New PQRS Reporting Requirements in the Proposed 2014 Medicare Fee Schedule Rule—Limited Impact on Anesthesia
Just as happens every summer, CMS has released its proposed rule with updates and changes to the Medicare Physician Fee Schedule that will take effect on January 1, 2014. Not unexpectedly, the Agency is projecting that the sustainable growth rate (SGR) impact would be a 24.4 percent cut in 2014. Do not bank on this number though. It is going to change before the end of the year.
Of greater significance, CMS has proposed modifications to quality reporting under both the Physician Quality Reporting System (PQRS) and electronic health record (EHR) incentive programs.
The basic PQRS principle for 2014 remains the same: eligible professionals (EPs), including anesthesiologists, pain physicians and nurse anesthetists who satisfactorily report data on PQRS quality measures are eligible to receive an incentive bonus equal to 0.5 percent of the total estimated Medicare Part B allowed charges for all covered professional services furnished by the eligible professional or group practice during the applicable reporting period. The incentive payment for 2014 will remain 0.5 percent. The 2014 reporting period data will be used as the basis for both the 2014 incentive payment (0.5%) and the 2016 negative payment adjustment (-2.0%).
Individual Measures—Minimum Number to Increase from 3 to 9
The definition of “satisfactorily report data” will change, however, if the proposal is finalized. Physicians and other EPs who submit individual quality measures via claims—the method used not just by ABC clients and the vast majority of anesthesia practices, but also by 72 percent of EPs in the most recent year for which data are available—or via a clinical data registry will need to report at least nine measures during calendar year 2014, not just three, in order to earn the incentive bonus; and the measures are to cover at least three of the National Quality Strategy domains. Reporting three measures in 2014 will still be sufficient to avoid the negative adjustment in 2016.
The National Quality Strategy Domains are:
- Person and Caregiver-Centered Experience and Outcomes
- Patient Safety
- Communication and Care Coordination
- Community/Population Health
- Efficiency and Cost Reduction
- Effective Clinical Care
If fewer than nine measures apply, the EP can meet the satisfactory reporting requirement by reporting those that do apply—as few as one or as many as eight measures. This is similar to the exception to the current requirement, if fewer than three measures apply. CMS will continue to use the Measure Applicability Validation (MAV) process to test whether the EP should have reported additional measures.
Commenting on the proposed increase in the minimum number of measures from three to nine, CMS stated:
We understand that this is a significant increase in the number of measures an eligible professional is required to report. However, we believe that the need to collect enough quality measures data to better capture the picture of the care being furnished to a beneficiary, especially when this data may be used to evaluate an eligible professional’s quality performance under the Value-Based Payment Modifier, justifies the change. We believe that collecting data on 9 measures applicable to an eligible professional’s practice as opposed to 3 measures would provide us with a better picture of the overall quality of care furnished by that eligible professional for purposes of having PQRS reporting being used to assess quality performance under the Value-Based Payment Modifier.
While it is true that data on nine measures would give a better picture of the overall quality of care provided by an EP, none of the 47 new measures proposed by CMS apply to anesthesiologists. The antibiotic prophylaxis, maintenance of perioperative temperature and prevention of catheter-related bloodstream infection measures still constitute the sum total of measures for our specialty.
Measure Submission via Registries and Electronic Health Records
In addition to submitting PQRS measures by placing the applicable Quality Data Codes on claims, EPs have the option of using electronic health records (EHRs) or registries. CMS is attempting to harmonize requirements under its various quality reporting programs. The criteria for satisfactory reporting for the 2014 PQRS incentive align with the criteria for meeting the Clinical Quality Measure component of achieving meaningful use under the 2014 Medicare EHR Incentive Program in 2014. Specifically, under the PQRS, an individual EP will meet the criteria for satisfactory reporting for the 2014 PQRS incentive using either a direct EHR or an EHR data submission vendor product that is appropriately certified if, during the 12-month 2014 PQRS incentive reporting period, the EP reports nine measures covering at least three National Quality Strategy domains (unless fewer than nine measures apply). Note: to qualify for EHR incentive payments, however, providers still have to use a federally certified EHR and report to the registry those quality measures required by that program.
Registry-based reporting is another means of submitting quality data to the PQRS. As with claims- and EHR-based methods, the minimum number of measures would increase from three to nine in 2014. Instead of requiring that the EP using registry- or EHR-based methods report each measure for at least 80 percent of the Medicare patients to whom the measure applies, CMS will set the reporting threshold at 50 percent under the proposed rule. This is consistent with the current year 50-percent threshold for claims-based reporting.
CMS has introduced a new, alternative registry-based reporting method in the proposed rule, under the authority of the American Taxpayer Relief Act of 2012, which allows EPs to be treated as satisfactorily submitting data on quality measures if the EP satisfactorily participates in a “qualified clinical data registry.” A “qualified clinical data registry” differs from a “traditional clinical registry” in that it must meet a number of specific data collection, participation, reporting and benchmarking conditions to receive CMS approval. Under this “qualified clinical data registry” option, EPs report the measures used by the clinical data registry instead of those on the PQRS measure list. Eligible professionals may report measures on all patients, regardless of whether or not they are Medicare Part B FFS patients. For the 2014 PQRS incentive and 2016 PQRS payment adjustment, CMS proposes that EPs using qualified clinical data registries would meet the criteria for satisfactory participation by reporting on at least nine measures (not necessarily PQRS measures) to the registry covering at least three of the National Quality Strategy domains, and reporting each measure for at least 50 percent of the eligible professional’s applicable patients. At least one of the measures would have to be an outcome measure.
Given the complexity of the PQRS changes for individual EPs, we will defer discussion of some of the CMS proposals for group-based reporting until a later date. We would just note, for now, another new reporting mechanism that would be available to group practices comprised of 25 or more EPs: the certified patient-experience survey vendor. We would also like to signal a new proposed back pain measures group (see Table 37 on page 397) that would appear relevant to pain management practices. Like all measures groups going forward, the back pain group would be reportable through registry-based reporting only.
The proposed rule is scheduled to appear in the Federal Register today (July 15th) and when it does, we will continue to study it. We also plan to participate in the National Provider Call on the PQRS that CMS will host on July 25th from 1:30 - 2:30pm EST. To register for this call, go to http://www.eventsvc.com/blhtechnologies . Remember, we are still dealing with a proposed rule only, which won’t be finalized until after CMS considers the public comments it will receive through September 6, 2013. We will do our best to prepare you for the changes that are still taking shape.