WIXLIB

2015 PQRS Measures for Physiatry

AcknowledgmentsThe Academy gratefully acknowledges the Evidence-Based Practice’s Performance Metrics Committeefor their extensive review of the measures in the 2015 PQRS program and identifying the measureswhich may have applicability to PM&R.Members of the Performance Metrics CommitteeElizabeth Sandel, MD, ChairDavid Berbrayer, MDMichael Hatzakis, MDKurtis M. Hoppe, MDAmy Houtrow, MDDeepthi Saxena, MDMichael P. Schaefer, MDFelicia M. Skelton, MDDisclaimerAll information provided by the American Academy of Physical Medicine and Rehabilitation, its employees, agents,or representatives who participate in Academy Committee work is based on information deemed to be as current andreliable as reasonably possible. The Academy shall not be liable to you or any other party to any extent whatsoever forerrors in, or omissions from any such information provided by the Academy, its employees, agents or representatives.

2015 PQRS OverviewAm I Eligible to Participate? If you are providing covered professional services paid under or based on the MPFS you areconsidered an eligible professional under PQRS. If you are a Medicare-enrolled provider, there are no exemptions from PQRS participation.Why Participate in PQRS: Physicians who successfully participate in PQRS will avoid a penalty in 2017 Physicians who choose not to participate in 2015 will be subject to a - 2% penalty on all their 2017Medicare Part B, Medicare as a Secondary Payer, and Railroad Medicare allowables, less durablemedical equipment and any injectable drug Non-PQRS reporters will also experience an additional - 4% penalty under the value-based paymentmodifier programPQRS changes in 2015: The Value-Based Modifier now applies to all PQRS Eligible Medicare Physicians The Low Back Pain Measures Group was removed Remove Claims-Based only reporting option for all new measures Remove Claims-Based reporting option for Measures Groups Deadline for Group Practice Registration modified to June 30 of the year in which the reportingperiod occurs: June 30, 2015 Group Practices are required to report on at least 2 cross-cutting measures (if they see at least 1Medicare patient in a face to face encounter)

2015 Reporting Requirements & DeadlinesReporting Individual Measures:EPs and group practices must report 9 measures covering at least 3 NQS Domains for at least 50percent of the Medicare Part B FFS patients seen during the reporting period.National Quality Strategy (NQS) Domains Patient safety Communication and care coordination Efficiency Clinical process and effectiveness Population health Patient and family experienceReporting Measures Groups: Individual EPs must report at least 1 measures group on a 20-patient sample, a majority of which(at least 11 out of 20) must be Medicare Part B FFS patientsReporting Period:January 1, 2015 – December 31, 2015Reporting Deadlines:Claims-Based Reporting: Claims processed by the MAC must reach the national Medicare claimssystem data warehouse by February 26, 2016 to be included in analysis. For specific instructions onhow to bill appropriately, contact your MAC.Registry-Based Reporting: Registry vendors will provide specific instructions on how and when tosubmit data. The 2015 PQRS data submission window will be in the first quarter of 2016.EHR-Based Reporting: EPs and group practices must submit final electronic reporting files withquality measure data, or ensure that their EHR DSV submits files by the data submission

PQRS MEASURES FOR PHYSIATRYTABLE OF CONTENTSIndividual MeasuresMeasure #Measure TitleOsteoporosis: Communication with the Physician Managing On-going Care Post-Fracture ofHip, Spine or Distal Radius for Men and Women Aged 50 Years and OlderStroke and Stroke Rehabilitation: Discharged on Antithrombotic TherapyStroke and Stroke Rehabilitation: Anticoagulant Therapy Prescribed for Atrial Fibrillation(AF) at DischargeScreening or Therapy for Osteoporosis for Women Aged 65 Years and OlderOsteoporosis: Management Following Fracture of Hip, Spine or Distal Radius for Men andWomen Aged 50 Years and OlderOsteoporosis: Pharmacologic Therapy for Men and Women Aged 50 Years and OlderMedication ReconciliationCare PlanUrinary Incontinence: Assessment of Presence or Absence of Urinary Incontinence inWomen Aged 65 Years and OlderUrinary Incontinence: Plan of Care for Urinary Incontinence in Women Aged 65 Years andOlderOsteoarthritis (OA): Function and Pain AssessmentPreventive Care and Screening: Influenza ImmunizationPneumonia Vaccination Status for Older AdultsAntibiotic Treatment for Adults with Acute Bronchitis: Avoidance of Inappropriate UseDiabetes Mellitus: Diabetic Foot and Ankle Care, Peripheral Neuropathy – NeurologicalEvaluationDiabetes Mellitus: Diabetic Foot and Ankle Care, Ulcer Prevention – Evaluation of FootwearPreventive Care and Screening: Body Mass Index (BMI) Screening and Follow-Up PlanDocumentation of Current Medications in the Medical RecordPain Assessment and Follow-UpPreventive Care and Screening: Screening for Clinical Depression and Follow-Up PlanOncology: Medical and Radiation – Plan of Care for PainRadiology: Exposure Time Reported for Procedures Using FluoroscopyFalls: Risk Assessmenttable of contents continued

PQRS MEASURES FOR PHYSIATRYIndividual MeasuresMeasure #Measure TitleFalls: Plan of CareDiabetes: Foot ExamPreventive Care and Screening: Unhealthy Alcohol Use – ScreeningRheumatoid Arthritis (RA): Functional Status AssessmentElder Maltreatment Screen and Follow-Up PlanFunctional Outcome AssessmentUse of High-Risk Medications in the ElderlyCardiac Rehabilitation Patient Referral from an Outpatient SettingPreventive Care and Screening: Screening for High Blood Pressure and Follow-UpDocumentedCAHPS for PQRS Clinician/Group SurveyAdult Major Depressive Disorder (MDD): Coordination of Care of Patients withSpecific Comorbid ConditionsAmyotrophic Lateral Sclerosis (ALS) Patient Care PreferencesTobacco Use and Help with Quitting Among AdolescentsMeasures GroupsMeasure #Measure TitleDementia Measures GroupParkinson’s Measures Groupbacktable of contents continued

PQRS MEASURES FOR PHYSIATRYElectronic Clinical Quality MeasuresSuccessful submission of CQM data will meet PQRS reporting requirements and the CQMcomponent of the Medicare EHR Incentive Program.eID#PQRSMeasure TitleAnti-Depressant Medication ManagementAdult Major Depressive Disorder (MDD): Suicide Risk AssessmentPreventive Care and Screening: Influenza ImmunizationPneumonia Vaccination Status for Older AdultsPreventive Care and Screening: Body Mass Index (BMI) Screening and FollowUp PlanDocumentation of Current Medications in the Medical RecordPreventive Care and Screening: Screening for Clinical Depression and FollowUp PlanDiabetes: Foot ExamUse of High-Risk Medications in the ElderlyWeight Assessment and Counseling for Nutrition and Physical Activity forChildren and AdolescentsChildhood Immunization StatusUse of Imaging Studies for Low Back PainPreventive Care and Screening: Screening for High Blood Pressure and FollowUp DocumentedFalls: Screening for Fall RiskADHD: Follow-Up Care for Children Prescribed Attention-Deficit/HyperactivityDisorder (ADHD) MedicationDepression Remission at Twelve MonthsDepression Utilization of the PHQ-9 ToolClosing the Referral Loop: Receipt of Specialist ReportFunctional Status Assessment for Knee ReplacementFunctional Status Assessment for Hip ReplacementFunctional Status Assessment for Complex Chronic ConditionsChild and Adolescent Major Depressive Disorder (MDD): Suicide RiskAssessmentback

Return to table of contentsPQRS MEASURE 9 EMEASURE ID #128Anti-Depressant Medication ManagementEligible Patient PopulationPatients 18 years of age and older with a diagnosisof major depression in the 270 days (9 months) priorto the measurement period or the first 90 days (3months) of the measurement period, who were treatedwith antidepressant medication, and with a visit duringthe measurement periodAAPM&R PerformanceMetrics Committee rating:Limited applicability to asubset of AAPM&R membersOPTIMALpartialExclusionsNQS DomainPatients who were actively on an antidepressantmedication in the 90 days prior to the IndexPrescription Start DateEffective Clinical CareClinical action required by the measure forperformancePatients who have received antidepressant medication3limitedType of MeasureElectronic Clinical Quality Measure(CQM)Reporting Methods(s)Direct EHR Vendor / Data SubmissionVendorfull measure specificationClick here to access the full measurespecification. *Must download a zip fileto access specificationsAdditional Resources:CMS Resources: AAPM&R PQRS Resources PQRS EHR-based Reporting Option Website 2015 EHR-Based Reporting Made Simple Medicare EHR Incentive Program Website eCQM Library Certified EHR Technology Resources CMS PQRS Help Desk

Return to table of contentsPQRS MEASURE 24OSTEOPOROSIS: Communication with the Physician Managing On-Going Care Post-Fractureof Hip, Spine or Distal Radius for Men and Women Aged 50 Years and OlderIt is anticipated that clinicians who treat the hip,spine, or distal radial fracture will submit thismeasure.AAPM&R PerformanceMetrics Committee rating:1Optimal measure for PM&REligible Patient PopulationAll patients aged 50 years on the date of encountertreated for hip, spine, or distal radial fracture withthe appropriate diagnosis code (see measurespecification).Clinical action required by the measure forperformancePatients with documentation of communication with thephysician managing the patient’s on-going care that afracture occurred and that the patient was or should betested or treated for osteoporosisRelevant PM&R CPT Codes for this measureOPTIMALpartiallimitedNQS DomainCommunication and Care CoordinationType of MeasureIndividual MeasureReporting Methods(s)Claims or Registry99201, 99202, 99203, 99204, 99205, 99212,99213, 99214, 99215, *99238, *99239full measure specification*Physician Facility Based CodeClick here to access the full measurespecification.Additional Resources:CMS PQRS Resources: AAPM&R PQRS Resources 2015 Registry Reporting Made Simple AAPM&R Sponsored Registry – 2015 Claims Reporting Made Simple CMS PQRS Help Desk