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Your PQRS Questions Answered

As I mentioned in my December post, capturing data and reporting for the Physician Quality Reporting System (PQRS) is more important than ever in 2015. CMS will apply a negative payment adjustment to any Eligible Professionals not reporting PQRS data this year. The decision to move forward with PQRS reporting seems obvious, but with multiple reporting options and hundreds of quality measures to choose from, getting started can be a formidable task.

Some of the most common questions we receive from the charge capture practices that we work with are listed (and answered!) below.

How many measures do we need to choose?
CMS specifies that Eligible Professionals (EPs) need to report at least nine clinic quality measures across three National Quality Strategy (NQS) domains of care for at least 50% of the EP’s Medicare Part B patients. One of these measures must be a cross-cutting (or broadly applicable) measure. The NQS domains are Effective Clinical Care, Efficiency and Cost Reduction Use of Healthcare Resources, Community, Population and Public Health, Communication and Care Coordination, Patient Safety, and Person and Caregiver-Centered Experience Outcomes.

There are 254 total quality measures available for reporting in 2015, but some measures are only reportable through one or a subset of the possible reporting methods. Selecting a reporting method will decrease the number of measures from which to select; for example, there are 72 measures available for claims-based reporting.

How do we get PQRS data to CMS?
Providers can submit PQRS data to CMS via five different methods of reporting: claims-based, registry-based, qualified Electronic Health Record (EHR), Qualified Clinical Data Registry (QCDR), or as a group of providers via the Group Practice Reporting Option (GPRO).

What are the best measures to choose?
There are a wide variety of measures from which to select, and some are more suited toward certain medical specialties or provider types than others. Some factors to consider when choosing measures are clinical conditions treated, types of care (preventive, chronic, acute) provided, settings where care is usually delivered (office, hospital, emergency room), quality improvement goals for 2015, and any potential overlap with other reporting programs.

For example, Measure #164: Coronary Artery Bypass Graft (CABG): Prolonged Intubation is applicable to cardiologists, while Measure #336: Maternity Care: Post-Partum Follow-Up and Care Coordination might be more relevant to an obstetrician or primary care provider.

Cross-cutting measures, such as Measure #46: Medication Reconciliation and Measure #128: Body Mass Index (BMI) Screening and Follow-Up Plan are intended to be applicable to a wider range of providers.

You can download a list of the 2015 measures and their individual specifications here: 2015 PQRS Individual Claims Registry Measure Specification Supporting Documents

Do I have to capture PQRS data for all nine measures for every patient I see?
No. PQRS only applies to patients with Medicare Part B insurance. Additionally, each individual measure has specific criteria to determine if a patient should be included in the denominator for that measure calculation. These criteria include diagnoses, previous or current patient encounters, gender, and age. In the example of Measure #46 above, only patients who were discharged from the hospital in the current reporting period would qualify for this measure. For measure #164, only patients who underwent a CABG procedure in the reporting year would be included.
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