AAOS is working to help members avoid penalties
The Physician Quality Reporting System (PQRS) began in 2007 as the Physician Quality Reporting Initiative, a voluntary, incentive-based program for practitioners that was designed to better ensure high-quality healthcare services for Medicare beneficiaries. The program as it is known today will sunset on Dec. 31, 2016, as required under the Medicare Access and CHIP (Children's Health Insurance Program) Reauthorization Act of 2015 (MACRA). A new quality program, the Merit-Based Incentive Payment System (MIPS), will replace PQRS on Jan. 1, 2017.
With the landscape of medical practice poised for change, orthopaedic surgeons need to know what this means for them and what they can do now to report in 2016 to avoid penalties in 2018. To find out, spoke with Stephen M. McCollam, MD, of the AAOS Performance Measures Committee.
AAOS Now: Why are performance measures such a hot topic?
Dr. McCollam: The transition from traditional fee-for-service to alternative payment models is underway, evidenced by the Department of Health and Human Services announcing that an estimated 30 percent of Medicare payments are now tied to alternative payment models that reward the quality of care over quantity of services provided to beneficiaries.
Secondly, there is a paucity of orthopaedic quality measures to examine, let alone report. The most important piece for orthopaedic surgeons to understand is what they can do right now. The current 2016 reporting system, PQRS, requires an eligible physician to report on nine measures across three domains. To avoid penalities in 2018, surgeons should be reporting now.
AAOS Now: Will performance measures change how orthopaedic surgeons deliver care?
Dr. McCollam: Orthopaedic surgeons have the opportunity to improve the care they provide their patients by incorporating performance measures into a continuous quality improvement strategy. The goal is to move from using process-based performance measures to outcome performance measures to demonstrate improvement in care.
AAOS Now: How feasible will it be for orthopaedic surgeons to implement performance measures into their practices?
Dr. McCollam: Orthopaedic surgeons should choose measures that can be implemented without difficulty into their workflow. It is likely that they are already doing what is detailed in a measure, but they are not documenting and reporting it to the Centers for Medicare & Medicaid Services (CMS). I recommend reporting measures that can be easily mined from electronic health record (EHR) data.
AAOS Now: How will orthopaedic surgeons know which performance measures are relevant to them?
Dr. McCollam: To aid AAOS members with reporting requirements, the Performance Measures Committee evaluated all of the available 2016 PQRS performance measures and distilled them down into a list of 26 of the most relevant orthopaedic measures. This list was approved by the AAOS Board of Directors and is titled the Orthopaedic Preferred Specialty (OPS) Measure Set. The OPS Measure Set is available on the AAOS website
AAOS Now: Do orthopaedic surgeons have to use the measures listed in the OPS Measure Set?
Dr. McCollam: Use of the OPS Measure Set is not a requirement—it was developed as a resource to help orthopaedic surgeons choose measures to report. It contains the most relevant orthopaedic performance measures that the Performance Measures Committee identified from among the current CMS-published list of measures.
AAOS Now: What if there aren't enough measures in the OPS Measure Set that are relevant to an orthopaedic surgeon's specialty? Is AAOS doing anything to increase the number of relevant measures?
Dr. McCollam: Orthopaedic surgeons can always refer to the 16 general measures included in the OPS Measure Set. Many of these measures are applicable across orthopaedic specialties.
Beginning in 2014, the Performance Measures Committee has selected two new performance measures topics for measure set development each year, ensuring orthopaedic surgeons have a wide range of relevant measures from which to choose. Currently, there are three performance measures workgroups in progress: Osteoarthritis Function and Pain Assessment, Management of Hip Fractures in the Elderly, and Management of Anterior Cruciate Ligament Injuries. In the fall, a fourth work group will be convened to develop a set of performance measures related to Glenohumeral Joint Osteoarthritis.
AAOS Now: What mechanisms do surgeons have to report performance measures through PQRS?
Dr. McCollam: Currently, performance measures can be successfully reported to PQRS through the following six mechanisms:
- EHR—Eligible physicians can report PQRS through an EHR that is deemed a certified EHR technology system.
- Qualified registry (QR)—A QR has the ability to report nine PQRS measures that cover at least three National Quality Strategy domains.
- Qualified Clinical Data Registry (QCDR)—A QCDR collects/tracks clinical data to assist in improving the quality of care physicians are providing to their patients. Data submitted to CMS via a QCDR is not limited to Medicare and can include quality measures across multiple payers. The American Joint Replacement Registry has been deemed a QCDR for 2016.
- PQRS Group practice via Group Practice Reporting Option Web Interface—This option is available for any eligible physicians reporting as a group. They can participate in this option if they are reporting on PQRS or through their Accountable Care Organizations (ACOs).
- CMS-Certified Survey Vendor—This mechanism is open to eligible professionals reporting as a group. They can supplement reporting for 2016 PQRS with the Consumer Assessment of Healthcare Providers and Systems (CAHPS) survey. The data collected in the CAHPS survey must be submitted to CMS via a Certified Survey Vendor.
- Administrative Claims—This mechanism is available to individual providers through their routine billing processes. Group practices can also report using administrative claims, but they must include the correct quality data code.
To learn more about reporting mechanisms, visit the PQRS page on the AAOS website.
AAOS Now: What should orthopaedic surgeons do now?
Dr. McCollam: Orthopaedic surgeons can do the following now:
- Familiarize themselves with the OPS Measure Set and decide which measures are most applicable to their practice.
- Choose measures that align with their practice goals and are under their control.
- Stay abreast of how these reporting requirements and the payments will change with each passing year, as there will be escalating penalties for noncompliance.
- Be aware that although the CMS initiative applies only to Medicare providers, other private payers may also adopt this volume to value paradigm shift.
The AAOS Performance Measures Committee will continue to provide updates and new information as it becomes available.