Meaningful Use & Physician Quality Reporting System (PQRS)

1. Introduction and Welcome: Nancie McAnaugh, MSWCenter for Health PolicyMO HIT Assistance CenterPresenter: Sandra PogonesProgram Manager for Physician ServicesPrimaris Meaningful Use & Physician Quality Reporting System (PQRS)

2. Before we begin… • Phone lines are now muted • Press *4 to increase or decrease sound level • Find this or any previous webinar, go to http://www.EHRhelp.missouri.edu click on Webinars

3. MO HIT Assistance Center • Missouri’s Federally-designated • Regional Extension Center • University of Missouri: • Department of Health Management and Informatics • Center for Health Policy • Department of Family and Community Medicine • Missouri School of Journalism • Partners: • EHR Pathway • Hospital Industry Data Institute (Critical Access Hospitals) • Missouri Primary Care Association • Missouri Telehealth Network • Primaris

4. Vision Assist Missouri's health care providers in using electronic health records to improve the access and quality of health services; to reduce inefficiencies and avoidable costs; and to optimize the health outcomes of Missourians

5. What is our role? • For providers who do not have a certified EHR system - We help you choose and implement one in your office • For providers who already have a system - We help eligible providers meet the Medicare or Medicaid criteria for incentive payments

6. MO HIT Assistance Center Now Serves Large Practices & Specialists • Contact MO HIT Assistance Center for details and pricing

7. CME Credit Now Available • Instructions provided after today’s presentation

8. Disclosures • The Office of Continuing Education, School of Medicine, University of Missouri is accredited by the Accreditation Council for Continuing Medical Education (ACCME) to provide continuing medical education for physicians. • The Office of Continuing Education, School of Medicine, University of Missouri designates this live Internet educational activity for a maximum of one AMA PRA Category 1 Credit™. Physicians should only claim the credit commensurate with the extent of their participation in the activity. The learning objectives of this live Internet educational activity are: • Choose an appropriate electronic health record for the practice, create a change team, redesign practice workflow and successfully implement transition to electronic records. • Appropriately track quality measures in electronic health records and to create accurate reports of quality indicators; physicians will understand how to use indicators to improve patient outcomes. •  Identify potential privacy and security issues in individual practices that are utilizing electronic health records and provide tools for practices to use to assess their security measures to see if they are appropriate. • Measure and track the way individual practices are reporting on the meaningful use requirements in the federal HI Tech Act; understand additional clinical reporting requirements contained in meaningful use phases two and three. • Appropriately design and implement patient portals for patients to access their health care information and learn how to better take care of their health conditions. • The planning members for this activity have no commercial relationships to disclose. However, the presenter of today’s Webinar, Sandy Pogones is a Primaris employee.

9. Disclosures Cerner and the University of Missouri Health System have an independent strategic alliance to provide unique support for the Tiger Institute for Health Innovation, a collaborative venture to promote innovative health care solutions to drive down cost and dramatically increase quality of care for the state of Missouri. The Missouri Health Information Technology Assistance Center at the University of Missouri, however, is vendor neutral in its support of the adoption and implementation of EMRs by health care providers in Missouri as they move toward meaningful use. This regional extension center is funded through an award from the Office of the National Coordinator for Health Information Technology, Department of Health and Human Services Award Number 90RC0039/01

10. Physician Quality Reporting System: Beyond an Incentive Payment Sandra Pogones Program Manager, Physician Services Primaris – Columbia, MO

11. Who is Primaris • Primaris was founded in 1983 by the Missouri State Medical Association, Missouri Hospital Association and Missouri Association of Osteopathic Physicians and Surgeons • Among other roles, Primaris serves as the federally-designated Quality Improvement Organization (QIO) for the state of Missouri. • Mission of QIOs: To improve the effectiveness, efficiency, economy and quality of services delivered to Medicare beneficiaries. • Services provided under the QIO contract are free-of-charge to providers.

12. Objectives • Establish the importance of Physician Quality Reporting to the physician practice • Identify PQRS program requirements in terms of eligibility, incentives, reporting mechanisms and requirements • Examine specifications for a sample measure • Propose a workflow plan to incorporate quality measurement into daily practice • List resources to assist physician practices in successfully reporting PQRS • Question & Answer

13. Quality Reporting is First Step toward “Real Goals” • Success of Practice • Sense of Accomplishment/Professional Achievement • Improved Productivity/Set Practice Priorities • Move away from Defensive Medicine to Evidence-Based • Service to Patients • Improved Outcomes, Prevention, Diagnosis, Remediation • More engaged, self-responsibility • Improved Satisfaction, Better Coordination • Benefits for the Population • Efficacious Care and Improved Population Health • Less waste, right incentives—Drive Change

14. Where do PQRS Measures Come From? • National Quality Forum (NQF) measures are at the center of PQRS. • Experts in the clinical area and stakeholders are convened to define quality and standards through consensus process • Measures are adopted that are important, scientifically acceptable, useable, relevant, and feasible to track • Caregivers adopt and apply measures to improve their own practice • Measures provide benchmarks and best practices

15. Why Participate in PQRS? Financial • PQRS Incentives through 2014 • 2011 : 1% of provider’s allowable Part B PFS incentive • 2012, 2013, 2014: 0.5% incentive • Penalties beginning in 2015 for those who do not satisfactorily report • 2015: 1.5% payment reduction • 2016 and subsequent years: 2.0% payment reduction • Brings money into the practice—Medicare pays for many preventive services as first-dollar

16. Why Participate in PQRS? Financial (cont.) • We are moving away from Fee-for-Service to Value-based purchasing • Accountable Care Organizations • Patient-Centered Medical Homes • Missouri Foundation for Health/Healthcare Foundation of Greater KC/BCBS GKC (2011+) • Missouri HealthNet – Medicaid (2011+) • CMS “Comprehensive Primary Care Initiative (Sept 2011)

17. Why Participate in PQRS? Financial (cont.) • Value-based modifier is required for specific physicians by 1/1/2015 and all providers by 1/1/2017. Initial performance data is 2013. • Physicians in IA, KS, MO and NE will receive individual “Value-based” Reports late in 2011 • PQRS measures reported • Clinical measures derived from Claims data • Compare average per capita costs among physicians • Compare total per capita costs for patients with COPD, heart failure, CAD and diabetes • Reports will be refined for future Value-based reports and for public reporting

18. Why Participate in PQRS? Accountability • Close scrutiny of health care spending—accountability • Public outcry toward national spending has brought all federal programs to the forefront • Healthcare is the biggest ticket of federal budget & Medicare largest payer • PQRS performance can demonstrate that practice met standard of care • PQRS measures serve as window for evidence-based measure of quality upon which payment will be based

19. Why Participate in PQRS? Reputation • Supports public reporting of quality data • Quality reporting measures are becoming more closely aligned for all CMS initiatives—Meaningful Use, PQRS, Medicare Advantage, PCMHs, ACOs, etc. • CMS website contains a listing of all physicians that satisfactorily completed PQRI in 2009: http://www.cms.gov/PQRI • CMS sends a letter to your patients telling them their physician is participating in PQRS • Physician Compare quality reporting begins in 2013 for Groups; later for individual physicians • http://www.medicare.gov/find-a-doctor/provider-search.aspx

20. Physician Compare Website

21. Why Participate in PQRS? Excellence • Provides a way to measure and monitor the quality of care you provide your patients • Identify gaps in performance and take steps to correct • Provide better, more comprehensive care that meets professional standards • “You improve what you measure” • Build trust in your patients, engage them in care

22. Three Separate and Distinct CMS Programs • EHR Incentive Program (“Meaningful Use” of an EHR) • E-Prescribe Incentive Program (electronically transmit prescriptions) • PQRS Incentive Program (“Physician Quality Reporting System”—formerly PQRI; report quality measures to CMS via claims, registry or EHR) EPs may participate in all programs for incentives and MUST participate to avoid payment penalties. (Only Medicare EHR incentives and e-prescribe incentives are mutually exclusive. Otherwise, eligible providers can collect all three.)

23. Physician Quality Reporting System • PQRS requires reporting of clinical measures to CMS • Annual program, rules/measures change every year • PQRS incentives are independent of other CMS programs • Eligible professionals include physicians, NPs, PAs, therapists • Incentives based on Medicare Part B PFS allowable charges – incentives smaller/non-existent for RHC/FQHC providers

24. Reporting Mechanisms • Measures--EPs may report: • 3 individual PQRS measures (194 possible), OR • 1 measures group (14 different Measures Groups) • A group consists of 4-9 clinically-related measures • Reporting Options • Claims—traditional option • Qualified Registry—list not yet available for 2011 • Qualified EHR (20 individual measures—no measures groups)—28 EHRs are qualified in 2011

25. Participation Options • In 2011 Providers may participate as: • Individuals--No registration is required • Groups • Self-nomination by first of the year required and approval needed • Groups report 26 measures • Additional incentive (0.5%) for Maintenance of Certification Program – professional bodies only

26. Reporting through Part B Claims • Submit daily on the claim • Designed for paper-based clinical systems • Some practice management systems have alerts to assist reporting

27. Reporting through a Qualified Registry • Provider submits data to registry, or registry pulls data from EHR • Registry submits aggregate data to CMS on behalf of provider • Done once a year, usually with a cost

28. Reporting through a Qualified EHR • EHR must be Qualified by CMS • EHR pulls raw data from the EHR and submits to CMS • Done once a year – may be a cost from vendor • CMS calculates performance rate

29. Deadlines • All claims must be submitted by the end of February 2012 • Registry, EHR and GPRO must submit all data by the end of March 2012

30. Quality Measures--Analysis • Each measure has a denominator that defines the population included. e.g. Pneumococcal Vaccine • Denominator: All patients greater than or equal to 65 years at the beginning of the measurement period. Patients must have at least one face-to-face office visit during the measurement period. • Each measure has a numerator that defines the portion of population that met the measure • Patients who received a pneumococcal vaccination before the end of the measurement period

31. Quality Measure Analysis (continued) • Some measures have exclusions that remove a patient from both the numerator and denominator: • Medical reason for not having the vaccination, such as Allergy or Adverse effect • Reporting Rate: Accurately identifying all patients in the denominator • Performance Rate: Numerator/Denominator • Currently incentives are based only on Reporting. There is no threshold for Performance--yet. • 2011 and 2012 are “free years” to master the fundamentals of quality measurement and reporting using the EHR

32. What’s Required for Quality Measurement • Structured Data Capture in Defined Fields • Drop-down Lists - Dates • Checkboxes - Positive/Negative • Numerical values • NOT—scanned documents, dictation, narrative notes • May continue to use non-structured data but must be able to add underlying coding/structured element • Requires change to workflow and documentation habits • Requires team approach to accomplish change efficiently • Find a balance between structured/unstructured

33. Crosswalk between Prevention PQRS Measures and MU CQMs

34. Workflow for EHR-Based Reporting

35. Workflow (Continued)

36. Workflow (Continued)

37. Workflow (Continued)

38. Workflow (Continued)

39. Bottom Line • Quality measures are being aligned • Financial Reasons • Reputation • Accountability • Culture of Excellence “The healthcare organization that seeks merely to meet minimal standards may not ever reach any higher, and certainly will not achieve excellence.” (Janet Brown, RN, CPHQ, The Healthcare Quality Handbook, 2010-2011)

40. Resources • Primaris • Primaris has just received funding to assist 74 Missouri physicians to report PQRS using their EHR as part of our national QIO 10th Scope of Word (began August 2011).  • Free onsite and/or remote assistance for reporting Preventive Care Screening (flu/pneumonia vaccines, Colorectal Cancer Screens, Mammograms, BP measurement, Tobacco cessation) • Earn PQRS Incentives for 2012 (and possibly 2011) • Complete and return Interest Form to reserve your spot today. Eligibility criteria apply. • Primaris will offer best practices and consultation to any practice attempting to improve performance on the above measures

41. Resources (cont) • Missouri Health Information Technology Assistance Center • Website: http://ehrhelp.missouri.edu • E-Mail: EHRhelp@missouri.edu • Phone: 877-882-9933 • CMS INFORMATION RESOURCES: http://www.cms.gov/pqrs • How to Get Started • Measure Specifications for individual measure reporting • Measures Groups Specifications • EHR Specifications • GPRO Specifications • 2011 Implementation Guide

42. Resources (cont) • Also see: • Frequently Asked Questions • Supplemental education materials • National Provider Calls • Special Open Door Forums • QualityNet Help Desk • http://www.cms.hhs.gov/PQRI/36_HelpDeskSupport.asp • 7:00 a.m. - 7:00 p.m. CST at 866-288-8912 or qnetsupport@sdps.org

43. Thank You! • Questions? Contact: • PQRS and Improvement on Quality Measures: • Sandy Pogones, spogones@primaris.org • Cardiac Learning and Action Network: • Kristen Bird, kbird@primaris.org • Websites: • Primaris.org • PQRSMO.org Primaris: Your Local Connection to Achieving National Health Goals

44. Disclaimer This presentation was prepared as a tool to assist providers. Although every reasonable effort has been made to assure the accuracy of the information within these pages, the ultimate responsibility for the correct submission of claims and response to any remittance advice lies with the provider of services. Primaris employees, agents and staff make no representation, warranty, or guarantee that this compilation of information is error-free and will bear no responsibility or liability for the results or consequences of the use of this guide. This publication is a general summary that explains certain aspects of the Medicare Program, but is not a legal document. The official Medicare Program provisions are contained in the relevant laws, regulations, and rulings. Medicare policy changes frequently so links to the source documents have been provided for your reference to the most up-to-date information.

45. Your Phone Line is Now Open! • If you do not wish to ask a question, please press * 6 to mute your phone.

46. To Receive CME Credit • Go to: http://www.EHRhelp.missouri.edu • Click on on our home page • Look for today’s Webinar title • Download pdf or complete online questionnaire • Submit or fax completed questionnaire to 573-882-5666 by: Friday, November 11, 2011 Webinars

47. For More Information: • Website: http://ehrhelp.missouri.edu • E-Mail: • EHRhelp@missouri.edu • Phone: • 1-877-882-9933