HIT Today: Increase your income through quality reporting

In the "real" world, people expect to pay more for something if it's of higher quality or offers superior performance. That free-market standard promotes higher-quality products and services.

The healthcare industry, however, generally does not operate in this manner. Patients have few options for "kicking the tires," so to speak, before electing to start a drug treatment, undergo surgery or therapy, or choose a physician.

This inability to get a reading on the effectiveness of drugs and treatments hinders those tasked with improving the overall effectiveness of the healthcare industry. Thus, the government created pay-for-performance programs to incentivize you and your colleagues to collect and submit data on the outcomes of the drug treatments and procedures performed on your patients in anticipation that these programs would lead to evidence-based clinical guidelines that will improve the quality of care you deliver.

SHOULD YOU PARTICIPATE?

One reason to consider a pay-for-performance program is to join in the movement to improve healthcare in this country. Another is to make more money. And there's nothing wrong with that.

Healthcare can be a difficult industry in which to make a living. As reimbursement rates continue to shrink, programs such as the Physician Quality Reporting System (PQRS) provide opportunities for you to maintain your revenue.

The government launched the PQRS (formerly called the Physician Quality Reporting Initiative, or PQRI) program in 2006 so it could collect data on which drugs and treatments illicit the best outcomes and create evidence-based clinical guidelines to improve medical treatments. Doctors participating in Medicare Part B who choose to participate in the PQRS program can receive annual incentive checks equal to 0.5% of their Medicare Part B claims. They can earn another 0.5% when they also participate in a maintenance of certification (MOC) program for a year ("more frequently than is required to qualify for or maintain board-certification status") and successfully complete a qualified MOC program practice assessment for such year. No sign-up or pre-registration is required to participate.

What is an MOC program? Defined in the Social Security Act, an MOC program is "a continuous assessment program that advances quality and the lifelong learning and self-assessment of board-certified specialty physicians by focusing on the competencies of patient care, medical knowledge, practice-based learning, interpersonal and communication skills, and professionalism." Learn more athttps://www.cms.gov/PQRS/Downloads/2012_Maintenance_of_Certification_Requirements_2.pdf.

WHAT TO REPORT, AND HOW TO REPORT IT

Once you fill out the required self-nomination forms, you will select at least three measures to submit for consideration from the 2012 PQRS measures list. The list is in PDF format (along with other information you'll need to read) in the "downloads" area at the bottom of the "how to get started" page of the Medicare PQRS Web site, http://www.cms.gov/PQRS.

It's important to read these documents. They outline the codes you'll use to record the patient data and the methods by which you can submit them to CMS.

To qualify to receive the annual incentive check, physicians participating in Medicare Part B first must determine whether a claims-based or registry-based method of reporting best fits their practices. That choice will determine whether the reporting period will be 6 months or 12 months.

If you select the claims-based method, then you will add the PQRS reporting data to your Medicare Part B claims. If you select the registry-based method, then you will give your PQRS reporting data to the group that administers a qualified registry. The group then will submit those data on your behalf.

USING YOUR EHR TO SUBMIT PQRS DATA

This year, CMS added a third method for submitting patient PQRS data: the electronic health record (EHR) system. CMS qualifies EHR direct vendors and their products to participate. In addition, systems must:

• be able to collect and transmit all required data elements according to the 2012 EHR data submission specifications;


• be able to separate out and report on all Medicare Part B physician fee schedule (PFS) patients only;


• be able to include tax identification number/national provider identifier information submitted with an eligible professional's quality data;


• be able to transmit those data in the CMS-approved format;


• comply with a secure method for data submission;


• not be in a beta test form;


• have at least 25 active users;


• be able to report (and test submission) for all 51 e-specified measures;


• be able to report only the measures selected by the eligible professional; and


• report only those data elements (in a Quality Reporting Document Architecture level 1 format) needed to calculate the measures (if possible).

Also, each qualifying vendor must participate in mandatory support conference calls hosted by CMS (approximately one per month) and indicate the reporting options it seeks to qualify for its users to submit, including individual measures and e-prescribing for individuals and groups.

Knowing these requirements can help you when selecting an EHR for attesting to meaningful use.

ARE YOU ELIGIBLE?

With some exceptions, basically all doctors who bill directly for Medicare Part B payments under the Medicare PFS can participate in the PQRS program and earn the 1% incentive check for both successfully reporting PQRS data and for participating in an MOC program.

Physicians eligible to participate include doctors of medicine, osteopathy, podiatric medicine, optometry, oral surgery, dental medicine, and chiropractic. Other eligible practitioners include physician assistants, nurse practitioners, clinical nurse specialists, certified registered nurse anesthetists (and anesthesiologist assistants), certified nurse midwives, clinical social workers, clinical psychologists, registered dietitians, nutrition professionals, and audiologists. Physical therapists, occupational therapists, and qualified speech-language therapists also may participate.

Medical professionals cannot participate in these programs if they are paid under or based on the PFS-billing Medicare carriers/Medicare administrative contractors (MACs) that do not bill directly, or if they are paid under PFS-billing Medicare fiscal intermediaries (FIs) or MACs. That's because the FI/MAC claims processing systems currently cannot accommodate billing at the individual physician or practitioner level.

PROGRAM IS VOLUNTARY

Currently, the PQRS program is voluntary for doctors. If, however, you become involved with a Patient-Centered Medical Home or an accountable care organization, both of which engage in quality reporting as part of their revenue-generating procedures, then collecting and submitting drug treatment and prescription data, as well as patient outcomes, could become a mandatory part of your practice.

You will find PQRS program specifics for this year athttps://www.cms.gov/PQRS/03_How_To_Get_Started.asp#TopOfPage.

This Article Original Post at Medical Economy