2015 Physician Quality
Reporting System (PQRS) and
QRS
Scott Weinberg
Specialist, Quality Care & Patient Access
Objectives
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What is PQRS?
Why participate?
Who should participate?
What are the quality measures?
How to report the quality measures and
avoid payment reductions?
What is PQRS?
• CMS program (Medicare only)
• Physician Quality Reporting System
– Previously known as PQRI
• Applies a payment reduction to eligible
professionals (EPs) who do not satisfactorily
report data on quality measures for covered
professional services.
Why Report Quality Measures?
• Reporting quality measures in 2015 to avoid a
2.0% PQRS payment reduction in 2017.
• Groups of 10 or more physicians will automatically
receive a 4% VBM payment reduction in addition.
• Solo practitioners and groups of 2-9 physicians will
receive an automatic 2% VBM payment reduction.
• There is no longer an incentive available to EPs
who satisfactorily report PQRS measures.
Overall Penalties for 1-9 Provider
Practice
YEAR
EHR PENALTY
PQRS PENALTY
TOTAL PENALTIES
1%
Value Based
Modifier
0%
2015
1.5%
2.5%
2016
2%
0%
2%
4%
2017
3%
2%
2%
7%
2018
4%*
TBD**
2%
6% + VBM
2019
5%*
TBD**
2%
7% + VBM
Note: Percentages based on Medicare Part B allowed charges.
*EHR penalty will rise to 5% if less than 75% of all Medicare providers are participating in meaningful use by 2017.
**Scheduled to be announced in final rule for 2016 Medicare fee schedule.
Overall Penalties for 10+ Provider
Practice
YEAR
EHR PENALTY
PQRS PENALTY
TOTAL PENALTIES
1%
Value Based
Modifier
0%
2015
1.5%
2.5%
2016
2%
2%
2%
6%
2017
3%
Up to 4%
2%
Up to 9%
2018
4%*
TBD**
2%
6% + VBM
2019
5%*
TBD**
2%
7% + VBM
Note: Percentages based on Medicare Part B allowed charges.
*EHR penalty will rise to 5% if less than 75% of all Medicare providers are participating in meaningful use by 2017.
**Scheduled to be announced in final rule for 2016 Medicare fee schedule.
Who Should Participate?
• All MD, DO, PA, NP, CNS, APRN who are
reimbursed under the Medicare physician
fee schedule.
• AAD registry available to members and
non-physician clinicians who are employed
by AAD members.
How Many Quality Measures in 2015?
• Report at least 9 measures.
• Report at least 50% of applicable patients
for each measure for the full year.
• Measures should cover at least 3 National
Quality Strategy domains.
• Report at least 1 “cross-cutting” measure.
National Quality Strategy Domains
1) Patient Safety
2) Patient and Caregiver-Centered
Experience and Outcomes
3) Communication and Care Coordination
4) Effective Clinical Care
5) Community/Population Health
6) Efficiency and Cost Reduction
5 Dermatology-Specific Measures
1) Measure #137 — Melanoma: Continuity of Care
— Recall System
2) Measure #138 — Melanoma: Coordination of
Care
3) Measure #224 — Melanoma: Overutilization of
Imaging Studies
4) Measure #265 — Biopsy Follow-Up
5) Measure #337 — Tuberculosis Prevention for
Psoriasis and Psoriatic Arthritis Patients on a
Biological Immune Response Modifier
13 Dermatology-Applicable Measures
(included in AAD registry)
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Measure #397 – Melanoma Reporting (pathology)
Measure #46 - Medication Reconciliation (cross-cutting)
Measure #47 - Care Plan (cross-cutting)
Measure #110 - Preventive Care and Screening: Influenza
Immunization (cross-cutting)
• Measure #111 - Pneumonia Vaccination Status for Older
Adults (cross-cutting)
• Measure #128 - Preventive Care and Screening: Body
Mass Index (BMI) Screening and Follow-Up (cross-cutting)
• Measure #130 — Documentation of Current Medications
in the Medical Record (cross-cutting)
Included in AAD registry, cont.
• Measure #131 — Pain Assessment and Follow-Up (crosscutting)
• Measure #173 — Preventive Care and Screening: Unhealthy
Alcohol Use – Screening
• Measure #194 — Oncology: Cancer Stage Documented
• Measure #205 — HIV/AIDS: Sexually Transmitted Disease
Screening for Chlamydia and Gonorrhea
• Measure #226 — Preventive Care and Screening: Tobacco
Use: Screening and Cessation Intervention (cross-cutting)
• Measure #358 — Patient-Centered Surgical Risk
Assessment and Communication
Dermatology-Applicable Measure Update
#397
Melanoma Reporting
Pathology reports for primary malignant
cutaneous melanoma that include the pT
category and a statement on thickness and
ulceration and for pT1, mitotic rate.
Dermatology-Applicable Measure Codes
#397
ICD-9-CM: 172.0, 172.1, 172.2, 172.3,
172.4, 172.5, 172.6, 172.7, 172.8, 172.9
ICD-10-CM: C43.0, C43.20, C43.21,
C43.22, C43.30, C43.31, C43.39, C43.4,
C43.51, C43.52, C43.59, C43.60,
C43.61, C43.62, C43.70, C43.71,
C43.72, C43.8, C43.9
CPT: 88305
MAV Process
• “Measure-Applicability Validation”
• Allows eligible professionals to submit
data that does not meet satisfactory
reporting requirements, allowing for CMS
review to determine validity.
• At least one cross-cutting measure must
be reported.
MAV Process for Dermatology
• Successfully report as many measures that
are relevant and that fit into your practice
workflow.
• Successfully report at least one cross-cutting
measure.
• No guarantee of avoiding payment
reductions.
Measure Checklist
• Does this measure need to be reported
once per patient, or once per visit?
• Does this measure apply to every
Medicare patient, every Medicare patient
below a certain age, or just certain
diagnoses?
• Do I have at least one eligible Medicare
instance for this measure?
GPRO
• Group Practice Reporting Option
• 2 or more eligible providers under one TIN
• Registration with CMS must have been
completed by June 30, 2015
• AAD QRS supports GPRO in 2015
Important for Successfully Reporting
• Report at least 50% of applicable
patients/visits for each measure.
• No measure can have 0% performance.
• Select measures across 3 quality domains
(automated in QRS).
• Report at least one cross-cutting measure
• Enter NPI and TIN correctly into the
module.
2015 QRS Timeline
Academy to close purchase of QRS
December 11, 2015; January 15, 2016 is
last day to submit data
In early 2016, validation of all submitted
information occurs
If issues with your data arise, you will
be contacted to try and remedy
Registry submits all data to CMS in
February 2016
How to get started
1) Choose reporting option (individual vs.
group reporting and which registry).
2) Choose measures.
3) Track and log which Medicare patients
will be applicable to which measures.
How to Report
• 2015 AAD QRS now available for
members and affiliated non-physician
clinicians to purchase at
www.aad.org/QRS.
• Information about other qualified registries
available on: www.cms.gov/pqrs.
Questions?
• PQRS Questions: sweinberg@aad.org, (866) 5037546
• Current QRS Users:
QRSSupport@healthmonix.com, (844) 213-0030
• CMS QualityNet Help Desk:
qnetsupport@hcqis.org, (866) 288-8912
• Visit www.aad.org/QRS to:
• Purchase the 2015 AAD QRS Registry
• View online tutorials, FAQs, and coding specifications
• Latest information on PQRS