Healthcare acronyms and terms are confusing enough and the complexity of PQRS terms with similar sounding elements can make it even worse. We talk to so many clients who innocently confuse group measure reporting with the Group Practice Reporting Option (GPRO). They are not the same and depending on your situation, you want to use the one best for your practice.
Let’s start with what GPRO is and, therefore, what group measure reporting is not.
- GPRO referred to by CMS as PQRS group practices under one TIN
- Report only once per eligible TINs (tax identification number) vs. reporting for each Eligible Professional (EPs)
- NOTE: EPs are all doctors and non-physician practitioners who can bill Medicare Part B with an individual NPI
- Time saved by entering single set of data vs. data for every EP
- TIN must have 2 or more EPs in order for it to be considered a GPRO entity.
- Once a practice selects GPRO, CMS only reviews the practice as GPRO unless you request a change prior to the deadline (for 2016, June 30th).
- Must report 9 measures for >50% of all Medicare Part B FFS patients
- NOTE: 9 measures across 3 domains, with 1 crosscutting; i.e., same as individual reporting in terms of data requirements
- Specialty outliers (for whom individual reporting is impractical/impossible), achieve positive PQRS status. In other words, if the group passes, everyone passes!
There are some potential pitfalls:
- All or nothing; i.e., all EPs under the TIN collectively pass or fail
- Group practices have to register to be GPRO… a registry or EMR cannot do this for you.
- Create an EIDM account and register by the June 30th deadline
- Measure groups are excluded for GPRO practices
- Remember, ONLY Medicare Part B FFS patients count
- I.e., NOT Medicare Advantage a.k.a., Medicare Part C a.k.a., Medicare HMO replacement plans
So if you are single corporate entity (single Tax ID (TIN), a.k.a. employer identification number (EIN)) and you have two or more EPs who can bill Medicare Part B FFS, you should consider GPRO. It saves time and time is money.
If GPRO is not an option, Measure Group reporting is always our next best recommendation vs. reporting individual measures for each and every EP. Simply stated Measure Group reporting is ideal because it is faster and easier than individual measure reporting.
Measure Groups are clusters of measures centered around a disease state. The intent of the grouped measures is to bundle related measures to more ideally influence care, direct providers/patients, and optimize clinical practice. For PQRS, measures (quality metrics to many) are typically thought of as individual measures and there are hundreds. CMS has allowed certain individual measures to be clustered around a disease state/process to create Measure Groups.
Using the Measure Groups often means gathering/analyzing takes gather less data. Gather less data takes less time which costs less money. Some key elements that make Measure Groups appealing include:
- Disease specific categories affording targeting common issues and management processes
- Require only 20 patients per Eligible Provider (EP).
- Worth repeating… 20 patients/EP!
- 11 of the 20 must be Part B FFS
- Remaining 9 can be any payer… ANY payer.
- Opportunity to select the 20 that best that fit measure group metrics.
- 2016 Measure Groups
A good example always helps better illustrate a point. If a practice had 400 diabetics, using the Diabetes’ Measure Group, only 20 of the 400 require data capture for PQRS reporting. Without the Diabetes’ Measure Group only individual measures could work. This would mean gather data for 201 (i.e., >50%) of the 400 patients. Why would we gather data on hundreds of patients with thousands of data points when we could just work with 20 patients of our own choosing? It is truly that simple!
There is one enormous caveat to Measure Group reporting. Any EP attempting to meet PQRS Measure Group reporting must pass ALL of the quality components for the Measure Group. For instance, you cannot get 0 out of 20 and expect to pass the Measure Group. Even one out of twenty would allow you to pass. This “pass” required element demonstrates CMS moving from pay for reporting to truer pay for improved performance. There are always other factors such as Value Based Modifiers and evolving Merit-based Incentive-based Payment Systems (MIPS) but the performance, not just reporting, is the targeted focus.
By 2018, CMS is not just looking for providers to report data; they expect to see improved quality of care with diminished expense. Even in 2016, elevated performers will see Medicare Part B FFS monies paid as much as 130% more than peers in their markets. Mastering the optimal way to gather, analyze, and report data to CMS and other payers is slowly but steadily becoming a market norm. Take time now to learn how to optimize your personal and group performance… or at least learn how to place yourselves in the best light shining brightly from world of healthcare data analytics. And, don’t wait until the end of the reporting season to start. Too many last minute clients are simply averting percentage denials vs. embracing the opportunity to better understand how they compare to peers from around the country. This process and subject is not easy to master but requires diligence and perseverance to optimize information to improve trends for your practice’s financial performance and patient care.