IRIS Registry Web Portal Launches the Diabetic Retinopathy Measures Group

PQRS Alert! Act by Sept. 30. If you plan to participate in PQRS using the Diabetic Retinopathy Measures Group (DRMG), you must see at least 20 appropriate patients--and perform a blood pressure screening, which should include a blood pressure reading, at the qualifying visit--by Sept. 30. Starting Oct. 1, the qualifying ICD-10 codes for the DRMG measures will no longer be valid. For more information, see How to Report Diabetic Retinopathy Measures Group.

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Aside from the prospect of financial penalties, what major concerns have ophthalmol­ogists had about the Physician Qual­ity Reporting System (PQRS)? The 3 biggest sources of frustration have been the laborious reporting requirements, uncertainty over the ever-changing rules, and concerns that the measures being reported are not relevant to qual­ity of ophthalmic care.

Fortunately, the Academy IRIS Reg­istry, now in its third year, can help on all 3 counts—it provides a streamlined process for PQRS reporting; it is kept up-to-date with the latest PQRS rules; and the Academy has helped develop new reporting options that are more relevant to eye care.

Use the IRIS Registry for PQRS. Because not all practices have an electronic health record (EHR) system, the Academy has developed 2 sets of infrastructure for PQRS reporting.

• Practices with EHR can integrate with the clinical database. After you integrate your EHR system with the database, the IRIS Registry can extract the data needed for PQRS (see “EHRs and the IRIS Registry for PQRS”).
• Practices without EHR can man­ually report via the Web portal. You have 4 options for manually reporting PQRS data via the portal (see this month’s Web Extra, “No EHR? Use the IRIS Registry Web Portal”). For each option, the portal provides a step-by-step reporting process that includes safeguards to prevent errors. The portal also makes it easy to track your report­ing progress.

DRMG Overview

If you don’t have an EHR system, you will need to report PQRS manually, and the most straightforward way to do that is to report a measures group, which involves reporting on a minimum of 20 patients. Last year, there was only 1 measures group for ophthalmologists, the Cataracts Measures Group; this year, a second has been added.

New Diabetic Retinopathy Measures Group (DRMG) could streamline man­ual reporting. If you reported PQRS manually last year but didn’t perform enough cataract surgery to report the Cataracts Measures Group, the new DRMG may now give you an option for measures group reporting.

What to report. You will need to report the 7 DRMG measures for each of 20 or more patients. Those patients need to be at least 18 years old and no older than 75. At least 11 of them should be Medicare Part B fee-for-service patients; the rest can have Medicare Advantage or commercial insurance.

Deadlines. The patient encounters must take place between Jan. 1 and Dec. 31, 2016, and you must meet the following deadlines: By Oct. 31, you must have registered with the IRIS Reg­istry; by Dec. 1, you must have signed a data-release consent form; and by Jan. 15, 2017, you must have entered all your PQRS data into the portal.

The portal is expected to open for manual reporting of 2016 PQRS data by May. (To see deadlines for the other reporting options, read “EHRs and the IRIS Registry for PQRS” and this month’s Web Extra, “No EHR? Use the IRIS Registry Web portal.”)

Identify the appropriate patients. Look for patients who have both:

1. An ICD-10 code indicating diabetic retinopathy: E10.311, E10.319, E10.321, E10.329, E10.331, E10.339, E10.341, E10.349, E10.351, E10.359, E11.311, E11.319, E11.321, E11.329, E11.331, E11.339, E11.341, E11.349, E11.351, E11.359, E13.311, E13.319, E13.321, E13.329, E13.331, E13.339, E13.341, E13.349, E13.351, E13.359, and

2. One of these CPT codes:

• New patient eye visit code: 92002, 92004
• Established patient eye visit code: 92012, 92014
• New patient E&M code: 99202, 99203, 99204, 99205
• Established patient E&M code: 99212, 99213, 99214, 99215 

The 7 DRMG Measures

Measure 1. Diabetes: Hemoglobin A1c Poor Control. Enter the most recent he­moglobin A1c level. You do not have to draw blood; asking the patient will suf­fice—and if the patient doesn’t know, you can contact his or her primary care provider or internist. Note: Because this is an inverse measure, a lower calculat­ed performance rate indicates better clinical care or control.

Measure 18. Diabetic Retinopathy: Documentation of Presence or Ab­sence of Macular Edema and Level of Severity of Retinopathy. Confirm that you performed a dilated macular or fundus exam, including documentation in the patient’s record of the presence or absence of macular edema. In addi­tion, document the level of severity of the retinopathy.

Measure 19. Diabetic Retinopathy: Communication With the Physician Managing Ongoing Diabetes Care. Confirm whether or not you commu­nicated to the provider managing the patient’s ongoing diabetes care regard­ing the results of the dilated macular or fundus exam. You also should confirm that you performed the exam and documented the presence or absence of the macular edema and level of severity of retinopathy.

Measure 117. Diabetes: Eye Exam. Confirm whether or not a dilated retinal eye exam, with interpretation by an ophthalmologist or optometrist, was documented and reviewed.

Measure 130. Documentation of Current Medications in the Medical Record. Confirm that a list of current medications—including name, dosages, frequency, and route of administra­tion—was documented in the patient’s record. Note: CMS recently clarified that for DRMG reporting, you only need to report this measure once per patient. (For individual measures re­porting, report it at each visit.)

Measure 226. Preventive Care and Screening: Tobacco Use: Screening and Cessation Intervention. Confirm whether or not the patient was screened for tobacco use and, if identified as a tobacco user, received tobacco-cessa­tion counseling.

Measure 317. Preventive Care and Screening: Screening for High Blood Pressure and Follow-Up Documented. Record the patient’s blood pressure, keeping in mind the following:

• When reporting this measure, you must perform the blood pressure screening at the time of a qualifying visit. You may not obtain measure­ments from external sources.
• If the patient is prehypertensive or hypertensive, you will be asked to confirm whether you noted follow-up documentation in the medical record.
• This measure does not apply—and you do not need to report it—for pa­tients who have an active diagnosis of hypertension.
• If a patient does not already have a hypertension diagnosis, you must mea­sure his or her blood pressure.

MORE ONLINE. To see a comprehensive listing for each measure, including reporting instruc­tions, go to www.aao.org/practice-management/regulatory/pqrs-measure-specifications.