The importance of accurate data cannot be underestimated in the healthcare business world right now.  The development and use of a PQRS (Physician Quality Reporting System) report for your practice will mean not only incentive payment but also avoidance of penalties.

In 2013, eligible professionals (EPs) may earn an incentive payment of 0.05% for successfully reporting PQRS measures. CMS has announced that the following entities have become qualified for purposes of 2013 PQRS Maintenance Certification Program Incentive. Included in this group are either entities that have participated in a vetting process to ensure the Maintenance of Certification Programs they represent meet the requirements for participation, or will use a previously qualified registry to submit data on their behalf:

American Board(s) of Allergy & Immunology, Dermatology, Internal Medicine, Ophthalmology, Optometry, and Osteopathic Association.

In order to qualify for this incentive, based on the reporting period of January 1, 2013  – December 31, 2013 the physician will need to meet the following criteria:

• Satisfactorily submit data on quality measures as an individual physician or as a member of a group practice.
• There are  138 individual measures, with the biggest change for 2013 being PQRS measure #124 Adoption/Use of EHR.
• The eligible professional more frequently than is required, participates in and successfully completes a qualified Maintenance Certification Program practice assessment for a year.
• Information on the survey of the patient experience with care; and
• The methods, measures, and data used under the Maintenance of Certification Program and the qualified Maintenance of Certification Program practice assessment.
• Participate in educational and self-assessment programs that require assessment of what was learned;
• Demonstrate through a formalized secure examination, that the physician has fundamental diagnostic skills, medical knowledge, and clinical judgment to provide quality care in their respective specialty.

The 2013 PQRS incentive eligibility will also include a validation process.  Under the claims based reporting method of individual measure(s), the determination of satisfactory reporting will itself serve as a general validation because the analysis will assess whether quality-data codes (QDCs) are appropriately submitted in a sufficient proportion of the instances when a reporting opportunity exists.  In addition for those EPs who submit QDCs for fewer than three PQRS measures, a measure-applicability validation (MAV) process will determine whether they should have submitted QDCs for additional measures.

CMS will apply a two-step process to operationalize measure-applicability validation: (1) a “clinical relation” test and (2) a “minimum threshold” test.  Those who fail the validation process will not earn the incentive payment for 2013 and may be subject to a 2015 1.5% payment adjustment.

“Your practices ability to collect, analyze and report required data will become the key to PQRS success.“

Medical Management Services has developed the reports to track how each eligible professional has progressed with the measures they are reporting on.  These reports have been shared with practice management of multiple specialties and practices on a quarterly basis.
Give us a call if your practice needs help in developing, reporting and/or analyzing of this very specific data to conform to the PQRS guidelines.

Written by Matt Porter – Executive Consultant for Medical Management Services