Accessing Your PQRS Feedback Report

Clock and pen and paper

Update: PQRS feedback reports for program year 2015 are now available (via CMS, 9/26/16). 2017 PQRS negative payment adjustment letters will be distributed shortly. Informal review will be open until November 30, 2016 at 11:59 P.M. EST.

What is PQRS?

The Physician Quality Reporting System (PQRS) is a program established and managed by the Centers for Medicare and Medicaid Services (CMS). The federal initiative aims to incentivize the reporting of quality data by individual Eligible Professionals (EPs) and group practices to Medicare by tying it to reimbursement rates. As all individual EP’s and group practices likely know by now, failing to satisfactorily report PQRS data will result in a negative payment adjustment under the Medicare Physician Fee Schedule (PFS). Those who reported satisfactorily for program year 2015 will avoid the negative 2% payment adjustment in 2017.

When will PQRS feedback reports for program year 2015 be available?

CMS announced that the PQRS feedback reports for program year 2015 will be available sometime this month, September 2016. These reports indicate whether or not your practice met all reporting requirements and if you’ll be subject to the future negative payment adjustment. Additionally, CMS announced that payment adjustment letters are projected to be sent in late summer or early fall. We recommend reviewing your feedback report as soon as made available to ensure you have enough time to properly review and request an informal review should your organization determine there was an error or CMS incorrectly assessed your practice. (Check back for updates!)

How to access your PQRS Feedback Report

To access your PQRS feedback report, you will need an Enterprise Identity Management System (EIDM) account, which can be established using the CMS Enterprise Portal at https://portal.cms.gov. Once logged in, select the “PV-PQRS” tab and the “Feedback Reports” option to view your reports. The PQRS feedback can be viewed at three different levels: provider level, reporting mechanism level, and PQRS measure level. Detailed user guides can be found on the QualityNet portal page.

Quality Resource and Usage Reports

In addition to PQRS feedback reports, Quality and Resource Use Reports(QRURs) are also made available through the CMS Enterprise Portal. These reports show performance on all of the quality and cost measures at the Taxpayer Identification Number (TIN) level. These results are used by CMS to calculate the 2017 Medicare Value-Based Payment Modifier. CMS makes two types of QRURs available: the Mid-Year QRUR and the Annual QRUR. The Mid-Year QRUR (MY-QRURs) was made available in April 2016 and was for informational purposes only. Groups of 2 or more EPs and physicians who are subject to the 2017 Value-Based Payment Modifier can use the Annual QRUR to see how the value modifier will apply to the Medicare PFS physician payments. The QRUR is for informational purposes for all other groups and solo practitioners.

Requesting an informal review

If you believe that there was an error or a negative payment adjustment was applied incorrectly, you can request an informal review of the payment adjustment determination. If the review process concludes that satisfactory reporting actually occurred, CMS will reverse the application of the negative payment adjustment. Unfortunately, the informal review decision is final. CMS has no formal appeals process in place at this time.

To submit an informal review request, visit the Quality Reporting Communication Support Page (CSP). Informal review requests for 2015 may be submitted in the fall of 2016, and CMS will announce when this page is available. Remember, the informal review period is limited so review your feedback and get your requests in as soon as the page is available.

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September 21st, 2016 Categories: featured, MIPS Information

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Is GPRO the way to go?

GPRO SurveyVitals

Update: GPRO is a part of the retired PQRS program that has been replaced by MIPS under the Quality Payment Program (QPP). Learn more about MIPS here.

At SurveyVitals, we believe there’s great value in the Qualified Clinical Data Registry (QCDR) quality data reporting option. In 2015, only Eligible Professionals (EPs) can report through a QCDR. Some great news is that CMS recently shared they’re adding a reporting option allowing group practices to report quality measure data using a QCDR for 2016. Please read below for more detail about the differences between GPRO and QCDR.

By now, everyone understands that physicians who don’t report adequate quality measures in 2015 will see a 2% penalty in 2017. There are still questions, however, about the best way to report your quality data to CMS, especially for outpatient practices. And while the date to adjust your 2015 reporting mechanism has passed, we’d like to share some information as you start thinking about your plan for 2016.

At the highest level, you must decide whether to report as an individual EP (Eligible Professionals) or as part of a group. There are pros and cons to each, although SurveyVitals® recommends the individual EP route. Among other reasons, this option allows you to submit quality data through a QCDR (Qualified Clinical Data Registry) if one exists for your specialty.

GPRO, the Group Practice Reporting Option, is another method to submit your quality data, but has numerous CMS requirements. Here are a few things we’d like our clients to know about GPRO for 2015:

  • GPRO is optional.
  • GPRO only applies to EPs with a common Tax Identification Number (TIN).
  • If you chose a GPRO reporting method, the decision is irreversible for 2015 (the deadline was June 30, 2015).
  • You cannot submit your data through a QCDR if you choose GPRO.*
  • If you choose GPRO and have 100 or more EPs (25 or more for 2016), you’ll be required to run the CAHPS for PQRS survey. The survey is optional in 2015 for groups of 2-99 EPs.
    • Most importantly, the survey is tailored to primary care.
    • The survey will not be paid for or administered by CMS. Participating groups will be required to contract with a CMS-certified vendor to administer the CAHPS for PQRS survey.
    • The CAHPS for PQRS survey will be administered on paper with live phone follow-ups for non-responders. Surveys sent via email or text message aren’t allowed at this time, which makes improvement based on real-time feedback virtually impossible. This is why SurveyVitals is not a CMS-certified vendor.
    • CAHPS for PQRS does count as a measure.

Choosing whether to report quality measures as a group or by individual can be a complicated decision when you factor in eligibility and reporting requirements, and here’s why we recommend individual reporting:

  • Individual EPs can submit through QCDRs:
    • QCDRs can focus on more relevant, specialty-specific quality measures. Now is the time to promote the QCDR concept and its benefits to your specialty board.
    • The QCDR collects data for the purpose of providing improved quality of care for patients.
    • There is greater potential to meet the reporting requirement of 9 measures across 3 National Quality Strategy domains.
    • The QCDR typically submits data to CMS on your behalf.

As we announced earlier this year, our Patient Satisfaction Questionnaires (APSQ, SPSQ, or HSQ), fulfills measures for many QCDRs. We’re working to get a patient satisfaction measure included in other QCDRs for 2016. We expect that the list will continue to grow, so contact us if you’d like additional information on the measures SurveyVitals can help you meet for each QCDR.

If you don’t report through a QCDR, it is still beneficial to report individually since the measures that must be reported to CMS are the same. Although some variations exist in the methods (for 2015, claims-based for individual reporting and web interface for GPRO 25+ EPs), you can avoid the CAHPS for PQRS survey requirement and its expense. Additionally, the Value-Based Payment Modifier (VM) is not affected by reporting individually since the VM is calculated by TIN.

* In late October 2015, CMS released some preliminary information regarding PQRS for 2016. From the CMS website: “CMS makes changes to the PQRS measure set to add measures where gaps exist, as well as to eliminate measures that are topped out, duplicative, or are being replaced with a more robust measure. There will be 281 measures in the PQRS measure set and 18 measures in the GPRO Web Interface for 2016. Also, as recently authorized under MACRA, CMS is adding a reporting option that will allow group practices to report quality measure data using a Qualified Clinical Data Registry (QCDR).

We’ll wait for the final 2016 PQRS webpage to become available (typically by January 1, 2016) to see how this plays out, and SurveyVitals will attempt to stay on top of these ever changing requirements in order to provide the most value to our clients. Stay tuned for more!

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November 13th, 2015 Categories: CAHPS Surveys, featured, MIPS Information

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To GPRO, or not to GPRO, that is the question for anesthesiology providers

GPRO SurveyVitals

By now, everyone understands that physicians who don’t report adequate quality measures in 2015 will see a 2% penalty in 2017. There are still questions, however, about the best way to report your quality data to CMS, especially for anesthesiology providers. And while the date to adjust your 2015 reporting mechanism has passed, we’d like to share some information as you start thinking about your plan for 2016.

At the highest level, you must decide whether to report as an individual EP (Eligible Provider) or as part of a group. There are pros and cons to each, although SurveyVitals® recommends the individual EP route. Among other reasons, this option allows you to submit quality data through a QCDR (Qualified Clinical Data Registry).

GPRO, the Group Practice Reporting Option, is another method to submit your quality data, but has numerous CMS requirements. Here are a few things we’d like our clients to know about GPRO:

  • GPRO is optional.
  • GPRO only applies to EPs with a common Tax Identification Number (TIN).
  • If you chose a GPRO reporting method, the decision is irreversible for 2015 (the deadline was June 30, 2015).
  • You cannot submit your data through a QCDR if you choose GPRO.
  • If you choose GPRO and have 100 or more EPs (25 or more for 2016), you’ll be required to run the CAHPS for PQRS survey. The survey is optional in 2015 for groups of 2-99 EPs.
    • The survey is tailored to primary care, which does not help anesthesiology providers.
    • The survey will not be paid for or administered by CMS. Participating groups will be required to contract with a CMS-certified vendor to administer the CAHPS for PQRS survey.
    • The CAHPS for PQRS survey will be administered on paper with live phone follow-ups for non-responders. Surveys sent via email or text message aren’t allowed at this time, which makes improvement based on real-time feedback virtually impossible. This is why SurveyVitals is not a CMS-certified vendor.
  • By reporting via GPRO, you’re agreeing to have your PQRS performance results publicly posted on the Physician Compare website. The performance rates will apply to the entire group.

Choosing whether to report quality measures as a group or by individual can be a complicated decision when you factor in eligibility and reporting requirements, and here’s why we recommend individual reporting:

  • Individual EPs can submit through QCDRs:
    • QCDRs can focus on more relevant, anesthesia-specific quality measures.
    • The QCDR collects data for the purpose of providing improved quality of care for patients.
    • There is greater potential to meet the reporting requirement of 9 measures across 3 National Quality Strategy domains.
    • The QCDR typically submits data to CMS on your behalf.
    • As the ASA said on its website, “Participation in [the] ASA QCDR not only helps protect a practice’s income, but it also helps keep money in the practice so you can continue your focus on patient safety.

As we announced earlier this year, our Anesthesia Patient Satisfaction Questionnaire, the APSQ, fulfills measure #16 for NACOR, the Composite Patient Experience, and counts as an outcome measure as well. We’re also working to get a patient satisfaction measure included in other QCDRs like ABG and ASPIRE for 2016. We expect that list will continue to grow, so contact us if you’d like additional information on the measures SurveyVitals can help you meet for each QCDR.

If you don’t report through a QCDR, it is still beneficial to report individually since the measures that must be reported to CMS are the same. Although some variations exist in the methods (for 2015, claims-based for individual reporting and web interface for GPRO 25+ EPs), you can avoid the CAHPS for PQRS survey requirement and its expense. Additionally, the Value-Based Payment Modifier (VM) is not affected by reporting individually since the VM is calculated by TIN.

SurveyVitals will attempt to stay on top of these ever changing requirements in order to provide the most value to our clients. Stay tuned for more!

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October 7th, 2015 Categories: Anesthesia, CAHPS Surveys, featured, MIPS Information

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Avoid the 2% penalty

NACOR_QCDR

An easier, more valuable way to satisfy the PQRS reporting requirement

You’re probably familiar with the burden of PQRS reporting, and know that CMS has instituted a 2% penalty (to be levied in 2017) for group practices and individual EPs (eligible professionals) who do not report adequate quality measures in 2015.

Did you know that it’s not necessary to administer the CAHPS for PQRS (an expensive, 92-question, paper-only survey) if you submit your measures through NACOR, the National Anesthesia Clinical Outcomes Registry?

NACOR, maintained by the Anesthesia Quality Institute (AQI), has been designated as a Qualified Clinical Data Registry (QCDR) by CMS. You’re required to report 9 measures across 3 domains, including 2 outcome measures.

We’re pleased to announce that your SurveyVitals solution fulfills measure #16, the Composite Patient Experience, and counts as an outcome measure as well.

Please contact us if you’d like SurveyVitals to submit your quality data to NACOR on a monthly basis.

Note: This is not an option for GPRO-registered EPs in 2015, but you can opt out of GPRO in 2016 if you choose to submit your data to NACOR in 2016.

More Info on PQRS from the CMS website

PQRS is a reporting program that uses a combination of incentive payments and negative payment adjustments to promote reporting of quality information by EPs.

More Info on QCDR Reporting for 2015

NACOR was approved as a QCDR for the CMS PQRS in 2014. Remember, for 2015, all Eligible Professionals must report on 9 measures (across 3 domains), 2 of which must be outcome measures. Read more.


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July 13th, 2015 Categories: featured, MIPS Information

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