PQRS: The Time is Now to Track Quality Measures

What's all the fuss about quality measures?

Quality can be a subjective term to most people.  When it comes to throwing the term around in the health care payment realm, it takes on a somewhat different definition.  Payers struggle to evaluate necessity and appropriateness of care while also trying to determine which providers render the best and most efficient care.  While attempting to avoid subjective measures and terminology, payers have turned to quantitative reporting of qualitative measures as a first attempt to track performances other than simple numbers of patients seen or dollars spent per case.  

We continue to hear that the future payment schemes will move away from specific fees for specific services, and more toward global fees, case payments, and "pay for performance" incentives for rendering what they define as "quality" care.

Commercial payers were the first to dip their toes into the quality data gathering waters.  Their satisfaction with the process has now prompted CMS/Medicare to follow suit, and with a more aggressive intent.  Reimbursement reform is long overdue in the government-based health care systems. As a result, a move toward quality monitoring and measuring has become a priority.

There remains some controversy over whether some measures demonstrate competency or contribute to quality case management.  However, the whole process remains a dynamic feature that will be evaluated, monitored, and modified to arrive at a suitable method.

The Medicare Physician Quality Reporting System (PQRS) appears here to stay.  Beginning as an incentivized initiative in the earlier stages just a few short years ago, PQRS participation is still not technically mandatory, but failure to participate is now penalized.

So, technically, what is a "quality measure"?

According to the acatoday.org: 

"Quality measures, generally, are rooted in evidence-based medicine. They can be “guideline” measures (e.g., you get 12 visits for acute low back pain), “process” measures (e.g., when a patient comes in with a cardiovascular episode and you gave them an aspirin), or “outcome” measures (e.g., "X" condition was resolved). There are also other types of measures, such as “structural,” “efficiency,” or “cost of care” measures."

How does this affect me?

Currently, the only payer who consistently requests chiropractic physicians to report quality measures.  This is an opportunity to familiarize ourselves with the process, as every indication points to commercial payers transitioning to quality tracking measures sooner than later.

If you are not reporting with Medicare, it's not too late to begin doing so.  Reporting thresholds are still low, and early participation in 2015 would ensure you qualify and avoid the 2017 penalty.

Participation is simple.  No registration is required.  Simply begin reporting quality measures codes on your claim forms for the two mapped to codes 98940-98942:  pain assessment and outcome assessment.  Both activities are functions that should already be in place in your office as part of your Medicare PART documentation process.  However, reporting even allows for "non performance" of the measure as a selection.  To be clear, though, successful performance (actually doing the measure) has to be done at least once on each eligible Medicare patient.  Successfully reporting whatever you did or didn't do must be performed 50% of the time.

Need Help?

I have developed the "PQRS Survival Guide".  This written guide includes:

• Background information on PQRS
• Every current reporting code with its definition and an example of proper use
• Measure code selection flow charts for easy code selection
• Numerous examples of pain assessment tools
• A variety of standardized outcome assessment forms you can copy/print

The Guide can be emailed immediately as a protected .pdf (to prevent unauthorized copying/sharing) or can be printed and mailed as a hard copy.

Cost:   $99

Tennessee Chiropractic Association members:  $79

Massey  Practice Solutions members:  $59

(add $5.00 to cost for printed/mailed copy)

If you would like to receive discounts on products and services by virtue of your state association membership, please have their leadership contact me for further information.

To order with credit card:  Call 423.745.8500

To mail payment:  Massey Practice Solutions

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