PQRI Special Open Door Forum in Collaboration with the American Gastroenterological Association AGA

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PQRI Special Open Door Forum in Collaboration
with the American Gastroenterological Association
(AGA) Institute

• Tuesday, September 23, 2008
• 2-330 p.m. EDT

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Doing Well by Doing Good

• Simple Steps
• Collect and Report Quality Data
• Earn a Medicare Bonus Payment

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Conference Leaders

• Daniel Green, MD (CMS)
• Mary Igo, RN, MBA (AGA Institute)
• Joel Brill, MD, AGAF (AGA Institute)

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Topics

• Basic concepts
• Preparing for 2009 PQRI participation
• GI measures development for PQRI
• GI measures details and specifications
• Question and Answer Session

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Basic Concept

• Select quality measures that are important to
  your practice and patients
• Establish processes to systematically report the
  quality measures for each eligible patient
• Reporting mainly done by including a quality code
  on claim or through registries
• Receive feedback on extent to which patient got
  the recommended care described in the quality
  measure
• Receive modest payment for effort
• Use process to facilitate practice and patient
  care improvements

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PQRI Background - 2007 Program

• Federal law enacted in December 2006 established
  PQRI
• PQRI 2007 pays physicians 1.5 bonus for
  reporting quality measures July 1 December 31,
  2007
• Select up to three measures applicable to
  practice from a list of 74 and report on 80 of
  eligible encounters for each measure selected
• Report against measures on standard CMS claim
  form
• CMS determines who reported successfully
• CMS pays bonus and provides reporting/performance
  score feedback in mid-2008

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Update on PQRI 2007 Status

• Incentive payments for successful 2007 reporting
  issued mid-late July 2008
• Payments issued to Tax ID Number (TIN) for all
  associated physicians who earned bonus
• Feedback reports available in July that provided
  reporting/performance score for each individual,
  for group, and national averages for comparison
• Feedback reports are generated for all providers
  that reported a quality data code regardless of
  whether or not he/she received a bonus
• Individual physician or designated staff person
  needs to register with secure system to access
  confidential reports
• CMS has mechanisms to help physicians with
  registration and receipt of reports

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PQRI 2008 Program

• Congress passed December 2007 law continuing PQRI
  for 2008
• Includes many features of the 2007 PQRI program
• Report codes for individual quality measures
• Report on up to three individual measures for at
  least 80 of eligible encounters
• Earn a 1.5 bonus
• Additional changes/enhancements for 2008 PQRI
• Expansion from 74 to 119 measures
• Addition of two structural measures
• Additional reporting options
• No cap on the bonus incentive

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Why Participate in PQRI 2008

• Increase your ability to track patients with
  common conditions through practice management
  systems
• Promote team care and identify team member roles
  and responsibilities
• Collect clinical information at the point of
  care, as opposed to retrospective chart review
• Reporting quality codes on claims involves
  minimal burden when systems in place
• Measures can act as reminders for certain care
  actions

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Why Participate in PQRI 2008

• Learn about ability to routinely provide
  evidence-based care relevant to your patients
• Receive modest payment
• Gain experience in reporting and measuring
  against quality measures
• Programs likely to continue, and even grow, for
  Medicare and private payers
• PQRI experience to inform and be a component of
  broader quality improvement strategy

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Why participate in PQRI in 2009

• Increase to 2 from 1.5 bonus incentive
• The bonus incentive is contingent on
• achieving 80 percent success for patients that
  have a disease/diagnosis that a quality measure
  you selected is being reported for and
• achieving that success rate for three quality
  measures (or fewer measures if less apply to your
  practice). 

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PQRI Update

• Medicare Improvements for Patients and Providers
  Act of 2008 (MIPPA)
• - Passed in July 2008
• - Makes PQRI permanent however only 2009 and
  2010 incentives are funded
• - Increased 2009 PQRI incentive to 2
• - Added new E-Prescribing incentive for 2009, an
  additional 2 subject to qualifying for the
  measure
• - Additional provisions for PQRI 2010 and beyond

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2008 PQRI GI Measures

• Hepatitis C
• Measures in 2008 PQRI based on AQA Alliance
  adoption
• GERD
• One measure on GERD medication management in 2008
• Four measures in 2007 PQRI were not carried over
  into 2008 as not endorsed by NQF
• Weight Screening
• One measure on BMI screening in 2008

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2008 Measures

• Measure 77 GERD medication management
• Measures 83-90 - Treatment and Management of
  Hepatitis C
• Measure 113 Colorectal cancer screening
• Measure 124 - Health Information Technology
  (HIT) Adoption/Use of Health Information
  Technology (Electronic Health Records)
• Measure 125 - Health Information Technology
  (HIT) Adoption/Use of e-Prescribing
• Measure 128 BMI Screening

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GERD - Measure 77

• Assessment of GERD Symptoms in Patients Receiving
  Chronic Medication for GERD
• Percentage of patients aged 18 years and older
  with the diagnosis of GERD who have been
  prescribed continuous PPI or H2RA therapy who
  received an annual assessment of their GERD
  symptoms after 12 months of therapy

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Hepatitis C - Measure 83

• Testing of Patients with Chronic Hepatitis C
  (HCV) for Hepatitis C Viremia
• Percentage of patients aged 18 years and older
  with a diagnosis of hepatitis C seen for an
  initial evaluation who had HCV RNA testing
  ordered or previously performed

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Hepatitis C - Measure 84

• Initial Hepatitis C RNA Testing
• Percentage of patients aged 18 years and older
  with a diagnosis of chronic hepatitis C who are
  receiving antiviral treatment for whom
  quantitative HCV RNA testing was performed within
  6 months prior to initiation of treatment

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Hepatitis C - Measure 85

• HCV Genotype Testing Prior to Therapy
• Percentage of patients aged 18 years and older
  with a diagnosis of chronic hepatitis C who are
  receiving antiviral treatment for whom HCV
  genotype testing was performed prior to
  initiation of treatment

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Hepatitis C - Measure 86

• Consideration for Antiviral Therapy in HCV
  Patients
• Percentage of patients aged 18 years and older
  with a diagnosis of chronic hepatitis C who were
  considered for peginterferon and ribavirin
  therapy within the 12-month reporting period

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Hepatitis C - Measure 87

• HCV RNA Testing at Week 12 of Therapy
• Percentage of patients aged 18 years and older
  with a diagnosis of chronic hepatitis C who are
  receiving antiviral treatment for whom
  quantitative HCV RNA testing was performed at 12
  weeks from the initiation of antiviral treatment

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Hepatitis C - Measure 88

• Hepatitis A and B Vaccination in Patients with
  HCV
• Percentage of patients aged 18 years and older
  with a diagnosis of hepatitis C who were
  recommended to receive or who have received
  hepatitis A vaccination or who have documented
  immunity to hepatitis A AND who were recommended
  to receive or have received hepatitis B
  vaccination or who have documented immunity to
  hepatitis B

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Hepatitis C - Measure 89

• Counseling Patients with HCV Regarding Use of
  Alcohol
• Percentage of patients aged 18 years and older
  with a diagnosis of hepatitis C who received
  education regarding the risk of alcohol
  consumption at least once within the 12-month
  reporting period

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Hepatitis C - Measure 90

• Counseling of Patients Regarding Use of
  Contraception Prior to Starting Antiviral Therapy
  
• Percentage of female patients aged 18 through 44
  years and all men aged 18 years and older with a
  diagnosis of chronic hepatitis C who are
  receiving antiviral treatment who were counseled
  regarding contraception prior to the initiation
  of treatment

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CRC Screening - Measure 113

• Colorectal Cancer Screening
• Percentage of patients aged 50 through 80 years
  who received the appropriate colorectal cancer
  screening

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EHR Adoption - Measure 124

• HIT- Adoption/Use of Health Information
  Technology (Electronic Health Records)
• Documents whether provider has adopted and is
  using health information technology. To qualify,
  the provider must have adopted a qualified
  electronic medical record (EMR) that is either
  CCHIT certified or capable of all of the
  following
• Generating a medication list
• Generating a problem list
• Entering laboratory tests as discrete searchable
  data elements

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E-Prescribing - Measure 125

• HIT- Adoption/Use of e-Prescribing
• Documents whether provider has adopted a
  qualified e-Prescribing system and the extent of
  use in the ambulatory setting. To qualify this
  system must be capable of ALL of the following
• Generating a complete active medication list
• Selecting medications, printing prescriptions,
  electronically transmitting prescriptions, and
  conducting all safety checks
• Providing information related to the availability
  of lower cost, therapeutically appropriate
  alternatives (if any)
• Providing information on formulary or tiered
  formulary medications, patient eligibility, and
  authorization requirements from the patients
  drug plan

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BMI Screening - Measure 128

• Universal Weight Screening and Follow-Up
• Percentage of patients aged 65 years and older
  with a calculated Body Mass Index (BMI) within
  the past six months or during the current visit
  that is documented in the medical record and if
  the most recent BMI is 30 or
  plan is documented

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Proposed 2009 PQRI GI Measures

• Hepatitis C
• Proposed / modified for 2009 based on NQF
  endorsement
• GERD
• GERD medication management in 2009 Proposed Rule
  measure set
• Weight Screening
• One measure on BMI screening in 2009 proposed
  measure set
• Endoscopy
• Surveillance Colonoscopy Interval for Patients
  with a History of Colonic Polyps- Avoidance of
  Inappropriate Use
• Developed via PCPI process
• Adopted by AQA Alliance
• In 2009 proposed rule measure set

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Potential Changes in 2009 Measures

• Hepatitis C
• Hepatitis A and B vaccinations proposed as two
  separate measures (NQF endorsed as paired
  measures)
• Measures 84 (Hepatitis C RNA Testing before
  Initiating Treatment) and 85 (HCV Genotype
  Testing Prior to Treatment) NQF endorsed as
  paired measures
• Health Information Technology (HIT) Adoption/Use
  of e-Prescribing
• Could be eliminated as e-Prescribing requirements
  are implemented
• Endoscopy Polyp Surveillance Surveillance
  Colonoscopy Interval in Patients with History of
  Adenomatous Polyps
• Watch for measure specifications

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Endoscopy and Polyp Surveillance

• Surveillance Colonoscopy Interval for Patients
  with a History of Colonic Polyps- Avoidance of
  Inappropriate Use
• Percentage of patients aged 18 years and older
  receiving a surveillance colonoscopy, with a
  history of a prior colonic polyp in previous
  colonoscopy findings who had a follow-up interval
  of 3 or more years since their last colonoscopy
  documented in the colonoscopy report

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PQRI and Fee Schedule Update

• The 2009 Physician Fee Schedule (PFS) proposed
  rule
• - Includes the measures proposed for 2009 PQRI
• - Measures for 2009 PQRI will be published in
  Final PFS rule in November

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2008 Reporting Options Overview

• Alternate reporting periods and criteria
  significantly increases participation/reporting
  options
• January 1 - December 31, 2008 (12 months)
• July 1 - December 31, 2008 (6 months)
• Total of 9 PQRI reporting methods
• 3 claims-based
• 6 registry-based

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Claims-Based Options

• Reporting period January 1 December 31,
  2008
• Option 1 Report individual quality measures
  report on three quality measures for 80 of
  eligible patients
• Reporting period July 1 December 31, 2008
• Option 2 Report a measure group for 15
  consecutive eligible patients
• Option 3 Report a measure group for 80 of
  eligible patients over the six month period

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Reporting Individual Quality Measures

• If you have reported on three individual quality
  measures through claims for the first half of
  2008, continue to do so
• If reported in 2007, use CMS reporting/performance
  feedback from that year to assess whether to
  adjust 2008 participation
• CMS/AMA measure-specific PQRI Data Collection
  Worksheets are available at http//www.ama-assn.
  org/ama/pub/category/17493.html
• Bonus payment for full-year successful reporting
  is 1.5 of Medicare allowed charges over the 12
  month reporting period

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Reporting Individual Quality Measures

• Its not too late to start reporting individual
  quality measures and hit the 80 threshold of
  eligible cases
• Requires a systematic way to identify those
  patients when they come in to the office
• Assess whether patients eligible for selected
  measures have been seen in the office in the
  first six months of year/are likely to be seen in
  second half of the year
• May report a measures group or 15 consecutive
  patients (i.e., Preventive Care)

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Measure Group Reporting

• A measure group is a group of individual measures
  covering patients with a particular condition or
  preventive services
• Report applicable measures in a measure group for
  15 consecutive eligible beneficiaries OR
• Report applicable measures in a measure group for
  80 of eligible beneficiaries during six-month
  reporting period
• Can earn bonus even if failed to report on 15
  consecutive beneficiaries
• Provides a potentially more straightforward
  reporting method
• Bonus payment for successful reporting is 1.5 of
  Medicare allowed charges over the six month
  reporting period
• No measure group specifically geared to GI, but
  can report Preventive Care measure group

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Registry-Based Options

• CMS will accept quality information reported from
  a clinical registry on behalf of physicians
• Registries collect physician-submitted data,
  typically related to a clinical condition or
  specialty but general registries are available
  (see CMS website)
• Registry data can be used a number of ways to
  earn a PQRI bonus payment
• Registry data for up to three individual measures
  for 80 of eligible encounters over the full year
  or last six months
• It can be used for a measure group for 30 or 15
  consecutive patient or 80 of measure group
  eligible cases
• Nature and duration of reporting determines if
  bonus payment is equal to allowed charges for 12
  or 6 months
• No GI specific registry at this time but there
  are registries collecting GI related PQRI
  measures data

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If You Submit Quality Data to a Registry

• Check the CMS website at www.cms.hhs.gov/PQRI and
  click the reporting tab for a list of qualified
  registries.
• Contact a registry to see if they will report the
  measures you want to report and for the reporting
  period you want to report.
• Express your interest in having your data
  submitted for purpose of PQRI

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How to Submit Claims

• To participate in PQRI, you must have a NPI
  number.
• You can submit claims for PQRI measures
  electronically or on a paper CMS-1500 form.
• You will need to provide your NPI number in the
  Rendering Provider field on the claim.
• Quality-data code line items must be submitted
  with a charge of 0.00 or 0.01.

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Steps in Reporting Process

• Select the measures/measure option you will use
• Enlist team and assign roles and responsibilities
  
• Put systems in place to facilitate
  reporting/quality improvement, e.g. registries,
  reminders, standing orders
• Use a coding tool/worksheet
• Attach a copy of the coding tool/worksheet to the
  super-bill to alert coder to enter appropriate
  quality codes
• Coder verify patient eligibility, pertinent
  encounter, and correct quality codes

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Steps in Reporting Process

• Include the NPI for each physician on claim
• Keep a log of information for QI
• Analyze your own data to improve
• Use experience to establish/refine systems aimed
  at improvement
• Look for other opportunities and bonus payments
  in your market
• Cultivate a positive environment for quality
  improvement

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Minnesota GastroenterologyPQRI Experience
2007-2008

• Providers
• 56 Physicians
• 21 NP/PAs
• 2006 Quality Measure for Compensation
• Clinical
• Business 30 - 100

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Implementation 2007

• Identified Measures
• EMR Implementation
• Communication
• Email
• Fair Process
• Pop-up Screen With Questions
• Not Mandatory

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2007 Measures

• GERD 60 61 62
• Encounters Lots 231 369
• Compliance

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Implementation 2008

• Mandatory Fields
• GERD Measure 77 98.8
• Hep A B Measure 88 91.7
• Adoption of EMR Measure 124 100

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Minnesota Gastroenterology Data Collection Tools
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Minnesota Gastroenterology Data Collection Tools
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Question and Answer Session
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For More Information

• Visit the AGA Institute
• Center for Quality in Practice at
  www.gastro.org/quality for the latest updates on
  PQRI and other reporting programs.
• Questions may be submitted to pqri_at_gastro.org