Overview of PQRS, VM, & the EHR Incentive Programs Angela M McCrea, MT, ASCP Maureen Schwarzer, BSN,...
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Transcript of Overview of PQRS, VM, & the EHR Incentive Programs Angela M McCrea, MT, ASCP Maureen Schwarzer, BSN,...
Overview of PQRS, VM, & the EHR
Incentive Programs
Angela M McCrea, MT, ASCP
Maureen Schwarzer, BSN, RN Lynn Page, BSN, RN
Atlantic Quality innovation network (AQIN)•The Carolinas Center for Medical Excellence CCME) is
part of AQIN, a Quality Innovation Network (QIN)
•We serve as the QIN-Quality Improvement organization
(QIO) for South Carolina–Known as AQIN South Carolina
•The CCME mission: “We help people by improving the
quality of health care”
Objectives• Provide a high level overview of CMS’s incentive
payment programs (PQRS, VM, MU EHR incentive
program).• Review how to earn incentive bonuses under the these
programs.• Review the payments adjustment associated with not
participating in these programs.
What is the Physician Quality Reporting
System (PQRS)?•CMS quality improvement program that uses a combination
of incentive payments and penalties to promote reporting of
quality data.
•The Foundation of Value Based Purchasing
Who is Eligible for PQRS?• Eligible providers who bill under the Medicare Physician
Fee Schedule (part B). •Includes therapist and NP.
•Excludes FQHC, RHC, independent labs or
diagnostic testing centers, etc.
PQRS Overview• 2007, Pay for Reporting • 2014 was the last incentive year of .05%• MOC earn an additional .05%• Calendar Year Reporting • 2014 Reporting Period – 01/01/15 – 02/28/15• Incentive Payments release in the Fall 2015• Penalty-for-Not-Reporting – (Medicare uses the term
Payment Adjustments)
Value Modifier Program•The Value Modifier (VM) program assesses both quality of
care furnished and the cost of that care under the Medicare
Physician Fee Schedule.
•Implementation of the VM is based on participation in the
PQRS Program.
•Medicare Pay for Performance
Value Modifier Program• 2015 - the VM applies to groups of 100+ EP based on
2013 PQRS reporting.
• 2016 – the VM applies to 10 – 99 EPs based on 2014
PQRS reporting.
• 2017 – the VM applies to solo practitioners and groups
of two or more EPs based on 2015 PQRS reporting.
VBM 2016 (2014 Year of Care) Groups of 10-99
Submit PQRS
NO
YES
2%VBM
Adjustment
VBM Quality Tiering
Groups of 100 or More
Low Quality
Avg Quality
High Quality
0 +1% +2% Low Cost
-1% 0 +1% Avg Cost
-2% -1% 0 High Cost
Groups of 10 - 99
Low Quality
Avg Quality
High Quality
0 +1% +2% Low Cost
0 0 +1% Avg Cost
0 0 0 High Cost
2%PQRS
Adjustment
On Top Of
For the 2016 value modifier, quality tiering is mandatory for groups with 10 or more EPs.
Physicians in groups of 10 to 99 EPs will be subject to an upward or neutral payment adjustment,
VBM 2017 (2015 Year of Care)
Submit PQRS
YES
VBM Quality Tiering
Groups of 10 or More
Low Quality
Avg Quality
High Quality
0 +1% +4% Low Cost
-2% 0 +2% Avg Cost
-4% -2% 0 High Cost
Groups of 1 - 9
Low Quality
Avg Quality
High Quality
0 +1% +2% Low Cost
0 0 +1% Avg Cost
0 0 0 High Cost
< 10
For the 2017 value modifier, quality tiering is mandatory for all EPs
Physicians in groups of 1 to 9 EPs will be subject to an upward or neutral payment adjustment,
GroupSize
2% PQRS Payment
AdjustmentNO
4% V BM Payment
Adjustment
2% VBM Payment
Adjustment
> 10
Composite Scores
Quality Score
Based off PQRS measures reported
Cost Score
a. Diabetes
b. COPD
c. Coronary Artery Disease
d. Heart Failure
Quality Resource Use Reports (QRURs)
Provides physician with their performance scores used in
calculating the value-based payment modifier (VBM).
Provides physicians with comparative information about the
quality and cost of the care delivered to their Medicare fee-
for-service patients.
Physician Compare Website
Information about physicians and other healthcare
professionals who satisfactorily participate in CMS
incentive payment programs.
EHR Incentive Programs
The Medicare and Medicaid EHR Incentive Programs
provide incentive payments to eligible professionals (EPs)
who demonstrate meaningful use of electronic health records
(EHRs).
EPs must demonstrate meaningful use and submit measures
for Stage 1, Stage 2, and Stage 3.
MU Goals
Use certified EHR technology to improve quality, safety,
efficiency, and reduce health disparities.
Engage patients and families in their health care.
Improve care coordination.
Improve population and public health.
Maintain privacy and security.
MU Payment Adjustments
2015 for Medicare EPs who decide not to participate in the
program.
No payment adjustments for providers who are only eligible
for the Medicaid program.
It’s not just PQRS Anymore
Payment adjustments for not participating in CMS Incentive Programs
Year CY Data PQRS Value Modifer Meaningful Use
Total Posible Payment
Adjustments2015 2013 -1.5 -1.0 -1.0 -3.5
Groups of 100+ 2016 2014 -2.0 -2.0 -2.0 -6.0
Groups of 10+ 2017 2015 -2.0 -2.0 3.0 – 5%** TBD
Groups of <10 (each year 2017 2015 -2.0 -4.0 3.0 – 5%** TBD
Groups of > 10 (each year ** Penalty amount could increase up to 5% depending on meaningful use success rates
(800) 922-3089 • (803) 212-7500 • www.atlanticquality.org
Questions?
This material was prepared by the Atlantic Quality Innovation Network (AQIN), the Medicare Quality Innovation Network-Quality Improvement Organization for New York State,
South Carolina, and the District of Columbia, under contract with the Centers for Medicare & Medicaid Services (CMS), an agency of the U.S. Department of Health and Human
Services. The contents do not necessarily reflect CMS policy. 11SOW-AQINSC- TskB.4- 15 03
Sources• http://
www.cms.gov/Medicare/Quality-Initiatives-Patient-Assessment-Instruments/PQRS/index.html
• MLN Connects™ National Provider Call: “CY 2014 Medicare Physician Fee Schedule (PFS) Final Rule,” December 17, 2013. http://www.cms.gov/Outreach-and-Education/Outreach/NPC/ National-Provider-Calls-and-Events-Items/2013-12-17-PFS-NPC.html
• CMS Webinar: “CMS 2014 Physician Quality Reporting System (PQRS) Webinar”, January 7, 2014. http://www.qipa.org/getattachment/Materials/Prevention/2014-PQRS-Presentation-010714.pdf.aspx
• CMS Webinar: “2014 Value Modifier,” January 14 and 16, 2014. https://webinar.cms.hhs.gov/p1cx2h95k68