Steps to Begin Reporting PQRS measures for Anesthesia


Every year, the CMS adds PQRS measures. When we say “CMS adds measures”, of course there are larger organizations of physician organizations and participation in creating these reporting quality measures. And just like the fee schedule every year and the rules that CMS sends down to us, constantly changing regulations, the PQRS program will change every year or be modified, additions, subtractions – various things will happen every year. So you have to stay abreast of that.

Just like we look at the Federal Register, the physicians' final rule that's published every November, that's exactly where you're going to find a good deal of the decisions that CMS makes in this PQRS program. And so we will need to constantly be updating ourselves. When this Physician Quality Reporting System program first started, everybody was fairly confused by it because it was  a new program.

And luckily for anesthesia, anesthesia was really one of the easiest or simplest to report because we just started with that one measure 30 which was the antibiotic. So now they're adding to it and they will add every year.

So to qualify for the PQRS incentive payment, the eligible professional or EP – as we're going to say quite a bit; they talk about the EPs and that's the eligible professional – they have to meet certain healthcare rules’ criteria for satisfactory reporting. Then, we've got three ways to report. There are three reporting mechanisms.

One, we have the claims reporting; claims-based reporting. And that's the measure that is reported on your claim. Number two, a qualified registry. And number three, via at a qualified electronic health record.

The health record for sure, right now, is not available to the anesthesia people even if they are using electronic health records right now in the operating room. They still wouldn't be able to report PQRS that way as per CMS rules. The registry at this time is not available.

And CMS is actually – just to kind of clue you in – CMS is considering limiting the claims-based mechanism of reporting these quality measures. So it's really kind of interesting. Five of the 13 measure groups – there's 13 measure groups – and five of those are registry only as per healthcare guidelines. Now, the ASA did voice some concern and wrote a letter to CMS about that. Because should they go to registry-only reporting, that could, you know, impact anesthesia.

Right now we just really don't have a mechanism that much to report through the registry because we don't have that many measures and we don't have any of what we would call “measure groups”.

If you report, six months bonus, you'll get 2% of the allowed claims based on that six months' income. So the bonus is 2% – 2% of the EP's total estimated Medicare fee schedule allowed charges. Now, those have to be allowed charges. So any charges that were denied won't be coming in to that equation. And it's for the covered professional's services.

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