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Event ID: 2986351
Event Started: 6/29/2016 11:49:03 AM ET
Good afternoon or perhaps good morning for some of you. Welcome to the learning and action network event entitled PQRS and ASCs. We have a standard agenda. This is a five-year initiative to ignite powerful and sustainable change in healthcare quality. We welcome participants from Alabama, Indiana, Kentucky, Mississippi, and Tennessee as well as other states that may be participating. Thank you for taking the time to join us and we appreciate all of you.
During this webinar, we will review the physician quality reporting system, identify reporting utilized by physicians to practice in this setting,review penalties associated with reported measures and we will also discuss changes to reporting programs.
Before we begin, we want to run through a few housekeeping items. We have a chat feature. Depending on your window, the chat box is either located on the right side or top of your screen. Several of us will monitor the chat feature throughout the presentation. If you have a comment or question, you can post it into chat.
Additionally, we have a separate question and answer function. This will allow you to submit questions to the panelists. We will respond to your questions.
During today's presentation you will be asked to participate in some polling questions. If you do answer, please hit the submit button. Finally, this call is being recorded. It will be posted on the website.
So, if we could pull up our first question, we want to get a better idea of who is on the line and what your experience is. What is your level of experience with quality reporting? Either 2016 will be your first year, one or two years experience, or, you been doing this a while. Any with three or more years experience reporting?
Select your answer and don't forget to hit the submit button.
Take a moment and see if we could retrieve our answers.
We have a mixture on the line. For a lot, this is your first year. We have some that have done this a time or two in the past. Good information for those new to it. Also, some updates for those who have done it in the past. Let's move on to our next question. If you have reported or you plan to begin reporting this year, what method have you used or do you plan to use? Web interface? Qualified clinical data registry? Perhaps you don't know what you use or what you plan to use. That is okay. Let us know.
We will pause a moment for the results to come in.
A lot of claims-based reporting. Some of you don't know and you will learn more during today's presentation. With that, it is my pleasure to introduce our speaker. Ms. Logan is the vice president for AMSURG and has over 25 years of experience in the healthcare industry. She has responsibility for education and training for areas of coding, billing, documentation, and reimbursement. She also works with QDC and PQRS reporting and training. We will pass you the ball so you will have access to the slides and thank you for being with us today.
Thank you.
Welcome to the webinar today. And, I hope together we can come up with some good ideas that you could perhaps use in your reporting for this year.
As we discussed our objectives it is to review PQRS, identify reporting that is utilized by physicians that practice in the ASC setting, review what penalties and rewards are associated with reported measures and discuss upcoming changes to the reporting. We won't get into every variation and permutation of reporting today. The list, it would get really long and we just have one hour. But hopefully, we get the conversation started and that will assist you with your reporting for 2016.
So, the physician quality reporting system, that was were previously known as PQRI, and a lot of people refer to it that way, was implemented by CMS in 2006 through legislation. It actually was implemented in 2007. That is when the program actually started. It had about 99,000 participants which was about 16% of the eligible physician participants. The program started out with 74 measures and while the program was very well received by physicians who thought it was a great idea to report on quality, etc., many providers felt the bonuses were not sufficient to offset the cost of actually reporting. And, it is a quality reporting program – it uses incentives and penalties to encourage eligible professionals to report quality measures. The last year for bonuses was in 2014. So, we are now entering the penalty phase.
So, PQRS, as we mentioned was implemented under laws under the Tax Relief and Health Care Act of 2006, or, TRHCA. As you know, the government is very fond of using acronyms, so we will see quite a few of those today. Included in the participation was a bonus payment of 1.5% for successful participation. Medicare then came back and, with the Medicare Improvements for Patients and Providers Act in 2008, they made the program permanent. And, it also required CMS to post the names of eligible professionals and group practices who have reported satisfactorily. The Affordable Care Act of 2010 incorporated some program changes. It implemented timely feedback and a formal appeals process by 2011. It also incorporated penalties starting in 2015. CMS finalized the 2012 Medicare physician fee schedule that program penalties for 2015 would be based on 2013 performance. And, 2014, as I mentioned, was the last year for receiving an incentive for participating.
All of the reporting is done on a two-year schedule. Everything that we report in 2016 we will see any rewards or penalties in 2018. And, this sometimes makes it a little bit difficult when you are discussing these initiatives with your physicians because, two years from now it sounds like a long ways away. And, it is difficult sometimes to get their attention two years at a time.
So, the first thing we want to look at is, who is eligible to even participate?
And, the chart here shows that of course, all Medicare physicians that participate are eligible. Your MDs and DOs, etc. And, they are listed here. You also have practitioners. In the ASC setting, of these practitioners, the ones you'll see will be, CRNAs. Don't usually have therapists and other types of practitioners, but we certainly have CRNAs in the setting.
So, I think, we had in our polling, have you participated in the past?
I think we had the experience. I think we have some people that have participated.
We are waiting for the question.
So, we have a combination of yes, no, not sure, and some that did not answer. There's certainly a lot surrounding this. We're not sure of what the answer is.
The other question that we had, have you changed how you report?
Most of you have not. If you have participated in PQRS in the past, you have not changed how you have been reporting. I will say, we will talk a little bit about the changes that are upcoming so that should be something to look at. There are two ways to report in PQRS. This is your second step. Once you decide you are eligible to report, the second step is to determine if you want to report as an individual or as a group. Individual eligible professionals can report through the tax ID. If you practice in different places, it can be a combination for each location. Or, as a group practice, that obviously is defined as two or more eligible professionals who have assigned the billing rates to the same tax ID number. If you decide to report as an eligible professional, you do not have to sign up or register in order to participate because you can participate via claims based reporting. Group practices can register to participate in PQRS because a group practice reporting option becomes analyzed as a group tax ID number level. That is the first decision you'll make. Do you report as an eligible professional or as a group?
Providers can choose to report via electronic health record. Medicare part B claims, qualified PQRS registry, qualified clinical data registry, PQRS group practice via the GPRO web interface or CMS certified survey vendor. How the quality measures are reported depends on how a provider wants to report, whether there are eligible measures available. We are going to look at the options individually. For example, in the surgery setting, anesthesia professionals were able to report via claims-based measures until 2015. In 2016 there is only one measure available for anesthesia to report via claims; however, that would not be a measure that would likely be reported in a lot of the ambulatory surgery centers because of the types of procedures that we perform there. So, the anesthesia measures became registry measures. You have to report it via a registry or the other option is to go through a qualified clinical data registry.
In 2013, the requirement was to report on at least one patient and one measure to avoid the penalty. In 2014, you had to report on at least 50% of Medicare patients in order to report via claims and avoid the penalty. PQRS penalties began in 2015 for eligible providers that did not satisfactorily report their measures in 2013. The penalty applies to all of the part B covered professional services that are paid through the fee schedule. The 2015 penalty for the services performed in 2013 was 1.5%. From now on, the penalty for subsequent years is 2%.
You had incentives in 2013 and no penalties. And, 2014 incentive was 0.5% with no penalties. 2015 was no penalties. Then, penalties of 1.5% and in 2016, we will have, for services performed, no incentive but the penalties will be 2%.
It will go forward as well.
The next step is to choose quality measures you want to report. If you have at least one Medicare patient with a face-to-face encounter you must also report on one crosscutting measure. In 2016 the measures are classified according to the six National Quality Strategy domains. Reporting mechanisms require an eligible professional or PQRS group practice to report on nine or more measures. They have to cover at least three national quality strategy domains. For a billable face-to-face encounter, if it is done, then you have to report on at least one crosscutting measure to avoid the 2018 PQRS negative payment adjustment. So, what are the national quality strategy domains? They are patient safety; person and caregivers centered experience and outcomes; communication and care coordination; effective clinical care; community and population health;and efficiency and cost reduction. When you look at the quality measures, they will have what domain they belong to. Quality measures, what are they?
They consist of a denominator and numerator. The numerator details the quality clinical action expected that satisfies the condition and is the focus of the measurement for each patient. So, patients who have received a particular service or providers that completed a specific outcome or process.
The denominator must describe the population that is eligible or the episodes of care to be evaluated. It should indicate age, the condition, the setting, and the timeframe. It just depends on what is applicable. Each component is further defined by specific codes that are described in respective measure specification to tell you if you can report on that particular quality measure. Just to use an example, if you have all 18-year-oldswho have been smoking and advised to cease smoking, it applies to this code. You would have to have each one of those criteria in order to report on that measure.
Physician compare is the reporting that Medicare has done so you can have the feedback. It is out there for patients to review. It is out there for anyone to look at. They publish some of the quality measure reporting scores on the Physician Compare profile pages. There has been much discussion about this in the first year as to whether physicians want to not have this published, etc., but this is what Medicare has chosen. They chose to publish this to all patients, fellow physicians, etc. It is available to the public on the website. Patients can use this information to make healthcare decisions and to choose a healthcare professional. However, not all healthcare professionals and group practices have quality measure scores on their Physician Compare profile page. There are things that if you do not participate in the measures that Medicare has chosen to publish, then you will not have anything on that score.
So, today we are discussing PQRS, however there are other payment adjustments for providers in 2018 for services performed in 2016. PQRS is just one piece of that. We talked about incentives and now we are moving into the penalty phase. Medicare is using this as a motivator to get more people reporting. We will also have a new payment modifier under the Medicare Physician Fee Schedule that was mandated by the Affordable Care Act. That is the value-based modifier that assesses both the quality of care furnished and the cost of that care under the schedule. It is part of the effort to move physicians’ performance, reimbursement that rewards the value over volume in the Medicare program. Under the value-based modifier, CMS will apply an upward, downward, or neutral payment adjustment to an eligible professional or group covered services under the fee schedule based on the group’s quality and cost performance compared to national benchmarks. The 2016 performance year will be used to determine the Medicare payment adjustments in 2018. Performance on quality and cost measures are provided to physicians through annual feedback reports known as QRUR. Here is a chart about the value modifier. If the group does not successfully report PQRS, you are automatically assessed a penalty under the value modifier that is separate from the automatic 2% penalty. The penalties are, as you see above, if you have a group of 2 to 9 eligible professionals and solo practitioners, and did not participate in the 2015 PQRS, you not only get 2% penalty, you also get a value modifier penalty of 2%.
If you participated in the 2015 PQRS and based on the quality care you do, you'll have an upward adjustment or a neutral adjustment.
Again, that same scenario for groups of 10 or more, if you did not participate, then you get the 2% penalty and the group of 10 or more receive an additional value modifier penalty of 4%.
So, if the group does not report, then, you'll have these additional penalties.
The value modifier is applicable to all physician and non-physician solo practitioners and physicians and non-physicians in group practices of two or more eligible professionals. The payment adjustments are varied as we saw in the chart before.
Physicians and non-physicians in groups of 2 to 9 will have an upward, neutral or downward adjustment, based on quality care. So, they can have 2% downward adjustment to a factor of two of the Medicare fee schedule. Due to budget neutrality requirements, those that stimulate bonuses paid out must equal total penalties collected. This represents the upward payment adjustment factor and it will be established by CMS after the performance period has been concluded and will be based on the aggregate amount of penalties collected and the total number of practices eligible for bonuses. In other words, because of the budget neutrality rules, those that get the penalty are the ones paying the bonus for those that report successfully.
In addition, to the percentage of adjustments, if the groups and solo practitioners receive an upward adjustment under quality care, they will also be eligible for an additional factor of one if their average beneficiary risk scores are in the top 25% of all beneficiary risk scores nationwide.
Again, I think the emphasis is non-PQRS reporters will receive an automatic downward adjustment.
This is another chart to show that the value modifier payment adjustment in year 2015 for performance year 2013 was required for eligible professionals that had over 100 eligible professionals and that included physicians. The adjustment in year 2016 for the performance period of 2014 applied to 10 to 99 eligible physicians. And in 2017 for performance year 2015, is for solo physicians and group practices with 2 to 9 eligible professionals. And 2016 performance year for the value modifier payment adjustment in year 2018, it will be applicable to all groups, all eligible professionals including CRNAs, PAs, etc. Of course, physicians who have already been subject to the value modifier. CMS determines the group practice size at the tax ID number level. These data are from Medicare claims data. Within 10 days, CMS queries to calculate the number of eligible professionals assigned the Medicare billing privileges. And then, they match that against claims data. If the eligible professionals don't show claim activity during the performance year, Medicare will remove them from the list and they will use whichever number is lower. I wanted to have a chart here that shows this. Outside of physicians, this is the group practitioners that have been working in our centers. CRNAs are another group that practice in the setting. This talk about, they satisfactorily reported or participated, what the value modifier payment adjustments would be and what the reporting options would be. I use this as an example of those that were reporting under claims based and had to meet the 50% rule. This year, those that practice in our ASC will have to move to a QRUR our group registry in order to report on their measures.