Using Practice Fusion for PQRS EHR Reporting in 2014

Editor's Notes

• #2: Hello everyone and thank you for joining me today to learn about using Practice Fusion for PQRS EHR Reporting in 2014.
• #3: This video will address the following items related to PQRS EHR Reporting in 2014: An overview of PQRS requirements in 2014 Requirements for PQRS EHR Reporting Measure selection and EHR reporting applicability Detailed Deep Dive into Practice Fusion PQRS CQMs PQRS FAQs Resources
• #4: The Physician Quality Reporting System, or PQRS, is a CMS quality improvement program that uses a combination of incentive payments and penalties to promote reporting of quality data. Providers are eligible for participation in PQRS if they are reimbursed under the Medicare Physician Fee Schedule (PFS) and see Medicare Part B patients. This includes physicians, chiropractors, dentists, PAs, NPs, and other eligible practitioners and therapists. Under PQRS, payment incentives and penalties are determined based on eligible professional services that are paid under or based on the Medicare Physician Fee Schedule.
• #5: Your PQRS participation in 2014 determines both your potential payment incentive and possible adjustment penalties that will effect future Medicare reimbursements. Note that 2014 is the last year to earn a PQRS incentive payment, and payment penalties will continue to compound at 2% starting with participation this year. As you can see, reporting in 2014 can result in either a 0.5% payment incentive or a 2.0% payment adjustment that would be applied in 2016. Note that starting this year, the payment penalty increases to 2.0% of your Medicare Part B reimbursements each year moving forward.
• #6: PQRS is very complex - PQRS requirements vary based on the reporting mechanism that you choose. The complexities are good in that you have more options, but it also means that you need to become familiar specific requirements that apply to the option that you are using. PQRS requirements are specific to each calendar year – eligible PQRS measures, G-codes, reporting requirements, etc. may change from year to year, so make sure you refer to 2014 resources and materials PQRS actions don’t roll-over – You may have acted last year for PQRS, but that doesn’t mean you can get out of taking action this year. Reporting this year applies to 2016 reimbursements, reporting last year will be applied to 2015 reimbursements.
• #7: As reflected in the 2014 Medicare Physician Fee Schedule final rule, which went into effect on January 1, 2014, CMS has greatly increased the reporting requirements for providers who wish to earn the 2014 PQRS payment incentive. To qualify for the 2014 PQRS incentive, you must use one of the following reporting options and report the required number of measures as described: Claims-Based Reporting involves reporting quality data codes, or g-codes, on Medicare claims. Registry-based reporting is used when a provider registers or connects with a data registry. Qualified Clinical Data Registry reporting - New for 2014, the QCDR method provides a new standard to satisfy PQRS requirements based on satisfactory participation. A QCDR is a CMS-approved entity (such as a registry, certification board, collaborative, etc.) that collects medical and/or clinical data for the purpose of patient and disease tracking to foster improvement in the quality of care furnished to patients. The data submitted to CMS via a QCDR covers quality measures across multiple payers and is not limited to Medicare beneficiaries. The Group Practice Reporting Option, or GPRO, is available for group practices of two or more providers with a single Tax ID number. Group practices who wish to report via the GPRO web interface or GPRO registry reporting option must register with CMS and reporting is done via a web interface tool or providers can report via a registry as a group. Providers who report via GPRO will have their PQRS measure results posted publically on the CMS Physician Compare website. EHR Reporting option is available to providers using an EHR that has been certified to the most recent versions of the quality measures. Practice Fusion’s EHR has been certified to the most recent version of the CQMs, so any of the current CQMs can be used for PQRS if you meet the reporting requirements. This video will focus on the requirements related to PQRS EHR Reporting and how providers who wish to use this option with Practice Fusion should move forward.
• #8: EPs can earn a 2014 PQRS incentive and avoid the 2016 PQRS payment adjustment by meeting the following criteria for satisfactory reporting: Using a direct EHR product that is Certified EHR Technology (CEHRT) or EHR data submission vendor that is CEHRT, report on at least 9 measures covering 3 National Quality Strategy (NQS) domains If the EP’s CEHRT does not contain patient data for at least 9 measures covering at least 3 domains, then the EP must report the measures for which there is Medicare patient data. An EP must report on at least 1 patient for which there is Medicare patient data. If an EP satisfactorily reports for 2014 PQRS using the EHR-based reporting option, (s)he will also satisfy the CQM component of the EHR Incentive program; however, EPs will still be required to meet the other Meaningful Use objectives through the Medicare EHR Incentive Program Registration and Attestation System. Using the 2014 EHR reporting mechanism for PQRS and for MU will result in MU incentive payments being delayed until after the PQRS measures are reporting to CMS in 2015.
• #12: The measures in 2014 PQRS address various aspects of care, such as prevention, chronic- and acute-care management, procedure-related care, resource utilization, and care coordination. Measure selection should begin with a review of the 2014 Physician Quality Reporting System (PQRS) Measures List to determine which measures, associated domains, and reporting option(s) may be of interest to the practice and applicable to the EP or group practice. Please note, not all measures are available under all of the PQRS reporting options. EPs or group practices should avoid individual measures that do not or may infrequently apply to the services they provide to Medicare patients. The measures list is available as a downloadable document from the Measures Codes section of the CMS PQRS website. The following factors should be considered when selecting measures for reporting: • Clinical conditions usually treated • Types of care typically provided – e.g., preventive, chronic, acute • Settings where care is usually delivered – e.g., office, emergency department (ED), surgical suite • Quality improvement goals for 2014 • Other quality reporting programs in use or being considered
• #15: Diagnosis of hypertension must occur at least 6 months prior to the uncontrolled blood pressure. Providers should not be “dinged” for uncontrolled BP that occurs immediately the diagnosis of hypertension.
• #16: This timeline is helpful for understanding how this measure looks at hypertension diagnosis and blood pressure. Please note that this CQM is not intended to encompass all potential hypertensive patients, but rather this measure is looking specifically to see that providers can control the blood pressure of their hypertensive patients within the first 6 months of diagnosis.
• #17: Put in some examples of high-risk medications.
• #18: This measure looks to see what prescriptions have been written for this patient during the measurement period (or calendar year), even if they have been stopped. Examples of high risk medications as defined by this measure include certain dosages and strengths of: Acetaminophen Butabarbital sodium Diphenhydramine Hydrochloride Estrogens For a complete list of the medications defined as “high-risk” please refer to the Value Set group called “High Risk Medications for the Elderly” which can be accessed at www.ushik.org
• #20: More Measure Details Examples of smoking cessation interventions that you can choose are “smoking cessation education (procedure)” or “referral to stop smoking clinic (procedure)” The smoking cessation intervention that is added to the chart can be “performed” or “ordered” and a result is not needed to receive credit for this measure.
• #21: Colorectal cancer screenings can be recorded in the patient chart in the Screenings/ Interventions/Assessments section or by receiving structured lab results. Patients are identified as having a visit during the measurement period if they have a signed chart note labeled with an encounter type of “office visit.” To record the colorectal cancer screening, search for the screening that the patient received and select the appropriate screening. Use the modal to indicate that the screening was “performed” and the date that the screening occurred. For patients given a Fecal Occult Blood Test (FOBT), they will be included in the numerator once a structured lab result is received in the EHR. Only screenings that occur during the appropriate timeframe listed in the numerator description will receive numerator credit for this measure.
• #22: To record the colorectal cancer screening, search for the screening that the patient received and select the appropriate screening. Use the modal to indicate that the screening was “performed” and the date that the screening occurred. For patients given a Fecal Occult Blood Test (FOBT), they will be included in the numerator once a structured lab result is received in the EHR. Only screenings that occur during the appropriate timeframe listed in the numerator description will receive numerator credit for this measure. CMS has created the 2014 electronic clinical quality measures (eCQMs) to have more rigorous data collection requirements than previous Meaningful Use quality measures. As such, there are some limitations in how Practice Fusion can collect data for purposes of CQM calculations and reporting. An example of this is that CMS requires an actual lab result when a measure requires a performed FOBT test (or result). While we are working with our lab partners to increase how many send structured LOINC codes to identify these tests, we are also working with those lab partners to map and identify test results that come in with local laboratory codes so that we can properly give credit when we are able to.
• #24: More Measure Details This measure looks to see if providers are avoiding unnecessary imaging tests for patients with low back pain. Examples of eligible diagnoses for “low back pain” include: Sciatica, unspecified side Low back pain Lumbago Backache, unspecified Because this measure is looking to see whether an imaging test is performed within 28 days of diagnosis, you will not see any values for this numerator until at least 29 days after the encounter where the patient was diagnosed.
• #26: More Measure Details For this measure, the patient must have received the eye exam from an eligible eye professional. After determining that the patient has had this exam from a eligible eye professional, search and choose the applicable exam, indicate that it was performed and on what date, and if you choose, include a note about the provider in the comments section.
• #28: More Measure Details The data element “Diabetic foot exam (visual, sensory, and pulse)” has been mapped to the coded values for all three exams required for this measure. Instead of adding each exam individually, after confirming or performing the visual, sensory, and pulse foot exams, select the option highlighted in green above to get credit in the numerator.
• #31: Patients who meet the denominator criteria should be screened for depression using an age-appropriate depression screening instrument. After conducting the appropriate screening record “Adult [or Adolescent] depression screening assessment” in the Screenings /Interventions /Assessments section. If positive, record the appropriate follow-up plan in the same section.   Examples of data elements that meet the requirements for a follow-up plan include “Mental health care education (procedure),” “Referral to psychologist (procedure),” and “Case management follow up (procedure).”
• #32: Many of our customers have asked us about whether screenings that are suggested using clinical decision support are required for some specialties. If you are a specialist that doesn’t conduct depression screenings, you may see your denominator increase but not your numerator. This is perfectly acceptable as it is a known fact that not all specialties will conduct all preventative screenings. Since zero values are acceptable for MU, this will not prevent you from attesting successfully. If you wish, you can turn off the CDS alerts for depression screening in the clinical decision support settings section of the EHR, but make sure you have the minimum amount of alerts enabled as needed for your stage of MU.
• #34: More Measure Details This measure requires that you attest at each patient encounter that you have checked the patient’s current medication list and that it is up to date. Checking this checkbox not only allows you to document this attestation for the purposes of accurate documentation and calculations, it can also be used if you are ever audited to prove that you completed this clinical action.
• #36: Practice Fusion automatically calculations BMI for patients how have height and weight recorded in the EHR. Note that only BMIs that are less than 6 months old (meaning the patient had an encounter where height and weight were recorded sometime in the past 6 months) are eligible for numerator credit in this measure.
• #37: Must document the follow-up plan, either ordered or performed, and then provide a REASON for why the follow-up plan is being recorded. This reason will be either because the BMI falls above the normal parameters or because the BMI falls below the normal parameters. This information is entered in the Screenings/Assessments/Interventions section after the appropriate follow-up plan is selected.
• #39: More Measure Details Check the box in the referral tab to indicate that you have received the follow-up report from the specialist. This checkbox is tied to the appropriate codes in the database for CQM calculations. This measure is primarily targeted to primary care providers who are referring patients to specialty providers, however, providers who are specialists who also refer can track referral loops using this feature and can report on this CQM for PQRS.
• #45: We will now answer some questions submitted by you all during the course of the presentation.
• #46: We will now answer some questions submitted by you all during the course of the presentation.
• #47: We will now answer some questions submitted by you all during the course of the presentation.
• #48: We will now answer some questions submitted by you all during the course of the presentation.