Are Medicare Quality Data Getting Easier to Report?

Kenneth J. Terry, MA


May 13, 2015

In This Article

A Simplified Reporting Process?

Any time the federal government makes things easier rather than harder for physicians is cause for celebration. That's what the Centers for Medicare & Medicaid Services (CMS) has attempted to do with the quality data that physicians submit on their treatment of Medicare patients.

Until now, these data have been reported for three separate CMS initiatives: the physician quality reporting system (PQRS), the meaningful use electronic health records (EHR) incentive program, and the value-based modifier (VBM) program.

PQRS uses incentive payments and payment adjustments to promote reporting of quality information by eligible professionals (EPs), which include physicians.

The meaningful use program provides incentive payments to EPs as they adopt, implement, upgrade, or demonstrate meaningful use of certified EHR technology.

The VBM program pays a physician or group under the Medicare Physician Fee Schedule based on the quality of care furnished compared with the cost of care during a performance period. CMS will apply the VBM to all physicians in 2017, using data on 2015 performance.

Because all three programs involve quality measures for the treatment of Medicare patients, it makes sense for physicians to submit their quality data just once—electronically—rather than separately for three initiatives. Or so one would think.

But don't break out the champagne just yet. Is this new "just-once" approach really simpler than the traditional approach? The devil is in the details. Let's examine what they are.

Two Ways to Get Your Data to CMS

Under the just-once approach, practices can report one time on nine clinical quality measures rather than reporting on nine measures for PQRS and then on another nine for meaningful use. In addition, the electronic reporting methods that physicians must use to qualify for the just-once approach would seem, at first glance, to be simpler and easier than the claims-based reporting method that most physicians still use in PQRS reporting.

The new approach also eliminates the need to enter those time-consuming numerators, denominators and percentages in the attestation form for meaningful use. "It should absolutely streamline operations," says Rosemarie Nelson, a health information technology consultant with the Medical Group Management Association (MGMA).

Nevertheless, the investment of staff time and resources in shifting from claims-based to electronic reporting poses a challenge to many practices, notes Sara Brown, a governmental affairs representative for MGMA. In addition, claims-based reporting is the only free option for reporting to PQRS, she observes.

If you want to switch to just-once reporting, your quality data are electronically uploaded to CMS in one of two ways. The first is via a qualified clinical data registry. Most registries are operated either by specialty societies, specialty-specific or disease-oriented collaboratives, or quality improvement collaboratives.

The second method is to upload your data directly to CMS via your EHR, which will require special software that may be provided by your vendor. Alternatively, you can use a data submission vendor to extract the information from your EHR and submit it on your behalf. Some EHR vendors are also data submission vendors.

Unless you do the electronic submission yourself, expect to pay a fee, Brown says. Fees are generally modest, though. Most registry organizations, for example, charge only $200-$400 per provider, although a few go higher. Moreover, notes Cindy Dunn, another MGMA consultant, the registry organizations include experts who can walk EPs through the reporting process.

The downside of using registries is that they usually require manual data entry. Some registries are more automated than others, Dunn says. But they don't provide the same potential for automation that EHR direct reporting does.

These are the only just-once reporting options that CMS offers to EPs who report as individuals or as members of groups that have under 25 EPs. An alternative, the Group Practice Reporting Option web interface, exists for groups of 25 or more EPs. Groups of this size cannot use registries to report just once.


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