Integrating PQRS Registry Submission for EHR/PM systems facilitates quality compliance

Marla Harmon
Marla Harmon, Chief Operations Officer, Alpha II
Susan Melkonian
Susan Melkonian, PMP, Systems Analyst, Alpha II

Traditionally, studies have shown carrots are more effective than sticks in influencing behavior. Recent research, however, shows losses or punishments may have more effect than gains or rewards in shaping behavior.

That’s good news for the Physician Quality Reporting System (PQRS), introduced in 2007 by the Centers for Medicare and Medicaid Services (CMS) to reduce costs and improve the quality and efficiency of patient care.

New penalties

This year, the formerly voluntary program became not only mandatory, but CMS swapped carrots in the form of incentives for satisfactory reporting for sticks or penalties for unsatisfactory reporting. Also new this year is CMS’s budget-neutral Value Based Modifier Program (VM), which assesses the quality and cost of care under the Medicare fee-for-service (FFS) schedule for physician and practitioner services. Simply put, providers whose patient care is high cost and low quality will get paid the least. Those who provide high quality care at low cost will get paid the most.

This year, CMS will apply penalties under both PQRS and VM to all eligible professionals (EPs), including solo practitioners and group practices, who do not satisfactorily report data on quality measures for covered professional services during 2015. That means, under both programs, large Medicare providers who don’t comply with reporting this year will face up to six percent lower reimbursement in 2017.

Not only will penalties get stiffer, but the PQRS program continues to become more complex. One new requirement is that a cross-cutting measure must be included for all EPs that meet with patients face-to-face. The types of measures are getting tougher to achieve, too, as easy metrics that everyone meets are retired. Consider that more than 70 of the reportable measures in 2014 are now retired as goals became standard practice.

One-stop solution

To reduce administrative burdens, meet the end-of-year reporting deadline, obtain maximum reimbursement and free themselves to concentrate on patient care, many savvy providers rely on their EHR and practice management software partners to help integrate PQRS Registry Submission into their systems. By selecting a registry partner, like Alpha II Registry, EHR and PM vendors receive step-by-step integration support from an expert in quality measures, coding, and billing that makes it easy for the EHR/PM vendors to help their customers successfully satisfy PQRS requirements, without tying up resources.

EHR/PM vendors can avoid the time-consuming and complex development required every year to modify their systems by interfacing with a secure, web-based PQRS solution that collects, reports and provides feedback on all measures for individual providers and group practices.

The user-friendly, CMS-qualified Alpha II PQRS Registry does just that and takes it a step beyond many registries, providing support for all specialty types and practice sizes. It collects and reports on all quality metrics, including individual and measure groups and can be customized to meet any physician practices’ reporting needs. While providers can use the PQRS Registry submission directly, the integration with EHR and PM systems allows for data collection, editing and submission, avoiding duplication of entry and streamlining the process.

Immediate feedback

Most important, the Alpha II PQRS Registry provides real-time feedback so providers can improve performance in a timely fashion before final reporting to CMS and determine their reimbursement earlier. By permitting eligible professionals to view how their data meets the quality measures before they are finally reported to CMS, providers can see exclusions they may not have been aware of or inverse measures with negative effects. They can also see if the nine measures do not include a cross-cutting one so they can add one, or that they mistakenly chose to report on measures that were already retired. The earlier providers discover reporting errors, the more opportunity and control they have to affect their reimbursement.

Fee-for-value here to stay

The Department of Health and Human Services projects that by 2016, 85 percent of Medicare’s fee-for-service payments to hospitals, physicians and other providers will be tied to quality and value rather than volume. Because the penalties in the PQRS program are cumulative, he or she who hesitates loses more and more money as the years go by. It’s easier to gain and maintain the momentum of acquiring the highest Medicare dollars the sooner providers jump on the value train.

As the transition from fee-for-service to fee-for-value continues in healthcare, programs like PQRS will change and evolve, but paying for performance is here to stay. The value train will continue to accelerate and whether sticks or carrots spur compliance, they won’t make it easier to jump later on a speeding train.

Solo practitioners and group practices have until March 2016 to satisfactorily report their PQRS data for the entire 2015. To avoid penalties and obtain maximum reimbursement, however, integrating PQRS Registry submission into your EHR/PM systems now may be your best ticket to success. Are you ready to board?

Alpha II, Alpha II Registry, Centers for Medicare and Medicaid Services, CMS, Physician Quality Reporting System, PQRS, PQRS Registry Submission, Value Based Modifier Program, VM


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