Experience. Integrity. Advocacy.
Experience. Integrity. Advocacy.

Southeast Anesthesiologists, PC Among First in the Nation to Submit PQRS Data to the Anesthesia Quality Institute QCDR

laptop and stethoscope

An Indiana anesthesia group recently was among the first in the nation to submit quality data for the Physician Quality Reporting System (PQRS) to the Anesthesia Quality Institute’s (AQI) Qualified Clinical Data Registry (QCDR). When Southeast Anesthesiologists, PC (SEA) transmitted their January quality data to the National Anesthesia Clinical Outcomes Registry (NACOR), they became one of the first anesthesia groups in the nation to begin reporting PQRS using a QCDR, a PQRS reporting option made available for the first time in 2014.

AQI’s NACOR, in coordination with the American Society of Anesthesiologists (ASA), was just approved as a QCDR by the Centers for Medicare and Medicaid Services (CMS) in late 2014 for the 2015 reporting year. The NACOR QCDR option is offered for free to ASA members and offered at a nominal fee to non-members.

SEA, whose 41 physicians provide anesthesia services at Community South Hospital in Indianapolis and St. Francis Hospital in Greenwood, has participated in PQRS since its inception in 2007 through the claims reporting option, said SEA advisory board member Dr. Jaemy Hwang, MD.

PQRS is a program designed to encourage physicians and other eligible professionals to perform industry-recognized quality measures and report them to CMS. Through the 2012 reporting year, PQRS was an incentive-only program for successful participation. Continuing in 2013, successful participants could earn a .5 percent incentive, but non- or unsuccessful participants face a 1.5 percent payment adjustment for 2015 Part B Medicare claims.  The last year for eligible professionals to earn incentives was 2014, and non- or unsuccessful participants for that reporting year face a 2 percent payment adjustment for 2016 Part B Medicare claims. For 2015, non- or unsuccessful participants face a 2 percent payment adjustment for 2017 Part B Medicare claims.

Because the PQRS data also is used to measure quality in Medicare’s Value-Based Payment Modifier program, groups who do not participate in PQRS face up to an additional 4 percent payment adjustment in 2017.

This year, SEA decided to try the new QCDR option for two reasons. The first was a desire to more fully engage this new era of quality.

“In an age where quality reporting is what physician practices want and need to do, this was a great thing to jump on,” Dr. Hwang said.

The second reason was because of the limited opportunities for anesthesia practices among other reporting options, including claims. “It’s a limited system for anesthesia with few measures, questionable clinical value, and an ambiguous audit process,” Dr. Hwang explained. “With up to 6 percent of our Medicare payments on the line, we wanted more certainty.”

QCDR offers many advantages to physicians because though they must meet similar reporting guidelines—reporting 9 measures covering 3 National Quality Strategy Domains—the measures in QCDR are not limited to measures within the PQRS program. Each QCDR vendor can create measures that will be clinically valuable to participants.

According to Dr. Hwang, SEA actually is reporting more than the required number of measures to allow for any technical glitches that may possibly prevent any of their submissions from being counted.

In addition to fulfilling the requirements of PQRS and avoiding possible payment adjustments, participating with AQI’s QCDR also provides other benefits to SEA. Among those benefits is more comprehensive quality reporting—for the QCDR option, providers report measures for all patients, not just Medicare patients—which allows practices to troubleshoot their processes more effectively.

“We have great talent providing care to patients, and a more comprehensive reporting system is able to detect problems that weren’t even on our radar previously,” Dr. Hwang said. “It’s a tremendous first step in improving our whole system.”

On the down side, reporting via the QCDR option does require more work from everyone, from physicians and nursing staff, all the way down to SEA’s billing company, CIPROMS, Inc., who not only created the interface with AQI for the data transfer but also captures quality data submitted by physicians and enters it into their practice management system for every single patient SEA treats. CIPROMS then makes monthly data transfers on behalf of SEA.

“We are proud of the fact that we had the support of physicians, nurses, hospital administrators, our billing company—everyone—to help with this process,” Dr. Hwang said. “The fact that other practices haven’t yet been able to submit … everyone on our team deserves a pat on the back for this.”

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Charity Singleton Craig

Charity Singleton Craig is a freelance writer and editor who provides communications and marketing services for CIPROMS. She is responsible for creating, editing, and managing all content, design, and interaction on the company website and social media channels in order to promote CIPROMS as a thought leader in healthcare billing and management.

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