This week's installment of alphabet soup comes to you courtesy of the Centers for Medicare and Medicaid Services (CMS). Last time, we talked about Meaningful Use – just what the government ordered to make a physician's life more difficult. This week they are writing a new prescription: PQRS or Physician Quality Reporting System. Yes, my friends, there's even more for you to do!
The purpose of PQRS, according to CMS, is "to ensure that patients get the right care at the right time. By reporting PQRS quality measures, providers also can quantify how often they are meeting a particular quality metric. Using the feedback report provided by CMS, EPs can compare their performance on a given measure with their peers".1
This program gives providers a financial incentive, a payment equal to 0.5% of a physician's total estimated Medicare Part B covered charges. However, starting in 2016, physicians who do not satisfactorily report data on quality measures during the 2014 year will be docked 2% of their Medicare payments. The program starts with a carrot and ends with a big stick. It's funny that they call this a "payment adjustment."
This system requires providers or group practices to report on nine or more measures covering at least three National Quality Strategy domains. This has to be done for at least 50% of providers' Medicare patients. What are those domains you might ask?
Here they are:
- Patient Safety
- Person and Caregiver-Centered Experience and Outcomes
- Communication and Care Coordination
- Effective Clinical Care
- Community/Population Health
- Efficiency and Cost Reduction
So what are these measures we are supposed to report? As it turns out, there are 382 individual PQRS measures covering disease management from pediatric asthma through CHF to diabetes. You get to comb through the list and pick out a minimum of nine measures from three domains on which to report. I did some combing of my own and created the table below of some of the measures that would be pertinent to podiatrists.
PQRS Measures Pertinent to Podiatrists
PQRS # |
National Quality Strategy Domain |
Measure Description |
1 |
Effective Clinical Care |
Diabetes: Hemoglobin A1c Poor Control: Percentage of patients 18-75 years of age with diabetes who had hemoglobin A1c > 9.0% during the measurement period. |
20 |
Patient Safety |
Perioperative Care: Timing of Prophylactic Parenteral Antibiotic – Ordering Physician: Percentage of surgical patients aged 18 years and older undergoing procedures with the indications for prophylactic parenteral antibiotics, who have an order for prophylactic parenteral antibiotic to be given within one hour (if fluoroquinolone or vancomycin, two hours), prior to the surgical incision (or start of procedure when no incision is required). |
21 |
Patient Safety |
Perioperative Care: Selection of Prophylactic Antibiotic – First OR Second Generation Cephalosporin: Percentage of surgical patients aged 18 years and older undergoing procedures with the indications for a first OR second generation cephalosporin prophylactic antibiotic, who had an order for a first OR second generation cephalosporin for antimicrobial prophylaxis. |
30 |
Patient Safety |
Perioperative Care: Timing of Prophylactic Antiobiotic — Administering Physician: Percentage of surgical patients aged 18 years and older who receive an anesthetic when undergoing procedures with the indications for prophylactic parenteral antibiotics or whom administration of a prophylactic parenteral antibiotic ordered has been initiated within one hour (if fluoroquinolone or vancomycin, two hours) prior to the surgical incision (or start of procedure when no incision is required). |
109 |
Person and Caregiver-Centered Experience and Outcomes |
Osteoarthritis (OA): Function and Pain Assessment: Percentage of patient visits for patients aged 21 years and older with a diagnosis of osteoarthritis (OA) with assessment for function and pain |
126 |
Effective Clinical Care |
Diabetes Mellitus: Diabetic Foot and Ankle Care, Peripheral Neuropathy – Neurological Evaluation: Percentage of patients aged 18 years and older with a diagnosis of diabetes mellitus who had a neurological examination of their lower extremities within 12 months |
127 |
Effective Clinical Care |
Diabetes Mellitus: Diabetic Foot and Ankle Care, Ulcer Prevention – Evaluation of Footwear: Percentage of patients aged 18 years and older with a diagnosis of diabetes mellitus who were evaluated for proper footwear and sizing. |
128 |
Community / Population Health |
Preventive Care and Screening: Body Mass Index (BMI) Screening and Follow-Up: Percentage of patients aged 18 years and older with a documented BMI during the current encounter or during the previous six months AND when the BMI is outside of normal parameters, a follow-up plan is documented during the encounter or during the previous six months of the encounter.
Normal Parameters: Age 65 years and older BMI > 23 and < 30; Age 18 – 64 years BMI > 18.5 and < 25. |
130 |
Patient Safety |
Documentation of Current Medications in the Medical Record:
Percentage of visits for patients aged 18 years and older for which the eligible professional attests to documenting a list of current medications using all immediate resources available on the date of the encounter. This list must include ALL known prescriptions, over- the-counters, herbals, and vitamin/mineral/dietary (nutritional) supplements AND must contain the medications' name, dosage, frequency and route of administration. |
131 |
Community / Population Health |
Pain Assessment and Follow-Up: Percentage of visits for patients aged 18 years and older with documentation of a pain assessment using a standardized tool(s) on each visit AND documentation of a follow-up plan when pain is present |
142 |
Effective Clinical Care |
Osteoarthritis (OA): Assessment for Use of Anti-Inflammatory or Analgesic Over-the-Counter (OTC) Medications: Percentage of patient visits for patients aged 21 years and older with a diagnosis of osteoarthritis (OA) with an assessment for use of anti-inflammatory or analgesic over-the-counter (OTC)medications |
163 |
Effective Clinical Care |
Diabetes: Foot Exam: Percentage of patients aged 18-75 years of age with diabetes who had a foot exam during the measurement period |
173 |
Community / Population Health |
Preventive Care and Screening: Unhealthy Alcohol Use – Screening: Percentage of patients aged 18 years and older who were screened for unhealthy alcohol use at least once within 24 months using a systematic screening method |
182 |
Communication and Care Coordination |
Functional Outcome Assessment: Percentage of visits for patients aged 18 years and older with documentation of a current functional outcome assessment using a standardized functional outcome assessment tool on the date of the encounter AND documentation of a care plan based on identified functional outcome deficiencies on the date of the identified deficiencies |
219 |
Communication and Care Coordination |
Functional Deficit: Change in Risk-Adjusted Functional Status for Patients with Lower Leg, Foot or Ankle Impairments: Percentage of patients aged 18 or older that receive treatment for a functional deficit secondary to a diagnosis that affects the lower leg, foot or ankle in which the change in their Risk-Adjusted Functional Status is measured |
318 |
Patient Safety |
Falls: Screening for Future Fall Risk: Percentage of patients 65 years of age and older who were screened for future fall risk at least once during the measurement period |
357 |
Effective Clinical Care |
Surgical Site Infection (SSI): Percentage of patients aged 18 years and older who had a surgical site infection (SSI)
|
374 |
Communication and Care Coordination |
Closing the referral loop: receipt of specialist report: Percentage of patients with referrals, regardless of age, for which the referring provider receives a report from the provider to whom the patient was referred |
|
Closing the referral loop: receipt of specialist report: Percentage of patients with referrals, regardless of age, for which the referring provider receives a report from the provider to whom the patient was referred
Simple. Yeah right.
But, wait, there's more! These individual measures are broken up into treatment groups (for example diabetes management) and reporting is actually done through a variety of ways (five different ways actually), such as registries and direct coding among others.
Ah ah ah…there's more yet. When you code for one of the measures during a patient encounter, you'll have the option to add numerators to your codes (number and letter combinations that describe the service). Here's a screen shot of the coding method for a diabetic foot examination.
Looks suspiciously like CPT coding (and about as complicated). If your eyes are crossed, don't feel bad. Mine are too. This system is so complex and detailed that it takes an expert to fully understand it. In fact, it's likely I have omitted some important details, so as in all things, do your research and don't get caught with your proverbial pants down. It's hard enough to run a profitable medical practice today without yet another administrative responsibility to add. So, to all of you, I bid you good luck preparing for your PQRS reporting.
Best wishes,
Jarrod Shapiro, DPM
PRESENT Practice Perfect Editor
[email protected]
REFERENCES
- Physician Quality Reporting System (PQRS) Overview. 8/6/2013. www.cms.gov. Last accessed 10/27/14
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