Understanding PQRS and why reporting via an anesthesia QCDR is beneficial

1. Understanding PQRS and why reporting via an anesthesia QCDR is beneficial

2. Claims and the QCDR: Avoiding the Payment Adjustment Presented by: Matthew T. Popovich, Ph.D.Quality SpecialistAmerican Society of Anesthesiologists

3. Physician Quality Reporting System (PQRS) • Physician Quality Reporting System • What is the program? • Incentives and Payment (Negative) Adjustments • Reporting Options (Including the QCDR) • CMS Rulemaking Process • 2014 Physician Fee Schedule (PFS) • 2015 Proposed PFS • Final Rule (est. November 2014)

4. Physician Quality Reporting System (PQRS) • Defining PQRS • “Paid under or based on the Physician Fee Schedule” • Eligible Professionals (EPs) • Payment Incentives (ending in 2014) v. Payment Adjustments • Common Measures Reported by Anesthesiologists • #30 (NQF #0269): Timing of Prophylactic Antibiotic • #44 (NQF #0236): Preoperative Beta-Blocker in Patients with Isolated CABG Surgery • #76 (NQF #0464): Prevention of Catheter-Related Bloodstream Infections (CRBSI): Central Venous Catheter (CVC) Insertion Protocol • #193 (NQF #0454): Perioperative Temperature Management

5. Satisfactorily Report = Avoid the Payment Adjustment • Reporting Options (2014 & Proposed 2015) • Claims • Qualified Clinical Data Registry (QCDR) • “Traditional” Qualified Registry • Other Reporting Options • Alignment of Measure Reporting Requirements • Nine (9) quality measures • Three (3) National Quality Strategy (NQS) domains

6. Satisfactorily Report = Avoid the Payment Adjustment • National Quality Strategy Domains • Patient Safety • Person and Caregiver-Centered Experience and Outcomes • Communication and Care Coordination • Effective Clinical Care • Community / Population Health • Efficiency and Cost Reduction • Anesthesia Measures (Claims) • Patient Safety (PQRS #30, #76 and #193) • Effective Clinical Care (PQRS #44)

7. Satisfactorily Report = Avoid the Payment Adjustment • Satisfactorily Reporting – Claims (2014): • EPs must report ≥ 9 PQRS measures covering ≥ 3 NQS domains to qualify for an incentive payment for 50% of Medicare Part B patients for whom the measure applies • If fewer than 9 measures, then EP is subject to the Measure-Applicability Validation (MAV) process • EPs must report ≥ 3 measures in order to avoid the payment adjustment for 2016 • Subject to MAV process

8. Satisfactorily Report = Avoid the Payment Adjustment • Qualified Clinical Data Registry (QCDR) • Use of Established Specialty Society Registries • PQRS and non-PQRS Measures • AQI/NACOR: 8 PQRS and 11 Non-PQRS Measures • AQI/NACOR: 4 NQS Domains Available • QCDR Responsibilities

9. Satisfactorily Report = Avoid the Payment Adjustment • Claims-Based Reporting Challenges (Beyond 2014): • PQRS Measures for Consideration • PQRS #30, PQRS #109 • Potentially fewer measures to report via claims

10. Satisfactorily Report = Avoid the Payment Adjustment • QCDR Incentive Requirements (2014) • Report at least 9 measures covering at least 3 NQS domains AND report each measure for at least 50% of EP’s applicable patients seen during reporting period • One measure must be an outcome measure

11. Satisfactorily Report = Avoid the Payment Adjustment • QCDR Reporting Requirements • Avoid the payment adjustment (2016) • [For CY 2014] Report at least 3 measures covering at least 1 NQS domain for at least 50 percent of the EP’s applicable patients seen during the participation period

12. Satisfactorily Report = Avoid the Payment Adjustment • Avoid the payment adjustment (2017) • CMS PROPOSED: “For the 12-month reporting period [CY 2015] for the 2017 PQRS payment adjustment, the EP would report at least 9 measures available for reporting under a QCDR covering at least 3 of the NQS domains, AND report each measure for at least 50 percent of the eligible professional’s patients.” • Report 3 outcome measures or 2 outcome measures and at least 1 resource use, patient experience or efficiency/appropriate use measure

13. Resources • Learn and Understand PQRS • CMS PQRS Website (www.cms.gov/pqrs) • CMS QualityNet Help Desk (866-288-8912 or qnetsupport@hcqis.org) • ASA & AQI Member Resources • Quality and Regulatory Affairs (qra@asahq.org) • Anesthesia Quality Institute (http://www.aqihq.org/qcdr) • ASA web site (www.asahq.org/qcdr )

14. The Qualified Clinical Data Registry Presented by:Lance MuellerDirector Anesthesia quality institute

15. The Challenge The government wants to know that Ma and Pa are getting the health care they deserve… and that our taxes pay for.

16. Institute of Medicine report published in late 1999 • Highlighted preventable errors in the US healthcare system • “100,000 lives a year lost to preventable death” • Anesthesiology cited as leaders in advancing patient safety

17. The Physician Quality Reporting System • Individual physicians • For public reporting • Approved measures • Submitted and maintained by ‘stewards’ • Vetting through National Quality Forum • “Claims made” reporting • Scored by CMS • Incentives >>> penalties

18. “Pay for Performance” • Federal programs to promote quality over quantity in the delivery of healthcare • Based on measuring outcomes • Public reporting • Payment adjustments (penalties) >>> Incentives • Hospitals • Physicians

19. Key Points Pay for Performance programs are evolving over time What was true last year will not be true next year Complexity is increasing ASA (and all physician societies) must seize opportunities to guide this evolution ASA has worked hard to provide a solution for the profession

20. The Evolution of P4P From Process Measures To Outcomes

21. The Evolution of P4P From Big hospitals To Small hospitals, surgery centers, clinics and offices

22. The Evolution of P4P From Inpatients To ALL patients

23. The Evolution of P4P From Medicare only To ALL payers including Medicare Advantage, Medicaid

24. The Evolution of P4P From Incentives To Penalties

25. The Evolution of P4P From Clinical Safety Focused To Patient Centered

26. The Evolution of P4P From Individuals To Teams

27. The Evolution of P4P From Paper To Electrons

28. The Evolution of P4P From A demonstration project To The way we do business

29. The QCDR Qualified Clinical Data Registry New in 2014 A reporting mechanism for registry participants Similar to the registry reporting option for PQRS / VM Can use PQRS measures Can use non-PQRS, specialty specific measures

30. Why the QCDR is a big deal Measure definition by the specialty, for the specialty Data collection and scoring moves from CMS to the registry “One stop shop” for all requirements Public reporting by the society

31. The Anesthesiology Perspective The National Anesthesia Clinical Outcomes Registry (NACOR) is certified as a QCDR Available measures for perioperative care increased from 4-8 in PQRS to 19 4 domains, multiple outcome measures

32. Where Did New Anesthesia Measures Come From? • Existing in PQRS • Solves the stewardship problem • Existing in NQF • New measures mostly developed by ASA’s Committee on Performance and Outcome Measures (CPOM) • Developed, but never selected • Developed, but never submitted • Subspecialty possibilities • Aspirational measures

33. AQI as a QCDR • The Centers for Medicare and Medicaid Services (CMS) introduced the Qualified Clinical Data Registry (QCDR) as a reporting option in 2014. • 2015 Medicare Physician Fee Schedule Proposed Rule: • To avoid future payment adjustments an EP will have to report on 9 measures including 3 outcomes across 3 NQS domains. • The addition of QCDR reporting allows specialty societies to develop measures that reflect profession-specific priorities.

34. Performance Reporting through the QCDR • 2015 Anesthesia QCDR reporting is a product of ASA in partnership with AQI • ASA sells the service • AQI reports to CMS on behalf on the group and it’s EP’s • AQI provides monthly PQRS feedback reports • Groups must be participating in AQI and receive all benefits of participation • Free to ASA members who are participating in AQI’s NACOR registry • Additional charge for Eligible Professionals (EP) who are non-ASA members

35. QCDR Reporting Requirements. You Must: • Be a NACOR participant • If you are already participating – see next slide • If you are not already participating in NACOR steps include: • Completion of a Business Associate Agreement with the AQI • Completion of the AQI practice survey • Transmission of electronic data to the registry beginning in January 2015 • Pay AQI membership dues

36. QCDR Reporting – Steps to Report • Self-nomination with AQI for QCDR reporting in early 2015 (more details forthcoming) • Work with AQI to ensure proper data is being sent • AQI has staff to review your data and reports to ensure EP’s are reporting and have a reasonable expectation of satisfactorily reporting • Approve the final transmission of EP performance data to CMS (early 2016)

37. ASA QCDR Service Presented by:Terri Howard, CAEDirector of Member Services

38. ASA QCDR Service Definition of the service Costs associated with participating in QCDR Enrollment and membership processes Who to contact if interested in participating

39. ASA QCDR • ASA has partnered with AQI to provide PQRS reporting as a benefit of ASA membership. • To participate in QCDR, the entire practice enrolls in AQI’s NACOR. • ASA members: no cost to participate in NACOR • Non-ASA member independent providers: $1000 annually to participate • Non-physician providers in the care team: no cost to participate

40. ASA Membership / QCDR Purchase • Group Membership / QCDR Invoice • One invoice for all participating providers in the practice • Membership: Both ASA and state component society dues are required • ASA membership = $665 physicians, $335 CRNAs, AAs; state dues varies • Non-ASA members purchase QCDR only = $295 per provider annually

41. Enrollment Process • Submit roster template of participating EPs • Practice may add/subtract providers throughout the year • Sign AQI & ASA agreements • Work with AQI to submit data to NACOR • Submit new ASA member applications, as applicable • Practice reviews the roster prior to annual renewal of membership and QCDR service

42. Questions?

43. Getting Started • Contact ASA • Sara Moser, Director of Marketing & Corporate Development, s.moser@asahq.org 847-268-9230 • Terri Howard, Director of Member Services, t.howard@asahq.org 847-268-9269 • General questions: qcdr@asahq.org