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Medicare PQRS Program

  • ASTRO encourages all members who care for Medicare Part B FFS patients to participate in this important Medicare quality reporting program. There are a number of compelling reasons that radiation oncologists should participate.

    • Failure to participate in the 2016 program will result in a - 2.0 percent payment adjustment of total Medicare Part B FFS payments in 2018.
    • Providers who successfully participate in PQRS for two consecutive years can also earn credit for completing an American Board of Radiology (ABR) quality Practice Quality Improvement (PQI) project for MOC certification.
    • Providers' PQRS participation and performance is publicly reported on Medicare's Physician Compare website
    • CMS is using PQRS measures and participation as a proxy for the quality composite score component of the Merit Based Incentive Payment System, which will begin in 2017.
    • All participants will receive a feedback report on their performance in the program.

    Reporting Methods

    • Providers may choose any of the following methods to report PQRS measures on Medicare Part B FFS Medicare beneficiaries:
      • Part B Claims-Based Reporting
      • Registry-based Reporting (PQRSwizard)-recommended
      • Direct EHRs or EHR Data Submission Vendors
      • Group Practice Reporting Option (two or more providers)

    The reporting period for all methods listed above is January 1, 2016, to December 31, 2016.

    Reporting Period

    Criteria for Successfully Reporting 

    The threshold for successfully reporting varies by reporting method and measures selection. ASTRO recommends participating using the Oncology Measures Group and PQRSwizard, the less burdensome reporting options.

    PQRS Bonus and Penalty Schedule
     

    Successful PQRS + No MOC

    Successful PQRS + MOC  

    2012 0.5 % 1 %
    2013 0.5 % 1 %
    2014 0.5 % 1 %
    2015 (based on 2013 participation) -1.5 %
    2016 (based on 2014 participation) -2.0 %
    2017 (based on 2015 participation) -2.0 %
    2018 (based on 2016 participation) -2.0%

     

    Reporting Mechanism To Avoid a -2 Percent Payment Adjustment in 2018
    Oncology Measures Group via Registry (PQRSwizard)
    • 12-month reporting period, January 1, 2016 – December 31, 2016.
    • Report all measures in the Oncology Measures Group that are applicable to the provider’s patient population.
    • Report 20 unique patients, a minimum (11) of which must be Medicare Part B FFS patients.
    • Report at least 1 measures group for all 20 unique patients.
     
    Individual Measures via Claims or Registry (PQRSwizard)
    • 12-month reporting period
    • Report 9 measures across at least 3 National Quality Strategy (NQS) domains.
    • Report each measure for at least 50 percent of the EP’s Medicare Part B FFS patients. 
    • If less than 9 measures covering 3 NQS domains are reported, the provider would report on each measure that is applicable and report each measure for at least 50 percent of the Medicare Part B FFS patients.
    • Report at least 1 cross-cutting measure for individuals or practices with face-to-face encounters. (If at least 1 cross-cutting measure is not reported, the individual EP or group practice will be automatically subject to the 2018 negative payment adjustment.)
     
    Individual Measures via Direct EHR Product that is Certified EHR Technology (CEHRT) or CEHRT Data Submission Vendor that is CEHRT
    • 12-month reporting period
    • Report 9 measures across at least 3 National Quality Strategy (NQS) domains.
    • If less than 9 measures covering 3 NQS domains are reported, the provider would be required to report all of the measures for which there is Medicare patient data, and the clinician will be subject to the Measure-Applicability Validation (MAV) Process
    • Report at least 1 cross-cutting measure.
    • Report each measure for 50 percent of patients.
     

    Radiation oncologists can participate in PQRS by reporting either individual measures or the Oncology Measures Group. ASTRO encourages members to participate in PQRS by reporting the Oncology Measures Group because it significantly reduces the burden of participation. With the Oncology Measures Group, members are only required to report on 20 unique patients, a minimum of 11 of which must be Medicare Part B fee-for-service (FFS) patients, as opposed to nine individual measures and reporting each for at least 50 percent of applicable patients.

    Oncology Measures Group

    The Oncology Measures Group consists of a subset of seven PQRS measures. The following measures are included in the Oncology Measures Group:

    • 71 Breast Cancer: Hormonal Therapy for Stage IC-IIIC Estrogen Receptor/Progesterone Receptor (ER/PR) Positive Breast Cancer
    • 72 Colon Cancer: Chemotherapy Stage III Colon Cancer Patients
    • 110 Preventive Care and Screening: Influenza Immunization
    • 130 Documentation of Current Medications in the Medical Record
    • 143 Oncology: Medical and Radiation - Plan Intensity Quantified
    • 144 Oncology: Medical and Radiation - Plan of Care for Pain
    • 226 Preventive Care and Screening: Tobacco Use: Screening and Cessation Intervention

    It is possible that all the measures in the Oncology Measures Group may not apply to a provider's patient population. However, a provider may still participate in PQRS using the Oncology Measures Group option even if all of the measures do not apply. Providers are only required to report on those measures which apply to their patient population and to each patient. The table below provides example patients.

    Patient Applicable Measures
    (Reported)
    Innapplicable Measures
    (Not Reported)
    Denominator-eligible male patient with head/neck cancer, who is not experiencing pain, is seen in June 2016, and is a smoker.

    130 – Current Medications


    226 – Tobacco Screening and Cessation

    143 – Pain Intensity Quantified

    71 – Breast Cancer

    72 – Stage III Colon Cancer Chemotherapy
    110 – Influenza Immunization 

    144 – Plan of Care for Pain   

    Denominator-eligible female patient with breast cancer, who is experiencing pain, is seen October 2016, and is a smoker. 71 – Breast Cancer

    110 – Influenza Immunization 

    143 – Pain Intensity Quantified

    144 – Plan of Care for Pain

    130 – Current Medications

    226 – Tobacco Screening and Cessation
    72 – Stage III Colon Cancer

    Please see the Oncology Measures Group Overview for more information and specifications of the measures in the Oncology Measures Group. 

    Please see the Individual Measures Selection for more information on the individual measures recommended for radiation oncologists. 

    The 2016 PQRSwizard is now available!

    The ASTRO PQRSwizard is an online tool that takes the hassle out of reporting. 

    The ASTRO PQRSwizard is a CMS-qualified PQRS registry. The PQRSwizard provides:

    • A step-by-step guide to help you collect and report data.
    • An easy and secure way to upload patient data online.
    • Automatic data validation tool that takes the guesswork out of submission.
    • The ability to review your results before they are submitted to CMS.

    You may submit 2016 PQRS data until 5:00 p.m. Eastern time, February 28, 2017. The cost of the PQRSwizard is $299 per physician (discounts are offered for groups of 10 or more physicians).

    Maintenance of Certification (MOC) is an integral part of the quality movement in health care. It allows physicians to demonstrate their support for continuous quality improvement, professional development and quality patient care. More detailed information on participating in MOC can be found on the American Board of Radiology (ABR) website and ASTRO provides many opportunities to help you maintain your certification.

    What is the intersection between PQRS and MOC?

    PQRS and MOC are two separate programs. Under PQRS, you can receive a 0.5 percent incentive payment for satisfactory participation, and an additional 0.5 percent payment for participating in a MOC program "more frequently" than is required to qualify or maintain board certification. Thus, providers can receive up to 1 percent in incentive payments.

    ASTRO PQRSwizard PQI Template for MOC

    ASTRO offers members a MOC Part 4 Practice Quality Improvement template that allows PQRSwizard participants the opportunity to use their PQRS data to complete an ABR-qualified Practice Quality Improvement template.

    The PQRS Oncology Measures Group PQI template is based on the ABR's four-part Plan-Do-Study-Act (PDSA) process for continuous quality improvement. The PQI template requires members to participate in PQRS using the Oncology Measures Group and PQRSwizard reporting options. To complete the PQI template for MOC, participants will link two consecutive PDSA cycles together to create an action-oriented improvement plan that assesses the effects of their quality improvement strategy. For the purposes of this project, each of the two consecutive PDSA cycles will coincide with two consecutive PQRS reporting periods (1 cycle/reporting period = January 1-December 31).

    In the first PDSA cycle/PQRS reporting period, participants will use the Oncology Measures Group to collect baseline data, evaluate their performance and develop a performance improvement plan.

    Participants will select at least one measure that will be the focus of their performance improvement plan. If you have a 100 percent performance rate on all of the applicable measures, you will need to select another measure for which a definite gap in performance can be identified.

    In the second PDSA cycle/PQRS reporting period, participants will re-measure their performance on the Oncology Measures Group measures and evaluate their performance outcomes to see if their performance goals were met. The project concludes with a written participant reflection.

    Download the template.

    Oncology Measures Group

    What if all of the measures in the Oncology Measures Group do not apply to my patients?

    It is possible that all the measures in the Oncology Measures Group may not apply to a provider's patient population. However, a provider may still participate in PQRS using the measure group option even if all of the measures do not apply; the provider would not report the inapplicable measures. For example, if a provider sees a denominator eligible male patient who is not experiencing pain, the provider would not report measure #71 (Breast Cancer) or #144 (Plan of Care for Pain), as those are not "applicable" to that patient.

    I do not see any patients who fit measure 72 Colon Cancer: Chemotherapy Stage III Colon Cancer. Can I still report the Oncology Measures Group?

    You can still participate in PQRS by reporting the Oncology Measures Group even if you see no Stage III colon cancer patients. It is unlikely that radiation oncologists see patients who fit this measure. Therefore, it does not apply to their patient population and is an inapplicable measure.

    Do I have to report measures #110 Preventive Care and Screening: Influenza Immunization and #226 Preventive Care and Screening: Tobacco Use: Screening and Cessation Intervention?

    You must report these measures for at least one patient who meets the denominator criteria for these measures.

    How many patients do I need to report? Does it matter which ones I choose?

    For the Oncology Measures Group, you must report on 20 unique patients, a majority of which must be Medicare Part B Fee For Service patients. The remaining patients can be from any payer.

    For individual measure reporting, you must report on 50 percent of your Medicare Part B FFS patients that meet the denominator criteria for individual measures. All patients reported must have been seen during the 2015 calendar year.

    I selected the individual measures but would like to switch to the Oncology Measures Group?

    In order to change your selection of measures, please send the request via the "support" option on the PQRSwizard page. You will need to complete a short online form with your request to reset the measures selection. You will then be contacted by CECity with the next steps.

    ASTRO PQRSwizard

    How does the ASTRO PQRSwizard work?

    The ASTRO PQRSwizard greatly reduces the burden of reporting and increases your chances of earning a bonus. It's similar to online tax preparation software and helps guide professionals through a few easy steps to rapidly collect, validate and submit their results to CMS for payment. Participants must:

    • Select the Oncology Measures Group OR individual measures
    • Register
    • Add patient data
    • Review and submit

    How do I get started using the ASTRO PQRSwizard?

    Get started now. You will be directed to the ASTRO PQRSwizard homepage. Click on the GET STARTED button. Next, indicate if you will be reporting using an EMR or Other Data Source by clicking the appropriate button. Then click REGISTER. You will be prompted to create an account on the ASTRO PQRSwizard. Please note, the PQRSwizard does not automatically recognize your ASTRO username and password, so you must create a separate account.

    I have been submitting PQRS data through my claims or another registry. Can I still submit with PQRSwizard?

    Yes. If you would like to submit another report with the ASTRO PQRSwizard, you can certainly do so. CMS will review and analyze each submission independently and will use the submission that is most advantageous to you.

    When using the PQRSwizard, how do I know that I've completed the process?

    The ASTRO PQRSwizard "Progress Monitor" will visually display the requirements and track the number of eligible patients entered based on the measures selected. Once you have met the requirements, the ASTRO PQRSwizard will indicate that your report is complete and allow you to submit your report. Until you meet the requirements, you will not be able to submit your report.

    Do I need to submit anything to CMS?

    No, the ASTRO PQRSwizard will submit your reporting data to CMS. Once you have completed the ASTRO PQRSwizard and click "submit," you do not need to do anything else.

    What is the ASTRO MOC PQI template for the PQRS program?

    ASTRO offers members a PQRS Oncology Measures Group PQI template, based on the ABR's four-part Plan-Do-Study-Act (PDSA) process for continuous quality improvement. The PQI template requires members to participate in PQRS using the Oncology Measures Group and PQRSwizard reporting options. Members will link two consecutive PDSA cycles together to create an action-oriented improvement plan that assesses the effects of their quality improvement strategy. For the purposes of this project, each of the two consecutive PDSA cycles will coincide with two consecutive PQRS reporting periods (1 cycle/reporting period = January 1 - December 31).

    How do I complete PQRS when I work at multiple locations?

    PQRS participation is based on each NPI-TIN combination that bills Medicare Part B services. Therefore, failure to participate will result in the penalty for those NPI-TIN combinations that did not participate, even though the NPI may be associated with successful participation at another TIN.

  • The content on this website is provided to ASTRO members for informational purposes as a service to the profession. It is compiled from publicly available resources and is based on ASTRO staff's understanding of the program requirements. It should not be construed as legal advice. Reliance on this information is not a guarantee that the user will meet the Centers for Medicare and Medicaid Services’ Physician Quality Reporting System (PQRS) and Meaningful Use program requirements and/or avoid the negative payment adjustments for failure to meet the program requirements.