Embed Size (px)
Citation preview
Using the AOA CAP for CMS’ Physician Quality Reporting Initiative (PQRI)
Sharon L. McGill, MPHDirector
AOA Dept. of Quality and ResearchNovember 4, 2009
CMS’ Physician Quality Reporting Initiative (PQRI)
• CAP was chosen as a qualifying registry by CMS in both 2008 and 2009 for participation in its Physician Quality Reporting Initiative (PQRI) registry for payment program.
• Physicians can participate in the 2009 PQRI through four CAP Measure Groups: Diabetes, Preventive Care, Chronic Kidney Disease, and Back Pain.
CMS’ Physician Quality Reporting Initiative (PQRI)
• By entering data on 30 consecutive patients, osteopathic physicians are eligible for a 2% bonus payment based on all Medicare payments in 2009.
• Provides physicians with the opportunity to understand how their practice is doing in patient care by providing reports back to the physician.
2008 PQRI Diabetes Mellitus Measure Group: AOA-CAP Physician Average Scores
Measure Description Average Physician Score
Hemoglobin A1c Poor Control in Type 1 or 2 Diabetes Mellitus (PQRI Measure 1)
Percentage of patients aged 18 through 75 years with diabetes mellitus who had most recent
hemoglobin A1c greater than 9.0% 10.87%
79 physicians
Low Density Lipoprotein Control in Type 1 or 2 Diabetes Mellitus (PQRI Measure 2)
Percentage of patients aged 18 through 75 years with diabetes mellitus who had most recent LDL-
C level in control (less than 100 mg/dl) 61%
79 physicians
High Blood Pressure Control in Type 1 or 2 Diabetes Mellitus (PQRI Measure 3)
Percentage of patients aged 18 through 75 years with diabetes mellitus who had most recent blood
pressure in control (less than 140/80 mmHg) 50.1%
79 physicians
Dilated Eye Exam in Diabetic Patient in (PQRI Measure 117)
Percentage of patients aged 18 through 75 years with a diagnosis of diabetes mellitus who had a
dilated eye exam 48.7%
79 physicians
Urine Screening for Microalbumin or Medical Attention for Nephropathy in Diabetic Patients (PQRI Measure 119)
Percentage of patients aged 18 through 75 years of age with diabetes mellitus who received urine
protein screening or medical attention for nephropathy during at least one office visit within
12 months
77%
79 physicians
Getting Started: Log in using your AOA member ID and password
Click on the Clinical Resources tab and select CAP-PQRI
Go to DOCMEOnline.com to access PQRI information
This takes you to the My CME Profile screen.
On the drop down screen, select Physician as your profession.
Click on Enter Activity
Register for the AOA-CAP for PQRI using your Tax Identification Number (TIN), and National Provider Identifier (NPI). You must enter the TIN that you use to bill Medicare.
Verify your NPI and TIN. If you use an incorrect TIN, you will not qualify for PQRI and will have no opportunity to correct the information once data has been submitted to CMS.
Print out, sign and fax the attestation form.
For 2009, CMS requires that 30 consecutive patient charts be abstracted and entered into the CAP Web site for payment. The 30 consecutive patients must be 30 unique patients.
Identifying and selecting diabetic patients • Retrospective method
– Using billing information, identify 30 consecutive patients with an ICD-9 code for diabetes who were aged 18 to 75 years during the office visit and seen between January 1 – December 31, 2009.
– Qualifying ICD-9 codes and CPT codes are available– Patients who have a diagnosis of diabetes are eligible
for abstraction even if they did not have a diagnosis code (ICD-9) during the abstracted visit.
– Collect the required patient information for each patient ensuring that at least 2 patients in the group are Medicare Fee for Service patients.
Identifying and selecting diabetic patients • Prospective method
– Starting at any point in time, identify all diabetic patient office visits and collect the required information until you have 30 consecutive patients aged 18 to 75 years abstracted.
– Collect the required patient information for each patient ensuring that at least 2 patients in the group are Medicare Fee for Service patients.
Data can be collected on this abstraction form and later entered into the AOA-CAP PQRI Web site.
Here is the data entry form. Keep a record of the abstracted cases using the computer generated Patient ID number.
If you enter a patient who does not meet the inclusion criteria, you will receive a notification.
This will show as an invalid patient.
Data collection is complete. Click “Next”
After reviewing your report, click “Submit Data”
Submission of Data to CMS
• AOA will submit all data to CMS after the close of PQRI for 2009 which will be January 30, 2010.
• The claims for your 30 patients must be submitted in a timely manner to be processed by CMS by February 26, 2010.
• Please consult your carrier on when claims need to be submitted in order to be processed by the required date. The date can fluctuate from carrier to carrier and the method of claim submission (paper, electronic).
• CMS will make payments for 2009 in mid-2010.
