Aligning Meaningful Use CQM and PQRS Reporting for 2015 August 19, 2015
Introductions Marni Anderson Laura Sawyer Project specialist, MetaStar Clinical application coordinator, MPRO manderso@metastar.com lsawyer@mpro.org 608-441-8253 248-465-7384 Candy Hanson Ben West Program manager, Stratis Health CTO, Health eFilings chanson@stratishealth.org Bwest@Healthefilings.com 952-853-8524 608-841-1381 2
Agenda • Participating with Lake Superior Quality Innovation Network (QIN) • Review reporting requirements for Electronic Health Record (EHR) Incentive Program clinical quality measures (CQMs) and Physician Quality Reporting System (PQRS) • Review payment adjustments and potential incentives • How to report quality measures once for both programs directly from your certified EHR 3
Lake Superior QIN Three quality improvement organizations: • Stratis Health in Minnesota • MPRO in Michigan • MetaStar in Wisconsin Collaboration to improve health care for Medicare beneficiaries, share best practices and maximize efficiencies 4
Quality Improvement Initiatives Lake Superior QIN will focus on health care quality improvement initiatives that include: • Improving cardiac health and reducing cardiac health care disparities • Reducing disparities in diabetes care • Improving prevention coordination through health information technology • Reducing health care associated infections in hospitals • Reducing health care acquired conditions in nursing homes • Improving the coordination of care between health care settings • Improving quality through performance-based incentives and reporting systems • Improving identification of depression and alcohol use disorder in primary care for behavioral health conditions • Improving adult immunizations and reducing immunization disparities 5
Introduction to Health eFilings Health eFilings is a data submission vendor that works with any EHR. 100 percent of their customers’ files were accepted by Medicare last year. Ben West, CTO, is on the HL7 workgroup which created the Quality Reporting Document Architecture (QRDA) standard and advises Medicare and ONC on quality reporting standards. 6
Review of EHR Incentive Program CQM Requirements • Eligible professionals • Doctors of medicine or osteopathy • Doctors of dental surgery or dental medicine • Doctors of podiatry • Doctors of optometry • Chiropractors • Certified EHR Technology (CEHRT) • Electronic CQMs • Technical specifications for EHR reporting • The Centers for Medicare & Medicaid Services (CMS) guidance • Recommended adult and pediatric core set 7
Review of PQRS Reporting Requirements • Eligible professionals • Medicare physicians, practitioners and therapists billing Medicare Physician Fee Schedule (MPFS) Part B or critical access hospital (CAH) Method II • Reporting methods • Claims • Registry • Qualified Clinical Data Registry (QCDR) • Direct EHR • Data submission vendor • PQRS data analyzed by CMS and contributes to value based modifier 8
Why Electronic Reporting? 2015 is the performance year for 2017 payment adjustments. • EHR incentive program • PQRS and Value-Based Modifier (VBM) 2017 is the first performance year for Merit-Based Incentive Payment System (MIPS). • Incentives based on performance in EHR Incentive Program and PQRS/VBM Electronic reporting may be more efficient and satisfy multiple program reporting requirements. 9
2017 Payment Adjustments 10
How to Report Once To reduce the burden, CMS has aligned reporting requirements for those reporting electronically using their CEHRT. • The electronic clinical quality measures (eCQMs) specifications are used for electronic reporting option for PQRS as well as the Medicare EHR Incentive Program • Satisfactory reporting of eCQMs for PQRS will allow group practices to qualify for the CQM component of meaningful use 11
How to Report Once: Individual Report nine measures across three domains covering a full year of data. Submit this data in one of three ways: • Direct EHR • Data submission vendor • QCDR 12
How to Report Once: Group Direct EHR or Data Submission Vendor: • Submit a full year of data with nine measures • OR submit a full year of data with six measures, plus Consumer Assessment of Healthcare Providers and Systems (CAHPS) Using web interface (25+ EP’s only): • Submit a full year of data with all web interface measures • 100+ EP groups are required to additionally do CAHPS 13
How to Report Once: ACO Both Pioneer and the Medicare Shared Savings Program (MSSP) accountable care organizations (ACOs) are required to use the web interface with a full year of data. 14
Electronic Reporting Workflow (Not Using a DSV) 1. Create an Enterprise Identity Management system (EIDM) account 2. Work with your EHR vendor to extract QRDA files • Track and resolve any errors in your EHR • Track and ensure that files are created for every provider + taxpayer identification number (TIN) 3. Log in to QualityNet and upload your files from #2 4. Resolve any errors 5. Repeat 2-4 until all providers are submitted 15
Electronic Reporting Workflow (Using a DSV) 1. Create an EIDM account 2. Work with your EHR vendor to extract QRDA files • Track and resolve any errors in your EHR • Track and ensure that files are created for every provider + TIN 3. Login to QualityNet and upload your files from #2 4. Resolve any errors 5. Repeat 2-4 until all providers are submitted 1. Sign contract with a data submission vendor (DSV) 2. Some DSVs may make you do step number 2 above 16
Getting Started • Decide if you want to use a DSV • Determine available measures • Review eCQMs available in your CEHRT • Work with your CEHRT vendor to understand how to properly document patient care • Understand how an eCQM is different/similar to measures used in registry or claims reporting 17
Example eCQM: Controlling High Blood Pressure Domain: Clinical Process/ Effectiveness Measure description: • Percentage of patients 18-85 years of age who had a diagnosis of hypertension and whose blood pressure was adequately controlled (<140/90mmHg) during the measurement period. • CMS165v3; NQF# 0018 - PQRS # 236 - GPRO HTN-2 18
Technical Details • Quality Reporting Data Architecture (QRDA) • Category I and III • History of development and how they are created • PQRS portal 19
Common Error Messages • “SHALL contain exactly one [1..1] effectiveTime (CONF:26933).” • Meaning: a time is missing • “This id SHALL contain exactly one [1..1] @extension, which SHALL be selected from ValueSet CMS Program Name 2.16.840.1.113883.3.249.14.101 STATIC (CONF:711162).” • Meaning: program is incorrect (e.g. you didn’t declare that it was for PQRS) 20
Common Error Messages • Even if you don’t get an error message, that doesn’t mean the submission was valid! • If you don’t use a DSV, you will need to work with your EHR vendor to resolve these. 21
Example Feedback Report 22
Data Submission Vendor • EIDM account not required • Testing and error checking files submissions • Who is a data submission vendor? • EHR vendor • QCDR • Dedicated DSV (e.g. Health eFilings) 23
Things to Ask a DSV/EHR • Are you on the HL7 Clinical Quality Informatics workgroup? • This workgroup manages the standards, so entities on that group will be more familiar with them • Do you participate in the CMS quality reporting kaizens? • Medicare invites leaders in quality reporting to advise them on their quality programs. Participation indicates that the DSV is thought highly of and participates in making policy. 24
Resources 2015 How to Report Once for Medicare Quality Reporting Programs http://www.cms.gov/Medicare/Quality-Initiatives-Patient-Assessment- Instruments/PQRS/Downloads/2015HowtoReportOnce.pdf 2015 PQRS EHR Reporting Made Simple http://cms.gov/Medicare/Quality-Initiatives-Patient-Assessment- Instruments/PQRS/Downloads/2015_PQRS_EHR_Made_Simple.pdf 2015 Guide for Group Practices Reporting via PQRS GPRO Using an EHR http://cms.gov/Medicare/Quality-Initiatives-Patient-Assessment- Instruments/PQRS/Downloads/2015_GPRO_EHR_Reporting_forGroups.pdf Electronic Reporting Using an Electronic Health Record (EHR) https://www.cms.gov/Medicare/Quality-Initiatives-Patient-Assessment-Instruments/PQRS/Electronic- Health-Record-Reporting.html eCQM Library https://www.cms.gov/Regulations-and- Guidance/Legislation/EHRIncentivePrograms/eCQM_Library.html 25
Resources Payment Adjustment Information https://www.cms.gov/Medicare/Quality-Initiatives-Patient-Assessment- Instruments/PQRS/Payment-Adjustment-Information.html Intro to EHR Incentive program http://www.cms.gov/Regulations-and- Guidance/Legislation/EHRIncentivePrograms/downloads/Beginners_Guide.pdf PQRS Eligible Professionals http://www.cms.gov/Medicare/Quality-Initiatives-Patient-Assessment- Instruments/PQRS/Downloads/2015_PQRSList_of_Eligible_Professionals.pdf CMS Enterprise Portal http://portal.cms.gov CMS Enterprise Identity Management (EIDM) User Guide https://www.cms.gov/Research-Statistics-Data-and-Systems/CMS-Information- Technology/IACS/Downloads/IACS-EIDM-Migration-User-Guide.pdf 26
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