Quality Reporting: PQRS, CQM, GIQuIC Erin Dettrey Product Manager, Analytics Sylvia Cohen gadvisor Team Lead Laurie Parker GIQuIC Executive Director
Agenda - Setting the stage - Value Based Modifier - PQRS - ggastro Options - GIQuIC Options - How can you get help?
Consequences for not reporting in 2015-2% Automatic for PQRS (all practice sizes). -2% to -4% for groups 10+ EPs for VBM. -3% for not reporting Meaningful Use. + + For example, a practice with 12 eligible providers who does not report PQRS in 2015, can face up to -9% payment adjustments in 2017 Last day to submit PQRS data for the 2015 reporting year: EHR method: February 29 th, 2016 QCDRs and Registries: March 31 st, 2016
Value-Based Payment Modifier It is subject to quality-tiering. For the 2015 reporting year the VBM will apply an upward, neutral or downward payment adjustment to practices of 10+ providers. For practice with 1-9, downward adjustments will begin in the 2016 reporting year.
PQRS ggastro Solutions Sylvia Cohen gadvisor Team Lead
PQRS Reporting options Available Individual Providers Claims Registry - Individual Measures or Measures Groups Qualified Clinical Data Registry (QCDR) EHR reporting EHR data submissions vendor
PQRS Reporting Options - GPRO Groups of 2+ EPs who bill to the same TIN Requires registration by June 30th Registry EHR Reporting EHR data submissions vendor GPRO Web Interface (only for groups of 25+ providers) CAHPS for PQRS via Certified Survey Vendor 12 Summary Survey Modules in addition to web interface reporting. (optional for 25-99 EPs. Required for 100+)
Direct EHR Reporting of PQRS Can be done directly from ggastro, using MU Clinical Quality Measures (CQMs) Can be reported as individual providers or as GPRO IACS account needed. Can take time to obtain. Satisfies PQRS and the CQM portion of MU when reported via the QualityNet website for a full calendar year. Requires monitoring of measures and some specific actions to ensure high quality is reported. Downside: CQM submission has a limited number of measures, most of which are not GI specific.
List of ecqm measures available in ggastro 1. Closing the referral loop - Receipt of specialist report (CC) 2. Colorectal cancer screening 3. Controlling high blood pressure (CC) 4. Diabetes: Hemoglobin A1C Poor control (CC) 5. Diabetes: Low Density Lipoprotein (LDL) 6. Documentation of current medications in the medical record (CC) 7. HIV/AIDS: Medical visit 8. Ischemic Vascular Disease (IVD): Use of aspirin or another antithrombotic 9. Preventive care screening (BMI) Screening and follow-up (CC) 10. Use of appropriate medications for asthma 11. Use of high-risk medications in the elderly 12. Preventive Care and Screening: Tobacco Use: Screening and Cessation Intervention (CC) 13. Pneumonia Vaccination Status for Older Adults (CC) (CC) Indicates cross-cutting measure
ggastro s CQMs Why no IBD or Hep C measures? IBD and Hep C are not part of the ecqm s list of measures that are electronically reportable via direct EHR. Very few ecqms are relevant to GI. These are only available for reporting as measures group via Registry.
GIQuIC Overview of Changes Erin Dettrey- Product Manager, Analytics
GIQuIC reporting GIQuIC reporting from ggastro has been available for many years EGD reporting is now included as of 4.58 Many efficiencies and further automation added as of 4.58 Pathology findings automation a huge step forward
GIQuIC reporting efficiencies Indications Pathology Findings Sites Follow up Risk Complications 6/15/2015
PQRS The GIQuIC Solution Laurie Parker- GIQuIC
GIQuIC: A Quality Improvement Registry We created GIQuIC based on a belief that the scientific measurement of the quality of endoscopic procedures will provide valid and reliable comparative information to participating physicians and facilities to support their quality improvement initiatives. ~ Irving M. Pike, MD, FACG, FASGE President, GI Quality Improvement Consortium February 23, 2010 16
PQRS Participation via Registry Qualified PQRS Registry Individual eligible provider reporting Group Practice Reporting Option (GPRO) Includes PQRS measures and measure groups Qualified Clinical Data Registry (QCDR) Individual eligible provider reporting only Can include PQRS or non-pqrs measures (or both) 17
QCDR Reporting Requirements and Criteria to avoid the 2017 PQRS payment adjustment Requirement Report at least 9 individual measures At least 2 must be outcome measures GIQuIC Covering at least 3 National Quality Strategy (NQS) domains For 50% or more of applicable patients of each eligible provider (12 months) GIQuIC QCDR The GIQuIC QCDR has 13 individual measures from which to choose The GIQuIC QCDR has 4 outcome measures with those 13 The 13 GIQuIC QCDR measures cover 4 NQS domains To participate in GIQuIC a provider must upload 100% of colonoscopy cases done at the participating site(s) 18
PQRS Participation via the GIQuIC QCDR 19
Effective Clinical Care Adenoma Detection Rate [Outcome] Percentage of patients age 50 and over undergoing screening colonoscopy with a finding of at least one adenomatous polyp Adequacy of Bowel Preparation [Process] Percentage of colonoscopies with a bowel preparation documented as adequate or better 20
Effective Clinical Care Photodocumentation of the cecum, which is also known as cecal intubation rate All Colonoscopies [Process] Percentage of colonoscopies into the cecum including photodocumentation of one or more of the cecal landmarks (ileocecal valve, appendiceal orifice, or terminal ileum) 21
Effective Clinical Care Documentation of history and physical rate Colonoscopy [Process] Percentage of colonoscopies with history and physical documented Appropriate indication for colonoscopy [Process] Percentage of colonoscopy procedures performed for an indication that is included in a published standard list of appropriate indications and the indication is documented 22
Patient Safety Incidence of Perforation [Outcome] Percentage of total patients experiencing a perforation during colonoscopy, recognized immediately (before the patient leaves the facility) 23
Communication and Care Coordination Appropriate follow-up interval for normal colonoscopy in averagerisk patients [Process] Percentage of average-risk patients aged 50 to 75 years receiving a screening colonoscopy without biopsy or polypectomy who had a recommended follow-up interval of at least 10 years for repeat colonoscopy documented in their colonoscopy report 24
Communication and Care Coordination Appropriate follow-up interval of 3 years recommended based on pathology findings from screening colonoscopy in average-risk patients [Process] Percentage of average-risk patients aged 50 years and older receiving a screening colonoscopy with biopsy or polypectomy and pathology findings of 3-10 adenomas, Advanced Neoplasm ( 10 mm, high grade dysplasia, villous component), Sessile serrated polyp 10 mm OR sessile serrate polyp with dysplasia OR traditional serrated adenoma who had a recommended follow-up interval of 3 years for repeat colonoscopy 25
Communication and Care Coordination Appropriate management of anticoagulation in the periprocedural period rate EGD [Process] Percentage of patients undergoing an EGD on an anti-platelet agent or an anticoagulation who leave the endoscopy unit with instructions for management of this medication 26
Communication and Care Coordination Appropriate management of anticoagulation in the periprocedural period rate EGD [Process] Percentage of patients undergoing an EGD on an anti-platelet agent or an anticoagulation who leave the endoscopy unit with instructions for management of this medication 27
Efficiency and Cost Reduction Repeat screening colonoscopy recommended within one year due to inadequate bowel preparation [Outcome] Percentage of patients with an inadequate bowel preparation who received a recommendation for a repeat screening colonoscopy of one year or less Age appropriate screening colonoscopy [Outcome] Percentage of patients aged 85 years or older undergoing screening colonoscopy 28
GIQuIC QCDR Timeline September 15, 2015: Consent forms must be signed by each provider Mid January 2016: All data from 2015 must be entered into the GIQuIC registry Mid February 2016: Providers attest to accuracy of data GIQuIC will be submitting on their behalf Mid March 2016: GIQuIC submits quality measure data on behalf of providers to CMS for PQRS reporting 29
GIQuIC Questions: GIQuIC Laurie Parker, GIQuIC Executive Director lparker@gi.org QualityNet Help Desk qnetsupport@hcqis.org 866-288-8912 30 gmed 30Summit 2015
Where are things going? Erin Dettrey- Product Manager, Analytics
Real Time Performance Monitoring Immediate feedback Workflow Changes Improved VBM quadrant positioning Minimize Risk of reduction Know your data
Integration of Industry Benchmarks MGMA, gbenchmark, CMS, Triple Society..
Thank you.