Slide1 l.jpg
Advertisement
This presentation is the property of its rightful owner.
1 / 49

PQRI Special Open Door Forum in Collaboration with the American Gastroenterological Association (AGA) Institute PowerPoint PPT Presentation

PQRI Special Open Door Forum in Collaboration with the American Gastroenterological Association (AGA) Institute Tuesday, September 23, 2008 2-3:30 p.m. EDT Doing Well by Doing Good Simple Steps Collect and Report Quality Data Earn a Medicare Bonus Payment Conference Leaders

Download Presentation

PQRI Special Open Door Forum in Collaboration with the American Gastroenterological Association (AGA) Institute

An Image/Link below is provided (as is) to download presentation

Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author.While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server.


- - - - - - - - - - - - - - - - - - - - - - - - - - E N D - - - - - - - - - - - - - - - - - - - - - - - - - -

Presentation Transcript


Slide1 l.jpg

PQRI Special Open Door Forum in Collaboration with the American Gastroenterological Association (AGA) Institute

Tuesday, September 23, 2008

2-3:30 p.m. EDT


Doing well by doing good l.jpg

Doing Well by Doing Good

Simple Steps

Collect and Report Quality Data

Earn a Medicare Bonus Payment


Conference leaders l.jpg

Conference Leaders

Daniel Green, MD (CMS)

Mary Igo, RN, MBA (AGA Institute)

Joel Brill, MD, AGAF (AGA Institute)


Topics l.jpg

Topics

Basic concepts

Preparing for 2009 PQRI participation

GI measures development for PQRI

GI measures details and specifications

Question and Answer Session


Basic concept l.jpg

Basic Concept

Select quality measures that are important to your practice and patients

Establish processes to systematically report the quality measures for each eligible patient

Reporting mainly done by including a quality code on claim or through registries

Receive feedback on extent to which patient got the recommended care described in the quality measure

Receive modest payment for effort

Use process to facilitate practice and patient care improvements


Pqri background 2007 program l.jpg

PQRI Background - 2007 Program

Federal law enacted in December 2006 established PQRI

PQRI 2007 pays physicians 1.5% bonus for reporting quality measures July 1 – December 31, 2007

Select up to three measures applicable to practice from a list of 74 and report on 80% of eligible encounters for each measure selected

Report against measures on standard CMS claim form

CMS determines who reported successfully

CMS pays bonus and provides reporting/performance score feedback in mid-2008


Update on pqri 2007 status l.jpg

Update on PQRI 2007 Status

Incentive payments for successful 2007 reporting issued mid-late July 2008

Payments issued to Tax ID Number (TIN) for all associated physicians who earned bonus

Feedback reports available in July that provided reporting/performance score for each individual, for group, and national averages for comparison

Feedback reports are generated for all providers that reported a quality data code regardless of whether or not he/she received a bonus

Individual physician or designated staff person needs to register with secure system to access confidential reports

CMS has mechanisms to help physicians with registration and receipt of reports


Pqri 2008 program l.jpg

PQRI 2008 Program

Congress passed December 2007 law continuing PQRI for 2008

Includes many features of the 2007 PQRI program

Report codes for individual quality measures

Report on up to three individual measures for at least 80% of eligible encounters

Earn a 1.5% bonus

Additional changes/enhancements for 2008 PQRI

Expansion from 74 to 119 measures

Addition of two “structural measures”

Additional reporting options

No cap on the bonus incentive


Why participate in pqri 2008 l.jpg

Why Participate in PQRI 2008

Increase your ability to track patients with common conditions through practice management systems

Promote team care and identify team member roles and responsibilities

Collect clinical information at the point of care, as opposed to retrospective chart review

Reporting quality codes on claims involves minimal burden when systems in place

Measures can act as reminders for certain care actions


Why participate in pqri 200810 l.jpg

Why Participate in PQRI 2008

Learn about ability to routinely provide evidence-based care relevant to your patients

Receive modest payment

Gain experience in reporting and measuring against quality measures

Programs likely to continue, and even grow, for Medicare and private payers

PQRI experience to inform and be a component of broader quality improvement strategy


Why participate in pqri in 2009 l.jpg

Why participate in PQRI in 2009

Increase to 2% from 1.5% bonus incentive

The bonus incentive is contingent on

achieving 80 percent success for patients that have a disease/diagnosis that a quality measure you selected is being reported for; and

achieving that success rate for three quality measures (or fewer measures if less apply to your practice). 


Pqri update l.jpg

PQRI Update

Medicare Improvements for Patients and Providers Act of 2008 (MIPPA)

- Passed in July 2008

- Makes PQRI permanent; however only 2009 and 2010 incentives are funded

- Increased 2009 PQRI incentive to 2%

- Added new E-Prescribing incentive for 2009, an additional 2% subject to qualifying for the measure

- Additional provisions for PQRI 2010 and beyond


2008 pqri gi measures l.jpg

2008 PQRI GI Measures

Hepatitis C

Measures in 2008 PQRI based on AQA Alliance adoption

GERD

One measure on GERD medication management in 2008

Four measures in 2007 PQRI were not carried over into 2008 as not endorsed by NQF

Weight Screening

One measure on BMI screening in 2008


2008 measures l.jpg

2008 Measures

Measure 77 – GERD medication management

Measures 83-90 - Treatment and Management of Hepatitis C

Measure 113 – Colorectal cancer screening

Measure 124 - Health Information Technology (HIT) – Adoption/Use of Health Information Technology (Electronic Health Records)

Measure 125 - Health Information Technology (HIT) Adoption/Use of e-Prescribing

Measure 128 – BMI Screening


Gerd measure 77 l.jpg

GERD - Measure 77

  • Assessment of GERD Symptoms in Patients Receiving Chronic Medication for GERD

    • Percentage of patients aged 18 years and older with the diagnosis of GERD who have been prescribed continuous PPI or H2RA therapy who received an annual assessment of their GERD symptoms after 12 months of therapy


Hepatitis c measure 83 l.jpg

Hepatitis C - Measure 83

  • Testing of Patients with Chronic Hepatitis C (HCV) for Hepatitis C Viremia

    • Percentage of patients aged 18 years and older with a diagnosis of hepatitis C seen for an initial evaluation who had HCV RNA testing ordered or previously performed


Hepatitis c measure 84 l.jpg

Hepatitis C - Measure 84

  • Initial Hepatitis C RNA Testing

    • Percentage of patients aged 18 years and older with a diagnosis of chronic hepatitis C who are receiving antiviral treatment for whom quantitative HCV RNA testing was performed within 6 months prior to initiation of treatment


Hepatitis c measure 85 l.jpg

Hepatitis C - Measure 85

  • HCV Genotype Testing Prior to Therapy

    • Percentage of patients aged 18 years and older with a diagnosis of chronic hepatitis C who are receiving antiviral treatment for whom HCV genotype testing was performed prior to initiation of treatment


Hepatitis c measure 86 l.jpg

Hepatitis C - Measure 86

  • Consideration for Antiviral Therapy in HCV Patients

    • Percentage of patients aged 18 years and older with a diagnosis of chronic hepatitis C who were considered for peginterferon and ribavirin therapy within the 12-month reporting period


Hepatitis c measure 87 l.jpg

Hepatitis C - Measure 87

  • HCV RNA Testing at Week 12 of Therapy

    • Percentage of patients aged 18 years and older with a diagnosis of chronic hepatitis C who are receiving antiviral treatment for whom quantitative HCV RNA testing was performed at 12 weeks from the initiation of antiviral treatment


Hepatitis c measure 88 l.jpg

Hepatitis C - Measure 88

  • Hepatitis A and B Vaccination in Patients with HCV

    • Percentage of patients aged 18 years and older with a diagnosis of hepatitis C who were recommended to receive or who have received hepatitis A vaccination or who have documented immunity to hepatitis A AND who were recommended to receive or have received hepatitis B vaccination or who have documented immunity to hepatitis B


Hepatitis c measure 89 l.jpg

Hepatitis C - Measure 89

  • Counseling Patients with HCV Regarding Use of Alcohol

    • Percentage of patients aged 18 years and older with a diagnosis of hepatitis C who received education regarding the risk of alcohol consumption at least once within the 12-month reporting period


Hepatitis c measure 90 l.jpg

Hepatitis C - Measure 90

  • Counseling of Patients Regarding Use of Contraception Prior to Starting Antiviral Therapy

    • Percentage of female patients aged 18 through 44 years and all men aged 18 years and older with a diagnosis of chronic hepatitis C who are receiving antiviral treatment who were counseled regarding contraception prior to the initiation of treatment


Crc screening measure 113 l.jpg

CRC Screening - Measure 113

  • Colorectal Cancer Screening

    • Percentage of patients aged 50 through 80 years who received the appropriate colorectal cancer screening


Ehr adoption measure 124 l.jpg

EHR Adoption - Measure 124

  • HIT- Adoption/Use of Health Information Technology (Electronic Health Records)

    • Documents whether provider has adopted and is using health information technology. To qualify, the provider must have adopted a qualified electronic medical record (EMR) that is either CCHIT certified or capable of all of the following:

      • Generating a medication list

      • Generating a problem list

      • Entering laboratory tests as discrete searchable data elements


E prescribing measure 125 l.jpg

E-Prescribing - Measure 125

  • HIT- Adoption/Use of e-Prescribing

    • Documents whether provider has adopted a qualified e-Prescribing system and the extent of use in the ambulatory setting. To qualify this system must be capable of ALL of the following:

      • Generating a complete active medication list

      • Selecting medications, printing prescriptions, electronically transmitting prescriptions, and conducting all safety checks

      • Providing information related to the availability of lower cost, therapeutically appropriate alternatives (if any)

      • Providing information on formulary or tiered formulary medications, patient eligibility, and authorization requirements from the patient’s drug plan


Bmi screening measure 128 l.jpg

BMI Screening - Measure 128

  • Universal Weight Screening and Follow-Up

    • Percentage of patients aged 65 years and older with a calculated Body Mass Index (BMI) within the past six months or during the current visit that is documented in the medical record and if the most recent BMI is ≥ 30 or < 22, a follow-up plan is documented


Proposed 2009 pqri gi measures l.jpg

Proposed 2009 PQRI GI Measures

Hepatitis C

Proposed / modified for 2009 based on NQF endorsement

GERD

GERD medication management in 2009 Proposed Rule measure set

Weight Screening

One measure on BMI screening in 2009 proposed measure set

Endoscopy

Surveillance Colonoscopy Interval for Patients with a History of Colonic Polyps- Avoidance of Inappropriate Use

Developed via PCPI process

Adopted by AQA Alliance

In 2009 proposed rule measure set


Potential changes in 2009 measures l.jpg

Potential Changes in 2009 Measures

  • Hepatitis C

    • Hepatitis A and B vaccinations proposed as two separate measures (NQF endorsed as paired measures)

    • Measures # 84 (Hepatitis C RNA Testing before Initiating Treatment) and #85 (HCV Genotype Testing Prior to Treatment) NQF endorsed as paired measures

  • Health Information Technology (HIT) Adoption/Use of e-Prescribing

    • Could be eliminated as e-Prescribing requirements are implemented

  • Endoscopy & Polyp Surveillance: Surveillance Colonoscopy Interval in Patients with History of Adenomatous Polyps

    • Watch for measure specifications


Endoscopy and polyp surveillance l.jpg

Endoscopy and Polyp Surveillance

  • Surveillance Colonoscopy Interval for Patients with a History of Colonic Polyps- Avoidance of Inappropriate Use

    • Percentage of patients aged 18 years and older receiving a surveillance colonoscopy, with a history of a prior colonic polyp in previous colonoscopy findings who had a follow-up interval of 3 or more years since their last colonoscopy documented in the colonoscopy report


Pqri and fee schedule update l.jpg

PQRI and Fee Schedule Update

The 2009 Physician Fee Schedule (PFS) proposed rule:

- Includes the measures proposed for 2009 PQRI

- Measures for 2009 PQRI will be published in Final PFS rule in November


2008 reporting options overview l.jpg

2008 Reporting Options Overview

Alternate reporting periods and criteria significantly increases participation/reporting options

January 1 - December 31, 2008 (12 months)

July 1 - December 31, 2008 (6 months)

Total of 9 PQRI reporting methods

3 claims-based

6 registry-based


Claims based options l.jpg

Claims-Based Options

Reporting period: January 1 – December 31, 2008

Option 1 – Report individual quality measures; report on three quality measures for 80% of eligible patients

Reporting period: July 1 – December 31, 2008

Option 2 – Report a measure group for 15 consecutive eligible patients

Option 3 – Report a measure group for 80% of eligible patients over the six month period


Reporting individual quality measures l.jpg

Reporting Individual Quality Measures

If you have reported on three individual quality measures through claims for the first half of 2008, continue to do so

If reported in 2007, use CMS reporting/performance feedback from that year to assess whether to adjust 2008 participation

CMS/AMA measure-specific “PQRI Data Collection Worksheets” are available at: http://www.ama-assn.org/ama/pub/category/17493.html

Bonus payment for full-year successful reporting is 1.5% of Medicare allowed charges over the 12 month reporting period


Reporting individual quality measures35 l.jpg

Reporting Individual Quality Measures

It’s not too late to start reporting individual quality measures and hit the 80% threshold of eligible cases

Requires a systematic way to identify those patients when they come in to the office

Assess whether patients eligible for selected measures have been seen in the office in the first six months of year/are likely to be seen in second half of the year

May report a measures group or 15 consecutive patients (i.e., Preventive Care)


Measure group reporting l.jpg

Measure Group Reporting

A measure group is a group of individual measures covering patients with a particular condition or preventive services

Report applicable measures in a measure group for 15 consecutive eligible beneficiaries; OR

Report applicable measures in a measure group for 80% of eligible beneficiaries during six-month reporting period

Can earn bonus even if failed to report on 15 consecutive beneficiaries

Provides a potentially more straightforward reporting method

Bonus payment for successful reporting is 1.5% of Medicare allowed charges over the six month reporting period

No measure group specifically geared to GI, but can report Preventive Care measure group


Registry based options l.jpg

Registry-Based Options

CMS will accept quality information reported from a clinical registry on behalf of physicians

Registries collect physician-submitted data, typically related to a clinical condition or specialty but general registries are available (see CMS website)

Registry data can be used a number of ways to earn a PQRI bonus payment

Registry data for up to three individual measures for 80% of eligible encounters over the full year or last six months

It can be used for a measure group for 30 or 15 consecutive patient or 80% of measure group eligible cases

Nature and duration of reporting determines if bonus payment is equal to allowed charges for 12 or 6 months

No GI specific registry at this time but there are registries collecting GI related PQRI measure’s data


If you submit quality data to a registry l.jpg

If You Submit Quality Data to a Registry

Check the CMS website at www.cms.hhs.gov/PQRI and click the reporting tab for a list of “qualified” registries.

Contact a registry to see if they will report the measures you want to report and for the reporting period you want to report.

Express your interest in having your data submitted for purpose of PQRI


How to submit claims l.jpg

How to Submit Claims

To participate in PQRI, you must have a NPI number.

You can submit claims for PQRI measures electronically or on a paper CMS-1500 form.

You will need to provide your NPI number in the “Rendering Provider” field on the claim.

Quality-data code line items must be submitted with a charge of $0.00 or $0.01.


Steps in reporting process l.jpg

Steps in Reporting Process

Select the measures/measure option you will use

Enlist team and assign roles and responsibilities

Put systems in place to facilitate reporting/quality improvement, e.g. registries, reminders, standing orders

Use a coding tool/worksheet

Attach a copy of the coding tool/worksheet to the super-bill to alert coder to enter appropriate quality codes

Coder verify patient eligibility, pertinent encounter, and correct quality codes


Steps in reporting process41 l.jpg

Steps in Reporting Process

Include the NPI for each physician on claim

Keep a log of information for QI

Analyze your own data to improve

Use experience to establish/refine systems aimed at improvement

Look for other opportunities and bonus payments in your market

Cultivate a positive environment for quality improvement


Minnesota gastroenterology pqri experience 2007 2008 l.jpg

Minnesota GastroenterologyPQRI Experience 2007-2008

Providers

56 Physicians

21 NP/PA’s

2006 Quality Measure for Compensation

Clinical

Business 30% - 100%


Implementation 2007 l.jpg

Implementation2007

Identified Measures

EMR Implementation

Communication

Email

Fair Process

Pop-up Screen With Questions

Not Mandatory


2007 measures l.jpg

2007 Measures

GERD606162

EncountersLots231369

Compliance <4.3%61.6%4.3%


Implementation 2008 l.jpg

Implementation 2008

Mandatory Fields

GERD Measure7798.8%

Hep A & B Measure8891.7%

Adoption of EMR Measure124100%


Slide46 l.jpg

Minnesota Gastroenterology Data Collection Tools


Slide47 l.jpg

Minnesota Gastroenterology Data Collection Tools


Question and answer session l.jpg

Question and Answer Session


For more information l.jpg

For More Information

Visit the AGA Institute

Center for Quality in Practice at www.gastro.org/quality for the latest updates on PQRI and other reporting programs.

Questions may be submitted to [email protected]


  • Login