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Physician Quality Reporting System

Resources to help you avoid the 2017 PQRS penalty by successfully reporting in 2015.

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2015 PQRS Facts:

  • If you are a Medicare Part B enrolled physician, there are no exemptions for the PQRS penalty.
  • Individual reporting is captured by the physician’s National Provider Identifier (NPI).
  • Electronic health records are not required to report PQRS.
  • IRIS™ Registry will help automate PQRS reporting.

PQRS Changes for 2015

To avoid the 2 percent 2017 penalty of all Medicare Part B, Medicare as a secondary payer, and Railroad Medicare allowables less durable medical equipment and injected drugs, ophthalmologists must successfully report one of the six reporting options (see Reporting Options section below).

Measure 18 Diabetic retinopathy: documentation of presence or absence of macular edema and level of severity of retinopathy, has been deleted from claims and registry reporting, and is only available to report through an EHR.

Four new measures have been added to registry reporting:

  • 1. Measure 384: Adult primary rhegmatogenous retinal detachment repair success rate
  • 2. Measure 385: Adult primary rhegmatogenous retinal detachment surgery success rate
  • 3. Measure 388:Cataract Surgery with Intra-Operative Complications (Unplanned Rupture of Posterior Capsule Requiring Unplanned Vitrectomy)
  • 4. Measure 389: Cataract Surgery: Difference Between Planned and Final Refraction within +-1.0D

The cataracts measures group increased to 8 measures, including the newly added Measures 388 and 389.

The claims and qualified registry reporting options increased to 9 measures to avoid the penalty, and include the requirement that at least one “cross-cutting” measure must be reported.

View all 2015 PQRS Measure Specifications

2015 Reporting Options

Option 1: IRIS™ (Intelligent Research in Sight) Registry EHR System Integration

Academy members with EHR can have the Academy's IRIS Registry integrate with their EHR system to extract data needed to report clinical quality measures for PQRS which can also meet the CQM requirements for 2015 EHR Meaningful Use Incentive Program, as well as Stage 2 Menu Measure 6 (specialized registry). 

Report nine clinical quality measures across three quality domains. If your EHR does not contain patient data for nine measures covering three domains, then report all of the measures for which there is Medicare Part B patient data. Physicians are required to report on at least one measure for which there is Medicare Part B data.

Pros Cons
  • No manual data entry
  • Simultaneously reports for both EHR MU and PQRS
  • High success rate
  •  Requires EHR certified to the 2014 standards be in place for the full year.

Deadlines: 

  • March 1, 2015 submit signed IRIS Registry agreements to report Stage 2 Meaningful Use Menu Measure 6.
  • June 1, 2015 submit signed IRIS Registry agreements for EHR Integration for 2015 PQRS.
  • Oct. 21, 2015 submit signed consent allowing data to be sent to CMS.

Option 2: Direct EHR Product

Some EHRs will report directly from EHR to CMS to meet the requirements of PQRS, as well as the CQM requirements for the EHR Meaningful Use Incentive Program. Report nine clinical quality measures across three domains. If your EHR does not contain patient data for nine measures covering three domains, then report all of the measures for which there is Medicare Part B patient data. Physicians are required to report on at least one measure for which there is Medicare Part B data.

Option 3: Cataracts Measures Group

Cataract surgeons can report the Cataracts Measures Group through the IRIS Registry.

New in 2015: This measures group has eight measures. 

  • 1. Measure 191  Cataracts: 20/40 or better visual acuity within 90-days following cataract surgery, and
  • 2. Measure 192  Cataracts: Complications within 30 days following cataract surgery requiring additional surgical procedures, and
  • 3. Measure 303  Improvement in patient’s visual function within 90 days following cataract surgery, and
  • 4. Measure 304  Patient satisfaction within 90 days following cataract surgery, and
  • 5. Measure 388  Cataract surgery with intraoperative complications (unplanned rupture of posterior capsule requiring unplanned vitrectomy), and
  • 6. Measure 389  Cataract surgery: difference between planned and final refraction, and two “cross cutting measures”
  • 7. Measure 130  Documentation of current medications in the medical record, and
  • 8. Measure 226  Preventative care and screening: tobacco use: screening and cessation intervention

Twenty surgical cases must be reported. Of the twenty, at least eleven patients must have Medicare Part B insurance. The remaining patients may have Medicare Advantage or commercial insurance.

View all 2015 PQRS Measure Specifications

Pros Cons
  • Low burden option for physicians without EHR.
  • High success rate in avoiding PQRS penalty
  • Not an option for non-cataract surgeons
  • Not an option for attesting for meaningful use

Deadlines:

  • By Aug. 1, submit signed IRIS Registry agreements.
  • By Sept. 30, provide pre-surgical forms and perform at least 20 cataract surgeries
  • By Oct. 21,submit signed consent, allowing data to be sent to CMS
  • By Jan. 15, 2016 submit all data to IRIS Registry.

Option 4: Individual Measure Reporting via IRIS Registry Web Portal (No EHR)

Physicians without an EHR can use the IRIS Registry to report individual measures.

Option A: Identify nine measures across three quality domains for at least 50 percent of the qualifying Medicare Part B, Medicare as a secondary payer, and Railroad Medicare patients seen between Jan. 1 and Dec. 31, 2015.  At least one measure must be a “cross-cutting” measure. When you use the Web portal to select a measure, you will be provided with a measure description that indicates what type of measure it is.

If you report less than nine measures, CMS will use the Measure Application Validity (MAV) process to determine whether you should have reported additional measures.

Option B: Identify nine measures across three quality domains for at least 50 percent of total patients seen between Jan. 1 and Dec. 31, 2015. Two measures must be “outcomes” measures, and if two outcomes measures are not available, must report at least one outcomes measure, and one of the following types of measures: resource use, patient experience of care, efficiency / appropriate use, or patient safety. When you use the Web portal to select a measure, you will be provided with a measure description that indicates what type of measure it is.

Pros Cons
  • Measures do not have to be entered in real time.
  • Option B, can report new ophthalmology measures being developed by IRIS Registry not available in PQRS measure set
  •  More labor intensive than EHR Integration or Cataracts Measures Group.

Option 5: Claims Based Reporting From Your Office

Physicians who have been successfully reporting PQRS from the office setting may choose to continue to do so. To avoid the penalty, nine clinical quality measures across three domains, including at least one “cross-cutting” measure, should be submitted for at least 50 percent of the Medicare Part B FFS patients seen during the reporting period.

However in 2015 there are only eight measures that apply to most ophthalmologist that can be reported via claims due to the deletion of claims reporting option for Measure 18 Diabetic retinopathy: documentation of presence or absence of macular edema and level of severity of retinopathy.  Physicians reporting fewer than nine measures across three domains will be subject to the MAV process.

Pros Cons
  • Familiarity
  •  There are not nine ophthalmic measures that can be reported via claims.
  • All physicians will be subject to the MAV process and may not successfully avoid the penalty.
  • This option will likely be eliminated in future PQRS years



Option 6: Group Reporting Option

Ophthalmologists who are part of a large multi-specialty group practice may choose to report every physician in the group reporting option. Details can be found at www.cms.gov.


Frequently Asked Questions

Question Answer

What are the six quality domains?

PQRS measures are grouped into six quality domains:

  • 1. Patient  safety
  • 2. Person and caregiver-centered experience and outcomes
  • 3. Communication and care coordination
  • 4. Effective clinical care
  • 5. Community / population health
  • 6. Efficiency and cost reduction
What are "cross-cutting measures"? These are primary care measures that are intended to represent core competencies that apply to multiple specialties. 



Disclaimer and Limitation of Liability

All information provided by the American Academy of Ophthalmology, its employees, agents, or representatives who participate in the Academy’s coding service is based on information deemed to be as current and reliable as reasonably possible. The Academy does not provide legal or accounting services or advice, and you should seek legal and/ or accounting advice if appropriate to your situation. Coding is a complicated process involving continually changing rules and the application of judgment to factual situations. The Academy does not guarantee or warrant that either public or private payers will agree with the Academy’s information or recommendations. The Academy shall not be liable to you or any other party to any extent whatsoever for errors in, or omissions from any such information provided by the Academy, its employees, agents or representatives. The Academy’s sole liability for any claim connected to its provision of coding information or services shall be limited to the amount paid by you to the Academy for the information or coding service.

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