TOPIC: All Gain, No Pain PQRS Reporting Dec. 19th, 2012: 1:00 p.m. – 2:00 p.m. Moderator: Stephanie Gramling, Communications Leader at Physician Sales & Service Presented by Jim Clifford, Senior Solutions Consultant at Wellcentive Topics of Discussion • PQRS and CMS • Eligible Professionals • Reporting Options • Wellcentive PQRS PQRS Overview Providers Incentive Payment Enter Patient Data Quality Care CMS Wellcentive Submit Registry Data In Your Office Choose Reporting Method Measure Groups Individual Measures Choose Measures To Report Pick measures that fit your specialty or what services you perform. Gather Patient Data Run EHR Reports Billing Data From PM System Pull Paper Charts Choose How You Would Like to Enter Data Manual Entry Upload Data Sheets Enter Data into Wellcentive PQRS Our intuitive application gives you feedback on the data you enter We Submit For You After all your data is entered, sit back and let Wellcentive do the work of submitting to CMS Eligible Professionals (EP) Physicians • • • • • • • MD/DO Podiatrist Optometrist Oral Surgeon Dentist Chiropractor Ophthalmologist Therapists • • • Physical Therapist Occupational Therapist Qualified Speech/Language Pathologist Practitioners • Physician Assistant Nurse Practitioner • • • • • • • • Clinical Nurse Specialist Certified Registered Nurse Anesthetist Certified Nurse Midwife Certified Social Worker Clinical Psychologist Registered Dietician Nutrition Professional Audiologist The Reporting Options Measure Groups Individual Measures Measure Group Reporting • • • • • 22 Diagnosis - Based Group Measures Must report for at least 1 measure group Must have a Performance Rate > 0% The Reporting Period is January 1, 2012 – December 31, 2012 3 options for reporting: Report 30 unique Medicare Part B FFS patients for at least one measure group Report 80% or more applicable Medicare Part B FFS patients for 12 months for at least one measure groups with a minimum of 15 patients Report 80% or more applicable Medicare Part B FFS patients for 6 months for at least one measure group with a minimum of 8 patients Measure Groups Measure Groups (22 measure groups) – Diabetes Mellitus (6 measures) – Chronic Kidney Disease (CKD) (4 measures) – Preventive Care (9 measures) – Coronary Artery Bypass Graft (CABG) (10 measures) – Rheumatoid Arthritis (6 measures) – Perioperative Care (4 Measures) – Back Pain (4 measures) – Hepatitis C (8 measures) – Heart Failure (5 measures) – Coronary Artery Disease (CAD) (4 measures) – Ischemic Vascular Disease (IVD) (5 measures) – HIV/AIDS (8 measures) – Community-Acquired Pneumonia – – – – – – – – – (CAP) (4 measures) Asthma (4 measures) Chronic Obstructive Pulmonary Disease (COPD)(5 measures) Inflammatory Bowel Disease (IBD) (8 measures) Sleep Apnea (4 measures) Dementia (9 measures) Parkinson’s (6 measures) Hypertension (8 measures) Cardiovascular Disease (6 measures) Cataracts (4 measures) Individual Measures • 208 Individual Measures • Must report on a minimum of 3 measures • Must have a Performance Rate > 0 • Eligible Professionals must report at least 80% of their Medicare Part B FFS patients during the reporting period for whom the measure applies to • The Reporting Period is January 1, 2012 – December 31, 2012 Note: For 2012 the 6-month reporting option for Individual Measures has been removed The Bonus Payment • • • • This is a Pay-for-Reporting program Professionals that report in years 2012-2014 successfully are eligible for a 0.5% percent bonus payment for PQRS. Potential bonus payment is calculated using total allowed charges for services furnished during the reporting period and paid under the Medicare Physician Fee Schedule. The penalty for not reporting in 2013 is a 1.5% payment reduction in 2015 0.5% Incentive for reporting | 2012 0.5% Incentive for reporting | 2013 0.5% Incentive for reporting | 2014 1.5% Penalty for not reporting in 2013/2014/2015 | 2015 Why Registry? Registry-Based Claims-Based 2010 Success Rate: 91%* 2010 Success Rate: 57%* • Submit 2012 data right up until the CMS deadline in March 2013 (no need to track claims throughout the year) • Must have someone in the clinic who “owns” PQRS: complete audits, know all the ins/outs, keep record of the % completed, etc. • Higher potential for meeting reporting criteria and receiving bonus payment • Auditing process can be tedious and potentially a productivity loss, especially if you have a large Medicare patient population • Measures and measure groups updated automatically each year as information is provided by CMS, which keeps staff from having to become measure experts • Must complete and submit proper forms in proper format for eligible patients • No internal automated check/ balance system provided by billing company: submits only what you give them *Centers for Medicare and Medicaid Services, 2010 PQRS Reporting Experience, February 2012 Why Wellcentive? The most streamlined, reliable reporting solution available • Easy registry-based reporting - just provide data on 30 unique Medicare Part B FFS patients for a single measure group • Data verification prior to submission delivers 99% incentive eligibility • Maintain staff productivity with fast, simple reporting • Enterprise PQRS solutions available for larger organizations A leader in PQRS reporting • • • Comprehensively certified by CMS since 2007 Worked with CMS to test registry submission process in 2007 Charter Founder Member of the CMS Registry Initiative Summary • Identify the patients for whom PQRS measures apply • Capture clinical information • Enter your data electronically to Wellcentive or enter manually into Wellcentive PQRS data collection tool • We Submit the data to CMS for you • Integrate the measures into your practice • Improve Quality! Thank You! For FAQs and to register please visit: www.PSS-PQRS.com The goal is improving patient wellness.