SCHIE Mission
To improve the quality and efficiency of health care for all stakeholders
in the Santa Cruz community.
To deliver technology assistance, guidance and information on best
practices to providers with the goal of creating a healthcare delivery
system that offers a seamless, integrated experience for patients
and providers.
Provide services and tools to participating healthcare providers to
become meaningful users of EHRs connected to the Santa Cruz
Health Information Exchange.
These are foundational for Accountable Care, Clinical Integration,
Medical Home and surviving payment reform.
Physician Quality Reporting System
Bill Beighe, CIO
June 10, 2013
Housekeeping Items


Return to goal of 20 to 30 minutes maximum
No interactive Q&A today
 Audio
Issues
 Use the question feature in Go To Webinar and we
will respond during or after the meeting

Slides and the recording to be on the SCHIE
website and the PMG blue portal
What is PQRS?

The Physician Quality Reporting System
 Formerly PQRI



Medicare Part B
Incentive / Penalty
Voluntary



Bonus on Part B Payments 2013
Penalty in 2015 based on activity in 2013
Group reporting available (GPRO)
Incentive & Penalty History

2011 PQRI/PQRS Incentive PAYMENT Results
 280,000
Providers
 $260 million in Bonuses Paid

2012 Penalties on Medicare eRx Program are
being reported by Providers
Incentive Payment and Payment Adjustments
In 2013, physicians and other eligible professionals who successfully report quality measure data can
earn a 0.5% incentive payment on their total allowed charges for covered Medicare Part B Physician Fee
Schedule (PFS) services provided during the reporting period. Earning an incentive payment in 2013
will avoid the 2015 penalty adjustment.
Reporting Period
2013
2014
Incentive Amount
0.5%
0.5%
Penalty Amount
2015*
2016*
-1.5%
-2.0%
*The 2015 payment adjustment is based on PQRS participation during the 2013 reporting period
**The 2016 payment adjustment is based on PQRS participation during the 2014 reporting period
Eligibility to Participate

Medicare Doctors










Doctor of Medicine
Doctor of Osteopathy
Doctor of Podiatric Medicine
Doctor of Optometry
Doctor of Oral Surgery
Doctor of Dental Medicine
Doctor of Chiropractic
Practitioners – Individual / Group Considerations
Therapists
http://www.cms.gov/Medicare/Quality-Initiatives-PatientAssessment-Instruments/PQRS/Downloads/PQRS_List-ofEligibleProfessionals_022813.pdf
Tactics to mitigate potential loses

Properly report for the Physician Quality Reporting
System (PQRS) starting in 2013 to avoid penalties in
2015 and beyond.

Those who report satisfactorily for the 2013 program
year may avoid the 2015 PQRS payment adjustment.
Additional information on how to avoid future PQRS
payment adjustments can be found through
supporting documentation available on the CMS
website at http://www.cms.gov/Medicare/QualityInitiatives-Patient-Assessment-Instruments/PQRS.
PQRS Measures May Vary by Year
The PQRS measure documents for the current
program year may be different from the PQRS
measure documents for a prior year. Eligible
professionals are responsible for ensuring that
they are using the PQRS measure documents for
the correct program year.
How to get started?
Determine if you are eligible to participate
 Determine which reporting option best fits your
practice (reporting period varies with reporting
option selected)
 Select 3 measures to submit
- or –
 Select 1 measures group to submit
 Perform your own review of the measure
specifications you are reporting; understand
reporting principles

What Do I Have To Achieve?
If reporting via registry or EHR (not common)
• >80% on 3 or more individual measures
• 20 or more unique patients (>50% must be
Medicare) for 1 or more measures group
If reporting via claims: (you will likely do this)
• >50% on 3 or more individual measures for the 12
month reporting period
• 1 or more measures group for the 12 month
reporting period for 20 or more unique patients
Individual Measure Examples
Neurology Specific (Measure Group)
Examples
PQRS Services for SCHIE Providers
Provider /
Clinic
PMG Billing
Service
PMG
Hosted EHR
SCHIE
McKesson
SCHIE
Other EHR
or PM
1x1
Compliance
Assistance
Y
Training PQRS
Binder /
Forms /
Examples
Y
Y
Webinars
Comments
and ongoing
Education*
Y
Contact Amy
Hernandez
8 hours for 1
provider, max of
16 hours per
group
Y
Y
Y
Y
N
N
Y
Y
N
N
N
Y
2 hours max
Get specific advice
from your
EHR/PM Vendor
* Webinars and on-going educational sessions are completely free to all Santa Cruz
Providers and do not reduce the number of hours or support we are providing as part of
this program.
Additional Resources



http://www.cms.gov/Medicare/Quality-Initiatives-PatientAssessment-Instruments/PQRS/index.html?redirect=/PQRS/
http://www.cms.gov/Medicare/Quality-Initiatives-PatientAssessment-Instruments/PQRS/MeasuresCodes.html
CMS QualityNet Help Desk
Monday – Friday 7:00 am to 7:00 pm CST
Phone 1-866-288-8912
Email: qnetsupport@sdps.org

2013 Quality Reporting Programs Comparison Matrix (.pdf)
Coming up next
7/11/13 - Stage 2 Meaningful Use

https://www1.gotomeeting.com/register/855411001
7/18/13 – Direct Messaging

https://www1.gotomeeting.com/register/442346992
Contact the PMG and SCHIE resources at
831.465.7877, ask for Dawn Mackey, Becky
Shoemaker or Bill Beighe and we will get you
engaged with the right resource.

Presentation slides are available at:
http://www.santacruzhie.org/