As we have discussed in a previous blog, there are 2 methods of reporting your PQRS data to CMS: Claims-based or Registry based. Both have their advantages and disadvantages. Once you have decided on a reporting method, how do you decide on what measures to report on? Here are some tips on making this important decision.
1. Diagnoses or clinical conditions treated in your clinic: Having eligible patients who qualify for the measures you choose is important in attaining your end goal of the incentive. If using claims-based reporting, you must acheive a greater than 50% participation in reporting and if using registry-based, then you must acheive 80% or greater participation. So, if 50% of your payer mix is Medicare and you see 100 patients in a month, then at least 25 of your Medicare patients that month would require PQRS data for claims or 40 for registry based reporting. If you choose a measure that only 10% of your Medicare patients qualify for, then you will not meet the criteria for that measure; so knowing your patient population is important.
2. Current treatments/interventions provided by therapists in your clinic: Most of the measures are specific to a narrow field based on specific diagnosis requiring specfic treatment interventions. If you are already providing this service in your clinic, then its a no brainer, ie: diabetic foot evals. However, this can be complicated and may not be the right choice for a clinic if they are not currently providing this service with a therapist proficient in this evaluation process. On the other hand, if you have a therapist who is interested in that service, its a great tool to monitor and grow another adjunct specialty to your practice.
3. Workflow considerations: Incentive payments are based on individual or group NPIs (you can choose). Things to consider are:
- documentation methods: (EMR, paper, or billing solutions?) specific CPT codes must accompany each measure as its completed in order to get credit for it
- productivity of your current staff: Newer grads may have some difficulty at 1st with now having to fill out yet another form as they try to make sure their Medicare documentation is up to snuff in the 1st place; if completing claims based, it is important to have 1 staff member completing a frequent audit to make sure that the 50% marker is being met and PQRS measures are being filled out appropriately and CPT codes are getting in to billing
- participating therapists: do all of your therapists see Medicare patients? Is there a possibility to using the 1% incentive as an added incentive for the therapists that do want to particpate? I say yes – acheiving success with PQRS reporting depends on the therapists to DO the testing and reporting, incentivizing them is crucial.
There are 8 individual measures, 1 group measure (has 4 sub measures that must all be reported on) and the 7 new 2011 measures (available via FOTO Registry reporting only) to choose from when implementing PQRS. To give you something a little more tangible to think about, we have compiled a quick list of the measures that are compatible with WebPT, one of only two PT specific CMS certified registries. You must choose at least three of them to maximize your ability in reaching your 80% goal.
Adoption/Use of an EHR #124: All of your Medicare patients should qualify for this measure and if you are using WebPT then the criteria would be met. If completing your documentation on paper, this would obviously NOT be a measure to choose.
BMI Screening and Follow-up #128: Most of your Medicare patients should qualify for this measure as its age qualifier is 18 and older. Body Mass Index calculation should be completed for patients on intial evaluation. Using an EMR allows for the system to complete the calculation for you, otherwise its a height/weight and age calculation that then must be compared to norms. This places the patient in upper, lower, or normal categories with a follow-up plan required.
Diabetic Foot and Ankle Care: Footwear eval #127 and Neuro eval #126: Diabetes diagnoses and age 18 or over are required to qualify for these measures. This measure is an example of a very specific target group with more complicated tests and interventions needed. Great opportunity to grow another part of your practice if you are not already focussing on diabetics -target referral sources such as podiatrists. Footwear eval requires: vascular, neurological, dermatological, and structural/biomechanical findings; Neuro eval requires: motor and sensory abilities and may include: reflexes, vibratory, proprioception, sharp/dull and 5.07 filament detection. All of these tests are available in WebPT and tagged if this measure is chosen.
Pain Assessment prior to initiation of physical therapy #131: Again, most of your patients should qualify for this measure as a pain scale (such as McGill) is required and a patient 18 years or older.
Documentation and verification of medications #130: Either verifying medications with the patient or an authorized representative of the patient will satisfy this measure of PQRS. Most of your patients should qualify for this measure as well even if they are not currently taking any medications.
Falls Risk Assessment and Plan of Care #154, #155: Similar to the diabetic measures, this measure pertains to a more finite group: must be 65 years or older and have had documented at least 2 falls or injury due to fall in the last year. A risk assessment for falls is comprised of balance/gait AND one or more of the following: postural blood pressure, vision, home fall hazards, and documentation on whether medications are a contributing factor or not to falls within the past year.
Using an EMR, like WebPT, can definitely give you an advantage in making sure that you have the appropriate tests completed and documented on the appropriate patient visits. Choosing the right measures to report on, however, is a clinic preference and should not be taken lightly as it can affect your chances of getting your incentive payment. Choose wisely and happy documentation.