2017 is almost upon us! Are you freaking out because we’re in the last few weeks of 2016 PQRS reporting and you haven’t actually participated in the program yet? Have you just received a letter from CMS telling you that you were penalized from last year, and you’re not sure what to do about any of it? Fear not, there’s a solution–and it’s not as scary as you think!
Consider submitting a measures group right now, in 2016, to avoid the potential 2018 2-4% PQRS payment adjustment. And you’ll want to get ‘em while they’re hot, because these measures groups are sunsetting under the new QPP 2017 program: this is the last year they will be available to program participants.
You have until the end of February 2017 to report on patients you have seen from January 1, 2016-December 31, 2016. You have until February 28th 2017 to file with P360. So, there’s still time. Don’t panic! Start now.
First up, a refresher on measures groups.
What makes measures groups so awesome? Simply put, the data required is less cumbersome and the quantity of patients you are required to report on is small: only 20. Yes, you read that correctly! For selecting a measures group in 2016, reporting requirements are: 20 patients, of which a minimum of 11 must be Medicare Part B FFS.
You must meet performance for at least one patient for each measure within the measures group you select. So, you can’t have a 0% performance rate on any of the measures within the measure group you select. However, chances are you’re selecting a measures group that works best for your specialty, and you wouldn’t pick a measures group where your provider(s) couldn’t or wouldn’t meet the performance at least once for every measure within the group. Since you only have to do this for 20 patients total for each provider, theoretically if you see a lot of Medicare Part B FFS patients, you could probably see enough patients in the next few weeks to actually meet these requirements. If you see 3 or 4 Medicare Part B FFS patients every day, then a measures group option at this point could be a very sensible and pragmatic way to avoid a hefty payment adjustment and allow you to participate in this program here in 2016. Have you seen the 2016 measures groups? Have a look here: CMS Manual on Measures Groups.
Okay, had a look and still feel overwhelmed? There are quite a few groups, so let’s talk about which might be easiest with only a month left!
Specific Clinical Illustration
Let's start with primary care and how to best choose groups that make sense for primary care docs. In turn, this might help you interpret these for your specialty if you are not in primary care.
At the heart of primary care is prevention. As such, family practice and internal medicine providers are often drawn to the Preventive Care Measures Group because, well, ‘that’s what we do!’
To be clear: The point of the Physician’s Quality Reporting System (PQRS) is to improve clinical outcomes and save the system money. In fact, at its inception, the PQRS measures (metrics, as some folks call them) were selected in order to address 95% of the money that was wasted by not rendering appropriate patient/clinical care or performing unnecessary care. Think about it: if we could remove 95% of the wasted money for improper or unnecessary services, the cost savings would be enormous. Thus, PQRS started as an experiment to see if giving bonus money to providers resulted in adjusted clinical habits resulting in cost savings. The answer was a resounding “yes.”
Knowing all this, should primary care providers use the preventive PQRS measures just because prevention is the primary goal of primary care? Selection of the Preventive Care Measure Group should be a no brainer, right? Wrong! There are easier ways to perform well (avoid penalty), and improve the quality of rendered care.
Perhaps the easiest Measures Group just so happens to be one of the oldest: Diabetes. Here’s a quick comparison of The Preventive Care Measures Group vs. Diabetes. Fair warning: the Preventative Measures Group can get confusing–that’s the point! Feel free to skip ahead and see how easy it is to use the Diabetes Measures Group.
The Preventive Measures Group encompasses Measures 39, 48, 110, 111, 112, 113, 128, 134, 226, & 431
- Measures 39, 48 and 112 are only for women; the rest are for men and women.
- To participate, you have to find 20 patients that meet the inclusion and exclusion criterion of these measures (that’s pretty simple)
- BUT now that 39, 48 and 112 are just for women, you can’t use the same 20 patients for all measures unless you want to use just women for your reporting.
- The usual rule that 11 of the 20 have to be Medicare Part B Fee for Service—non-HMO or non-Medicare Advantage—and the rest can be Medicare, Medicaid, private pay, cash or any other type of payment.
- REAL ISSUE: In addition to having to report on 10 measures for 20 patients (200 data points per provider reporting) you may have to have more than 20 if you plan to report on some of the men in your practice.
- If you’re a primary care gynecologist this may be great, but it doesn’t help a family practitioner or internist who has both sexes.
Diabetes Measure Group has 6 measures consisting of 1, 110, 117, 119, 126 and 226.
- That’s only 120 data points or 60% of the data needed to successfully report, compared to the Preventive Care Measure Group
- AND you select 20 diabetics regardless of them being male or female.
- The same 11 out of 20 rule exists for all the measure groups so it counts here too.
- In short, the Diabetes Measure Group is easier, faster, less data and allows you to not think about PQRS reporting again until next year.
In the end, if you are in love with the Preventive Care Measure Group, then use it. However, if you are looking to be compliant, avoid PQRS penalty, and are a primary care provider, the Diabetes Measures Group is your easiest and best option, hands down. There are many other scenarios and options for most specialties, so please take a look at all the 2016 Measures Groups in the link provided and try to apply the above rationale when thinking about what’s best for your specialty.