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Practice Management

Medicare's PQRS Program

The Physician Quality Reporting System (PQRS) is an incentive program that provides bonuses and confidential feedback for satisfactorily reporting quality measures on FFS Medicare beneficiaries. Learn more about PQRS and the ASTRO PQRSwizard - an online tool that takes the uncertainty out of participation and greatly increases your likelihood of success in receiving a bonus from Medicare.  

Deadline to submit 2013 PQRS data is this Thursday, March 13, 2014!

A PQI template for the Oncology Measures Group for MOC requirements is now available for 2013 reporting. Don't delay and register today!

Overview of the 2014 Medicare PQRS Program.

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

  • For the 2013 reporting period, eligible professionals (EPs) who successfully participate can receive a 0.5 percent incentive payment based on Medicare FFS Part B payments.
  • For the 2013 reporting period, EPs who successfully participate in PQRS could also receive an additional 0.5 percent for Maintenance of Certification (MOC) incentive requirements.
  • Beginning in 2015, penalties (payment adjustments) will be applied based on 2013 reporting.
  • CMS is required to post on a website the names of EPs who satisfactorily report. This information is now posted on the Medicare Physician Compare website
  • PQRS measures and participation are being used as foundations in other Medicare physician value-based purchasing initiatives. Consequently, Medicare is using PQRS as a proxy for quality performance.
  • All participants will receive a feedback report on their performance in the program.

While the importance of PQRS within the Medicare programs grows, the participation of radiation oncologists remains low. ASTRO remains concerned that the lack of participation in PQRS by radiation oncologists could disadvantage the specialty as CMS further develops quality programs targeted at physicians.

You do not need to sign up or preregister in order to participate in PQRS. There are a number of resources available from ASTRO and CMS on the program, and we do recommend doing a little research in preparation to determine the best method of participation for your practice. Important information about the 2013 PQRS program is below.

  • Reporting Methods 
    • Eligible professionals (EPs) may choose any of the following methods to report PQRS measures on FFS Medicare beneficiaries:
      • Part B Claims-Based Reporting
      • Registry-Based Reporting
      • EHR-Based Reporting
      • Group Practice Reporting Option (2 or more EPs)
        • The deadline to register to report using the Group Practice Reporting Option is October 15, 2013.
    • Reporting Period 
      • The reporting period for all reporting methods except Registry-based is from January 1, 2013 to December 31, 2013.
      • The Registry-based method has the following reporting periods:
        • January 1, 2013 to December 31, 2013, OR
        • July 1, 2013 to December 31, 2013.
  • Criteria for Successfully Reporting 
    • The threshold for successfully reporting varies by reporting method and measures selection.
  Individual Measures  Measures Group 
Claims-based   50 percent of applicable Part B patients for 3 individual measures. 20 applicable Part B patients for measures group.
Registry-based   80 percent of applicable Part B patients for 3 individual measures. 1.20 patients for measures group (only 11 are required to be applicable Part B patients).
EHR-based   80 percent of applicable Part B patients for 3 individual measures. N/A
Group Practice
Reporting Option
 
80 percent of applicable Part B patients for 3 individual measures. N/A
PQRS Bonus and Penalty Schedule 
  Successful PQRS + No MOC Successful PQRS + MOC
2012 0.5 percent 1 percent
2013 0.5 percent 1 percent
2014 0.5 percent 1 percent
2015 -1.5 percent
2016 -2.0 percent

What PQRS measures are available for radiation oncologists? 

ASTRO recommends members participate in PQRS by reporting the Oncology Measures Group. The Oncology Measures Group significantly reduces the burden of participation in PQRS because, instead of having to report on 80 percent of patients for 3 measures, eligible providers (EPs) are only required to report on 20 unique patients, a majority of which must be Medicare FFS patients.

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

More information on the Oncology Measures Group is available here.

The PQRSwizard 2013 program is now available! 

Most radiation oncologists currently participating in PQRS do so via claims which can be very burdensome. The ASTRO PQRSwizard is an online tool that takes the hassle out of reporting. Participants using registry tools like the PQRSwizard have a 95 percent success rate.

The ASTRO PQRSwizard is a CMS-qualified PQRS registry. For $299 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 that takes the guesswork out of submission.
  • The ability to review your results before they are submitted to CMS.

It’s not too late to get started. You may submit 2013 PQRS data until March 13, 2014. Learn more and see how the ASTRO PQRSwizard can improve your chances of earning a bonus for 2013 and avoid the penalty in 2015. Start now.

What is MOC?

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 ABR website and ASTRO provides many opportunities to help you maintain your certification.

What is the intersection between PQRS and MOC?

The PQRS + MOC program offers eligible physicians who have satisfactorily submitted data under PQRS the opportunity to earn an additional incentive of 0.5 percent for participating in a CMS-qualified Maintenance of Certification program "more frequently" than is required to qualify or maintain board certification.

The "more frequently" requirements have been defined by the ABR and can be viewed online. Participation in MOC does not guarantee the additional incentive of PQRS. The additional incentive can only be earned when physician participants meet both the requirements of PQRS reporting and participating more frequently than is required in an approved MOC program.

How are the programs different?

PQRS is an incentive program that provides bonuses and confidential feedback for satisfactorily reporting quality measures on FFS Medicare beneficiaries. MOC is a certification program that focuses on continual physician improvement. PQRS and MOC are standalone programs that when combined can result in an additional incentive from CMS.

The CMS website has a wealth of information on PQRS. Please visit the website to learn more about the program.

What is PQRS?
The Physician Quality Reporting System (PQRS), created in 2007 by Congress as the Physician Quality Reporting Initiative, is a voluntary Medicare reporting program that provides financial incentives for satisfactorily reporting data on quality measures for FFS Medicare Part B beneficiaries.

What is a PQRS performance measure?
Currently, most PQRS performance measures focus on processes that are linked to patient outcomes. Performance measures play a crucial role in state and federal reporting programs as yardsticks for pay-for-performance as well as public reporting.

What is the Oncology Measures Group?
The Oncology Measures Group is an alternative to the individual measures reporting option. The Oncology Measures Group significantly reduces the burden of participation in PQRS because, instead of having to report on 80 percent of all patients for 3 measures, providers are only required to report on 20 unique patients, a majority of which must be Medicare FFS patients.

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 experience 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.

What measures are included in the Oncology Measures Group?
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
  • 194 Oncology: Cancer Stage Documented
  • 226 Preventive Care and Screening: Tobacco Use: Screening and Cessation Intervention

What are the incentives that come along with PQRS participation?
PQRS participants who successfully report can earn a 0.5 percent bonus in 2013, with the opportunity to earn an additional 0.5 percent with successful participation in a Maintenance of Certification (MOC) program. Beginning with the 2013 reporting period, penalties will be assessed on those who do not successfully report under PQRS.

What is the timeline for reporting?
You can begin reporting at any time during the reporting period. You can submit 2013 data (claims or registry) until March 14, 2014. However, all data reported must correspond to patients seen during the 2013 calendar year.

How do I participate in PQRS?
You do not need to sign up or preregister in order to participate in PQRS. You can choose to report PQRS measures on fee-for-service Medicare beneficiaries to CMS through their Part B claims, a qualified registry, or via a qualified electronic health record (EHR) product. A number of resources are available from ASTRO and CMS on the program. ASTRO offers the PQRSwizard for those who are interested in participating via a registry.

What is the ASTRO PQRSwizard?
The ASTRO PQRSwizard is an online registry tool that provides a step-by-step guide to collect and report data for both individual measures and the Oncology Measures Group.

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:

  1. Select individual measures OR the Oncology Measures Group
  2. Register
  3. Add patient data
  4. Review and submit

How can I change the selection of measures?
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.

How much does the ASTRO PQRSwizard cost?
For just $299 per physician, per PQRS reporting period, you can reduce the burden of reporting via claims and increase your rate of success. Participants using registry tools like the ASTRO PQRSwizard have a 95 percent success rate.

Does ASTRO offer a group discount for practices with multiple physicians?
Yes. ASTRO offers a 10 percent discount for purchases of 10 or more physicians.

Is the ASTRO PQRSwizard a tool only for radiation oncologists?
No, any physician can use the ASTRO PQRSwizard as a gateway to report data on quality measures for FFS Medicare beneficiaries.

How do I get started using the ASTRO PQRSwizard?
Click here to get started. You will be directed to the ASTRO PQRSwizard homepage. Click on the START NOW 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.

Can I use the ASTRO PQRSwizard if I do not use an EMR?
Yes, you do not need an EMR to use the ASTRO PQRSwizard. You can enter the data into our system by completing the online questionnaire OR by uploading the data from your existing EMR system into PQRSwizard using an .XLS, .XLSX, or .CSV file.

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.

Will the ASTRO PQRSwizard recognize my ASTRO username and password?
No, the ASTRO PQRSwizard does not recognize your ASTRO username and password. Therefore, when you use the ASTRO PQRSwizard for the first time, you must create an account. You may do so by clicking the START NOW button on the ASTRO PQRSwizard homepage.

Which measures should I report?
It is recommended that you report using the Oncology Measures Group. However, should you prefer to report individual measures, it is recommended that you choose measures that apply to your patient population. The ASTRO PQRSwizard has a built-in measures selection guide to help you select the appropriate measures.

What if I do not see measures that are applicable to my practice?
Refer to the complete list of PQRS measures available on the CMS website.

If I report on more than 3 measures, will I increase my incentive payment?
No. For 2013, CMS is offering a maximum incentive of 0.5 percent of your total allowed Medicare charges for FFS covered services.

Should I report on a measures group or on individual measures?
ASTRO recommends that you report on the Oncology Measures Group, but you have the option to report on individual measures.

How many patients do I need to report? Does it matter which ones I choose?
For individual measure reporting, you must report on 80 percent of your Medicare Part B FFS patients that meet the denominator criteria for three individual measures if reporting via registry. If you are reporting using the claims-based method, the threshold is 50 percent. All patients reported must have been seen during the 2013 calendar year.

For the Oncology Measures Group, you must report on 20 unique patients, a majority of which must be Medicare FFS patients.

Is there a benefit to reporting more than the required percent?
Medicare recommends that participants capture all eligible claims per the measure denominator for each measure selected.

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.

How will my incentive be paid?
If you currently receive your claim payments from Medicare electronically, then your PQRS incentive payment will be paid electronically to the same account.

If you currently receive your claim payments from Medicare on a paper check, then your PQRS incentive payment will also be paid by paper check. The check will be mailed to the address associated with the Tax ID Number and NPI in the National Plan and Provider Enumeration System (NPPES) system. If that address is incorrect or has been changed, you will need to update the address with NPPES.

What is Maintenance of Certification (MOC)?
Maintenance of Certification is a certification program that focuses on continual physician improvement. Learn more about the individual parts of MOC.

What is the correlation between MOC and PQRS?
PQRS and MOC are standalone programs that when combined can result in an additional incentive from CMS. Physicians who satisfactorily submit data under PQRS can earn an additional incentive for participating in a CMS-qualified MOC program “more frequently” than is required.

Does ASTRO offer opportunities to satisfy Maintenance of Certification (MOC) requirements?
Yes, ASTRO provides learning opportunities in two of the four components of maintenance of certification: Lifelong learning and self-assessment and practice quality improvement. Learn more about MOC opportunities at ASTRO.

What if I choose not to participate in PQRS?
Beginning in 2015, physicians who do not participate and successfully report claims during the 2013 reporting period will face a 1.5 percent penalty for non-participation. Additionally, if you do not participate in PQRS, your non-participation will be indicated on CMS's Medicare Physician Compare website.

Content last updated 3/12/2014
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