Wednesday, October 14, 2015

There’s Still Time to Succeed at PQRS - Here’s How

Joy Rios
According to Joy Rios, MBA, CHTS-PW, “The year is closing in on us and the countdown to MU and PQRS submission season has begun.”

You may think that the game is over, but there’s still time to make a big impact in your quality score even if you thought it was too late.

At this stage of the game, if you haven’t started PQRS, let’s talk about your best options.

Since the deadline to report as a group passed at the end of June, eligible providers - even if practicing as part of a group - will need to report as individuals.

The two options left to report as an individual are either through your EHR or through a Registry.

Option 1: EHR Reporting

It is important to understand the measures for which your EHR can capture data and whether or not the measures align with your specialty.

Question: In your EHR, when you run the PQRS report, how many measures have a denominator and of those measures, which ones have a numerator greater than zero?

Answer 1: If the answer is 9 or more and the measures align with your specialty, you will likely be able to use the EHR-Direct method to report.

To do so, confirm that your EHR vendor can generate a QRDA I or QRDA III file that passes the validation test to be submitted to QualityNet.

Then make sure you have the right user roles set up to be able to submit that QRDA file — they will most likely be the Security Official and the PQRS Submitter roles.

Answer 2: If you run the PQRS report and you show results for fewer than 9 measures AND/OR if your numerators are particularly low for the measures for which you are capturing data, you may want to consider reporting through a Registry.

Option 2: Registry Reporting

Although you can report 9 individual measures (covering at least 3 NQS domains) through a Registry, you would need to submit data for at least 50% of your Medicare patients from January 1 - December 31, 2015. If you have not been collecting data, this method is too difficult to chase.

However, there is a more attainable Registry-based reporting method — via a Measures Group.
The beauty of the Measures Group method is you only need to collect data on a minimum of 20 patients, 11 of whom must be on Medicare. This is a task that can be completed by the end of the year.

CMS has defined 22 groups of measures (aka a Measures Group) to choose from this year. Each group revolves around a particular topic (i.e. Oncology Care, Diabetes, IBD, etc.) However, if none of those match your patient population, I implore you to consider the Preventive Care group.

This group is designed to collect data on patients aged 50 years and older with a specific patient encounter code (i.e., 99201 - 99205, 99212 - 99215).

You’ll need to collect data on a total of 10 measures that are geared toward preventive care. For example, you’ll ask the patient if they’ve had a flu shot this year or whether they have had their Pneumonia vaccine - that’s two. You’ll ask it for eight more measures.

Then you’ll fill out a Data Collection Worksheet for each of the 20 patients. Don’t worry, this document is provided by the Registry. Once data has been collected on enough patients, you’ll transfer that information over to an Excel Document and upload that to the Registry.

The Registry will then submit the data on your behalf to CMS.

And that’s it - you’re done.

Where can you sign up with a Registry? Well, Joy’s personal favorite is PQRSwizard.com - it will cost about $300 per provider and is worth every penny.

The clock is ticking and if you have done nothing for PQRS up until now, this would be your best option to avoid up to 6% in penalties.

For more information on how to successfully participate in PQRS this year, check out my book,  ABCs of PQRS: Your 2015 Guide to Successfully Participating in the Physician Quality Reporting System or order at (800) 933-3711. Also now available on Kindle.