The 2009 PQRI consists of 153 quality measures and 7 measures groups. Nine (9) may be reported as “emergency medicine” measures:
#28 Aspirin at Arrival for Acute Myocardial Infarction (AMI) †
#31
Stroke and Stroke Rehabilitation: Deep Vein Thrombosis Prophylaxis (DVT) for Ischemic Stroke or Intracranial Hemorrhage†
#34
Stroke and Stroke Rehabilitation: Tissue Plasminogen Activator (t-PA) Considered†
#54
12-Lead Electrocardiogram (ECG) Performed for Non-Traumatic Chest Pain†
#55 12-Lead Electrocardiogram (ECG) Performed for Syncope†
#56 Community-Acquired Pneumonia (CAP): Vital Signs*
#57
Community-Acquired Pneumonia (CAP): Assessment of Oxygen Saturation*
#58 Community-Acquired Pneumonia (CAP): Assessment of Mental Status*
#59
Community-Acquired Pneumonia (CAP): Empiric Antibiotic*
†The Part B claim form place of service field must indicate emergency department
* Clinicians utilizing the critical care code (99291) must indicate the emergency department place of service (23) on the Part B claim form in order to report this measure.
Source: http://m.acep.org/practres.aspx?id=32148
Monday, September 7, 2009
Monday, August 31, 2009
PQRI for physical therapists and occupational therapists
Beginning in 2009, physical therapists or occupational therapists who report on quality measures will receive a 2% bonus. The reporting period for 2009 is January 1 - December 31, 2009.
With CPT codes 97001-97546, physical and occupational therapists could report the following individual PQRI measures:
#114. Inquiry regarding tobacco use (CPT 97003, 97004)
http://www.ama-assn.org/ama1/pub/upload/mm/370/2009/Individual_Measures/wrksht_114_09.pdf
#124. Adoption/use of electronic health records (EHR) (CPT 97001,
97002 (physical therapy evaluation),
and 97003, 97004 (occupational therapy evaluation))
http://www.ama-assn.org/ama1/pub/upload/mm/370/2009/Individual_Measures/wrksht_124_09.pdf
#126. Diabetic foot and ankle care, peripheral neuropathy:
neurological evaluation (CPT 97001, 97002 (physical therapy
evaluation))
http://www.ama-assn.org/ama1/pub/upload/mm/370/2009/Individual_Measures/wrksht_126_09.pdf
#127. Diabetic foot and ankle care, ulcer prevention: evaluation of
footwear (CPT 97001, 97002 (physical therapy evaluation))
http://www.ama-assn.org/ama1/pub/upload/mm/370/2009/Individual_Measures/wrksht_127_09.pdf
#128. Body mass index (BMI) screening and follow-up (CPT 97001,97003)
http://www.ama-assn.org/ama1/pub/upload/mm/370/2009/Individual_Measures/wrksht_128_09.pdf
#130. Documentation and verification of current medications in the
medical record (CPT 97001, 97002, 97003, 97004)
http://www.ama-assn.org/ama1/pub/upload/mm/370/2009/Individual_Measures/wrksht_130_09.pdf
#131. Pain assessment prior to initiation of patient therapy and
follow-up (CPT 97001, 97003)
http://www.ama-assn.org/ama1/pub/upload/mm/370/2009/Individual_Measures/wrksht_131_09.pdf
#134. Screening for clinical depression and follow-up plan (CPT 97003)
http://www.ama-assn.org/ama1/pub/upload/mm/370/2009/Individual_Measures/wrksht_134_09.pdf
#154. Falls - Risk assessment (CPT 97001, 97002, 97003, 97004)
http://www.ama-assn.org/ama1/pub/upload/mm/370/2009/Individual_Measures/wrksht_154_09.pdf
#173. Unhealthy alcohol use - screening (CPT 97003, 97004)
http://www.ama-assn.org/ama1/pub/upload/mm/370/2009/Individual_Measures/wrksht_173_09.pdf
#181. Elder maltreatment screen and follow-up plan (CPT 97003)
http://www.ama-assn.org/ama1/pub/upload/mm/370/2009/Individual_Measures/wrksht_181_09.pdf
"We have not recorded BMI or done a Fall assessment on a regular basis. Is there an opportunity to go back and check our documentation for this item and report that, even if this is an omission, and report forward in 2009?"
Yes - with a registry like MDinteractive you can go back and report
old PQRI 2009 data and then report forward.
Also please be aware that there is no performance requirement with
PQRI. Your providers will get 2% bonus just for reporting data. For
example if when you go back and check the BMI you find out that the
BMI was not calculated or that BMI (≥ 30 or < style="font-weight: bold;">
"How many patients need to be reported and what population to qualify
for your registry requirements?"
You need to report 3 individual PQRI measures to be eligible for the 2% bonus.
On each individual PQRI measure, you will need to report at least on
80% of Medicare patients on which that measure applies.
For example, for the BMI measure (#128) you would need to report on at
least 80% of your 2009 Medicare patients aged 18 years and older on
date of of visit with CPT 97001 and 97003.
"We have an EHR, however, within physical therapy we do not record the medications and laboratory so it's my understanding we do not meet the guidelines."
You only qualify for the EHR measure if:
- You have 97001, 97002 (physical therapy evaluation) and 97003, 97004
(occupational therapy evaluation) CPT codes.
- You are using CCHIT-certified EMR or, if not CCHIT certified, the
system must be capable of all of the following:
1) Ability to manage a medication list
2) Ability to manage a problem list
3) Ability to manually enter or electronically receive, store and
display laboratory results as discrete searchable data elements
4) Ability to meet basic privacy and security elements
With CPT codes 97001-97546, physical and occupational therapists could report the following individual PQRI measures:
#114. Inquiry regarding tobacco use (CPT 97003, 97004)
http://www.ama-assn.org/ama1/pub/upload/mm/370/2009/Individual_Measures/wrksht_114_09.pdf
#124. Adoption/use of electronic health records (EHR) (CPT 97001,
97002 (physical therapy evaluation),
and 97003, 97004 (occupational therapy evaluation))
http://www.ama-assn.org/ama1/pub/upload/mm/370/2009/Individual_Measures/wrksht_124_09.pdf
#126. Diabetic foot and ankle care, peripheral neuropathy:
neurological evaluation (CPT 97001, 97002 (physical therapy
evaluation))
http://www.ama-assn.org/ama1/pub/upload/mm/370/2009/Individual_Measures/wrksht_126_09.pdf
#127. Diabetic foot and ankle care, ulcer prevention: evaluation of
footwear (CPT 97001, 97002 (physical therapy evaluation))
http://www.ama-assn.org/ama1/pub/upload/mm/370/2009/Individual_Measures/wrksht_127_09.pdf
#128. Body mass index (BMI) screening and follow-up (CPT 97001,97003)
http://www.ama-assn.org/ama1/pub/upload/mm/370/2009/Individual_Measures/wrksht_128_09.pdf
#130. Documentation and verification of current medications in the
medical record (CPT 97001, 97002, 97003, 97004)
http://www.ama-assn.org/ama1/pub/upload/mm/370/2009/Individual_Measures/wrksht_130_09.pdf
#131. Pain assessment prior to initiation of patient therapy and
follow-up (CPT 97001, 97003)
http://www.ama-assn.org/ama1/pub/upload/mm/370/2009/Individual_Measures/wrksht_131_09.pdf
#134. Screening for clinical depression and follow-up plan (CPT 97003)
http://www.ama-assn.org/ama1/pub/upload/mm/370/2009/Individual_Measures/wrksht_134_09.pdf
#154. Falls - Risk assessment (CPT 97001, 97002, 97003, 97004)
http://www.ama-assn.org/ama1/pub/upload/mm/370/2009/Individual_Measures/wrksht_154_09.pdf
#173. Unhealthy alcohol use - screening (CPT 97003, 97004)
http://www.ama-assn.org/ama1/pub/upload/mm/370/2009/Individual_Measures/wrksht_173_09.pdf
#181. Elder maltreatment screen and follow-up plan (CPT 97003)
http://www.ama-assn.org/ama1/pub/upload/mm/370/2009/Individual_Measures/wrksht_181_09.pdf
"We have not recorded BMI or done a Fall assessment on a regular basis. Is there an opportunity to go back and check our documentation for this item and report that, even if this is an omission, and report forward in 2009?"
Yes - with a registry like MDinteractive you can go back and report
old PQRI 2009 data and then report forward.
Also please be aware that there is no performance requirement with
PQRI. Your providers will get 2% bonus just for reporting data. For
example if when you go back and check the BMI you find out that the
BMI was not calculated or that BMI (≥ 30 or < style="font-weight: bold;">
"How many patients need to be reported and what population to qualify
for your registry requirements?"
You need to report 3 individual PQRI measures to be eligible for the 2% bonus.
On each individual PQRI measure, you will need to report at least on
80% of Medicare patients on which that measure applies.
For example, for the BMI measure (#128) you would need to report on at
least 80% of your 2009 Medicare patients aged 18 years and older on
date of of visit with CPT 97001 and 97003.
"We have an EHR, however, within physical therapy we do not record the medications and laboratory so it's my understanding we do not meet the guidelines."
You only qualify for the EHR measure if:
- You have 97001, 97002 (physical therapy evaluation) and 97003, 97004
(occupational therapy evaluation) CPT codes.
- You are using CCHIT-certified EMR or, if not CCHIT certified, the
system must be capable of all of the following:
1) Ability to manage a medication list
2) Ability to manage a problem list
3) Ability to manually enter or electronically receive, store and
display laboratory results as discrete searchable data elements
4) Ability to meet basic privacy and security elements
Monday, July 27, 2009
PQRI for Pulmonologists
There are several individual PQRI measures that apply for pulmonologists:
COPD Care
#51 - Chronic Obstructive Pulmonary Disease (COPD): Spirometry Evaluation
Measure description
Percentage of patients aged 18 years and older with a diagnosis
of COPD who had spirometry evaluation results documented
Data Collection Sheet
Coding Specifications
#52 - Chronic Obstructive Pulmonary Disease (COPD): Bronchodilator Therapy
Measure description
Percentage of patients aged 18 years and older with a diagnosis
of COPD and who have an FEV1/FVC less than 70% and have
symptoms who were prescribed an inhaled bronchodilator
Data Collection Sheet
Coding Specifications
Asthma Care
#53 - Asthma: Pharmacologic Therapy
Measure description
Percentage of patients aged 5 through 40 years with a diagnosis
of mild, moderate, or severe persistent asthma who were
prescribed either the preferred long-term control medication
(inhaled corticosteroid) or an acceptable alternative treatment
Data Collection Sheet
Coding Specifications
#64 - Asthma: Asthma Assessment
Measure description
Percentage of patients aged 5 through 40 years with a diagnosis
of asthma who were evaluated during at least one office visit
within 12 months for the frequency (numeric) of daytime and
nocturnal asthma symptoms
Data Collection Sheet
Coding Specifications
Pneumonia Care
#56 - Community-Acquired Pneumonia (CAP): Vital Signs
Measure description
Percentage of patients aged 18 years and older with a diagnosis
of community-acquired bacterial pneumonia with vital signs
documented and reviewed
Data Collection Sheet
Coding Specifications
#57 - Community-Acquired Pneumonia (CAP): Assessment of Oxygen Saturation
Measure description
Percentage of patients aged 18 years and older with a
diagnosis of community-acquired bacterial pneumonia
with oxygen saturation documented and reviewed
Data Collection Sheet
Coding Specifications
#58 - Community-Acquired Pneumonia (CAP): Assessment of Mental Status
Measure description
Percentage of patients aged 18 years and older with a
diagnosis of community-acquired bacterial pneumonia
with mental status assessed
Data Collection Sheet
Coding Specifications
#59 - Community-Acquired Pneumonia (CAP): Empiric Antibiotic
Measure description
Percentage of patients aged 18 years and older with a diagnosis
of community-acquired bacterial pneumonia with an appropriate
empiric antibiotic prescribed
Data Collection Sheet
Coding Specifications
To get the 2% PQRI bonus, a pulmonologist will need to report at least 3 of the measures above for at least 80% of the applicable Medicare patients seen during the year of 2009.
For reporting purposes, it is easier for a pulmonologist to choose the Community-Acquired Pneumonia measures because we need a set of 3 measures and the COPD and asthma sets only have 2 measures each. Technically you could pick one COPD measure, one Asthma measure and one Community-Acquired Pneumonia but then you will reporting on 3 different patient populations. With Community-Acquired Pneumonia, once you identified the patient population you can report 4 measures on each patient.
There are 2 main options to report the above measures.
1 - Add the appropriate quality codes regarding each measure to each billing claim you send to Medicare.
For example when using Community-Acquired Pneumonia add the following codes to your Medicare patients
2010F (#56 - Vital signs checked)
3028F (#57 - Oxygen saturation results documented and reviewed)
2014F (#58 - Mental status assessed)
4045F (#59 - Appropriate empiric antibiotic prescribed)
You just need to bill the same way as before but add
CPT 2010F, 3028F, 2014F and 4045F on section 24 of the billing form
and charge $0.00 or $0.01 for each code.
Example from 2009 PQRI Implementation Guide
However if you start reporting now using this method you may not be able to receive the full PQRI bonus because you already missed reporting more than half of your 2009 patients (you need to report at least 80%). So you should report PQRI using a qualified PQRI registry:
2 - Using a qualified PQRI registry like MDinteractive a pulmonologist may report 3 of the above PQRI measures and make your 2% bonus. For the complete list of 2009 PQRI qualified registries check the PQRI CMS website
For further info read:
2009 Measure-Applicability Validation Process for Claims-Based Participation
2009 PULMONARY PQRI PERFORMANCE MEASURES
COPD Care
#51 - Chronic Obstructive Pulmonary Disease (COPD): Spirometry Evaluation
Measure description
Percentage of patients aged 18 years and older with a diagnosis
of COPD who had spirometry evaluation results documented
Data Collection Sheet
Coding Specifications
#52 - Chronic Obstructive Pulmonary Disease (COPD): Bronchodilator Therapy
Measure description
Percentage of patients aged 18 years and older with a diagnosis
of COPD and who have an FEV1/FVC less than 70% and have
symptoms who were prescribed an inhaled bronchodilator
Data Collection Sheet
Coding Specifications
Asthma Care
#53 - Asthma: Pharmacologic Therapy
Measure description
Percentage of patients aged 5 through 40 years with a diagnosis
of mild, moderate, or severe persistent asthma who were
prescribed either the preferred long-term control medication
(inhaled corticosteroid) or an acceptable alternative treatment
Data Collection Sheet
Coding Specifications
#64 - Asthma: Asthma Assessment
Measure description
Percentage of patients aged 5 through 40 years with a diagnosis
of asthma who were evaluated during at least one office visit
within 12 months for the frequency (numeric) of daytime and
nocturnal asthma symptoms
Data Collection Sheet
Coding Specifications
Pneumonia Care
#56 - Community-Acquired Pneumonia (CAP): Vital Signs
Measure description
Percentage of patients aged 18 years and older with a diagnosis
of community-acquired bacterial pneumonia with vital signs
documented and reviewed
Data Collection Sheet
Coding Specifications
#57 - Community-Acquired Pneumonia (CAP): Assessment of Oxygen Saturation
Measure description
Percentage of patients aged 18 years and older with a
diagnosis of community-acquired bacterial pneumonia
with oxygen saturation documented and reviewed
Data Collection Sheet
Coding Specifications
#58 - Community-Acquired Pneumonia (CAP): Assessment of Mental Status
Measure description
Percentage of patients aged 18 years and older with a
diagnosis of community-acquired bacterial pneumonia
with mental status assessed
Data Collection Sheet
Coding Specifications
#59 - Community-Acquired Pneumonia (CAP): Empiric Antibiotic
Measure description
Percentage of patients aged 18 years and older with a diagnosis
of community-acquired bacterial pneumonia with an appropriate
empiric antibiotic prescribed
Data Collection Sheet
Coding Specifications
To get the 2% PQRI bonus, a pulmonologist will need to report at least 3 of the measures above for at least 80% of the applicable Medicare patients seen during the year of 2009.
For reporting purposes, it is easier for a pulmonologist to choose the Community-Acquired Pneumonia measures because we need a set of 3 measures and the COPD and asthma sets only have 2 measures each. Technically you could pick one COPD measure, one Asthma measure and one Community-Acquired Pneumonia but then you will reporting on 3 different patient populations. With Community-Acquired Pneumonia, once you identified the patient population you can report 4 measures on each patient.
There are 2 main options to report the above measures.
1 - Add the appropriate quality codes regarding each measure to each billing claim you send to Medicare.
For example when using Community-Acquired Pneumonia add the following codes to your Medicare patients
2010F (#56 - Vital signs checked)
3028F (#57 - Oxygen saturation results documented and reviewed)
2014F (#58 - Mental status assessed)
4045F (#59 - Appropriate empiric antibiotic prescribed)
You just need to bill the same way as before but add
CPT 2010F, 3028F, 2014F and 4045F on section 24 of the billing form
and charge $0.00 or $0.01 for each code.
Example from 2009 PQRI Implementation Guide
However if you start reporting now using this method you may not be able to receive the full PQRI bonus because you already missed reporting more than half of your 2009 patients (you need to report at least 80%). So you should report PQRI using a qualified PQRI registry:
2 - Using a qualified PQRI registry like MDinteractive a pulmonologist may report 3 of the above PQRI measures and make your 2% bonus. For the complete list of 2009 PQRI qualified registries check the PQRI CMS website
For further info read:
2009 Measure-Applicability Validation Process for Claims-Based Participation
2009 PULMONARY PQRI PERFORMANCE MEASURES
Saturday, July 25, 2009
PQRI Measures for Radiologists
There are several individual PQRI measures that apply for radiologists:
#10 - Stroke and Stroke Rehabilitation: Computed Tomography (CT) or Magnetic Resonance Imaging (MRI) Reports
Measure description
Percentage of final reports for CT or MRI studies of the brain
performed within 24 hours of arrival to the hospital for patients
aged 18 years and older with either a diagnosis of ischemic
stroke or transient ischemic attack (TIA) or intracranial
hemorrhage or at least one documented symptom consistent
with ischemic stroke or TIA or intracranial hemorrhage that
include documentation of the presence or absence of each of the
following: hemorrhage and mass lesion and acute infarction
AMA Data Collection Form
AMA Coding specifications
#11 - Stroke and Stroke Rehabilitation: Carotid Imaging Reports
Measure description
Percentage of final reports for carotid imaging studies (neck
MR angiography [MRA], neck CT angiography [CTA], neck
duplex ultrasound, carotid angiogram) performed for patients
aged 18 years and older with the diagnosis of ischemic stroke or
transient ischemic attack (TIA) that include direct or indirect
reference to measurements of distal internal carotid diameter
as the denominator for stenosis measurement1
AMA Data Collection Form
AMA Coding specifications
#145 - Radiology: Exposure Time Reported for Procedures Using Fluoroscopy
Measure description
Percentage of final reports for procedures using fluoroscopy that
include documentation of radiation exposure or exposure time
AMA Data Collection Form
AMA Coding specifications
#146 - Radiology: Inappropriate Use of “Probably Benign” Assessment Category in Mammography Screening
Measure description
Percentage of final reports for screening mammograms that are
classified as “probably benign”
AMA Data Collection Form
AMA Coding specifications
147 - Nuclear Medicine: Correlation with Existing Imaging Studies for All Patients Undergoing Bone Scintigraphy
Measure description
Percentage of final reports for all patients, regardless of age,
undergoing bone scintigraphy that include physician
documentation of correlation with existing relevant imaging
studies (eg, x-ray, MRI, CT, etc.) that were performed
AMA Data Collection Form
AMA Coding specifications
To get the 2% PQRI bonus, a radiologist will need to report at least 3 of the measures above for at least 80% of the applicable Medicare patients seen during the year of 2009.
There are 2 main options to report the above measures.
1 - Add the appropriate quality codes regarding each measure to each billing claim you send to Medicare. However if you start reporting now using this method you may not be able to receive the full PQRI bonus because you already missed reporting more than half of your 2009 patients (you need to report at least 80%). So you should report PQRI using a qualified PQRI registry:
2 - Using a qualified PQRI registry like MDinteractive a radiologist may report 3 of the above PQRI measures and make your 2% bonus. For the complete list of 2009 PQRI qualified registries check the PQRI CMS website
For further info read:
2009 Measure-Applicability Validation Process for Claims-Based Participation
CMS releases PQRI reporting measures that affect radiologists
#10 - Stroke and Stroke Rehabilitation: Computed Tomography (CT) or Magnetic Resonance Imaging (MRI) Reports
Measure description
Percentage of final reports for CT or MRI studies of the brain
performed within 24 hours of arrival to the hospital for patients
aged 18 years and older with either a diagnosis of ischemic
stroke or transient ischemic attack (TIA) or intracranial
hemorrhage or at least one documented symptom consistent
with ischemic stroke or TIA or intracranial hemorrhage that
include documentation of the presence or absence of each of the
following: hemorrhage and mass lesion and acute infarction
AMA Data Collection Form
AMA Coding specifications
#11 - Stroke and Stroke Rehabilitation: Carotid Imaging Reports
Measure description
Percentage of final reports for carotid imaging studies (neck
MR angiography [MRA], neck CT angiography [CTA], neck
duplex ultrasound, carotid angiogram) performed for patients
aged 18 years and older with the diagnosis of ischemic stroke or
transient ischemic attack (TIA) that include direct or indirect
reference to measurements of distal internal carotid diameter
as the denominator for stenosis measurement1
AMA Data Collection Form
AMA Coding specifications
#145 - Radiology: Exposure Time Reported for Procedures Using Fluoroscopy
Measure description
Percentage of final reports for procedures using fluoroscopy that
include documentation of radiation exposure or exposure time
AMA Data Collection Form
AMA Coding specifications
#146 - Radiology: Inappropriate Use of “Probably Benign” Assessment Category in Mammography Screening
Measure description
Percentage of final reports for screening mammograms that are
classified as “probably benign”
AMA Data Collection Form
AMA Coding specifications
147 - Nuclear Medicine: Correlation with Existing Imaging Studies for All Patients Undergoing Bone Scintigraphy
Measure description
Percentage of final reports for all patients, regardless of age,
undergoing bone scintigraphy that include physician
documentation of correlation with existing relevant imaging
studies (eg, x-ray, MRI, CT, etc.) that were performed
AMA Data Collection Form
AMA Coding specifications
To get the 2% PQRI bonus, a radiologist will need to report at least 3 of the measures above for at least 80% of the applicable Medicare patients seen during the year of 2009.
There are 2 main options to report the above measures.
1 - Add the appropriate quality codes regarding each measure to each billing claim you send to Medicare. However if you start reporting now using this method you may not be able to receive the full PQRI bonus because you already missed reporting more than half of your 2009 patients (you need to report at least 80%). So you should report PQRI using a qualified PQRI registry:
2 - Using a qualified PQRI registry like MDinteractive a radiologist may report 3 of the above PQRI measures and make your 2% bonus. For the complete list of 2009 PQRI qualified registries check the PQRI CMS website
For further info read:
2009 Measure-Applicability Validation Process for Claims-Based Participation
CMS releases PQRI reporting measures that affect radiologists
Saturday, July 4, 2009
Highlights of the proposed PQRI rules for 2010
New proposed PQRI rules for 2010 were published on July 1, 2009 on the Federal Registry. You can read the full rules here. CMS will accept comments on the Proposed Rule until August 31, 2009.
During the PQRI Registry Kick-Off Meeting some people complained that they haven't enough time to read the Federal Registry. I felt very patriotic after a nice July 4th display of fireworks in Vermont and decided to read the Federal Registry.
These are some of the highlights:
- "In addition, given our desire to transition from the use of the claims based reporting mechanism as the primary reporting mechanism for clinical quality measures for PQRI after 2010 to rely more heavily on registry-based reporting (see section II.G.2.d. of this proposed rule for further discussion), we do not believe it appropriate to add a new 6-month reporting period for claims-based reporting of individual measures.
- "Beginning with the 2010 PQRI, group practices who satisfactorily submit data on quality measures also would be eligible to earn an incentive payment equal to 2.0 percent of the estimated total allowed charges for all covered professional services furnished by the group practice during the applicable reporting period."
- "We propose that a “group practice” would consist of a physician group practice, as defined by a TIN, with at least 200 or more individual eligible professionals (or, as identified by NPIs) who have reassigned their billing rights to the TIN.
- "We note that the 6-month reporting period, beginning July 1, 2010, is proposed to be available for reporting on measures groups and for reporting using the registry-based reporting mechanism only.
- "If we finalize this proposal, then, unlike in prior years, an eligible professional would be able to earn a PQRI incentive payment through the EHR-based reporting mechanism in 2010."
- "Therefore, we propose to add an EHR-based reporting mechanism for the 2010 PQRI in
order to promote the adoption and use of EHRs and to provide both eligible professionals and CMS experience on EHR-based quality reporting."
- "In summary, we propose that for 2010, an eligible professional may choose to report data on PQRI quality measures through claims, to a qualified registry (for the qualification requirements for registries, see section II.G.2.i.(4) of this proposed rule), or through a qualified EHR product (for the qualification requirements for EHR vendors and their products, see section II.G.2.i.(5) of this proposed rule)."
- "While we propose to retain the claims-based reporting mechanism for 2010, we note that we are considering significantly limiting the claims-based mechanism of reporting clinical quality measures for the PQRI after 2010. This would be contingent upon there being an adequate number and variety of registries available and/or EHR reporting options."
- "Reducing our reliance on the claims-based reporting mechanism after 2010 will allow us and eligible professionals to devote available resources to maximizing
the potential of registries and EHRs for quality measurement reporting. Both mechanisms hold the promise of more sophisticated and timely reporting on clinical quality measures. Clinical data registries allow the collection of more detailed data, including outcomes, without the necessity of a single submission contemporaneously with claims billing, which overcomes some of the limitations of
the claims-based reporting mechanism. Registries can also provide feedback and quality improvement information based on reported data. Finally, clinical data registries can also receive data from EHRs, and therefore, serve as an alternative means to reporting clinical quality data extracted from an EHR. As we continue to qualify additional registries, we believe that there will be a sufficient number of qualified PQRI registries by 2011 to make it possible to reduce or even discontinue the claims-based reporting mechanism for most measures after 2010."
- "All claims for services furnished between January 1, 2010 and December 31, 2010 must be processed by no later than February 28, 2011 to be included in the 2010 PQRI analysis.
- "We propose the following new requirements for registries for the 2010
PQRI:
● Registries must have at least 25 participants;
● Registries must provide at least 1 feedback report
per year to participating eligible professionals;
● Registries must not be owned and managed by an
individual locally-owned single-specialty group (in other
words, single-specialty practices with only 1 practice
location or solo practitioner practices would be prohibited
from self-nominating to become a qualified PQRI registry);
● Registries must participate in ongoing 2010 PQRI
mandatory support conference calls hosted by CMS
(approximately 1 call per month);
● Registries must provide a flow and XML of a
measure’s calculation process for each measure type that
the registry intends to calculate; and
● Registries must use PQRI measure specifications to
calculate reporting or performance unless otherwise stated."
- "Regardless of the reporting mechanism chosen by the
eligible professional, we propose that the minimum patient
sample size for reporting individual quality measures be 15
Medicare Part B FFS patients for the 12-month reporting
period. An eligible professional would need to meet this
minimum patient sample size requirement for at least one
measure on which the eligible professional chooses to
report."
- "Unlike the 2009 PQRI, which required that eligible
professionals report on consecutive patients (that is,
patients seen in order, by date of service), the 30
patients on which an eligible professional would need to
report a measures group for 2010 would not need to be
consecutive patients."
- "In addition, the questions we receive from eligible
professionals indicate that many eligible professionals are
not clear on how to determine which patients are
“consecutive” and should be included in the patient sample.
We believe that any adverse effect on the reliability or
validity of the quality information received as a result of
the removal of the requirement to report on patients seen
consecutively and allowing eligible professionals to report
on any 30 patients would be minimal."
- "Group practices interested in participating in the 2010 PQRI through the group practice reporting option would be required to submit a self-nomination letter to CMS or a CMS designee requesting to participate in the 2010 PQRI group practice reporting option. We propose that each group practice would be required to meet the following requirements:
● Have an active Individuals Access to CMS Systems
(IACS) user account;
● Provide CMS or a CMS designee with the group
practice’s TIN and the NPI numbers and names of all
eligible professionals who will be participating as part of
the group practice (that is, all individual NPI numbers
CMS-1413-P 258
associated with the group practice’s TIN). This
information must be provided in an electronic format
specified by CMS, such as in an Excel spreadsheet; and
● Agree to have the group practice’s PQRI quality
measurement performance rates for each measure publicly
reported by posting of the results on a CMS Web site."
- "We propose that group practices
would be required to submit information on these measures
using a data collection tool based on the data collection
tool used in CMS’ Medicare Care Management Performance
(MCMP) demonstration and the quality measurement and
reporting methods used in CMS’ PGP demonstration. We
propose that physician groups selected to participate in
the 2010 PQRI through the group practice reporting option
would be required to report on a common set of 26
NQF-endorsed quality measures that are based on measures
currently used in the MCMP and/or PGP demonstration and
that target high-cost chronic conditions and preventive
care. These quality measures are identified in Table 34.
Additional information on the MCMP and PGP demonstrations
is posted on the Medicare Demonstrations section of the CMS
Web site at http://www.cms.hhs.gov/DemoProjectsEvalRpts/MD/list.asp#Top
OfPage
- "We propose a unique reporting mechanism for the group
practice reporting option that would not be available to
individual eligible professionals participating in the 2010
PQRI. We propose that each physician group selected to
participate in the group practice reporting option would
have access to a database (that is, a data collection tool)
that would include the assigned beneficiary sample and the
quality measures."
- "Identical to the sampling method used in the PGP demonstration, the random
sample must consist of at least 411 assigned beneficiaries."
- "We anticipate being able to provide the selected physician groups with access
to this prepopulated database by the fourth quarter of 2010. The physician group would be required to populate the remaining data fields necessary for capturing quality measure information on each of the assigned beneficiaries."
- "TABLE 34: Measures Proposed for Physician Groups
Participating in the 2010 PQRI Group Practice Reporting
Option"
- "For example, information on the measure development process
employed by us when CMS or a CMS contractor is the measure
developer is available in the “Measures Management System
Blueprint” found on the CMS Web site at
http://www.cms.hhs.gov/apps/QMIS/mmsBlueprint.asp.
Eligible professionals also have the opportunity to
provide input on a measure as the measure is being vetted
through the NQF consensus endorsement process (and
previously, the AQA consensus adoption process). In
particular, the NQF employs a public comment period for
measures vetted through its consensus endorsement process
(and previously, for the AQA, its consensus adoption
process).
Finally, eligible professionals have an opportunity to
provide input on the measures proposed for inclusion in the
2010 PQRI through this proposed rule, which provides a
60-day comment period."
- "Measures that are high impact and support CMS and
HHS priorities for improved quality and efficiency of care
for Medicare beneficiaries. These current and long term
priority topics include: prevention; chronic conditions;
high cost and high volume conditions; elimination of health
disparities; healthcare-associated infections and other
conditions; improved care coordination; improved
efficiency; improved patient and family experience of care;
improved end-of-life/palliative care; effective management
of acute and chronic episodes of care; reduced unwarranted
geographic variation in quality and efficiency; and
adoption and use of interoperable HIT."
- "TABLE 17: Proposed 2010 Measures Selected From the 2009
PQRI Quality Measure Set Available for Either Claims-based
Reporting or Registry-based Reporting"
1 - Diabetes Mellitus: Hemoglobin A1c Poor Control in Diabetes Mellitus.
2 - Diabetes Mellitus: Low Density Lipoprotein (LDL–C) Control in Diabetes Mellitus.
3 - Diabetes Mellitus: High Blood Pressure Control in Diabetes Mellitus.
6 - Coronary Artery Disease (CAD): Oral Antiplatelet Therapy Perscribed for Patients with CAD.
9 - Major Depressive Disorder (MDD): Antidepressant Medication During Acute Phase for Patients with MDD.
10 - Stroke and Stroke Rehabilitation: Computed Tomography (CT) or Magnetic Resonance Imaging (MRI) Reports.
12 - Primary Open Angle Glaucoma (POAG): Optic Nerve Evaluation.
14 - Age-Related macular Degeneration (AMD): Dilated Macular Examination.
18 - Diabetic Retinopathy: Documentation of Presence or Absence of Macular Edema and Level of Severity of Retinopathy.
19 - Diabetic Retinopathy: Communication with the Physician Managing On-going Diabetes Care.
20 - Perioperative Care: Timing of Antibiotic Prophylaxis— Ordering Physician.
21 - Perioperative Care: Selection of ProphylacticAntibiotic—First OR Second Generation Cephalosporin.
22 - Perioperative Care: Discontinuation of Prophylactic Antibiotics (Non-Cardiac Procedures).
23 - Perioperative Care: Venous Thromboembolism (VTE) Prophylaxis (When Indicated in ALL Patients).
24 - Osteoporosis: Communication with the Physician Managing On-going Care Post Fracture.
28 - Aspirin at Arrival for Acute Myocardial Infarction (AMI).
30 - Perioperative Care: Timing of Prophylactic Antibiotics—Administering Physician.
31 - Stroke and Stroke Rehabilitation: Deep Vein Thrombosis Prophylaxis (DVT) for Ischemic Stroke or Intracranial Hemorrhage.
32 - Stroke and Stroke Rehabilitation: Discharged on Antiplatelet Therapy.
35 - Stroke and Stroke Rehabilitation: Screening for Dysphagia.
36 - Stroke and Stroke Rehabilitation: Consideration for Rehabilitation Services.
39 - Screening or Therapy for Osteoporosis for Women Aged 65 Years and Older.
40 - Osteoporosis: Management Following Fracture.
41 - Osteoporosis: Pharmacologic Therapy
43 - Coronary Artery Bypass Graft (CABG): Use of Internal Mammary Artery (IMA) in Patients with Isolated CABG Surgery.
44 - Coronary Artery Bypass Graft (CABG): Preoperative Beta-Blocker in Patients with Isolated CABG Surgery.
45 - Perioperative Care: Discontinuation of Prophylactic Antiobitics (Cardiac Procedures).
46 - Medication Reconciliation: Reconciliation After Discharge from an Inpatient Facility.
47 - Advance Care Plan
48 - Urinary Incontinence: Assessment of Presence or Absence of Urinary Incontinence in Women Aged 6 Years and Older.
49 - Urinary Incontinence: Characterization of Urinary Incontinence in Women Aged 65 Years and Older.
50 - Urinary Incontinence: Plan of Care for Urinary Incontinence in Women Aged 65 Years and Older.
51 - Chronic Obstructive Pulmonary Disease (COPD): Spirometry Evaluation.
52 - Chronic Obstructive Pulmonary Disease (COPD): Bronchodilator Therapy.
53 - Asthma: Pharmacologic Therapy
54 - 12-Lead Electrocardiogram (ECG) Performed for Non-Traumatic Chest Pain.
55 - 12-Lead Electrocardiogram (ECG) Performed for Syncope.
56 - Community-Acquired Pneumonia (CAP): Vital Signs.
57 - Community-Acquired Pneumonia (CAP): Assessment of Oxygen Saturation.
58 - Community-Acquired Pneumonia (CAP): Assessment of Mental Status.
59 - Community-Acquired Pneumonia (CAP): Empiric Antibiotic.
64 - Asthma: Asthma Assessment
65 - Treatment for Children with Upper Respiratory Infection (URI): Avoidance of Inappropriate Use.
66 - Appropriate Testing for Children with Pharyngitis.
67 - Myelodysplastic Syndrome (MDS) and Acute Leukemias: Baseline Cytogenetic Testing Performed on Bone Marrow.
68 - Myelodysplastic Syndrome (MDS): Documentation of Iron Stores in Patients Receiving Erythropoietin Therapy.
69 - Multiple Myeloma: Treatment with Bisphosphonates.
70 - Chronic Lymphocytic Leukemia (CLL): Baseline Flow Cytometry.
71 - Breast Cancer: Hormonal Therapy for Stage IC–IIIC Estrogen Receptor/Progesterone Receptor (ER/PR) Positive Breast Cancer.
72 - Colon Cancer: Chemotherapy for Stage III Colon Cancer Patients.
76 - Prevention of Catheter-Related Bloodstream Infections (CRBSI): Central Venous Catheter (CVC) Insertion Protocol.
79 - End Stage Renal Disease (ESRD): Influenza Immunization with Patients in ESRD.
84 - Hepatitis C: Ribonucleic Acid (RNA) Testing Before Initiating Treatment.
85 - Hepatitis C: HCV Genotype Testing Prior to Treatment.
86 - Hepatitis C: Antiviral Treatment Prescribed
87 - Hepatitis C: HCV Ribonucleic Acid (RNA) Testing at Week 12 of Treatment.
89 - Hepatitis C: Counseling Regarding Risk of Alcohol Consumption.
90 - Hepatitis C: Counseling Regarding Use of Contraception Prior to Antiviral Therapy.
91 - Acute Otitis Externa (ACE): Topical Therapy
92 - Acute Otitis Externa (ACE): Pain Assessment.
93 - Acute Otitis Externa (ACE): Systemic Antimicrobial Therapy—Avoidance of Inappropriate Use.
99 - Breast Cancer Resection Pathology Reporting: pT Category (Primary Tumor) and pN Category (Regional Lymph Nodes) with Histologic Grade.
100 - Colorectal Cancer Resection Pathology Reporting: pT Category (Primary Tumor) and pN Category (Regional Lymph Nodes) with Histologic Grace.
102 - Prostate Cancer: Avoidance of Overuse of Bone Scan for Staging Low-Risk Prostate Cancer Patients.
104 - Prostate Cancer: Adjuvant Hormonal Therapy for High-Risk Prostate Cancer Patients.
105 - Prostate Cancer: Three-Dimensional (3D) Radiotherapy.
106 - Major Depressive Disorder (MDD): Diagnostic Evaluation.
107 - Major Depressive Disorder (MDD): Suicide Risk Assesmment.
108 - Rheumatoid Arthritis (RA): Disease Modifying Anti-Rheumatic Drug (DMARD) Therapy.
109 - Osteoarthritis: Function and Pain Assessment.
110 - Preventive Care and Screening: Influenza Immunization for Patients =50 Years Old.
111 - Preventive Care and Screening: Pneumonia Vaccination for Patients 65 Years and Older.
112 - Preventive Care and Screening: Screening Mammography.
113 - Preventive Care and Screening: Colorectal Cancer Screening.
114 - Preventive Care and Screening: Inquiry Regarding Tobacco Use.
115 - Preventive Care and Screening: Advising Smokers to Quit.
116 - Antibiotic Treatment for Adults with AcutemBronchitis: Avoidance of Inappropriate Use.
117 - Diabetes Mellitus: Dilated Eye Exam in Diabetic Patient.
119 - Diabetes Mellitus: Urine Screening forMicroalbumin or Medical Attention for Nephropathy in Diabetic Patients.
121 - Chronic Kidney Disease (CKD): Laboratory Testing (Calcium, Phosphorous, Intact Parathyroid Hormone (iPTH) and Lipid Profile).
122 - Chronic Kidney Disease (CKD): Blood Pressure Management.
123 - Chronic Kidney Disease (CKD): Plan of Care—Elevated Hemoglobin for Patients Receiving Erythropoiesis-Stimulating Agents (ESA).
124 - Health Information Technology (HIT): Adoption/Use of Electronic Health Records (EHR).
126 - Diabetes Mellitus: Diabetic Foot and Ankle Care, Peripheral Neuropathy—Neurological Evaluation.
127 - Diabetes Mellitus: Diabetic Foot and Ankle Care, Ulcer Prevention—Evaluation of Footwear.
128 - Preventive Care and Screening: Body Mass Index (BMI) Screening and Follow-Up.
130 - Documentation and Verification of Current Medications in the Medical Record.
131 - Pain Assessment Prior to Initiation of Patient Therapy and Follow-Up.
134 - Screening for Clinical Depression and Follow-Up Plan.
135 - Chronic Kidney Disease (CKD): Influenza Immunization.
140 - Age-Related Macular Degeneration (AMD): Counseling on Antioxidant Supplement.
142 - Osteoarthritis (OA): Assessment for Use of Anti-Inflammatory or Analgesic Over-the-Counter (OTC) Medications.
145 - Radiology: Exposure Time Reported for Procedures Using Fluoroscopy.
146 - Radiology: Inappropriate Use of ‘‘Probably Benign’’ Assessment Category in Mammography Screening.
147 - Nuclear Medicine: Correlation with Existing Imaging Studies for All Patients Undergoing Bone Scintigraphy.
153 - Chronic Kidney Disease (CKD): Referral for Arteriovenous (AV) Fistula.
154 - Falls: Risk Assessment
155 - Falls: Plan of Care
156 - Oncology: Radiation Dose Limits to Normal Tissues.
157 - Thoracic Surgery: Recording of Clinical Stage for Lung Cancer and Esophageal Cancer Resection.
158 - Endarterectomy: Use of Patch During Conventional Endarterectomy.
163 - Diabetes Mellitus: Foot Exam
172 - Hemodialysis Vascular Access Decision-Making by Surgeon to Maximize Placement of Autogenous Arterial Venous (AV) Fistula.
173 - Preventive Care and Screening: Unhealthy Alcohol Use—Screening.
175 - Pediatric End Stage Renal Disease (ESRD): Influenza Immunization.
176 - Rheumatoid Arthritis (RA): Tuberculosis Screening.
177 - Rheumatoid Arthritis (RA): Periodic Assessment of Disease Activity.
178 - Rhuematoid Arthritis (RA): Functional Status Assessment.
179 - Rheumatoid Arthritis (RA): Assessment and Classification of Disease Prognosis.
180 - Rheumatoid Arthritis (RA): Glucocorticoid Management.
181 - Elder Maltreatment Screen and Follow-Up Plan.
182 - Functional Outcome Assessment in Chiropractic Care.
183 - Hepatitis C: Hepatitis A Vaccination in Patients with HCV.
184 - Hepatitis C: Hepatatis B Vaccination in Patients with HCV.
185 - Endoscopy & Polyp Surveillance: Colonoscopy Interval for Patients with a History of Adenomatous Polyps—Avoidance of Inappropriate Use.
186 - Wound Care: Use of Compression System in Patients with Venous Ulcers.
- "TABLE 20: Proposed 2010 Measures Available for EHR-based
Reporting"
- "The 6 new measures groups proposed for
the 2010 PQRI are:
(1) Coronary Artery Disease (CAD);
(2) Heart Failure (HF);
(3) Ischemic Vascular Disease (IVD);
(4) Hepatitis C;
(5) Human Immunodeficiency Virus (HIV)/Acquired Immune Deficiency Syndrome (AIDS);
(6)Community Acquired Pneumonia (CAP)."
- "In December 2008, we listed, by State, the names of eligible
professionals who participated in the 2007 PQRI on the
Physician and Other Health Care Professionals Directory."
- "Based on the assumptions discussed above, we estimate
the total annual cost per eligible professional associated
with claims-based reporting to range from $174.45 [($0.21
per measure X 3 measures X 15 cases per measure) + $165] to
$617.70 [($10.06 per measure X 3 measures X 15 cases per
measure) + $165]."
- "For registry-based reporting, eligible professionals
must generally incur a cost to submit data to registries.
Estimated fees for using a qualified registry range from a
nominal charge for an eligible professional to use the
registry to costing eligible professionals several thousand
dollars. Thus, we conservatively estimate the cost
incurred by an eligible professional to participate in PQRI
via registry-based reporting to be approximately $500 per
eligible professional.
During the PQRI Registry Kick-Off Meeting some people complained that they haven't enough time to read the Federal Registry. I felt very patriotic after a nice July 4th display of fireworks in Vermont and decided to read the Federal Registry.
These are some of the highlights:
- "In addition, given our desire to transition from the use of the claims based reporting mechanism as the primary reporting mechanism for clinical quality measures for PQRI after 2010 to rely more heavily on registry-based reporting (see section II.G.2.d. of this proposed rule for further discussion), we do not believe it appropriate to add a new 6-month reporting period for claims-based reporting of individual measures.
- "Beginning with the 2010 PQRI, group practices who satisfactorily submit data on quality measures also would be eligible to earn an incentive payment equal to 2.0 percent of the estimated total allowed charges for all covered professional services furnished by the group practice during the applicable reporting period."
- "We propose that a “group practice” would consist of a physician group practice, as defined by a TIN, with at least 200 or more individual eligible professionals (or, as identified by NPIs) who have reassigned their billing rights to the TIN.
- "We note that the 6-month reporting period, beginning July 1, 2010, is proposed to be available for reporting on measures groups and for reporting using the registry-based reporting mechanism only.
- "If we finalize this proposal, then, unlike in prior years, an eligible professional would be able to earn a PQRI incentive payment through the EHR-based reporting mechanism in 2010."
- "Therefore, we propose to add an EHR-based reporting mechanism for the 2010 PQRI in
order to promote the adoption and use of EHRs and to provide both eligible professionals and CMS experience on EHR-based quality reporting."
- "In summary, we propose that for 2010, an eligible professional may choose to report data on PQRI quality measures through claims, to a qualified registry (for the qualification requirements for registries, see section II.G.2.i.(4) of this proposed rule), or through a qualified EHR product (for the qualification requirements for EHR vendors and their products, see section II.G.2.i.(5) of this proposed rule)."
- "While we propose to retain the claims-based reporting mechanism for 2010, we note that we are considering significantly limiting the claims-based mechanism of reporting clinical quality measures for the PQRI after 2010. This would be contingent upon there being an adequate number and variety of registries available and/or EHR reporting options."
- "Reducing our reliance on the claims-based reporting mechanism after 2010 will allow us and eligible professionals to devote available resources to maximizing
the potential of registries and EHRs for quality measurement reporting. Both mechanisms hold the promise of more sophisticated and timely reporting on clinical quality measures. Clinical data registries allow the collection of more detailed data, including outcomes, without the necessity of a single submission contemporaneously with claims billing, which overcomes some of the limitations of
the claims-based reporting mechanism. Registries can also provide feedback and quality improvement information based on reported data. Finally, clinical data registries can also receive data from EHRs, and therefore, serve as an alternative means to reporting clinical quality data extracted from an EHR. As we continue to qualify additional registries, we believe that there will be a sufficient number of qualified PQRI registries by 2011 to make it possible to reduce or even discontinue the claims-based reporting mechanism for most measures after 2010."
- "All claims for services furnished between January 1, 2010 and December 31, 2010 must be processed by no later than February 28, 2011 to be included in the 2010 PQRI analysis.
- "We propose the following new requirements for registries for the 2010
PQRI:
● Registries must have at least 25 participants;
● Registries must provide at least 1 feedback report
per year to participating eligible professionals;
● Registries must not be owned and managed by an
individual locally-owned single-specialty group (in other
words, single-specialty practices with only 1 practice
location or solo practitioner practices would be prohibited
from self-nominating to become a qualified PQRI registry);
● Registries must participate in ongoing 2010 PQRI
mandatory support conference calls hosted by CMS
(approximately 1 call per month);
● Registries must provide a flow and XML of a
measure’s calculation process for each measure type that
the registry intends to calculate; and
● Registries must use PQRI measure specifications to
calculate reporting or performance unless otherwise stated."
- "Regardless of the reporting mechanism chosen by the
eligible professional, we propose that the minimum patient
sample size for reporting individual quality measures be 15
Medicare Part B FFS patients for the 12-month reporting
period. An eligible professional would need to meet this
minimum patient sample size requirement for at least one
measure on which the eligible professional chooses to
report."
- "Unlike the 2009 PQRI, which required that eligible
professionals report on consecutive patients (that is,
patients seen in order, by date of service), the 30
patients on which an eligible professional would need to
report a measures group for 2010 would not need to be
consecutive patients."
- "In addition, the questions we receive from eligible
professionals indicate that many eligible professionals are
not clear on how to determine which patients are
“consecutive” and should be included in the patient sample.
We believe that any adverse effect on the reliability or
validity of the quality information received as a result of
the removal of the requirement to report on patients seen
consecutively and allowing eligible professionals to report
on any 30 patients would be minimal."
- "Group practices interested in participating in the 2010 PQRI through the group practice reporting option would be required to submit a self-nomination letter to CMS or a CMS designee requesting to participate in the 2010 PQRI group practice reporting option. We propose that each group practice would be required to meet the following requirements:
● Have an active Individuals Access to CMS Systems
(IACS) user account;
● Provide CMS or a CMS designee with the group
practice’s TIN and the NPI numbers and names of all
eligible professionals who will be participating as part of
the group practice (that is, all individual NPI numbers
CMS-1413-P 258
associated with the group practice’s TIN). This
information must be provided in an electronic format
specified by CMS, such as in an Excel spreadsheet; and
● Agree to have the group practice’s PQRI quality
measurement performance rates for each measure publicly
reported by posting of the results on a CMS Web site."
- "We propose that group practices
would be required to submit information on these measures
using a data collection tool based on the data collection
tool used in CMS’ Medicare Care Management Performance
(MCMP) demonstration and the quality measurement and
reporting methods used in CMS’ PGP demonstration. We
propose that physician groups selected to participate in
the 2010 PQRI through the group practice reporting option
would be required to report on a common set of 26
NQF-endorsed quality measures that are based on measures
currently used in the MCMP and/or PGP demonstration and
that target high-cost chronic conditions and preventive
care. These quality measures are identified in Table 34.
Additional information on the MCMP and PGP demonstrations
is posted on the Medicare Demonstrations section of the CMS
Web site at http://www.cms.hhs.gov/DemoProjectsEvalRpts/MD/list.asp#Top
OfPage
- "We propose a unique reporting mechanism for the group
practice reporting option that would not be available to
individual eligible professionals participating in the 2010
PQRI. We propose that each physician group selected to
participate in the group practice reporting option would
have access to a database (that is, a data collection tool)
that would include the assigned beneficiary sample and the
quality measures."
- "Identical to the sampling method used in the PGP demonstration, the random
sample must consist of at least 411 assigned beneficiaries."
- "We anticipate being able to provide the selected physician groups with access
to this prepopulated database by the fourth quarter of 2010. The physician group would be required to populate the remaining data fields necessary for capturing quality measure information on each of the assigned beneficiaries."
- "TABLE 34: Measures Proposed for Physician Groups
Participating in the 2010 PQRI Group Practice Reporting
Option"
- "For example, information on the measure development process
employed by us when CMS or a CMS contractor is the measure
developer is available in the “Measures Management System
Blueprint” found on the CMS Web site at
http://www.cms.hhs.gov/apps/QMIS/mmsBlueprint.asp.
Eligible professionals also have the opportunity to
provide input on a measure as the measure is being vetted
through the NQF consensus endorsement process (and
previously, the AQA consensus adoption process). In
particular, the NQF employs a public comment period for
measures vetted through its consensus endorsement process
(and previously, for the AQA, its consensus adoption
process).
Finally, eligible professionals have an opportunity to
provide input on the measures proposed for inclusion in the
2010 PQRI through this proposed rule, which provides a
60-day comment period."
- "Measures that are high impact and support CMS and
HHS priorities for improved quality and efficiency of care
for Medicare beneficiaries. These current and long term
priority topics include: prevention; chronic conditions;
high cost and high volume conditions; elimination of health
disparities; healthcare-associated infections and other
conditions; improved care coordination; improved
efficiency; improved patient and family experience of care;
improved end-of-life/palliative care; effective management
of acute and chronic episodes of care; reduced unwarranted
geographic variation in quality and efficiency; and
adoption and use of interoperable HIT."
- "TABLE 17: Proposed 2010 Measures Selected From the 2009
PQRI Quality Measure Set Available for Either Claims-based
Reporting or Registry-based Reporting"
1 - Diabetes Mellitus: Hemoglobin A1c Poor Control in Diabetes Mellitus.
2 - Diabetes Mellitus: Low Density Lipoprotein (LDL–C) Control in Diabetes Mellitus.
3 - Diabetes Mellitus: High Blood Pressure Control in Diabetes Mellitus.
6 - Coronary Artery Disease (CAD): Oral Antiplatelet Therapy Perscribed for Patients with CAD.
9 - Major Depressive Disorder (MDD): Antidepressant Medication During Acute Phase for Patients with MDD.
10 - Stroke and Stroke Rehabilitation: Computed Tomography (CT) or Magnetic Resonance Imaging (MRI) Reports.
12 - Primary Open Angle Glaucoma (POAG): Optic Nerve Evaluation.
14 - Age-Related macular Degeneration (AMD): Dilated Macular Examination.
18 - Diabetic Retinopathy: Documentation of Presence or Absence of Macular Edema and Level of Severity of Retinopathy.
19 - Diabetic Retinopathy: Communication with the Physician Managing On-going Diabetes Care.
20 - Perioperative Care: Timing of Antibiotic Prophylaxis— Ordering Physician.
21 - Perioperative Care: Selection of ProphylacticAntibiotic—First OR Second Generation Cephalosporin.
22 - Perioperative Care: Discontinuation of Prophylactic Antibiotics (Non-Cardiac Procedures).
23 - Perioperative Care: Venous Thromboembolism (VTE) Prophylaxis (When Indicated in ALL Patients).
24 - Osteoporosis: Communication with the Physician Managing On-going Care Post Fracture.
28 - Aspirin at Arrival for Acute Myocardial Infarction (AMI).
30 - Perioperative Care: Timing of Prophylactic Antibiotics—Administering Physician.
31 - Stroke and Stroke Rehabilitation: Deep Vein Thrombosis Prophylaxis (DVT) for Ischemic Stroke or Intracranial Hemorrhage.
32 - Stroke and Stroke Rehabilitation: Discharged on Antiplatelet Therapy.
35 - Stroke and Stroke Rehabilitation: Screening for Dysphagia.
36 - Stroke and Stroke Rehabilitation: Consideration for Rehabilitation Services.
39 - Screening or Therapy for Osteoporosis for Women Aged 65 Years and Older.
40 - Osteoporosis: Management Following Fracture.
41 - Osteoporosis: Pharmacologic Therapy
43 - Coronary Artery Bypass Graft (CABG): Use of Internal Mammary Artery (IMA) in Patients with Isolated CABG Surgery.
44 - Coronary Artery Bypass Graft (CABG): Preoperative Beta-Blocker in Patients with Isolated CABG Surgery.
45 - Perioperative Care: Discontinuation of Prophylactic Antiobitics (Cardiac Procedures).
46 - Medication Reconciliation: Reconciliation After Discharge from an Inpatient Facility.
47 - Advance Care Plan
48 - Urinary Incontinence: Assessment of Presence or Absence of Urinary Incontinence in Women Aged 6 Years and Older.
49 - Urinary Incontinence: Characterization of Urinary Incontinence in Women Aged 65 Years and Older.
50 - Urinary Incontinence: Plan of Care for Urinary Incontinence in Women Aged 65 Years and Older.
51 - Chronic Obstructive Pulmonary Disease (COPD): Spirometry Evaluation.
52 - Chronic Obstructive Pulmonary Disease (COPD): Bronchodilator Therapy.
53 - Asthma: Pharmacologic Therapy
54 - 12-Lead Electrocardiogram (ECG) Performed for Non-Traumatic Chest Pain.
55 - 12-Lead Electrocardiogram (ECG) Performed for Syncope.
56 - Community-Acquired Pneumonia (CAP): Vital Signs.
57 - Community-Acquired Pneumonia (CAP): Assessment of Oxygen Saturation.
58 - Community-Acquired Pneumonia (CAP): Assessment of Mental Status.
59 - Community-Acquired Pneumonia (CAP): Empiric Antibiotic.
64 - Asthma: Asthma Assessment
65 - Treatment for Children with Upper Respiratory Infection (URI): Avoidance of Inappropriate Use.
66 - Appropriate Testing for Children with Pharyngitis.
67 - Myelodysplastic Syndrome (MDS) and Acute Leukemias: Baseline Cytogenetic Testing Performed on Bone Marrow.
68 - Myelodysplastic Syndrome (MDS): Documentation of Iron Stores in Patients Receiving Erythropoietin Therapy.
69 - Multiple Myeloma: Treatment with Bisphosphonates.
70 - Chronic Lymphocytic Leukemia (CLL): Baseline Flow Cytometry.
71 - Breast Cancer: Hormonal Therapy for Stage IC–IIIC Estrogen Receptor/Progesterone Receptor (ER/PR) Positive Breast Cancer.
72 - Colon Cancer: Chemotherapy for Stage III Colon Cancer Patients.
76 - Prevention of Catheter-Related Bloodstream Infections (CRBSI): Central Venous Catheter (CVC) Insertion Protocol.
79 - End Stage Renal Disease (ESRD): Influenza Immunization with Patients in ESRD.
84 - Hepatitis C: Ribonucleic Acid (RNA) Testing Before Initiating Treatment.
85 - Hepatitis C: HCV Genotype Testing Prior to Treatment.
86 - Hepatitis C: Antiviral Treatment Prescribed
87 - Hepatitis C: HCV Ribonucleic Acid (RNA) Testing at Week 12 of Treatment.
89 - Hepatitis C: Counseling Regarding Risk of Alcohol Consumption.
90 - Hepatitis C: Counseling Regarding Use of Contraception Prior to Antiviral Therapy.
91 - Acute Otitis Externa (ACE): Topical Therapy
92 - Acute Otitis Externa (ACE): Pain Assessment.
93 - Acute Otitis Externa (ACE): Systemic Antimicrobial Therapy—Avoidance of Inappropriate Use.
99 - Breast Cancer Resection Pathology Reporting: pT Category (Primary Tumor) and pN Category (Regional Lymph Nodes) with Histologic Grade.
100 - Colorectal Cancer Resection Pathology Reporting: pT Category (Primary Tumor) and pN Category (Regional Lymph Nodes) with Histologic Grace.
102 - Prostate Cancer: Avoidance of Overuse of Bone Scan for Staging Low-Risk Prostate Cancer Patients.
104 - Prostate Cancer: Adjuvant Hormonal Therapy for High-Risk Prostate Cancer Patients.
105 - Prostate Cancer: Three-Dimensional (3D) Radiotherapy.
106 - Major Depressive Disorder (MDD): Diagnostic Evaluation.
107 - Major Depressive Disorder (MDD): Suicide Risk Assesmment.
108 - Rheumatoid Arthritis (RA): Disease Modifying Anti-Rheumatic Drug (DMARD) Therapy.
109 - Osteoarthritis: Function and Pain Assessment.
110 - Preventive Care and Screening: Influenza Immunization for Patients =50 Years Old.
111 - Preventive Care and Screening: Pneumonia Vaccination for Patients 65 Years and Older.
112 - Preventive Care and Screening: Screening Mammography.
113 - Preventive Care and Screening: Colorectal Cancer Screening.
114 - Preventive Care and Screening: Inquiry Regarding Tobacco Use.
115 - Preventive Care and Screening: Advising Smokers to Quit.
116 - Antibiotic Treatment for Adults with AcutemBronchitis: Avoidance of Inappropriate Use.
117 - Diabetes Mellitus: Dilated Eye Exam in Diabetic Patient.
119 - Diabetes Mellitus: Urine Screening forMicroalbumin or Medical Attention for Nephropathy in Diabetic Patients.
121 - Chronic Kidney Disease (CKD): Laboratory Testing (Calcium, Phosphorous, Intact Parathyroid Hormone (iPTH) and Lipid Profile).
122 - Chronic Kidney Disease (CKD): Blood Pressure Management.
123 - Chronic Kidney Disease (CKD): Plan of Care—Elevated Hemoglobin for Patients Receiving Erythropoiesis-Stimulating Agents (ESA).
124 - Health Information Technology (HIT): Adoption/Use of Electronic Health Records (EHR).
126 - Diabetes Mellitus: Diabetic Foot and Ankle Care, Peripheral Neuropathy—Neurological Evaluation.
127 - Diabetes Mellitus: Diabetic Foot and Ankle Care, Ulcer Prevention—Evaluation of Footwear.
128 - Preventive Care and Screening: Body Mass Index (BMI) Screening and Follow-Up.
130 - Documentation and Verification of Current Medications in the Medical Record.
131 - Pain Assessment Prior to Initiation of Patient Therapy and Follow-Up.
134 - Screening for Clinical Depression and Follow-Up Plan.
135 - Chronic Kidney Disease (CKD): Influenza Immunization.
140 - Age-Related Macular Degeneration (AMD): Counseling on Antioxidant Supplement.
142 - Osteoarthritis (OA): Assessment for Use of Anti-Inflammatory or Analgesic Over-the-Counter (OTC) Medications.
145 - Radiology: Exposure Time Reported for Procedures Using Fluoroscopy.
146 - Radiology: Inappropriate Use of ‘‘Probably Benign’’ Assessment Category in Mammography Screening.
147 - Nuclear Medicine: Correlation with Existing Imaging Studies for All Patients Undergoing Bone Scintigraphy.
153 - Chronic Kidney Disease (CKD): Referral for Arteriovenous (AV) Fistula.
154 - Falls: Risk Assessment
155 - Falls: Plan of Care
156 - Oncology: Radiation Dose Limits to Normal Tissues.
157 - Thoracic Surgery: Recording of Clinical Stage for Lung Cancer and Esophageal Cancer Resection.
158 - Endarterectomy: Use of Patch During Conventional Endarterectomy.
163 - Diabetes Mellitus: Foot Exam
172 - Hemodialysis Vascular Access Decision-Making by Surgeon to Maximize Placement of Autogenous Arterial Venous (AV) Fistula.
173 - Preventive Care and Screening: Unhealthy Alcohol Use—Screening.
175 - Pediatric End Stage Renal Disease (ESRD): Influenza Immunization.
176 - Rheumatoid Arthritis (RA): Tuberculosis Screening.
177 - Rheumatoid Arthritis (RA): Periodic Assessment of Disease Activity.
178 - Rhuematoid Arthritis (RA): Functional Status Assessment.
179 - Rheumatoid Arthritis (RA): Assessment and Classification of Disease Prognosis.
180 - Rheumatoid Arthritis (RA): Glucocorticoid Management.
181 - Elder Maltreatment Screen and Follow-Up Plan.
182 - Functional Outcome Assessment in Chiropractic Care.
183 - Hepatitis C: Hepatitis A Vaccination in Patients with HCV.
184 - Hepatitis C: Hepatatis B Vaccination in Patients with HCV.
185 - Endoscopy & Polyp Surveillance: Colonoscopy Interval for Patients with a History of Adenomatous Polyps—Avoidance of Inappropriate Use.
186 - Wound Care: Use of Compression System in Patients with Venous Ulcers.
- "TABLE 20: Proposed 2010 Measures Available for EHR-based
Reporting"
- "The 6 new measures groups proposed for
the 2010 PQRI are:
(1) Coronary Artery Disease (CAD);
(2) Heart Failure (HF);
(3) Ischemic Vascular Disease (IVD);
(4) Hepatitis C;
(5) Human Immunodeficiency Virus (HIV)/Acquired Immune Deficiency Syndrome (AIDS);
(6)Community Acquired Pneumonia (CAP)."
- "In December 2008, we listed, by State, the names of eligible
professionals who participated in the 2007 PQRI on the
Physician and Other Health Care Professionals Directory."
- "Based on the assumptions discussed above, we estimate
the total annual cost per eligible professional associated
with claims-based reporting to range from $174.45 [($0.21
per measure X 3 measures X 15 cases per measure) + $165] to
$617.70 [($10.06 per measure X 3 measures X 15 cases per
measure) + $165]."
- "For registry-based reporting, eligible professionals
must generally incur a cost to submit data to registries.
Estimated fees for using a qualified registry range from a
nominal charge for an eligible professional to use the
registry to costing eligible professionals several thousand
dollars. Thus, we conservatively estimate the cost
incurred by an eligible professional to participate in PQRI
via registry-based reporting to be approximately $500 per
eligible professional.
Wednesday, July 1, 2009
2009 PQRI Registry Kick-Off Meeting
Today all PQRI qualified Registries had a meeting at Medicare headquarters.
This is the main Medicare building - I was so excited about visiting Medicare that I forgot to keep my finger away from my lens.
Medicare headquarters are at 7500 Security Boulevard in Baltimore. And they mean security :-) Your car will be thoroughly inspected before entering the parking lot. Then you enter the building and you go through an airport style inspection, with the additional step that they check your laptop id. Then someone escorts you to your final destination.
Inside the main auditorium we finally met Dr. Daniel Green and all his PQRI team.
He put us at ease with his sense of humor - he is an Ob/Gyn doctor, his wife practices internal medicine in the state with the "worst reimbursement rates" in the country and they just bought a pregnant horse last week. Supposedly he also owns a mini-donkey but we are not sure if he was serious about that :-)
These are some of the highlights of the meeting:
- 74 registries qualified this year. Last year there were 32 Medicare qualified registries. 31 sent data. These registries sent PQRI Quality data regarding 10000-99999 patients. They are not sure about the actual numbers yet.
- CMS is working hard to make sure that physicians that reported data can get their 2% reward over their Medicare charges. One of the problems is that sometimes the TIN (tax id number) submitted by the physician has no actual Medicare charges because it is the wrong one (2% of $0.00 is $0.00). Many physicians have several TINs - To avoid this problem - physicians need to be reminded by registries to always use the one they use to submit data to Medicare. I think they have 300 physicians with "wrong" TINs.
- As a aside I have an hypothesis regarding why physicians sent the "wrong" number. In the past I had physicians that requested P4P money from insurances companies to be sent to their personal TINs because they would like the money not to go to the physician group. For example if a doctor works in a group with other 10 physicians that share the same group TIN and this doctor decides to submit PQRI data individually, he/she may hope that the PQRI reward to return to him/her so then he/she tries to send the individual tax id for the PQRI. Unfortunately there are no Medicare charges with this individual TIN - so no reward. DOCTOR - ALWAYS GIVE THE TIN YOU USE TO BILL MEDICARE
- Some registries submitted data in the name of medical residents - big mistake. Always use the attending NPI and TIN.
- Providers can sign electronically the doc authorizing registry to submit data to CMS if state law allows it - I am not sure which states don't allow electronic signatures - I sign electronically all the time when I open a new bank account...
- The quality measures should match the specialists - Technically you can report on diabetes for orthopedic surgeons but that's not the idea behind the PQRI.
- Once a registry gets approved for one specific PQRI measure tag (Procedure, Episode, Patient - Process, etc) it can ask permission by email to add another PQRI measure of the same type. For example if a registry is approved for Measure #176 Rheumatoid Arthritis (RA): Tuberculosis Screening that has type "Patient-Process", it can request to be approved for another measure of similar type like 127 Diabetes Mellitus: Diabetic Foot and Ankle Care, Ulcer Prevention – Evaluation of Footwear.
- There will be monthly conference calls with the registries. If a registry misses one call, it will be forgiven. If a registry misses two monthly support calls, it will not qualify anymore - the registry will turn into dust...
- Providers submitting PQRI data with claims and registries will be paid using the most favorable method. CMS will not combine methods.
- Two IACS accounts per registry are necessary to submit data. One will be for backup. The actual submission will be done through the PQRI Portal using the IACS authentication. You can submit test data and there is a feedback email that tells the registry if the XML file has the correct format.
- The way we were tested during the registry vetting process using a 4GB DVD to send an encrypted 10k XML test file to CMS was just a test...
- Central Utah registry talked about their PQRI experience. Some of their providers wanted to complicate things and add extra measures. Also suggested that contracts to be signed by the doctors should be easy or else it will scare them. Their physicians signed all authorization forms online. Central Utah reminded everyone to be sure that the right combination TIN/NPI is used by each provider.
- CINA, another 2008 qualified registry reported on 360 providers. CINA reminded us that PQRI measures are not created equal. For example some dialysis measures are reported per month. Be careful with the formal measure type (tag). CINA mentioned that providers got very engaged when they see their reports. Also suggested registries to enter TIN and NPI electronically to avoid errors. However, Dr. Green mentioned earlier that some providers on some registries got "too engaged" regarding their performance reports and didn't want to submit their data to CMS because they thought their performance scores were low. Reminded registries that for now providers will be paid by reporting and not by performance.
- Docsite registry submitted data from ~ 2200 providers. Docsite noticed that doctors got confused with the 30 consecutive patients concept despite being explained a lot on their website. Docsite found the AMA worksheets very useful. Again remind doctors - NPI and TIN use the ones you use to bill Medicare.
- During the meeting, lots of questions regarding the new XML tag encounter-from date and encounter-to-date . CMS wants encounter dates but they may change where they place this tag - one registry suggested to place this XML tag at the level of the provider and Dr. Green thought that idea is very reasonable. The "final 2009" XML specs maybe will not be so final.
- One registry mentioned the 18MB file limit on XML file to submit on the PQRI portal. I didn't understand why this was a problem. Probably with 18Mb we could report PQRI on all doctors on planet Earth... Anyway registries can submit multiple XML files.
- Next year providers can request their PQRIs reports from their respective Medicare carriers and they will be sent to the provider's email.
- This year you can submit more than 100 providers in one XML file.
- You can resubmit PQRI XML data from the same provider again if there is a correction. Last updated data will replace the old one on the CMS PQRI datawarehouse.
- Payments for PQRI 2008 are only coming in the Fall of 2009.
- Dr. Green mentioned that the new proposed PQRI rules for 2010 were published today on the Federal Registry. You can find a summary here and you can read the full rules here. CMS will accept comments on the Proposed Rule until August 31, 2009. "The Proposed Rule is scheduled to appear in the Federal Register on July 13, 2009" - from a good place to get Medicare updates - http://medicareupdate.typepad.com/medicare_update
- One registry commented that it is kind of hard to read the Federal Registry everyday and he would like some kind of summaries to be sent to registries regularly. Dr. Green mentioned that will be one of the functions of the monthly calls.
- I talked with Shiby Thomas from the Boston Medical Center PQRI registry. He mentioned that he had some difficulties implementing the rules for measure #159 - HIV/AIDS: CD4+ Cell Count or CD4+ Percentage - it needs to be done twice a year. CMS worked with measure owner and revised the rule.
- Another registry mentioned that in the foot exam for diabetes there was a rule that required 5 components on this exam but CMS supposedly thinks that 2 components are enough. Other registries were not aware of this change
- I suggested that the registries should create a user group to share their experiences, exchange tips and new information. Dr. Green liked the idea. He is going to collect emails from registries interested in this. In meantime I am suggesting to use twitter with the tag #pqri to post comments during this conference and even after. Registries could also use blogs to share their experiences and support each other efforts. Another suggestion - create a PQRI user group wiki. Someone suggested a facebook PQRI group page where everyone could get updates.
My final impression is that the hard working PQRI CMS team is very transparent, open-minded and looking forward to collaborate with all our registries to improve the quality of care in the US.
As an example of registry collaboration - I ended the day with a dinner at the Inner Harbour paid by the registry Outcome (thanks FX Campion!!) and enjoying the view of the beautiful National Aquarium in Baltimore.
This is the main Medicare building - I was so excited about visiting Medicare that I forgot to keep my finger away from my lens.
Medicare headquarters are at 7500 Security Boulevard in Baltimore. And they mean security :-) Your car will be thoroughly inspected before entering the parking lot. Then you enter the building and you go through an airport style inspection, with the additional step that they check your laptop id. Then someone escorts you to your final destination.
Inside the main auditorium we finally met Dr. Daniel Green and all his PQRI team.
He put us at ease with his sense of humor - he is an Ob/Gyn doctor, his wife practices internal medicine in the state with the "worst reimbursement rates" in the country and they just bought a pregnant horse last week. Supposedly he also owns a mini-donkey but we are not sure if he was serious about that :-)
These are some of the highlights of the meeting:
- 74 registries qualified this year. Last year there were 32 Medicare qualified registries. 31 sent data. These registries sent PQRI Quality data regarding 10000-99999 patients. They are not sure about the actual numbers yet.
- CMS is working hard to make sure that physicians that reported data can get their 2% reward over their Medicare charges. One of the problems is that sometimes the TIN (tax id number) submitted by the physician has no actual Medicare charges because it is the wrong one (2% of $0.00 is $0.00). Many physicians have several TINs - To avoid this problem - physicians need to be reminded by registries to always use the one they use to submit data to Medicare. I think they have 300 physicians with "wrong" TINs.
- As a aside I have an hypothesis regarding why physicians sent the "wrong" number. In the past I had physicians that requested P4P money from insurances companies to be sent to their personal TINs because they would like the money not to go to the physician group. For example if a doctor works in a group with other 10 physicians that share the same group TIN and this doctor decides to submit PQRI data individually, he/she may hope that the PQRI reward to return to him/her so then he/she tries to send the individual tax id for the PQRI. Unfortunately there are no Medicare charges with this individual TIN - so no reward. DOCTOR - ALWAYS GIVE THE TIN YOU USE TO BILL MEDICARE
- Some registries submitted data in the name of medical residents - big mistake. Always use the attending NPI and TIN.
- Providers can sign electronically the doc authorizing registry to submit data to CMS if state law allows it - I am not sure which states don't allow electronic signatures - I sign electronically all the time when I open a new bank account...
- The quality measures should match the specialists - Technically you can report on diabetes for orthopedic surgeons but that's not the idea behind the PQRI.
- Once a registry gets approved for one specific PQRI measure tag (Procedure, Episode, Patient - Process, etc) it can ask permission by email to add another PQRI measure of the same type. For example if a registry is approved for Measure #176 Rheumatoid Arthritis (RA): Tuberculosis Screening that has type "Patient-Process", it can request to be approved for another measure of similar type like 127 Diabetes Mellitus: Diabetic Foot and Ankle Care, Ulcer Prevention – Evaluation of Footwear.
- There will be monthly conference calls with the registries. If a registry misses one call, it will be forgiven. If a registry misses two monthly support calls, it will not qualify anymore - the registry will turn into dust...
- Providers submitting PQRI data with claims and registries will be paid using the most favorable method. CMS will not combine methods.
- Two IACS accounts per registry are necessary to submit data. One will be for backup. The actual submission will be done through the PQRI Portal using the IACS authentication. You can submit test data and there is a feedback email that tells the registry if the XML file has the correct format.
- The way we were tested during the registry vetting process using a 4GB DVD to send an encrypted 10k XML test file to CMS was just a test...
- Central Utah registry talked about their PQRI experience. Some of their providers wanted to complicate things and add extra measures. Also suggested that contracts to be signed by the doctors should be easy or else it will scare them. Their physicians signed all authorization forms online. Central Utah reminded everyone to be sure that the right combination TIN/NPI is used by each provider.
- CINA, another 2008 qualified registry reported on 360 providers. CINA reminded us that PQRI measures are not created equal. For example some dialysis measures are reported per month. Be careful with the formal measure type (tag). CINA mentioned that providers got very engaged when they see their reports. Also suggested registries to enter TIN and NPI electronically to avoid errors. However, Dr. Green mentioned earlier that some providers on some registries got "too engaged" regarding their performance reports and didn't want to submit their data to CMS because they thought their performance scores were low. Reminded registries that for now providers will be paid by reporting and not by performance.
- Docsite registry submitted data from ~ 2200 providers. Docsite noticed that doctors got confused with the 30 consecutive patients concept despite being explained a lot on their website. Docsite found the AMA worksheets very useful. Again remind doctors - NPI and TIN use the ones you use to bill Medicare.
- During the meeting, lots of questions regarding the new XML tag encounter-from date and encounter-to-date . CMS wants encounter dates but they may change where they place this tag - one registry suggested to place this XML tag at the level of the provider and Dr. Green thought that idea is very reasonable. The "final 2009" XML specs maybe will not be so final.
- One registry mentioned the 18MB file limit on XML file to submit on the PQRI portal. I didn't understand why this was a problem. Probably with 18Mb we could report PQRI on all doctors on planet Earth... Anyway registries can submit multiple XML files.
- Next year providers can request their PQRIs reports from their respective Medicare carriers and they will be sent to the provider's email.
- This year you can submit more than 100 providers in one XML file.
- You can resubmit PQRI XML data from the same provider again if there is a correction. Last updated data will replace the old one on the CMS PQRI datawarehouse.
- Payments for PQRI 2008 are only coming in the Fall of 2009.
- Dr. Green mentioned that the new proposed PQRI rules for 2010 were published today on the Federal Registry. You can find a summary here and you can read the full rules here. CMS will accept comments on the Proposed Rule until August 31, 2009. "The Proposed Rule is scheduled to appear in the Federal Register on July 13, 2009" - from a good place to get Medicare updates - http://medicareupdate.typepad.com/medicare_update
- One registry commented that it is kind of hard to read the Federal Registry everyday and he would like some kind of summaries to be sent to registries regularly. Dr. Green mentioned that will be one of the functions of the monthly calls.
- I talked with Shiby Thomas from the Boston Medical Center PQRI registry. He mentioned that he had some difficulties implementing the rules for measure #159 - HIV/AIDS: CD4+ Cell Count or CD4+ Percentage - it needs to be done twice a year. CMS worked with measure owner and revised the rule.
- Another registry mentioned that in the foot exam for diabetes there was a rule that required 5 components on this exam but CMS supposedly thinks that 2 components are enough. Other registries were not aware of this change
- I suggested that the registries should create a user group to share their experiences, exchange tips and new information. Dr. Green liked the idea. He is going to collect emails from registries interested in this. In meantime I am suggesting to use twitter with the tag #pqri to post comments during this conference and even after. Registries could also use blogs to share their experiences and support each other efforts. Another suggestion - create a PQRI user group wiki. Someone suggested a facebook PQRI group page where everyone could get updates.
My final impression is that the hard working PQRI CMS team is very transparent, open-minded and looking forward to collaborate with all our registries to improve the quality of care in the US.
As an example of registry collaboration - I ended the day with a dinner at the Inner Harbour paid by the registry Outcome (thanks FX Campion!!) and enjoying the view of the beautiful National Aquarium in Baltimore.
Sunday, June 28, 2009
Becoming a Medicare Qualified PQRI Patient Registry
This will be the first of a series of posts describing MDinteractive's experience of becoming a Medicare Qualified PQRI Registry.
General Introduction
To improve quality of the healthcare in the US, Medicare has a innovative program called Physician Quality Reporting Initiative that rewards physicians for reporting quality measures like checking cholesterol levels on diabetics patients, doing mammograms, giving smoke cessation advice, etc.
This is part of a movement to slowly change the way the system rewards physicians - right now with a fee-for-service payment system, healthcare professionals are paid more for "doing things" to patients and not for keeping patients healthy.
With the PQRI incentive program, physicians can earn an incentive payment of 2% above the regular Medicare Physician Fee charges.
The 153 PQRI Quality measures can be found here:
http://www.cms.hhs.gov/PQRI
Examples of PQRI Measures:
How to Report PQRI
There are basically two main options to report PQRI options:
- Claims Based Reporting
- Registry Reporting
Claims-Based Reporting:
In this case, a physician will need to report at least 3 PQRI Quality Measures for at least 80% of applicable patients.
For example, a pulmonary specialist would report 3 measures from all Medicare patients seen with the diagnosis of community acquired pneumonia(measures 56, 57 and 58).
Measure 56 - Community-Acquired Pneumonia (CAP): Vital Signs
Percentage of patients aged 18 years and older with a diagnosis of
community-acquired bacterial pneumonia with vital signs documented and
reviewed
When the doctor treats someone with the diagnosis of pneumonia (ICD-9 code 481), and a CPT code for a office visit like 99204 then she/he will also add the CPT II code 2010F in the same CMS-1500 billing form. This code means that vital signs like temperature, pulse, respiratory rate, and blood pressure were documented and reviewed.
The worksheet for these measures can be seen at the AMA website:
Participation Tools: Individual Quality Measures for 2009 PQRI and more specifically here for measure #56
On the same CMS-1500 claim form he also enter quality codes for measures #57 (Assessment of oxygen saturation - code 3028F) and for measure #58 (Assessment of mental status - code 2014F).
Each one of the quality codes must be submitted with a line-item charge of $0.00. Charge field cannot be left blank.
At the end of the year, if the above pulmonary specialist saw 10 Medicare patients with community-acquired pneumonia and reported measures #56, #57 and #58 on at least 8 of those patients will receive a 2% bonus over all her/his Yearly Medicare Part B Fee-for-Service revenues.
We should note that the 2% applies to all the Medicare Part B fees charged for all the Medicare patients seen by the doctor and not only to the patients with community-acquired pneumonia. For example if the the yearly revenues were $100000, the bonus would be $2000.
In the next post, we will describe an Alternative Reporting Method using a Qualified Medicare Registry like MDinteractive.
General Introduction
To improve quality of the healthcare in the US, Medicare has a innovative program called Physician Quality Reporting Initiative that rewards physicians for reporting quality measures like checking cholesterol levels on diabetics patients, doing mammograms, giving smoke cessation advice, etc.
This is part of a movement to slowly change the way the system rewards physicians - right now with a fee-for-service payment system, healthcare professionals are paid more for "doing things" to patients and not for keeping patients healthy.
With the PQRI incentive program, physicians can earn an incentive payment of 2% above the regular Medicare Physician Fee charges.
The 153 PQRI Quality measures can be found here:
http://www.cms.hhs.gov/PQRI
Examples of PQRI Measures:
How to Report PQRI
There are basically two main options to report PQRI options:
- Claims Based Reporting
- Registry Reporting
Claims-Based Reporting:
In this case, a physician will need to report at least 3 PQRI Quality Measures for at least 80% of applicable patients.
For example, a pulmonary specialist would report 3 measures from all Medicare patients seen with the diagnosis of community acquired pneumonia(measures 56, 57 and 58).
Measure 56 - Community-Acquired Pneumonia (CAP): Vital Signs
Percentage of patients aged 18 years and older with a diagnosis of
community-acquired bacterial pneumonia with vital signs documented and
reviewed
When the doctor treats someone with the diagnosis of pneumonia (ICD-9 code 481), and a CPT code for a office visit like 99204 then she/he will also add the CPT II code 2010F in the same CMS-1500 billing form. This code means that vital signs like temperature, pulse, respiratory rate, and blood pressure were documented and reviewed.
The worksheet for these measures can be seen at the AMA website:
Participation Tools: Individual Quality Measures for 2009 PQRI and more specifically here for measure #56
On the same CMS-1500 claim form he also enter quality codes for measures #57 (Assessment of oxygen saturation - code 3028F) and for measure #58 (Assessment of mental status - code 2014F).
Each one of the quality codes must be submitted with a line-item charge of $0.00. Charge field cannot be left blank.
At the end of the year, if the above pulmonary specialist saw 10 Medicare patients with community-acquired pneumonia and reported measures #56, #57 and #58 on at least 8 of those patients will receive a 2% bonus over all her/his Yearly Medicare Part B Fee-for-Service revenues.
We should note that the 2% applies to all the Medicare Part B fees charged for all the Medicare patients seen by the doctor and not only to the patients with community-acquired pneumonia. For example if the the yearly revenues were $100000, the bonus would be $2000.
In the next post, we will describe an Alternative Reporting Method using a Qualified Medicare Registry like MDinteractive.
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