If you pay attention to our blog posts this month, you may notice a theme. That’s because we always have themes, but this particular month is über important. For us here at WebPT, November is synonymous with PQRS prep. So we thought we’d share our vast PQRS knowledge with you, giving you all the info you need to prepare yourself for 2013.
Can you believe it’s already November? That means two things: Thanksgiving and PQRS 2013 (if you treat Medicare patients, of course). I know we’d much rather fill our thoughts—and bellies—with turkey, dressing, and buttery mashed potatoes. But you have to make room somewhere for Physicians Quality Reporting System (PQRS, formerly known as PQRI).
Last week WebPT hosted its most heavily attended webinar ever. Why so popular? Perhaps it was the brow-furrowing topic of compliance, or maybe it was our special guest—physical therapist and compliance expert Rick Gawenda of Gawenda Seminars. Together, Rick, moderator Mike Manheimer, and WebPT co-founder Heidi Jannenga, PT, set out to tackle compliance, making it entertaining, informative, and most importantly, understandable. Here’s a brief snapshot of what they discussed:
Here at WebPT HQ, we are gearing up for PQRS 2012. One of the pieces of PQRS that is most commonly misunderstood is the difference between claims and registry based services. Let’s take a minute and clear this up. Claims and registry-based reporting both result in the same outcome for your clinic– successful participation in PQRS. WebPT offers both options with claims-based being priced $99 per calendar year and registry-based at $299 for the calendar year. Many people look at the price and automatically assume claims is the way to go. Not so fast. There are some major cost and workflow considerations when taking on the claims-based beast.
What should we be measuring? Recently, there has been some debate from EMR providers over the type of data that should be provided to CMS when reporting clinical outcomes. CMS, in a newly proposed rule, wants to define and begin to use a new measure called CQM. CQM stands for Clinical Quality Measure and is used to establish the top tier providers for the effectiveness and necessity of specific treatments.
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.
The Centers for Medicare & Medicaid Services’ (CMS) Provider Communications Group will host a national provider conference call on the 2011 Physician Quality Reporting System and Electronic Prescribing (eRx) Incentive Program.
The eRx Incentive Program is an incentive program for eligible professionals initially implemented in 2009 as a result of section 132(b) of the MIPPA. The eRx Incentive Program promotes the adoption and use of eRx systems by individual eligible professionals and beginning with the 2010 eRx Incentive Program, group practices.