An explanation of Clinical Quality Measures, PQRS, and using Practice Fusion to successfully participate in quality programs.

1. Clinical Quality Measures and
PQRS Reporting with Practice
Fusion
Presented by:
Sophie Scheidlinger

2. + Emerging movement in healthcare where
providers are compensated based on:
 Quality of the service that they provide to patients
 How well they can improve health outcomes
+ Quality of care is evaluated using evidence-based
quality measurement
+ Public and private payers participating in Pay for
Quality initiatives
Pay for Performance (Pay for Quality)
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3. + Government-run Pay for Performance Initiatives
+ Incentivize or penalize providers to encourage
adoption of health technology and reporting of
Clinical Quality Measures (CQMs)
+ Examples include:
 EHR Incentive Program (Meaningful Use)
 Physician Quality Reporting System (PQRS)
 Accountable Care Organizations (ACOs)
 Comprehensive Primary Care initiative (CPCi)
 Chronic Care Management (CCM)
Physician Quality Programs
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4. + Requirement: Report at least 9 CQMs that relate
to at least 3 National Quality Strategy (NQS)
domains:
+ CMS selected 9 recommended CQMs for adult
and pediatric populations
 Practice Fusion supports the CMS recommended
CQMs for the adult population
 Practice Fusion’s CQMs cover all 6 NQS domains
Meaningful Use CQM Reporting Requirements
Patient and Family Engagement Patient Safety
Care Coordination Population and Public Health
Efficient Use of Healthcare Resources Clinical Processes/Effectiveness

5. CQM Reporting Methods
+ Medicare providers will submit CQMs to CMS electronically or via
attestation
+ Medicaid providers must submit CQM data to their State Medicaid
Agency
+ Reporting period: Entire calendar year or 90 day reporting period
+ Electronic submission for 2015: January 1, 2016 – February 29,
2016
 Medicare EPs have the option to submit a full year of data electronically to receive
credit for the EHR Incentive Program and the Physician Quality Reporting System
(PQRS) if using the PQRS EHR reporting mechanism.

6. + The PQRS is a CMS quality improvement
program that uses incentives and penalties to
promote reporting of quality data
+ Eligibility
 Providers who see Medicare Part B patients and are
reimbursed under the Medicare Physician Fee
Schedule (PFS)
 Physicians, chiropractors, dentists, PAs, NPs, and
others
+ 2015 Incentives and Penalties
 No incentive or -2% penalty in 2017
Physician Quality Reporting System (PQRS)
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7. + PQRS is very complex - PQRS requirements vary based
on the reporting mechanism that you choose.
Complexities mean more options, but you need to become
familiar with the requirements that apply to the option that
you are using.
+ PQRS requirements are specific to each calendar year –
eligible PQRS measures, G-codes, reporting
requirements, etc. may change from year to year, so make
sure you refer to 2015 resources. The 2015 PQRS
reporting period is January 1, 2015-December 31, 2015.
+ PQRS actions don’t roll-over – Reporting for a particular
year will affect your reimbursements in 2 years.
Important PQRS Facts
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8. + PQRS measures consist of two major components:
 Denominator: describes the eligible cases for a measure
(the eligible patient population)
 Numerator: describes the clinical action required by the
measure for reporting and performance
+ Each component is defined by specific clinical codes
described in each measure specification along with
reporting instructions.
+ For measures eligible for EHR reporting, Practice Fusion
has implemented the measure according to very specific
guidelines (including how data must be collected and how
the measure is calculated).
Understanding PQRS Measures
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9. + To avoid the 2017 PQRS
payment adjustment of
2%, you must use one of
the following reporting
options:
Avoiding the 2017 PQRS Payment Penalty
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Claims-Based Reporting
Registry Reporting
Qualified Clinical Data Registry
(QCDR) Reporting
Group Practice Reporting
Option (GPRO) Reporting
EHR Reporting*EHR Reporting
is the only option
that Practice
Fusion supports

10. + Measures with a zero value denominator cannot be used for PQRS
+ The PQRS measurement period length is a full calendar year, so for
2015 it would run from January 1, 2015 through December 31, 2015.
+ Practice Fusion will act as a Direct EHR Vendor (EHR Direct)
 PF will allow providers to generate a file to attest to CMS with as
individuals who choose this reporting option
 You can do this from the PQRS Clinical Quality Measures
Dashboard
EHR Reporting for PQRS
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11. + The following factors should be considered when selecting measures
for reporting:
 Clinical conditions usually treated
 Types of care typically provided – e.g., preventive, chronic, acute
 Settings where care is usually delivered – e.g., office, emergency
department (ED), surgical suite
 Quality improvement goals for 2015
 Other quality reporting programs in use or being considered
 Those available under your selected PQRS reporting option
 Those that apply to your Medicare patients
PQRS Measure Selection
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12. + MAV is a validation process that will determine whether individual
eligible professionals or group practices should have reported
additional measures OR additional domains.
+ MAV determines 2017 PQRS payment adjustment status for individual
providers and group practices.
+ MAV is applied to individual providers and group practices that report
less than nine measures OR less than three domains for PQRS. If
MAV analytically determines that the provider or group practice could
have reported additional measures or domains within the clinical
cluster, then the 2017 PQRS payment adjustment may apply.
+ Claims-based MAV is applicable to individual EPs, whereas registry-
based MAV is applicable to individual EPs and group practices.
Measure-Applicability Validation (MAV)
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13. + An Enterprise Identity Management (EIDM)
account
 CMS transitioned all IACS accounts to EIDM in July
2015
 An individual in your organization (who does not
plan to submit) or solo providers will first need to
register for an Approver Role
 Afterwards, the individuals who plan to submit will
need to register for a PQRS Submitter Role
 CMS resources include an EIDM toolkit
Information you will need to attest

14. Practice Fusion Product
Demonstration
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15. • The population of patients or encounters for which the measure applies.Denominator
• The population of patients from the denominator who meet the measure specified
clinical requirements or the population of encounters from the denominator where
the measure specific requirement has been performed.
Numerator
• Specifications that would remove a patient from the denominator of a specific
quality measure.
• Includes certain diagnoses that make it clinically unnecessary for the patient to
receive the numerator clinical action and/or provider or patient determined reasons
for refusing certain clinical actions.
Exclusion/Exception
• This is also known as the EHR reporting period and refers to the time frame for
which the CQMs will be calculated.
Measurement
Period
CQM Terminology
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16. • The six NQS domains, one of which is assigned to each CMS eCQM, are:
Patient and Family Engagement, Patient Safety, Care Coordination,
Population and Public Health, Efficient Use of Healthcare Resources, and
Clinical Processes/Effectiveness
National Quality
Strategy (NQS)
Domains
• NQF reviews, endorses, and recommends use of standardized quality
measures. Not all quality measures are “NQF-endorsed,” but those that are
have an assigned NQF number.
National Quality
Forum (NQF)
• Lists of specific values (terms and their codes) derived from single or
multiple standard vocabularies used to define clinical concepts (e.g. patients
with diabetes, clinical visit, reportable diseases) used in clinical quality
measures and to support effective health information exchange.
Value sets
• An HL7-based standard document format for reporting clinical quality
measure data to CMS for quality improvement programs.
Quality Reporting
Document
Architecture (QRDA)
CQM Terminology
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17. CMS
eMeasureID
NQF
number
CQM title NQS domain
CMS2v4 0418 Preventive Care and Screening:
Screening for Clinical Depression and
Follow-Up Plan
Population and Public
Health
CMS22v3 N/A Screening for High Blood Pressure
and Follow-Up Documented
Population/Public Health
CMS50v3 N/A Closing the referral loop: receipt of
specialist report
Care Coordination
CMS68v4 0419 Documentation of Current
Medications in the Medical Record
Patient Safety
CMS69v3 0421 Preventive Care and Screening: Body
Mass Index (BMI) Screening and
Follow-Up
Population and Public
Health
CMS90v4 N/A Functional Status Assessment for
Complex Chronic Conditions
Patient and Family
Engagement
CMS122v3 0059 Diabetes: Hemoglobin A1c Poor
Control
Clinical Process and
Effectiveness
CMS123v3 0056 Diabetes: Foot Exam Clinical Process and
Effectiveness
Practice Fusion Supported CQMs
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18. CMS
eMeasureID
NQF
number
CQM title NQS domain
CMS124v3 0032 Cervical Cancer Screening Clinical
Processes/Effectiveness
CMS125v3 0031 Breast Cancer Screening Clinical
Processes/Effectiveness
CMS126v3 0036 Use of Appropriate Medications for
Asthma
Clinical
Processes/Effectiveness
CMS127v3 0043 Pneumonia Vaccination Status for
Older Adults
Clinical
Processes/Effectiveness
CMS130v3 0034 Colorectal Cancer Screening Clinical
Processes/Effectiveness
CMS131v3 0055 Diabetes: Eye Exam Clinical
Processes/Effectiveness
CMS138v3 0028 Preventive Care and Screening:
Tobacco Use: Screening and
Cessation Intervention
Population and Public
Health
CMS139v3 0101 Falls: Screening for Future Fall Risk Patient Safety
Practice Fusion Supported CQMs
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19. CMS
eMeasureID
NQF
number
CQM title NQS domain
CMS144v3 0083 Heart Failure (HF): Beta-Blocker
Therapy for Left Ventricular Systolic
Dysfunction (LVSD)
Clinical
Processes/Effectiveness
CMS147v3 0041 Preventative Care and Screening:
Influenza Immunization
Population/Public Health
CMS149v3 N/A Dementia: Cognitive Assessment Clinical
Processes/Effectiveness
CMS153v3 0033 Chlamydia Screening for Women Clinical
Processes/Effectiveness
CMS155v3 0024 Weight Assessment and Counseling
for Nutrition and Physical Activity for
Children and Adolescents
Population/Public Health
CMS156v3 0022 Use of High-Risk Medications in the
Elderly
Patient Safety
CMS163v3 0064 Diabetes: Low Density Lipoprotein
(LDL) Management
Clinical
Processes/Effectiveness
CMS164v3 0068 Ischemic Vascular Disease (IVD): Use
of Aspirin or Another Antithrombotic
Clinical
Processes/Effectiveness
Practice Fusion Supported CQMs
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20. + PQRS Center
 www.practicefusion.com/pqrs
Resources for PQRS
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21. + PQRS Clinical Quality Measures Dashboard
 For you to monitor your progress on your Clinical Quality Measures
 Click on the measure names to get to a detailed knowledge base article
on the CQM
 Allows you to select CQMs you wish to report
 Allows you to generate a file to submit to CMS
Resources for CQMs
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22. + Practice Fusion is not able to offer individual
guidance on choosing PQRS measures or
reporting options that are not EHR reporting.
+ If you have questions regarding individual
measures or how PQRS requirements apply to
you, please reach out to the CMS QualityNet Help
Desk.
CMS QualityNet Help Desk
Phone: 866-288-8912,
TTY: 877-715-6222
Email: qnetsupport@sdps.org
Need Individual Help with PQRS?
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23. Frequently Asked Questions
PQRS and CQMs
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24. + A: Most health care providers who are reimbursed
under the Medicare Physician Fee Schedule are
eligible for PQRS.
+ For additional details and a list of eligible PQRS
providers go to:
http://www.cms.gov/Medicare/Quality-Initiatives-
Patient-Assessment-
Instruments/PQRS/How_To_Get_Started.html
Q: How do I find out if I’m eligible for PQRS?
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25. + A: PQRS offers over 300 quality measures, which can be
reported using various reporting mechanisms (although
not all measures are available for all reporting options).
+ If you wish to use Practice Fusion, you only have the
measures we support available to use for PQRS reporting.
You may report less than 9 measures if you meet the other
EHR reporting criteria, but you will be subject to the
Measure Applicability Validation process which means you
may not earn the incentive (although you could avoid the
penalty).
+ If you are a specialty provider who wants to report PQRS
measures that are not available for EHR reporting, we
suggest looking into other reporting mechanisms.
Q: Practice Fusion’s CQMs don’t apply to my
specialty. How will I participate in PQRS?
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26. + PQRS is a separate and distinct program from
Meaningful Use. Providers who do not report for
PQRS in 2015 will be subject to a 2% payment
penalty – regardless of whether or not they
successfully participate in Meaningful Use.
Q: I’m participating in Meaningful Use this year,
will there be penalties if I don’t also participate in
PQRS?
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27. + A: The EHR reporting option for PQRS require
that providers report CQM data for all patients,
regardless of their insurance status. Providers will
report data for all patients whom the CQM applies
that have data in the EHR.
Q: Does PQRS EHR Reporting only apply to
Medicare patients?
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28. + A: Please reach out to the CMS QualityNet Help
Desk.
CMS QualityNet Help Desk
Phone: 866-288-8912,
TTY: 877-715-6222
Email: qnetsupport@sdps.org
Q: How do we check if we have completed
PQRS successfully with Medicare?
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29. + A: Unfortunately not. Your participation in 2014
determined your penalty in 2016. To avoid a 2017
penalty, be sure to report successfully for the
2015 reporting period.
Q: I received notification from Medicare that I
will be penalized in 2016. Is there anything I can
do now to avoid this?
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30. + We have recorded this session, and will make the
slide deck and recording available on our Tutorials
Center
Q: Will a recording of the webinar be made
available?
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