Webinar 6 - Detailed Overview of PQRS and CQM 2014

Webinar 6:
Detailed Overview of PQRS &

CQM 2014
using DigiDMS EHR 2014 Edition
Tuesday, April 14, 2014 at 3:30 PM EST
Wednesday, April 15, 2014 at 4:30 PM EST
EHR * PM * Patient Portal * Direct Messaging * Secure Healthcare Messaging
1
Clinical Quality Measure (CQM)
Quick Facts
EPs will have to report using the new 2014 criteria regardless of whether they are participating in
Stage 1 or Stage 2 of the EHR Incentive Programs.
All Medicare EPs have the option of submitting three months of CQM data online through the CMS
registration and attestation system. Medicare EPs also have the option to submit a full year of data
electronically using the QRDA format to receive credit for the EHR incentive Program and Physician
Quality Reporting System (PQRS).
Medicaid EPs must submit their clinical quality measurement data to their State
Medicaid Agency
Begining in 2014, EPs must select and report on 9 of a possible list of 64 approved CQMs for the EHR
Incentive Programs. The 6 domains are:
Patient and Family Engagement
Patient Safety
Care Coordination
Population and Public Health
Efficient Use of Health Care Resources
Clinical Processes/ Effectiveness
Physician Qualitative Reporting System (PQRS)
Quick Facts
By submitting PQRS for year 2014, EPs can earn 0.5% incentive and avoid 2% adjustment for year 2016.
All Measure Groups are reportable via Registry only, meaning EP can not submit Group PQRS
measures via claims in 2014.
For earning incentive and avoiding penalty, Total 9 individual measures out of 3 strategic national
quality domain must be submitted for 50% of Medicare Part B and Railroad Medicare claims from Jan
1, 2014 to Dec 31, 2014.
Just to avoid penalty, Report at least 3 measures covering 1 NQS domain for at least 50% of the EP's
Medicare part B FFS Patients satisfactorily.
PQRS data can be submitted via preferred methods of Claims, Stage 2 Certified EHR OR
Registry. Refer PQRS guidelines by CMS for other reporting methods.
CMS Strongly encourages all EPs and practices to begin billing 2014 QDC codes with a $0.01 charge.
The RA/ EOB Denial code N365 is your indication that PQRS codes were received into the CMS
National claims history (NCH) database.
PQRS
How to Report once or individual for 2014 Medicare
Quality Programs Reporting (PQRS & CQM)?
Eligible Professionals (EPs) have a choice to report one time during the 2014 program year in
order to become incentive eligible for 2014 PQRS, avoid 2016 adjustment, and satisfy the Clinical
Quality Measure (CQM) component of the EHR Incentive Program. Refer PQRS guidelines by CMS
to check one time reporting options available to individual Eligible Professional and Group of 2 or
more Eligible Professionals.
To Report once and get qualified for PQRS and CQM incentive program, EP has to report at
least 9 of the CQM out of 3 strategic National Quality Domain for entire year of 2014. EP
will need IACS account to upload data files extracted from EHR CQM Reports. EPs will also
have to attest for CQM at time of attestation using same report.
To Report individual for PQRS and CQM, EP will have to follow CQM reporting for the same
90 day period of Meaningful Use and use data at time of attestation. For PQRS, EP can
submit data via claim or qualified registry.
Requirements for Implementing
MU in 2014
1. Select CQM for 2014, Select PQRS for 2014. You can choose common CQM
and PQRS to meet both incentive program requirements.
Choose 9 OR more measures from at least 3 domains
Even If you are demonstrating for MU Stage 1, You will have to
selct Stage 2 CQMs
2. Mark as Implemented and Active in DigiDMS Patient Screening
Module. [Optional ]
3. Verify Alert [Optional]
4. Take appropriate actions
5. Review PQRS codes suggested by system.
6. Verify CQM and PQRS Performance
7. Generate QRDA Report for CQM Attestation [Optional]
5
Step 1: Select CQM and PQRS
6
Step 1: Select Common CQM & PQRS
7
Certified PQRS CMS ID NQF Domain Title
Yes 1 122 59 C,R Clinical Process/ Effectiveness Diabetes: Hemoglobin A1c Poor Control
Yes 2 163 64 C,R Clinical Process/ Effectiveness Diabetes: Low Density Lipoprotein (LDL) Management
Yes 5 135 81 C,R Clinical Process/ Effectiveness
Heart Failure (HF): Angiotensin-Converting Enzyme (ACE) Inhibitor or
Angiotensin Receptor Blocker (ARB) Therapy for Left Ventricular
Systolic Dysfunction (LVSD)
Yes 111 127 43 C,R Clinical Process/ Effectiveness Pneumonia Vaccination Status for Older Adults
Yes 112 125 31 C,R Clinical Process/ Effectiveness Breast Cancer Screening
Yes 113 130 34 C,R Clinical Process/ Effectiveness Colorectal Cancer Screening
Yes 117 131 55 C,R Clinical Process/ Effectiveness Diabetes: Eye Exam
Yes 119 134 62 C,R Clinical Process/ Effectiveness Diabetes: Urine Protein Screening
Yes 163 123 56 C,R Clinical Process/ Effectiveness Diabetes: Foot Exam
Yes 204 164 68 C,R Clinical Process/ Effectiveness
Ischemic Vascular Disease (IVD): Use of Aspirin or Another
Antithrombotic
Yes 236 165 18 C,R Clinical Process/ Effectiveness Controlling High Blood Pressure
Yes 130 68 419 C,R Patient Safety Documentation of Current Medications in the Medical Record
Yes 110 147 41 C,R Population/ Public Health Preventative Care and Screening: Influenza Immunization
Yes 128 69 421 C,R Population/ Public Health
Preventive Care and Screening: Body Mass Index (BMI) Screening and
Follow-Up
Preventive Care and Screening: Screening for Clinical Depression and
Follow-Up Plan
Preventive Care and Screening: Tobacco Use: Screening and Cessation
Intervention
Step 1: Option
1. Select CQM [for 90 Days of Your Meaningful Use Demonstration]
2. Select PQRS [for Entire Year]
8
Choose CQM [64 CQM]
Choose PQRS [284 Measures]
Report Separately for CQM at time of MU Attestation & PQRS via Claims
Step 2: Activate Alerts (Optional)
9
DigiDMS EHR Patient Screening Module
10
Step 3: Verify Alerts (Optional)
DigiDMS EHR Patient Chart Alerts
11
Step 4: Take Appropriate Actions
PQRS CMS IDNQF Domain Title
226 138 28 C,R Population/ Public Health
Preventive Care and Screening: Tobacco Use: Screening
and Cessation Intervention
Percentage of patients aged 18 years and older who were screened for tobacco
use one or more times within 24 months AND who received cessation
counseling intervention if identified as a tobacco user
Numerator:
If Patient is a smoker
Order 99406 : Counselling
OR
Order Medication
12
Step 5: Review PQRS Code suggested by EHR)
13
Step 5: Review PQRS Code suggested by EHR)
14
Step 6: Verify CQM Performance
15
Step 7: Generate QRDA Report for submission
[ Optional ]
16
CQM Explanation CQM 165
Percentage of patients 18-85 years of age who had a diagnosis of hypertension
and whose blood pressure was adequately controlled (<140/90mmHg) during
the measurement period.
Numerator:
Systolic BP< 140
Diastolic BP<90
PQ
RS
CMS
IDNQF Domain Title
236 16518 C,R
Clinical Process/
Effectiveness Controlling High Blood Pressure
17
Percentage of patients 18-75 years of age with diabetes who had hemoglobin
A1c > 9.0% during the measurement period.
Numerator:
HBA1C > 9.0%
PQ
RS
CMS
IDNQF Domain Title
1 12259 C,R
Clinical Process/
Effectiveness
Diabetes: Hemoglobin A1c Poor
Control
18
Percentage of women 40-69 years of age who had a mammogram to screen
for breast cancer.
Numerator:
HBA1C > 9.0%
PQR
S
CMS
IDNQF Domain Title
112 12531 C,R
Clinical Process/
Effectiveness Breast Cancer Screening
Please Refer DigiDMS HER version 14.0.10 OR Refer document links provided in
earlier slide to refer details of other CQMs
19
CQM Explanation
Please Refer DigiDMS EHR version 14.0.10
OR
Refer document links provided in earlier
slide to refer details of other CQMs
Questions & Answers
?
20
Thank You!
21

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