SCHIE Mission

To improve the quality and efficiency of health care for all stakeholders in the Santa Cruz community.

To deliver technology assistance, guidance and information on best practices to providers with the goal of creating a healthcare delivery system that offers a seamless, integrated experience for patients and providers. 

Provide services and tools to participating healthcare providers to become meaningful users of EHRs connected to the Santa Cruz Health Information Exchange.

These are foundational for Accountable Care, Clinical Integration, Medical Home and surviving payment reform.

Physician Quality Reporting SystemBill Beighe, CIO

June 10, 2013

Housekeeping Items

Return to goal of 20 to 30 minutes maximum No interactive Q&A today

Audio Issues Use the question feature in Go To Webinar and we

will respond during or after the meeting Slides and the recording to be on the SCHIE

website and the PMG blue portal

What is PQRS?

The Physician Quality Reporting System Formerly PQRI

Medicare Part B Incentive / Penalty Voluntary

Bonus on Part B Payments 2013 Penalty in 2015 based on activity in 2013

Group reporting available (GPRO)

Incentive & Penalty History

2011 PQRI/PQRS Incentive PAYMENT Results 280,000 Providers $260 million in Bonuses Paid

2012 Penalties on Medicare eRx Program are being reported by Providers

Incentive Payment and Payment Adjustments

Reporting Period 2013 2014 2015* 2016*

Incentive Amount 0.5% 0.5%

Penalty Amount -1.5% -2.0%

In 2013, physicians and other eligible professionals who successfully report quality measure data can earn a 0.5% incentive payment on their total allowed charges for covered Medicare Part B Physician Fee Schedule (PFS) services provided during the reporting period. Earning an incentive payment in 2013 will avoid the 2015 penalty adjustment.

*The 2015 payment adjustment is based on PQRS participation during the 2013 reporting period **The 2016 payment adjustment is based on PQRS participation during the 2014 reporting period

Eligibility to Participate

Medicare Doctors Doctor of Medicine Doctor of Osteopathy Doctor of Podiatric Medicine Doctor of Optometry Doctor of Oral Surgery Doctor of Dental Medicine Doctor of Chiropractic

Practitioners – Individual / Group Considerations Therapists http://

www.cms.gov/Medicare/Quality-Initiatives-Patient-Assessment-Instruments/PQRS/Downloads/PQRS_List-of-EligibleProfessionals_022813.pdf

Tactics to mitigate potential loses

Properly report for the Physician Quality Reporting System (PQRS) starting in 2013 to avoid penalties in 2015 and beyond.

Those who report satisfactorily for the 2013 program year may avoid the 2015 PQRS payment adjustment. Additional information on how to avoid future PQRS payment adjustments can be found through supporting documentation available on the CMS website at http://www.cms.gov/Medicare/Quality-Initiatives-Patient-Assessment-Instruments/PQRS.

PQRS Measures May Vary by Year

The PQRS measure documents for the current program year may be different from the PQRS measure documents for a prior year. Eligible professionals are responsible for ensuring that they are using the PQRS measure documents for the correct program year.

How to get started?

Determine if you are eligible to participate Determine which reporting option best fits your

practice (reporting period varies with reporting option selected)

Select 3 measures to submit - or – Select 1 measures group to submit Perform your own review of the measure

specifications you are reporting; understand reporting principles

What Do I Have To Achieve?

If reporting via registry or EHR (not common)• >80% on 3 or more individual measures • 20 or more unique patients (>50% must be

Medicare) for 1 or more measures group

If reporting via claims: (you will likely do this)• >50% on 3 or more individual measures for the 12

month reporting period • 1 or more measures group for the 12 month

reporting period for 20 or more unique patients

Individual Measure Examples

Neurology Specific (Measure Group) Examples

PQRS Services for SCHIE ProvidersProvider / Clinic

1x1 Compliance Assistance

Training PQRS Binder / Forms / Examples

Webinars and on-going Education*

Comments

PMG Billing Service Y Y Y Y

Contact Amy Hernandez

PMG Hosted EHR

Y Y Y Y

8 hours for 1 provider, max of 16 hours per group

SCHIE McKesson N N Y Y

2 hours max

SCHIE Other EHR or PM

N N N YGet specific advice from your EHR/PM Vendor

* Webinars and on-going educational sessions are completely free to all Santa Cruz Providers and do not reduce the number of hours or support we are providing as part of this program.

Additional Resources

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

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

CMS QualityNet Help DeskMonday – Friday 7:00 am to 7:00 pm CSTPhone 1-866-288-8912Email: qnetsupport@sdps.org

2013 Quality Reporting Programs Comparison Matrix (.pdf)

7/11/13 - Stage 2 Meaningful Use https://www1.gotomeeting.com/register/855411001

7/18/13 – Direct Messaging https://www1.gotomeeting.com/register/442346992

Contact the PMG and SCHIE resources at 831.465.7877, ask for Dawn Mackey, Becky Shoemaker or Bill Beighe and we will get you engaged with the right resource.

Coming up next

http://www.santacruzhie.org/

Presentation slides are available at: