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SCHIE Mission

SCHIE Mission. To improve the quality and efficiency of health care for all stakeholders in the Santa Cruz community.

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SCHIE Mission

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  1. SCHIE Mission To improve the quality and efficiency of health care for all stakeholders in the Santa Cruz community. To deliver technology assistance, guidance and information on best practices to providers with the goal of creating a healthcare delivery system that offers a seamless, integrated experience for patients and providers.  Provide services and tools to participating healthcare providers to become meaningful users of EHRs connected to the Santa Cruz Health Information Exchange. Theseare foundational for Accountable Care, Clinical Integration, Medical Home and surviving payment reform.

  2. Physician Quality Reporting System Bill Beighe, CIO June 10, 2013

  3. Housekeeping Items • Return to goal of 20 to 30 minutes maximum • No interactive Q&A today • Audio Issues • Use the question feature in Go To Webinar and we will respond during or after the meeting • Slides and the recording to be on the SCHIE website and the PMG blue portal

  4. What is PQRS? • The Physician Quality Reporting System • Formerly PQRI • Medicare Part B • Incentive / Penalty • Voluntary • Bonus on Part B Payments 2013 • Penalty in 2015 based on activity in 2013 • Group reporting available (GPRO)

  5. Incentive & Penalty History • 2011 PQRI/PQRS Incentive PAYMENT Results • 280,000 Providers • $260 million in Bonuses Paid • 2012 Penalties on Medicare eRx Program are being reported by Providers

  6. Incentive Payment and Payment Adjustments In 2013, physicians and other eligible professionals who successfully report quality measure data can earn a 0.5% incentive payment on their total allowed charges for covered Medicare Part B Physician Fee Schedule (PFS) services provided during the reporting period. Earning an incentive payment in 2013 will avoid the 2015 penalty adjustment. *The 2015 payment adjustment is based on PQRS participation during the 2013 reporting period **The 2016 payment adjustment is based on PQRS participation during the 2014 reporting period

  7. Eligibility to Participate • Medicare Doctors • Doctor of Medicine • Doctor of Osteopathy • Doctor of Podiatric Medicine • Doctor of Optometry • Doctor of Oral Surgery • Doctor of Dental Medicine • Doctor of Chiropractic • Practitioners – Individual / Group Considerations • Therapists • http://www.cms.gov/Medicare/Quality-Initiatives-Patient-Assessment-Instruments/PQRS/Downloads/PQRS_List-of-EligibleProfessionals_022813.pdf

  8. Tactics to mitigate potential loses • Properly report for the Physician Quality Reporting System (PQRS) starting in 2013 to avoid penalties in 2015 and beyond. • Those who report satisfactorily for the 2013 program year may avoid the 2015 PQRS payment adjustment. Additional information on how to avoid future PQRS payment adjustments can be found through supporting documentation available on the CMS website at http://www.cms.gov/Medicare/Quality-Initiatives-Patient-Assessment-Instruments/PQRS.

  9. PQRS Measures May Vary by Year The PQRS measure documents for the current program year may be different from the PQRS measure documents for a prior year. Eligible professionals are responsible for ensuring that they are using the PQRS measure documents for the correct program year.

  10. How to get started? • Determine if you are eligible to participate • Determine which reporting option best fits your practice (reporting period varies with reporting option selected) • Select 3 measures to submit - or – • Select 1 measures group to submit • Perform your own review of the measure specifications you are reporting; understand reporting principles

  11. What Do I Have To Achieve? If reporting via registry or EHR (not common) • >80% on 3 or more individual measures • 20 or more unique patients (>50% must be Medicare) for 1 or more measures group If reporting via claims: (you will likely do this) • >50% on 3 or more individual measures for the 12 month reporting period • 1 or more measures group for the 12 month reporting period for 20 or more unique patients

  12. Individual Measure Examples

  13. Neurology Specific (Measure Group) Examples

  14. PQRS Services for SCHIE Providers * Webinars and on-going educational sessions are completely free to all Santa Cruz Providers and do not reduce the number of hours or support we are providing as part of this program.

  15. Additional Resources • http://www.cms.gov/Medicare/Quality-Initiatives-Patient-Assessment-Instruments/PQRS/index.html?redirect=/PQRS/ • http://www.cms.gov/Medicare/Quality-Initiatives-Patient-Assessment-Instruments/PQRS/MeasuresCodes.html • CMS QualityNet Help Desk Monday – Friday 7:00 am to 7:00 pm CST Phone 1-866-288-8912 Email: qnetsupport@sdps.org • 2013 Quality Reporting Programs Comparison Matrix (.pdf)

  16. Coming up next 7/11/13 - Stage 2 Meaningful Use https://www1.gotomeeting.com/register/855411001 7/18/13 – Direct Messaging https://www1.gotomeeting.com/register/442346992 Contact the PMG and SCHIE resources at 831.465.7877, ask for Dawn Mackey, Becky Shoemaker or Bill Beighe and we will get you engaged with the right resource.

  17. Presentation slides are available at: http://www.santacruzhie.org/

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