Physician Quality Reporting System
Physician Quality Reporting System What You Need to Know for 2015 Since 2007, the Physician Quality Reporting System (PQRS) has been a voluntary federal program, offering Medicare incentive payments to those who report quality measure data to the Centers for Medicare and Medicaid Services (CMS). However, the Affordable Care Act requires that CMS phase out incentive payments and instead apply penalties by 2015 to physicians who fail to satisfy PQRS reporting requirements. As a result, physicians who do not satisfy the program’s requirements in 2015 will be subject to a 2.0% penalty in 2016.* PQRS measure data also will be used to calculate a separate performance-based payment adjustment known as the Value- Based Payment Modifier. Given the payment implications of these new policies, it is critical that HRS members understand PQRS and its reporting requirements. Upcoming PQRS Incentives and Penalties Action Satisfy PQRS reporting criteria Take no action/fail to satisfy PQRS reporting criteria Reporting Year Affected Payment Year Payment Adjustment 2015 2017 0% 2015 2017 -2% Reporting into the PQRS will become mandatory beginning in 2015 *Payment adjustments are applied to total allowed charges for covered Medicare Part B Physician Fee Schedule services provided during the reporting period. How to Get Started 1. Review the PQRS reporting criteria to determine which reporting option is best for you. Eligible professionals can choose from multiple reporting options to satisfy PQRS reporting requirements, including: Reporting as an individual physician or as a group practice under the Group Practice Reporting Option (GPRO) Reporting individual measures or measures groups (i.e., sets of clinically relevant measures reported together)1 Reporting via claims, qualified registry, electronic health record (EHR), or qualified clinical data registry (QCDR) 1 CMS removed the Cardiovascular Prevention Measures Group for 2015. continued Heart Rhythm Society | 1400 K St. NW, Suite 500 | Washington, DC 20005 | 202-464-3400 | Fax: 202-464-3401 | www.HRSonline.org | [email protected] Reporting requirements differ depending on the reporting method selected and certain requirements have changed for 2015. To avoid the 2017 penalty, if reporting individual measures via claims or a qualified registry as an individual physician, you must submit data on nine PQRS measures, one of which is from a list of “cross-cutting” measures, for at least 50% of applicable Medicare Part B patients. For those opting to use the Group Practice Reporting Option, CMS defines “group practice” as those with 2 or more eligible professionals, identified by individual National Provider Identifiers (NPIs), who reassign their billing rights to a single Tax Identification Number (TIN). All individual physicians under a TIN that reports satisfactorily as a group will be considered satisfactory PQRS reporters even if the individual does not have measure data reported on their individual services. When selecting a reporting method, choose the one that is most relevant and meaningful to your patient population, but also the least burdensome to your practice. Since certain measures can only be reported via certain methods, confirm that there are sufficient measures applicable to your practice and are available via that reporting method. More information about PQRS reporting options is available at www.cms.gov/Medicare/QualityInitiatives-Patient-Assessment-Instruments/pqrs/ 2. Select your measures Listed below are select 2015 PQRS measures that may be relevant to your practice. A complete list of measures, including more detailed specifications, is available at www.cms.gov/Medicare/Quality-Initiatives- PatientAssessment-Instruments/PQRS/MeasuresCodes.html. An eligible professional cannot participate in PQRS both as an individual and as part of a group practice. PQRS # Measure Title Domain PQRS Reporting Mechanisms Individual Measures 348 392 ICD Complications Rate NEW for 2015 Cardiac Tamponade and/or Pericardiocentesis Following Atrial Fibrillation Ablation Patient Safety Registry Patient Safety Registry NEW for 2015 Infection within 180 Days of Cardiac Implantable Electronic Patient Safety Device (CIED) Implantation, Replacement, orAnticoagulation Revision AF and Atrial Flutter: Chronic Therapy Effective Clinical Care Registry Patient Safety Claims, Registry 23 Perioperative Care: Selection of Prophylactic Antibiotic – 1st OR 2nd Generation Cephalosporin Perioperative Care: Venous Thromboembolism (VTE) Prophylaxis Patient Safety Claims, Registry 118 CAD: ACE Inhibitor or ARB- Therapy -- Diabetes or LVEF < 40% Effective Clinical Care Registry 145 Radiology: Exposure Time Reported for Procedures Using Fluoroscopy Patient Safety Claims, Registry 226 47 Preventive Care and Screening: Tobacco Use: Screening and Cessation + Intervention Advance Care Plan+ 46 Medication Reconciliation+ Community/Population Claims, Registry, EHR Health Communication/Care Claims, Registry Coordination Patient safety Claims, Registry 393 326 21 +Cross-cutting Claims, Registry measure continued Heart Rhythm Society | 1400 K St. NW, Suite 500 | Washington, DC 20005 | 202-464-3400 | Fax: 202-464-3401 | www.HRSonline.org | [email protected] The Society recognizes the limited number of performance measures to capture electrophysiologists’ highly specialized care. Efforts continue to develop and test more appropriate measures for inclusion in federal reporting programs and to ensure the availability of meaningful measures for electrophysiologists. For more information, visit our website at www. HRSonline.org/Policy, and select Quality/Outcomes Reporting in the left navigation bar. If you have questions, please email Policy@ HRSonline.org. 3. Regis ter and Start R e p o r t i n g Updated November 2014 There is no registration for individuals seeking to participate in the 2015 PQRS. If using the claims-based reporting option, start reporting the Quality-Data Codes (QDCs) listed in the measure specifications you have selected on applicable Medicare Part B claims. If using a third party entity to submit your measure data to CMS, such as a qualified registry or EHR vendor, confirm with the entity if it has its own set of registration and reporting deadlines. Group practices choosing to take part in the PQRS GPRO for the 2015 reporting year must register online by September 30, 2015. For more information on the GPRO, including how to register, please visit www.cms. gov/Medicare/Quality-Initiatives-Patient-AssessmentInstruments/PQRS/Group_Practice_Reporting_Option. html. . Heart Rhythm Society | 1400 K St. NW, Suite 500 | Washington, DC 20005 | 202-464-3400 | Fax: 202-464-3401 | www.HRSonline.org | [email protected]
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