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 Physician Quality Reporting Initiative (PQRI) is a program designed by the Center for Medicare and Medicaid Services (CMS) to improve the quality of reporting in the healthcare industry. The program is now considered to be permanent and therefore the program name has been amended to the Physician Quality Reporting System (PQRS). PQRS reporting is based on individual measures which are associated to a specific patient group by diagnosis, ailment, age, or clinical action taken by the reporting therapist. All Medicare Part B FFS (fee for service) patients are eligible, but must meet inclusion criteria for each measure.
There are 2 methods of reporting your clinical data to CMS: Claims-based and Registry. Choosing your reporting method is very important in reaching your 1% incentive goal. What is the difference between the 2 methods? What are the Pros and Cons of each? Let’s explore:
In our effort to simplify the clinical environment while maintaining quality and compliance, we decided to dedicate this month the exciting topic of Medicare Regulations. This topic can to be either terrifying or boring for PTs, but it is something that must be considered and is equally important in patient care.
This article aims to clear up some of the most common questions regarding the program formally known as PQRI. For your convenience I have translated the legislative jargon into plain English.
Note: WebPT is one of 2 certified PQRI Registries in the Physical Therapy space. We have just finished updating our module to the 2011 specifications. WebPT members can contact their member representatives to learn how to activate this feature and begin participating in this program.
What are PQRI and PQRS?
PQRI stands for the Physician Quality Reporting Initiative. This program is administered by the Center for Medicare and Medicaid Services (CMS). In regular governmental fashion, CMS has recently changed the program to a permanent feature rather than a temporary initiative (as of January 2011). In light of this adjustment the name of PQRI was changed to PQRS. PQRS stands for the Physician Quality Reporting System. This is the new lingo so let’s get with it. (I’m also trying to light a fire under CMS here– their website is not even updated with the new name yet).
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.
Some major changes are headed our way in terms of the 2011 Medicare Final Rule on the Physician Fee schedule and Other Policies to be effective January 1, 2011. The Rule included a number of provisions that have impact on outpatient therapy services. The net effect of the policies could lead to payment reductions of approximately 30%.
If you see Medicare patients and they impact your revenue, there are several things to pay attention to and deal with proactively. These changes pose a significant threat to a growing population of baby boomers and their ability to access PT. Changes to these payment reductions can only be averted through Congressional action. APTA is notifying its members of opportunities to advocate on behalf of the profession to eliminate these payment cuts and any developments associated with the implementation of the Multiple Procedure Payment Reduction (MPPR). Many believe that an extension of the therapy cap exceptions process and a reprieve for Medicare Fee Schedule cut will be considered and with some heavy lobbying are expected to be passed. Please stay alert to these changes and be pro-active in standing up for our profession and the value of the services that we provide.
Here is a brief summary of these provisions to provide a better understanding of the rulings. For a more comprehensive summary for APTA members, please see the 2011 APTA Fee Schedule Summary.