QCDR Overview - Anesthesia Quality Institute

Report
The Qualified Clinical Data Registry
Overview of the Problem
Richard P. Dutton, M.D., M.B.A.
aqihq.org
“Pay for Performance”
• Federal programs to promote quality over quantity in the
delivery of healthcare.
• Based on measuring outcomes
o Public reporting
o Payment incentives and penalties
• Hospitals
• Physicians
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Key Points
Pay for Performance programs are evolving over time
What was true last year will not be true next year
Complexity is increasing
ASA (and all physician societies) must seize opportunities
to guide this evolution
ASA has worked hard to keep up
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The Evolution of P4P
From
Process Measures
To
Outcomes
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The Evolution of P4P
From
Big hospitals
To
Small hospitals, surgery centers,
clinics and offices
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The Evolution of P4P
From
Inpatients
To
All patients
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The Evolution of P4P
From
Medicare only
To
Medicare Advantage, Medicaid, and
all payers
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The Evolution of P4P
From
Incentives
To
Penalties
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The Evolution of P4P
From
Clinical Safety Focused
To
Patient Centered
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The Evolution of P4P
From
Individuals
To
Teams
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The Evolution of P4P
From
Paper
To
Electrons
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The Evolution of P4P
From
Individual reporting
To
Group and registry reporting
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The Evolution of P4P
From
A demonstration project
To
The way we do business
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Physician Quality Reporting System (PQRS)
• Defining PQRS
o “Paid under or based on the Physician Fee Schedule”
o Eligible Professionals (EPs)
• Common Measures Reported by Anesthesiologists
o #30 (NQF #0269): Timing of Prophylactic Antibiotic
o #44 (NQF #0236): Preoperative Beta-Blocker in Patients with Isolated CABG
Surgery
o #76 (NQF #0464): Central Venous Catheter (CVC) Insertion Protocol
o #193 (NQF #0454): Perioperative Temperature Management
• Anesthesiology PQRS Participation Rate (2012)
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Physician Quality Reporting System (PQRS)
• Payment Incentive
o 2014 is the final year for the incentive
o Incentive @ 0.5% per $10,000 = $50
• Payment (Negative) Adjustment
o 2.0% adjustment applied in 2016 based on 2014
reporting year data
o Adjustment per $10,000 = $200
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Satisfactorily Report =
Avoid the Payment Adjustment
• Reporting Options
o
o
o
o
Claims
Qualified Clinical Data Registry (QCDR)
“Traditional” Qualified Registry
Other Reporting Options
• Alignment of Measure Reporting Requirements
o Nine (9) quality measures
o Three (3) National Quality Strategy (NQS) domains
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Satisfactorily Report =
Avoid the Payment Adjustment
• Satisfactorily Reporting – Claims (2014):
o EPs must report ≥ 9 PQRS measures covering ≥ 3 NQS domains to qualify
for an incentive payment for 50% of Medicare Part B patients for whom the
measure applies
− If fewer than 9 measures, then EP is subject to the MeasureApplicability Validation (MAV) process
o EPs must report ≥ 3 measures in order to avoid the payment adjustment for
2016
− Subject to MAV process
• Claims-Based Reporting Challenges (Beyond 2014):
o PQRS Measures for Consideration
o PQRS #30, PQRS #109
o Narrowing of Reporting Options
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Satisfactorily Report =
Avoid the Payment Adjustment
• Qualified Clinical Data Registry (QCDR)
o Use of Established Specialty Society Registries
o PQRS and non-PQRS Measures
− AQI/NACOR: 8 PQRS and 11 Non-PQRS Measures
o QCDR Responsibilities
• QCDR Incentive Requirements (2014)
o Report at least 9 measures covering at least 3 NQS domains AND
report each measure for at least 50% of the EP’s applicable
patients seen during the reporting period.
o One measure must be an outcome measure
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Satisfactorily Report =
Avoid the Payment Adjustment
• QCDR Reporting Requirements
o Avoid the payment adjustment (2016)
− [For CY 2014] Report at least 3 measures covering at least 1 NQS domain for at
least 50 percent of the EP’s applicable patients seen during the participation
period
o Avoid the payment adjustment (2017)
− CMS PROPOSED: “For the 12-month reporting period [CY 2015] for the 2017
PQRS payment adjustment, the EP would report at least 9 measures available for
reporting under a QCDR covering at least 3 of the NQS domains, AND report each
measure for at least 50 percent of the eligible professional’s patients.”
− Report 3 outcome measures or 2 outcome measures and at least 1 resource
use, patient experience or efficiency/appropriate use measure
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Physician Quality Reporting System
Preparing for the Future
• Learn and Understand PQRS
o CMS PQRS Website (www.cms.gov/pqrs)
o CMS QualityNet Help Desk (866-288-8912 or
qnetsupport@hcqis.org)
• Member Resources
o Quality and Regulatory Affairs (qra@asahq.org)
o Anesthesia Quality Institute (http://www.aqihq.org/qcdr)
• Prepare for PQRS Reporting in 2015
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PQRS Today
• Must report at least 3 measures, or file for hardship
• + 0.5% incentive for cases in 2014
• - 1.5% ‘withhold’ in 2015
• - 2% penalty in 2016, 2017
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PQRS Participation
• 54% of eligible anesthesiologists submitted data in 2011
(61% in 2013)
• 84% of this group received an incentive
• Average $400 per provider (max: $14,000)
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Value Based Modifier (VM)
• Also based on the PQRS measure set
• Requires 9 measures
o 3 domains
o at least 1 outcome …
o …or hardship exemption
• 2% penalty in 2014 for not participating; escalates in
future years
• Losers pay for winners!
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Domains
•
•
•
•
•
•
Patient safety
Patient and caregiver experience
Care coordination
Clinical care
Population health
Efficiency and cost reduction
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The QCDR
•
•
•
•
•
Qualified Clinical Data Registry
New in 2014
A reporting mechanism for registry participants
Similar to the group reporting option for PQRS / VM
Can use PQRS measures
• Can use non-PQRS, specialty specific measures
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More about the QCDR

New method for satisfactorily reporting PQRS

a CMS-approved entity that collects clinical data for
patient/disease tracking for quality improvement

QCDRs are typically specialty society registries like AQI’s
National Anesthesia Clinical Outcomes Registry (NACOR)

Measure data across multiple payers, not limited to Medicare
beneficiaries

Allowed to report “non-PQRS” and PQRS measures for
successful PQRS reporting
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Why the QCDR is a big deal
• Measure definition by the specialty, for the specialty
• Data collection and scoring moves from CMS to the
registry
• “One stop shop” for all requirements
• Public reporting by the society
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Benefits of using a QCDR

Greater potential to meet the 9/3 reporting requirements;
increasing strictness with other reporting mechanisms.
 Support better outcome under the Value Modifier
program; using a QCDR, quality scores:
 Are easier to monitor and improve throughout the
reporting year
 Could be higher because of the frequent
feedback/monitoring
 Greater choice of measures to report=potential higher
quality scores.
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The Anesthesiology Perspective
• The National Anesthesia Clinical Data Registry is
certified as a QCDR
• Available measures for perioperative care increased
from 4-8 in PQRS to 19
• 4 domains, multiple outcome measures
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PQRS reporting through AQI
• AQI has partnered with ASA to offer a mechanism for
anesthesia EP’s to satisfactorily report for PQRS
• New offering - ASA QCDR
• ASA will signup the groups/participants
o Free to ASA members, Fee for non-members
• AQI will collect and analyze the data, and report the data
to CMS
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Where Did New Anesthesia Measures Come From?
• Existing in PQRS
o Solves the stewardship problem
• Existing in NQF
• New measures mostly developed by ASA’s Committee
on Performance and Outcome Measures (CPOM)
• Developed, but never selected
• Developed, but never submitted
• Subspecialty possibilities
• Aspirational measures
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AQI as a QCDR
• The Centers for Medicare and Medicaid Services (CMS) introduced
the Qualified Clinical Data Registry (QCDR) as a reporting option in
2014.
• 2014 QCDR reporting:
o EPs must report on 9 measures including 1 outcome across 3
NQS domains.
o EPs that successfully report are eligible for a payment incentive.
• 2015 Medicare Physician Fee Schedule Proposed Rule:
o To avoid future payment adjustments an EP will have to report
on 9 measures including 3 outcomes across 3 NQS domains.
• The addition of QCDR reporting allows specialty societies to develop
measures that reflect profession-specific priorities.
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QCDR reporting through AQI
• AQI only reports on measures for Anesthesia
o 8 existing PQRS measures
o 11 non-PQRS QCDR measures
• No Measure Groups, GRPO, or eRx
• Working with ASA on additional measures for 2015
• Reports for Eligible Anesthesia Providers: MD, DO, and
CRNA
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Performance Reporting through the QCDR
• 2015 Anesthesia QCDR reporting is a product of ASA
o ASA sells it
o AQI delivers the goods
• Groups must be participating in AQI
• Free to ASA members who are participating in NACOR
• Additional charge for non-ASA members (i.e CRNAs)
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QCDR Reporting Requirements. You Must:
• Be a NACOR participant. If you are not already participating in
NACOR steps include:
o Completion of a Business Associate Agreement with the AQI
o Payment of fees (AQI participation is free to ASA members
and any EPs working with them in the care team model.)
o Completion of the AQI practice profile
o Transmission of electronic data to the registry beginning in
January 2015
• Self-nomination with AQI for QCDR reporting in early 2015
• Work with AQI to ensure proper data is being sent
• Approve the final transmission of EP performance data to CMS
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What to do next – 2 of 3
If your group already sends data to AQI
Thank you for your support
Go to next step
Or Else
Contact AQI to become an AQI Participant
Participation is required for AQI to report on your behalf
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What to do next – 3 of 3
• Does your group collect clinical outcomes intraoperatively and in the PACU?
• Yes - you are well on your way to satisfactorily report for
PQRS via QCDR
• No – work to get a process in place to collect the
appropriate outcomes
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Upcoming Webinar…
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Additional Resources
• AQI website: http://aqihq.org/
• AQI PQRS: http://aqihq.org/PQRSOverview.aspx
• AQI QCDR – http://aqihq.org/qcdr
• ASA QCDR: http://asahq.org/qcdr
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Questions?
www.aqihq.org
or
askaqi@asahq.org

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