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Time for PQRS – Let’s Review

posted by SamK on December 6, 2012

Michael Jopling, MD, Executive VP, Accel Anesthesia, LLC

December 8, 2012


As we approach the end of 2012, it is a good time to review the important elements of the Physician Quality Reporting System (PQRS).  PQRS, formerly known as the Physician Quality Reporting Initiative (PQRI), is a voluntary program that was authorized by the Tax Relief and Health Care Act of 2006 (TRCHA) and was implemented on July 1, 2007. The goal of PQRS is to provide a financial incentive to eligible professionals to improve patient care through evidence-based measures and to prepare for future pay-for-performance programs.


Eligible professionals who satisfactorily report data on quality measures for covered Physician Fee Scheduled (PFS) services furnished to Medicare Part B beneficiaries will qualify to earn an incentive payment.  This payment is a percentage of the eligible professional’s total Medicare Part B PFS allowable charges, and it has progressively decreased from a high of 2% in 2009 and 2010 to 1% in 2011 and 0.5% in 2012-2014.  Beginning in 2015 there will be a penalty of 1.5% for failing to report PQRS measures, and in 2016 (and forward) the penalty increases to 2%.


The three PQRS measures for anesthesiology include:


Measure #30, Perioperative Care: Timely Administration of Prophylactic Parenteral Antibiotics.  This is the percentage of surgical patients aged 18 years and older who receive an anesthetic when undergoing procedures with the indications for prophylactic parenteral antibiotics for whom administration of the 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).


Measure #76, Prevention of Catheter-Related Bloodstream Infections:  Central Venous Catheter (CVC) Insertion Protocol.  This is the percentage of patients, regardless of age, who undergo CVC insertion for whom CVC was inserted with all elements of maximal sterile barrier technique [cap, mask, sterile gown, sterile gloves, large sterile sheet, hand hygiene, 2% chlorhexidine for cutaneous antisepsis (or acceptable alternative antiseptics per current guideline)].


Measure #193, Perioperative Temperature Management.  This is the percentage of patients, regardless of age, undergoing surgical or therapeutic procedures under general or neuraxial anesthesia of 60 minutes duration or longer, except patients undergoing cardiopulmonary bypass, for whom either active warming was used intraoperatively for the purpose of maintaining normothermia, OR at least one body temperature equal to or greater than 36 degrees Centigrade (or 96.8 degrees Fahrenheit) was recorded within the 30 minutes immediately before or the 15 minutes immediately after anesthesia end time.


Because claims processing times may vary, participating eligible professionals should submit claims from the end of 2012 promptly, so that those claims will reach the Medicare National Claims History (NCH) file by February 23, 2013. PQRS incentive payments will be made as a lump sum in mid-2013.


As in years past, thresholds for determining successful PQRS reporting will depend on the number of quality measures applicable to the services provided by the anesthesiologist. CMS recommends that professionals report on every quality measure that is applicable to their patient population in order to increase the likelihood that they will reach the requisite 50 percent reporting requirement for the appropriate measures and also to increase the likelihood that they will not be affected by the bonus payment cap.


Claims-based reporting is the traditional method use by eligible professionals.  The EP must report on at least 3 Physician Quality Reporting measures, or 1-2 measures if less than 3 apply to the eligible professional, for at least 50% of applicable Medicare Part B beneficiaries.  The reporting period is Jan 1- December 31, 2012.  Measures Groups containing a measure with a 0% performance rate will not be counted.


I hope this information is beneficial to you.  Please contact myself or anyone at Accel Anesthesia with your specific questions and issues.  We are happy to assist with the challenges you face!