Physician Quality Reporting InitiativeCSNS Provider UpdateAffordable Care Act Task Force

Dr. Justin Singer, MDDr. Nicholas Bambakidis, MD

What is PQRI?

• Center for Medicare and Medicaid Services (CMS) initiative which began in 2014 to promote physician quality reporting for eligible practitioners.

• Eligible practitioners or group practices who participate in Medicare Physician Fee Schedule (PFS) are mandated to participate in the Physician Quality Reporting System (PQRS).

• Physicians who satisfactorily submit PQRS quality reporting data are eligible for a 0.5 % incentive payment (IP) of their total estimates Medicare Part B PFS.

What’s New in 2015?

• PQRS is initiating negative payment (NP) adjustments to providers who did not satisfy reporting requirements for quality measures in 2014 of 1.5 % of their Medicare PFS.

• In 2016 negative adjustment increases to 2% for non-compliance with reporting for 2015 fiscal year.

What is Reported?

• For a list of currently tracked measures go to:

2015 PQRS Measures List

• Most current measures applicable to Neurosurgeons relate to perioperative measures. A few examples included:– Perioperative parenteral antibiotics prior to incision and

discontinuing prior to 24 hours post op.– Surgical Site Infections.– Unanticipated 30 day readmissions post-operatively.

• CMS is accepting suggestions for new measures.

Why should Neurosurgeons Care about PQRS?

• Reporting is mandatory for Neurosurgeons who participate in the Medicare part B PFS.

• Starting this year failure to adequately participate will results in 1.5% negative adjustment to PFS eligible reimbursement.

• Practicing Neurosurgeons who did not satisfactorily report quality data in 2014 will receive 98% of the fee schedule amount for services rendered starting 2016.

How Can Neurosurgeons Avoid 2016 Negative Adjustments Through PQRS?

• Neurosurgeons will have had to meet 1 of the following criteria during the 2014 PQRS program year– Meet requirement criteria for 2014 PQRS incentive

eligibility– Repeat minimum of 3 measures covering one National

Quality Strategy (NQS) domain for at least 50% eligible Medicare Part B FFS patients via claims or qualified registry.

– Participate through a qualified data registry for which at least 3 measures cover a minimum of 1 NQS domain for 50% of applicable patients.

What you can do in 2015 to avoid Negative Adjustments in 2017?

• Report on Min. 9 individuals measures covering 3 NQS domains for 50% of the practitioners Medicare Part B FFS patients.

• Reports at least 1 measures group from a sample of 20 patients, where majority of patients must be Medicare Part B FFS patients.

• 2015 Reporting Registry Made Simple

How To Report

• Claims base reporting• Registry based reporting

– More On Registry Reporting• Qualified Electronic Health Record (EHR)

– More On EHR Reporting• Qualified Clinical Data Registry (QCDR)

– More On QCDR• Group Practice Reporting Option (GPRO)

– More ON GPRO• 2014 Physician Quality Reporting System Implementa

tion Guide

How To Get Started with PQRS?

One Last Thing!!!

• Proposed Changes via “Medicare Access and CHIP Reauthorization Act”– May eliminate negative adjustments or penalties

under CMS programs (ie. PQRS)– May Consolidates the PQRS, EHR and Value-Base

Payment Modifier (VM) programs– Includes Positive incentives for quality improvement

payment programs to include All physicians

H.R.2 - Medicare Access and CHIP Reauthorization Act of 2015

Stay Tuned For Future Updates Following Passage of H.R. 2

For more information check out

http://www.cms.gov/Medicare/Quality-Initiatives-Patient-Assessment-Instruments/PQRS/index.html

http://cms.gov/Medicare/Quality-Initiatives-Patient-Assessment-Instruments/PQRS/Downloads/2015_PQRS_ImplementationGuide.pdf

http://www.cms.gov/Medicare/Quality-Initiatives-Patient-Assessment-Instruments/PQRS/Downloads/PQRS-Timeline-2014-2016.pdf