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As the New Year greets us, are you wondering where to begin for quality reporting in 2014? PQRS measures are components of PQRS reporting, Meaningful Use, and the Value-Based Modifier. Here is a step-by-step guide to get you started.
1. Determine if you are an eligible medical care professional (EP) for PQRS and payment adjustments.
2. If you are an ACO or participant in another CMS innovation payment program, follow PQRS group reporting requirements as required by the program, using measures contained in the GPRO web interface as your guide.
3. If you are not an ACO, decide if group reporting would be beneficial. Groups need to self-nominate by September 30, 2014. All EPs must report the same measures, use the same mechanism, and send in one submission for the entire group. Keep in mind that all patients seen by any provider in the TIN will be included in selected measures if they meet denominator criteria. (For example, a Medicare patient age 70 seen by a podiatrist in a multi-specialty group would be considered in the denominator of the "flu vaccine" measure.)
4. Choose the mechanism you will use to report PQRS.
- Your choice will depend on your electronic capabilities and the availability of appropriate measures for your specialty within each mechanism.
- If you use CEHRT to report PQRS, you may also qualify to receive credit for reporting Clinical Quality Measures under Meaningful Use. (You will still need to attest to other objectives).
- We strongly suggest using a mechanism other than Claims-based reporting, as Claims has the lowest rate of success and will eventually be phased out.
- Available mechanisms include CEHRT Direct, CEHRT Data Submission Vendor, Qualified Registry, Qualified Clinical Data Registry (new), Certified CG-CAHPs vendor (New--groups> 25 only), GPRO web interface (groups 25+ only), and Claims (individuals only).
5. Select at least nine measures to report. The measures must cover at least three domains of care. The list of PQRS measures, their domains, and available reporting mechanisms can be found on the CMS PQRS website as the "2014 PQRS Measure List Implementation Guide" zip file under "Getting Started."
- While not required, we recommend providers report Core PQRS measures for Adults or Children to meet requirements, substituting alternative measures from respective domains for core measures that are not relevant to the practice. These measures will help providers focus on high priority conditions.
- Regardless of specialty, we recommend reporting PQRS#236 (NQF#0018) "Blood Pressure Control." Blood pressure is so critical to patient health that no provider should overlook it, and is easily reported.
- Reporting a Measures Group using a Qualified Registry (instead of nine individual measures) is another good option for individuals, and has a relatively high success rate.
6. If your TIN has 10+ EPs AND your providers wish to report individually (instead of as a group as discussed in step three) make certain at least 50% report PQRS to avoid downward payment adjustments under the Value-Based Modifier (VBM). This is a new option for determining group performance under the VBM. The option allows the group to use multiple reporting mechanisms, individuals in the group do not have to report the same measures, and self-nomination as a group is not required. Each individual EP in the group submits their own PQRS report, then a weighted quality score is calculated for the group VBM.
7. Develop a written process for providing services and documenting each measure. Make certain EVERYONE in the practice understands and follows it. Healthcare and business experts overwhelmingly agree that documentation of the process is a critical factor in improving care. Process documentation also protects the practice from losing ground during staff turnover.
8. Monitor and improve performance rates on your selected measures throughout the year. Performance rates for certain measures reported in 2014 will be publicly reported on Physician Compare in 2015.
There are MANY details to successful reporting to earn an incentive and avoid payment adjustments. PQRS, EHR Incentive (meaningful use), Value-Based Modifier, ACO, and PCMH programs are all closely related, and many providers will be able to satisfy components of each through one submission of quality measures.
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