem
• Existing in NQF
• New measures mostly developed by ASA’s Committee on Performance and Outcome Measures (CPOM)
– Developed, but never selected
– Developed, but never submitted
• Subspecialty possibilities
• Aspirational measures
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AQI as a QCDR
• The Centers for Medicare and Medicaid Services (CMS) introduced the Qualified Clinical Data Registry (QCDR) as a reporting option in 2014.
• 2015 Medicare Physician Fee Schedule Proposed Rule:
– To avoid future payment adjustments an EP will have to report on 9 measures including 3 outcomes across 3 NQS domains.
• The addition of QCDR reporting allows specialty societies to develop measures that reflect profession-specific priorities.
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Performance Reporting through the QCDR
• 2015 Anesthesia QCDR reporting is a product of ASA in partnership with AQI
– ASA sells the service
– AQI reports to CMS on behalf on the group and it’s EP’s
– AQI provides monthly PQRS feedback reports
• Groups must be participating in AQI and receive all benefits of participation
• Free to ASA members who are participating in AQI’s NACOR registry
• Additional charge for Eligible Professionals (EP) who are non-ASA members
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QCDR Reporting Requirements. You Must:
• Be a NACOR participant
• If you are already participating – see next slide
• If you are not already participating in NACOR steps include:
– Completion of a Business Associate Agreement with the AQI
– Completion of the AQI practice survey
– Transmission of electronic data to the registry beginning in January 2015
– Pay AQI membership dues
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QCDR Reporting – Steps to Report
• Self-nomination with AQI for QCDR reporting in early 2015 (more details forthcoming)
• Work with AQI to ensure proper data is being sent
– AQI has staff to review your data and reports to ensure EP’s are reporting and have a reasonable expectation of satisfactorily reporting
• Approve the final transmission of EP performance data to CMS (early 2016)
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PRESENTED BY:TERRI HOWARD, CAEDIRECTOR OF MEMBER SERVICES
ASA QCDR Service
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ASA QCDR Service
• Definition of the service
• Costs associated with participating in QCDR
• Enrollment and membership processes
• Who to contact if interested in participating
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ASA QCDR
•ASA has partnered with AQI to provide PQRS reporting as a benefit of ASA membership.
•To participate in QCDR, the entire practice enrolls in AQI’s NACOR.
– ASA members: no cost to participate in NACOR
– Non-ASA member independent providers: $1000 annually to participate
– Non-physician providers in the care team: no cost to participate
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ASA Membership / QCDR Purchase
• Group Membership / QCDR Invoice
– One invoice for all participating providers in the practice
– Membership: Both ASA and state component society dues are required
• ASA membership = $665 physicians, $335 CRNAs, AAs; state dues varies
– Non-ASA members purchase QCDR only = $295 per provider annually
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Enrollment Process
• Submit roster template of participating EPs
– Practice may add/subtract providers throughout the year
• Sign AQI & ASA agreements
• Work with AQI to submit data to NACOR
• Submit new ASA member applications, as applicable
• Practice reviews the roster prior to annual renewal of membership and QCDR service
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Questions?
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Getting Started
• Contact ASA
– Sara Moser, Director of Marketing & Corporate Development, [email protected] 847-268-9230
– Terri Howard, Director of Member Services, [email protected] 847-268-9269
– General questions: [email protected]
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