Jarrod Shapiro, DPM
Physician Quality Reporting System...Oh My!

This week's installment of alphabet soup comes to you courtesy of the Centers for Medicare and Medicaid Services (CMS). Last time, we talked about Meaningful Use – just what the government ordered to make a physician's life more difficult. This week they are writing a new prescription: PQRS or Physician Quality Reporting System. Yes, my friends, there's even more for you to do!

The purpose of PQRS, according to CMS, is "to ensure that patients get the right care at the right time. By reporting PQRS quality measures, providers also can quantify how often they are meeting a particular quality metric. Using the feedback report provided by CMS, EPs can compare their performance on a given measure with their peers".¹

This program gives providers a financial incentive, a payment equal to 0.5% of a physician's total estimated Medicare Part B covered charges. However, starting in 2016, physicians who do not satisfactorily report data on quality measures during the 2014 year will be docked 2% of their Medicare payments. The program starts with a carrot and ends with a big stick. It's funny that they call this a "payment adjustment."

This system requires providers or group practices to report on nine or more measures covering at least three National Quality Strategy domains. This has to be done for at least 50% of providers' Medicare patients. What are those domains you might ask?

Here they are:

Patient Safety
Person and Caregiver-Centered Experience and Outcomes
Communication and Care Coordination
Effective Clinical Care
Community/Population Health
Efficiency and Cost Reduction

So what are these measures we are supposed to report? As it turns out, there are 382 individual PQRS measures covering disease management from pediatric asthma through CHF to diabetes. You get to comb through the list and pick out a minimum of nine measures from three domains on which to report. I did some combing of my own and created the table below of some of the measures that would be pertinent to podiatrists.

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Advancements in Regenerative Medicine: A Practical Approach
Steven A. Bernstein, DPM

PQRS Measures Pertinent to Podiatrists

PQRS #	National Quality Strategy Domain	Measure Description
1	Effective Clinical Care	Diabetes: Hemoglobin A1c Poor Control: Percentage of patients 18-75 years of age with diabetes who had hemoglobin A1c > 9.0% during the measurement period.
20	Patient Safety	Perioperative Care: Timing of Prophylactic Parenteral Antibiotic – Ordering Physician: Percentage of surgical patients aged 18 years and older undergoing procedures with the indications for prophylactic parenteral antibiotics, who have an order for prophylactic parenteral antibiotic to be given within one hour (if fluoroquinolone or vancomycin, two hours), prior to the surgical incision (or start of procedure when no incision is required).
21	Patient Safety	Perioperative Care: Selection of Prophylactic Antibiotic – First OR Second Generation Cephalosporin: Percentage of surgical patients aged 18 years and older undergoing procedures with the indications for a first OR second generation cephalosporin prophylactic antibiotic, who had an order for a first OR second generation cephalosporin for antimicrobial prophylaxis.
30	Patient Safety	Perioperative Care: Timing of Prophylactic Antiobiotic — Administering Physician: Percentage of surgical patients aged 18 years and older who receive an anesthetic when undergoing procedures with the indications for prophylactic parenteral antibiotics or whom administration of a prophylactic parenteral antibiotic ordered has been initiated within one hour (if fluoroquinolone or vancomycin, two hours) prior to the surgical incision (or start of procedure when no incision is required).
109	Person and Caregiver-Centered Experience and Outcomes	Osteoarthritis (OA): Function and Pain Assessment: Percentage of patient visits for patients aged 21 years and older with a diagnosis of osteoarthritis (OA) with assessment for function and pain
126	Effective Clinical Care	Diabetes Mellitus: Diabetic Foot and Ankle Care, Peripheral Neuropathy – Neurological Evaluation: Percentage of patients aged 18 years and older with a diagnosis of diabetes mellitus who had a neurological examination of their lower extremities within 12 months
127	Effective Clinical Care	Diabetes Mellitus: Diabetic Foot and Ankle Care, Ulcer Prevention – Evaluation of Footwear: Percentage of patients aged 18 years and older with a diagnosis of diabetes mellitus who were evaluated for proper footwear and sizing.
128	Community / Population Health	Preventive Care and Screening: Body Mass Index (BMI) Screening and Follow-Up: Percentage of patients aged 18 years and older with a documented BMI during the current encounter or during the previous six months AND when the BMI is outside of normal parameters, a follow-up plan is documented during the encounter or during the previous six months of the encounter. Normal Parameters: Age 65 years and older BMI > 23 and < 30; Age 18 – 64 years BMI > 18.5 and < 25.
130	Patient Safety	Documentation of Current Medications in the Medical Record: Percentage of visits for patients aged 18 years and older for which the eligible professional attests to documenting a list of current medications using all immediate resources available on the date of the encounter. This list must include ALL known prescriptions, over- the-counters, herbals, and vitamin/mineral/dietary (nutritional) supplements AND must contain the medications' name, dosage, frequency and route of administration.
131	Community / Population Health	Pain Assessment and Follow-Up: Percentage of visits for patients aged 18 years and older with documentation of a pain assessment using a standardized tool(s) on each visit AND documentation of a follow-up plan when pain is present
142	Effective Clinical Care	Osteoarthritis (OA): Assessment for Use of Anti-Inflammatory or Analgesic Over-the-Counter (OTC) Medications: Percentage of patient visits for patients aged 21 years and older with a diagnosis of osteoarthritis (OA) with an assessment for use of anti-inflammatory or analgesic over-the-counter (OTC)medications
163	Effective Clinical Care	Diabetes: Foot Exam: Percentage of patients aged 18-75 years of age with diabetes who had a foot exam during the measurement period
173	Community / Population Health	Preventive Care and Screening: Unhealthy Alcohol Use – Screening: Percentage of patients aged 18 years and older who were screened for unhealthy alcohol use at least once within 24 months using a systematic screening method
182	Communication and Care Coordination	Functional Outcome Assessment: Percentage of visits for patients aged 18 years and older with documentation of a current functional outcome assessment using a standardized functional outcome assessment tool on the date of the encounter AND documentation of a care plan based on identified functional outcome deficiencies on the date of the identified deficiencies
219	Communication and Care Coordination	Functional Deficit: Change in Risk-Adjusted Functional Status for Patients with Lower Leg, Foot or Ankle Impairments: Percentage of patients aged 18 or older that receive treatment for a functional deficit secondary to a diagnosis that affects the lower leg, foot or ankle in which the change in their Risk-Adjusted Functional Status is measured
318	Patient Safety	Falls: Screening for Future Fall Risk: Percentage of patients 65 years of age and older who were screened for future fall risk at least once during the measurement period
357	Effective Clinical Care	Surgical Site Infection (SSI): Percentage of patients aged 18 years and older who had a surgical site infection (SSI)
374	Communication and Care Coordination	Closing the referral loop: receipt of specialist report: Percentage of patients with referrals, regardless of age, for which the referring provider receives a report from the provider to whom the patient was referred

Closing the referral loop: receipt of specialist report: Percentage of patients with referrals, regardless of age, for which the referring provider receives a report from the provider to whom the patient was referred

Simple. Yeah right.

But, wait, there's more! These individual measures are broken up into treatment groups (for example diabetes management) and reporting is actually done through a variety of ways (five different ways actually), such as registries and direct coding among others.

Ah ah ah…there's more yet. When you code for one of the measures during a patient encounter, you'll have the option to add numerators to your codes (number and letter combinations that describe the service). Here's a screen shot of the coding method for a diabetic foot examination.

Looks suspiciously like CPT coding (and about as complicated). If your eyes are crossed, don't feel bad. Mine are too. This system is so complex and detailed that it takes an expert to fully understand it. In fact, it's likely I have omitted some important details, so as in all things, do your research and don't get caught with your proverbial pants down. It's hard enough to run a profitable medical practice today without yet another administrative responsibility to add. So, to all of you, I bid you good luck preparing for your PQRS reporting.

Best wishes,

Jarrod Shapiro, DPM
PRESENT Practice Perfect Editor
[email protected]