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Implementing PQRI measures in TwoSubspecialty Practices at UT MedicineMaureen Sheehan, M.D., Vascular SurgeryKent L. Anderson, MD, PhD, Ophthalmology
Aim StatementImplementing a method to capturedocumentation of appropriatePQRI measures in vascular andophthalmology clinics to allowfor reimbursement ( 80% in 3measures) within the next 4months.
TEAM PQRIMaureenSheehan, MDKent Anderson,MD, PhDMarti PonsJay CollinsAdministratorFinanceSusan HilgersEdward KennerdellEPICUT MedicineAmruta ParekhAndrew KrecekFacilitatorIT Services
CAUSE and EFFECT DIAGRAMPhysiciansTimeMixed inputInterestBuilding tions &directionsSystemEducationBurdenIT supportBuild/Transmit codesSoftware/HardwareEMR system /upgradePharmacies not inAudit systemCompeting PrioritiesNO PQRICoder ReviewEducationData csTimeStaffInstitution
What is PQRI? Voluntary physician quality reporting incentiveprogram–Medicare Part B covered professional services (NPI)–Became law; 12/2006; Reporting began 07/2007–2007 – 2008: 1.5 % 2009 – 2010: 2%–2011: 1.0%2012 - 1014: 0.5%–2015: -1.5%;2016 - ?: -2.9%–179 measures (2010); 13 measure groups Numerator: Clinical Action required Denominator: Eligible cases (Patient population)
How do we report PQRI? Report the entire calendar year (may alsoreport 6 months starting in July) Report 3 measures or a single measuresgroup on a specified group of patients–HIV, ESRD, CAD, CHF, CABG, Rec, MEL, CA, LBP, CAT Report for 80 % of cases for which measureis reportable Claims or Registry or EHR–PQRI CPT II codes, G codes, & P modifiers–CMS qualified registry; one submission annually
Why must we do PQRI? Our colleagues do it–AAO: 2008 (42%); 2009 (52%); 2010 (57%)–Success rate in 2008 was 48%–32% use an EMR; 52% E-prescribe Incentives Penalties Quality reporting is becoming more important–Political climate to protect the public–Patients as customers–Business as usual; marketing
What is our incentive?2007-2010Net Collectionsfor MedicarePart BPQRI Bonus %PQRI BonusOphthalmology Vascular Surgery UT Medicine 2,897,390 1,085,221 41,612,1091-5 – 2.0 % 55,3751-5 – 2.0 % 20,5441-5 – 2.0 % 790,386Registry: 600.00 per NPI; 10 doctors for 3 years 18,000
PQRI Measures: OphthalmologyPQRI MEASUREICD-9 CODESCODE & WHENMODIFIERS12: Glaucoma: POAG ONHOptic Nerve Head Evaluation365.10, 365.11365.12, 365.152027FDate of exam1P: Medical8P: Unspecified14: Macular Degeneration: DFEDilated Fundus Exam362.50, 362.51362.522019FDate of exam1P; 8P2P: Patient18: Diabetic Retinopathy: DFESeverity of DR, CSME362.01 – 362.06 2021FDate of exam1P; 2P; 8P19: Diabetic Retinopathy: PCPCommunicate DFE to PCP362.01 – 362.06 5010F & G8397Date of exam2P: Patient8P: Unspecified117: Diabetes: DFEDilated Eye Exam in DiabeticPatient250.00 - 250.93 2022F; 2024F357.2, 366.412026F; 3072F362.01 – 362.07 Date of exam648.00 – 648.048P: Unspecified
PQRI Measures: OphthalmologyPQRI MEASUREICD-9 CODESCODE & WHENMODIFIERS139: Cataract: Pre-Op AssessComprehensive Preoperative66982, 66983669840014FDate of surgery8P: Unspecified140: AMD: AREDSRecommend AREDS Vitamins362.50, 362.51362.524177FDate of exam8P: Unspecified141: POAG: IOP 15% IOP by 15% or have Plan365.10, 365.11365.12, 365.153284F DOS0517F & 3285F8P: Unspecified191: Cataract: PO VABCVA 20/40 in POD 1 - 90Lens CPT Codess comorbidities4175FPOD 1 – 908P: Unspecified192: Cataract: ComplicationsAdditional surgery in POD 1-30N: Comp CPTsD: CE CPT codeG8627 1-30G8628 30124. Health Information Technology (HIT): EHRAdoption/Use of Electronic Health RecordsG8447G8448125. E-Prescribing: 1 Rx created duringencounter was generated & transmittedelectronically using qualified eRx systemG8553: Report 25 times duringreporting period Jan 01 – Dec 31
Intervention: Encounter Form
Results 100 patients 37 patients: 1 PQRI measures apply–Mainly DM, DR, POAG, CAT vs. AMD, E-Rx Physician data entry is simple with nosignificant impact on time Physician education is simple Sheets can be easily implemented intodaily practice
No of times PQRI .0%79.0%70No of times reported100.0%No of times 2012F5010FG38972027F3284FPQRI measures4175F3285F0517FOther
PQRI Measures: Vascular Tobacco Use–1000F Tobacco use assessed 1034 F Current tobacco smoker 1035F Current smokeless tobacco user 1036F Current tobacco non-user–G8455 Current Tobacco User–G8456 Current Smokeless Tobacco User 4000F Tobacco use cessation intervention,counseling 4000F Tobacco use cessation intervention RX Tx
PQRI Measures: Vascular Current Medications–G8427 List of current meds w/ dosages andverification–G8430 Provider documentation that pt noteligible for med assess–G8507 Pt not eligible for pt verification ofcurrent meds–G8428 Documentation of current medsw/dosages w/o verification–G8429 Incomplete or no documentation
OUTPATIENT PQRI(Vascular Surgery)
PQRI Claims-Based ProcessCriticalStepVisit Documented in Encounter Formthe Medical RecordCoding & BillingN-365NCHAnalysis ContractorConfidentialReportNational ClaimsHistory File18Carrier/MACIncentivePayment
Pareto Chart showing CPT codes documented for June 2010100.0%97.4%94.7%3590.0%Number of CPT codes captured by 36F4000FCPT codes1034FG8428G8455
Grand Total of PQRI measures captured in the Vascular Surgery Clinic714.3Pre-interventionPost-interventionGrand Total of measures -329.2-329.2-329.2-485.7May-10Jun-10Time PeriodJul-10Aug-10
Net Gain Vascular Medicare Collections Januaryto June 2010– 478,501– 2% incentive payment - 9,570 Total UT Medicare Collections 2009– 14,754,638–2% incentive payment - 295,092
Conclusions Currently benefit is monetary gains Soon to become monetary losses Process possible but needs complexand requires constant surveillance Further implementation throughout UTMedicine system
PQRI MEASURE ICD-9 CODES CODE & WHEN MODIFIERS 139: Cataract: Pre-Op Assess Comprehensive Preoperative 66982, 66983 66984 0014F Date of surgery 8P: Unspecified 140: AMD: AREDS Recommend AREDS Vitamins 362.50, 362.51 362.52 4177F Date of exam 8P: Unspecified 141: POAG: IOP 15% IOP by 15% or have Plan 365.10, 365.11
