Clinical Quality, PQRS and Meaningful Use
Reporting Clinical Quality Measures (CQMs) is fast becoming part of every practice’s workflow. Beginning in 2014 the Physician Quality Reporting System (PQRS) and Meaningful Use reporting programs align.
Pick a 2014 Certified Vendor
Since PQRS reporting is a full year, Medicare providers should always pick a vendor like MediTouch that is already 2014 certified so they can report PQRS and Meaningful Use beginning January 1st 2014.
Clinical Quality Measures Overview (2014 and 2015)
- CQM Requirements are no longer associated with a “stage” of Meaningful Use
- CQM Requirements are now associated with the year you are reporting
- Stage 1 providers that report in 2014 must report on the new set of CQMs
- Stage 1 EPs and Stage 2 EPs report CQMs the same way
- CQMs are not a formal “measure” but must be reported to receive incentive payments
Alignment of CQM Programs
- Now the same set of measures and electronic reporting method will be used for multiple CMS programs
- PQRS and Meaningful Use CQM programs will align beginning in 2014
- This alignment will assist Meaningful Use 2014 EPs in avoiding PQRS penalties
- In 2014, PQRS must be reported for a full year and Meaningful Use for 3 months
Changes to CQM Reporting
- EPs must report 9 measures instead of 6
- Must cover 3 of 6 NQS domains*
- Core measures are recommended but not mandated
- Patient and Family Engagement
- Patient Safety
- Care Coordination
- Population and Public Health
- Efficient Use of Healthcare Resources
- Clinical Processes/Effectiveness
CMS provides a link to the list of measures and corresponding domains.
CQM Reporting Choices – there is no best of all worlds in 2014
The PQRS program is a one-year program and in 2014 the Meaningful Use program is just 3 months.
- Providers have the option to electronically report their CQM data for the full year of 2014 to receive credit for both the Medicare EHR Incentive Program and CMS quality programs (PQRS and IQR)
- Providers who choose to submit electronically will submit their CQM data as an electronic file
- Providers will not qualify for an incentive payment until they have submitted their CQMs
- Providers that do not successfully submit PQRS CQM data for 2014 will be subject to a negative payment adjustment.
Since payment for Meaningful Use will not be made until the CQMs are reported, those that report for a full year in 2014 with the goal of combining their PQRS reporting with Meaningful Use will need to wait until 2015 to receive their Meaningful Use payment.
Use MediTouch to Avoid Payment Adjustments aka Medicare Penalties
Medicare EPs who are not meaningful users will be subject to a payment adjustment beginning on January 1, 2015. In the out years the Medicare payment penalties are higher if the national Meaningful Use threshold of > 75% is not met.
- Depending on the total number of Medicare EPs who are meaningful users under the EHR Incentive Programs after 2018, the maximum cumulative payment adjustment can reach as high as 5%.
- EPs who first demonstrated Meaningful Use in 2011 or 2012 must demonstrate Meaningful Use for a full year in 2013 to avoid payment adjustments in 2015.
- They must continue to demonstrate Meaningful Use every year to avoid payment adjustments in subsequent years.
The table below illustrates the timeline to avoid payment adjustments for EPs who demonstrated Meaningful Use in 2011 or 2012.
** All data from the Centers for Medicare & Medicaid Services (CMS)