As the healthcare industry moves to adopt value based care its focus is shifting from the meaningful use of technology to patient care outcomes. Center for Medicare and Medicaid (CMS) is pushing for providers like physicians to report their Clinical Quality Measures (CQM) through Physician Quality Reporting System (PQRS) as those clinical guidelines can help improve the outcomes. It would be least surprising if CMS makes PQRS their basis for judging the performance of providers for reimbursements. Providers in return have an opportunity to avoid financial risks by complying.
Any individual or group of providers who bill Medicare part B under physician fee schedule are subject to PQRS and face a penalty of 2-4% of those payments in case they fail to do the submission. They are required to report for 9 quality measures covering 3 domains either through claims based data, Electronic Medical Records (EMRs) application or through qualified registry. It is important that providers identify the right measures for reporting based on the care they provide to Medicare beneficiaries for successful submission.Although claims-based reporting is the most popular, it has the much lower success rate of 56% vs. 96% when reporting through registry per CMS data.
Moreover CMS has indicated it will not continue to support claims-based reporting indefinitely.
The EMRs on the other hand offer support for limited number of quality measures leaving providers with greater chance of failed submissions unless the supported measures match the ones the provider needs.
The third choice, CMS qualified registry is essentially a service that gathers clinical quality data for PQRS through a web-based program, spreadsheets and/or electronic health records. It would be responsible for calculating and submitting quality measures data to CMS in a specified format on behalf of the eligible professional or group practice for the respective program year.
Although reporting through registry makes it simpler there is still the challenge of realizing the goal of PQRS – achieving better patient care outcomes. It is critical that the providers refer to the CQM guidelines at the point of care to make better decisions and record relevant data without having to deviate from their daily clinical workflow or lose their efficiency. The only way is to make that a reality is to make the PQRS related tasks a part of a simplified daily workflow that includes documenting clinical charts and eliminate the clinician’s struggle traversing through menus and screens so they can focus on patients instead of technology as they work towards better outcomes.