Showing posts with label PQRI. Show all posts
Showing posts with label PQRI. Show all posts

Monday, May 23, 2011

PQRI 2011

The Physician Quality Reporting Initiative (PQRI) is a program to improve the quality of reporting in the healthcare industry. The program is now considered to be permanent and therefore the program name has been amended to the Physician Quality Reporting System (PQRS). PQRS reporting is based on individual measures which are associated to a specific patient group by diagnosis, ailment, age, or clinical action taken by the reporting therapist. All Medicare Part B FFS (fee for service) patients are eligible, but must meet inclusion criteria for each measure. 

There are three methods of reporting your clinical data to CMS:  Claims, Registry and EHR-based.  Choosing your reporting method is very important in reaching your 1% incentive goal.  

Claims-based Reporting
With claims-based reporting, measures are tied to clinical practice reported on claims with CPT codes that link to measures.



To qualify for your 1% incentive, you must report on at least 3 measures ( atleast 3 individual measures or atleast 1 measure group ) and report on 50% of eligible patients (this is a reduction from the 80% requirement of 2010).

Advantages of claims-based reporting:
  1. You are in control of your own data from completion to submission
  2. Cost effective – no added cost
  3. Only 50% reporting requirement
  4. OK for smaller practice or if Medicare is a small portion of your payer mix
Disadvantages of claims-based reporting:
  1. Must have someone in the clinic who will own this project: complete audits, know all the ins/outs of PQRS, keep record of the % completed
  2. Auditing process can be tedious and potentially a productivity loss for an employee
  3. We must complete and submit the proper forms in proper format for the eligible patients
  4. Workload could be significant if large % of your patients are Medicare or part of a large clinic
Registry-based Reporting
With registry-based reporting, the eligible professional or group practice submits the data electronically to the registry, who then captures and stores the measure related data. The registry is then responsible for submitting the individual measure or measures group information to CMS on behalf of eligible professionals.  Registries provide CMS with calculated reporting and performance rates at the end of the reporting period.  Registries must pass stringent reporting method criteria annually and be qualified to participate.

 
To qualify for your 1% incentive, you must report on at least 3 measures ( atleast 3 individual measures or atleast 1 measure group ) and report on 80% of eligible patients or report.
 
Advantages of registry-based reporting:
  1. Form creation and submission is done by registry
  2. No need for auditing due to the EMR enforcing measure criteria and selecting eligible patients
  3. Staff productivity maintained
  4. Higher potential for meeting the reporting criteria and receiving your 1% incentive bonus
  5. Using a EMR registry gives you added insight and assistance with choosing most appropriate measures
  6. Measures are updated automatically each year as information is provided by CMS
Disadvantages of registry-based reporting: 
  1. There is a cost involved; but it is nominal ( around 300 $ per provider ) and definitely provides an ROI when staff time, paper/office supplies, and decreased stress levels are calculated
  2. 80% reporting requirement, but with the EMR in place, 100% data collection should be the expectation
  3. Data collection enforcement with all eligible patients – no choice but to report on each patient
The 1% incentive may not seem like much, if you have to spend staff time and effort to get the proper codes into billing, complete audits to ensure your clinic is meeting its minimum criteria, and manually submitting claims to CMS. Although there is a cost associated with using a registry, the savings on staff time and maintaining productivity alone is substantial.

EHR-based Reporting
Eligible professionals who choose to report on EHR measures need to select at least three EHR measures to report on to be able to qualify to earn a PQRI incentive payment.To qualify for the incentive, the correct quality action or performance exclusion will need to be reported on at least 80 percent of the eligible cases identified for each selected measure.



A case is eligible for PQRI purposes when the codes match the denominator inclusion criteria and are listed as PFS covered services according to the PQRI EHR Measure Specifications. Each measure has a reporting frequency or timeframe requirement for each eligible patient seen during the reporting period for each individual eligible professional.


Ensure all patient-care and visit-related information are documented in your EHR system. Ensure you identify and capture all eligible cases per the measure denominator for each measure you choose to report. Review all the denominator codes that can affect EHR-based reporting to make sure the correct quality action is performed and reported for the eligible case.
Create the required reporting file, which would be uploaded from your EHR system. A PQRI-qualified EHR would have been programmed already to generate this file. Submit final EHR reporting files with quality measure data by the data submission deadline.
 

Advantages of EHR-based reporting:
  1. Cost effective – no added cost
  2. EHR enforces measure criteria and selects eligible patients
  3. Staff productivity maintained
  4. Measures are updated automatically each year by EHR as information is provided by CMS
Disadvantages of EHR-based reporting:
  1. Must have adequate training on the EHR to manage the PQRI process
  2. Must generate and submit the EHR-PQRI reporting files
  3. 80% reporting requirement, but with the EMR in place, 100% data collection should be the expectation