What is PQRS?
First, the Physician Quality Reporting System (PQRS) has no connection to "Meaningful Use" or "Stage 1", "Stage 2", etc. PQRS is a Centers for Medicaid and Medicare Services (CMS) reporting program that uses a combination of incentive payments and negative payment adjustments to promote reporting of quality information by eligible professionals (EPs) - that's you, the physician.
PQRS gives participating EPs the opportunity to assess the quality of care they are providing to their patients, helping to ensure that patients get the right care at the right time. By reporting PQRS quality measures, providers also can quantify how often they are meeting a particular quality metric. Using the feedback report provided by CMS, EPs can compare their performance on a given measure with their peers.
At Graphium Health, we are creating a world where data and knowledge drive down medical costs, keep patients safe, and improve the healthcare experience.
Why do I need to do this?
In 2015, CMS reduced Medicare payments by 2% for all EPs and up to an additional 4% on value-based payment modifiers for larger groups who do not comply with PQRS Reporting.
In 2013, the value modifier system produced an impressive bonus for compliant groups. There were 319 groups penalized 1% for not participating, and this created a pool of $11,000,000 which was eventually split by only 14 groups who successfully reported 9 measures.
More importantly, this reporting requirement provides an opportunity for us to measure our performance, review the comparative results, and change our behavior in an effort to ultimately improve the patient experience. It offers us the opportunity to adopt solutions that may ultimately connect with our patients, making the potential of the "Perioperative Surgical Home" a reality.
If done correctly, this type of reporting allows us the chance to transform the practice of anesthesia into a data-driven, nationally-comparative improvement process. If executed poorly, it could simply increase our overhead, reduce our compensation, and have no meaningful impact on patient outcomes.
If you are interested in understanding what your financial penalty may be, you can use ASA's PQRS Online Calculator to estimate your group's projected penalty. Try it out here.
Mobility is an experience that fits naturally into our daily lives while delivering powerful, improved possibilities.
PeriOperative Medicine is no exception.
What do I need to report?
In 2016, you need to report a total of 9 metrics across 3 different domains. The library of metrics to choose from depends on the reporting mechanism you choose. For instance, if you stick with the traditional "claims-based" reporting method, you will need to identify 9 metrics from the CMS menu of over 250 metrics. Some of these metrics may appear familiar, including beta-blocker administration, CVL placement protocols, normothermia, smoking cessation efforts, medication reconciliation, etc. It remains challenging, however, to identify 9 metrics which apply to the standard anesthesia practice.
Thankfully, there is a new method of reporting, referred to as "QCDR-reporting" and this makes many more anesthesia specific metrics available to you. This is a list of 27 "Non-PQRS" metrics which includes such items as mortality, cardiac arrest, corneal abrasions, reintubations, adverse complications, among others.
Also in 2016 is requiring these metrics to span 3 different "domains". A domain is a specific type of patient care, and each metric is assigned to one of the following 6 domains: Patient Safety, Patient and Caregiver Experience, Care Coordination, Clinical Care, Population Health, Efficiency and Cost Reduction. It gets complicated to find a compliant set of metrics, and truth is, the complexity is only increasing in the future. It's best to find a reporting partner who can scale with you and change with your needs.
"Finally a way to be compliant that makes us smarter and faster."
- Dr. Merlin Wheling, President
How do I report?
There are several methods to avoid the 2% penalty by reporting to CMS. By far, the most common method has been claims-based reporting typically via your billing company.
Claims Based Reporting
This form of reporting limits your choice of metrics to the CMS library of over 250 "PQRS metrics". And, while this appears "large", these metrics unfortunately only apply to certain CPT codes - few of which are performed by anesthesiologists. This makes finding 9 metrics almost, if not entirely, impossible. It also requires reporting on over 50% of your Medicare Part B Fee-for-Service patients with 1 cross-cutting measure (e.g. medicine reconciliation). The need for a cross-cutting measure is specific to this reporting method and further complicates the ability for today's anesthesia practice to remain complaint. Thankfully, there are other options.
QCDR Based Reporting -- Thank you Anesthesia Quality Institute!
The most likely alternative for anesthesia providers to meet PQRS compliance is QCDR based reporting. First introduced in 2015, this allows the EP to choose from a very specific list of over 30 metrics defined by the AQI to cover the unique practice of anesthesia (except for pain practices). With this type of reporting, there is no need for a cross-cutting measure, there is no MAV process to cover failure, and you must report on over 50% of ALL annual cases.
The clear advantage of QCDR reporting includes both the immense ease of finding 9 qualifying metrics and it enables the AQI to eventually serve as your "one-stop shop" for many other data needs. For example, in the future the data you submit may be able to help you meet other requirements such OPPE, FPPE, and MOCA.