Eligible professionals using a qualified EHR to report PQRS will find this option reduces the burden of reporting, makes better use of EHR capabilities and fits well into the daily workflow of the facility. The entire care team can properly document visits at the point-of-care to capture PQRS data. Documentation for PQRS purposes is consistent with documentation for Meaningful Use, Patient-Centered Medical Homes, Accountable Care Organizations, and other quality initiatives, and you may be able to report the same or similar measures for all programs.
In order to participate in EHR-based PQRS reporting in 2012, certain requirements must be met:
- The practice must be using a Qualified EHR or Qualified EHR Data Submission Vendor. The final list of qualified vendors will be posted on the CMS Web site (under the “Alternative Reporting Mechanisms” heading) soon. Check here for updates.
- Your practice must have been using an EHR for the entire reporting period, although you may be able to upgrade to the qualified version at any time during the reporting year. Contact your vendor to determine when the upgrade must occur for successful PQRS reporting.
- All eligible encounters for the year must be contained in the EHR, along with all diagnosis, service, and procedure data.
- Data elements should be recorded as structured data (not as narrative text) in the manner specified by your vendor.
Editor’s note: If you have not yet read “Getting Started” please refer to Steps 1-5, which describe initial steps for PQRS reporting.
STEP 6: Select your measures
There are 51 individual measures which may be reported using an EHR in 2012, including all Clinical Quality Measures (CQMs) which are part of Meaningful Use. Primaris provides extended expertise with measures related to preventive care, but will also assist with any EHR-based measures.
While you must report a minimum of three individual measures, you may report as many measures as you like to increase your chances of reporting success. Built-in software can greatly reduce the additional time needed to report additional measures.
STEP 7: Review the Measure Specifications
The measure specifications for EHR-based measures can be found here (note: this link will take you to a CMS Web site page asking you to accept a license agreement. The specifications are part of the ZIP file you will then download). Make sure you understand the documentation requirements for the measures you select. Work with your EHR vendor if you have questions.
STEP 8: Set alerts for eligible patients
Use the clinical decision support function of your EHR to set alerts to identify all eligible cases for your measures. Many vendors have pre-defined alerts that align with PQRS measures. Work with your vendor to “turn-on” or define selected alerts.
STEP 9: Determine a workflow that assigns each staff and provider specific responsibilities for performing and documenting services
A sample workflow might be as follows: At the time the patient checks in, the front desk reviews alerts for prevention services that are due. The patient is queried as to whether any of the services were performed outside the clinic (such as a flu shot, mammogram or colonoscopy), and if so, where and when they were done. The patient’s response is documented as a note for the clinical staff. The patient is given educational brochures on prevention screens that are due and the EHR is documented to reflect educational materials given.
A standing order for flu and pneumococcal vaccine is a possible way to ensure all eligible patients are properly vaccinated. As staff perform and document vitals and the patient history, a standing order would allow administration of needed vaccines. Staff should be comfortable discussing the provider’s position on vaccines (e.g., “All Dr. X’s patients are vaccinated unless there is a specific medical reason to not vaccinate. The vaccines can save your life—and if you’re around children, may prevent you from spreading disease to them. The pneumococcal vaccine protects against the bacterium that causes middle ear infection, sinus infections, pneumonia, blood stream infections and meningitis. These diseases occur year-round, unlike influenza.”) Vaccines or medical exclusions are documented.
Nursing staff may also be assigned the responsibility to review tobacco use status and provide cessation counseling. Staff should be educated on how to counsel and should have patient education resources available. Smoking status and cessation counseling are documented. Nursing staff may also open discussion about the need for a mammogram and/or colorectal cancer screening and ask if the patient has any questions after reading the brochures provided by the front desk. Nurses should be familiar with all options for colorectal cancer screening, as some patients may oppose a colonoscopy (due to cost or other reasons), but be accepting of the FOBT or newer FIT screens. Medicare coverage of these screens can also be addressed.
After completing the visit, the provider reviews what has been done regarding prevention services thus far. The provider gives a convincing, strong recommendation and staff is asked to assist the patient in scheduling a mammogram and/or colonoscopy, or providing supplies for FOBT/FIT screening. Orders are documented using CPOE. Changes and additions to education, orders, counseling, referrals, or prescription are made and documented. A visit summary, including prevention care recommendations and follow-up appointments, is given to the patient.
STEP 10: Run monthly monitoring reports on the status of your PQRS patients.
Qualified software can generate monthly reports to track the status of patients for each quality measure. (Primaris can also help you establish these reports.) Your I.T. consultant can schedule a task for the EHR to automatically run the reports on the same day every month. Identify patients who have not met the measure and discuss results among staff and physicians at monthly meetings. Determine why patients did not meet the measure. Establish a plan for improvement.
STEP 11: After the end of the reporting year, create the PQRS file and submit the data to CMS
Before February 28, 2013 you will need to create the required reporting file from your EHR system and upload it to CMS through the PQRS Portal. Notify your vendor that you plan to participate in EHR-based reporting, so you will receive high priority for any necessary upgrades. Submit the file to CMS and collect your incentive payment.
Primaris assists Missouri providers with reporting preventive care measures in 2012. Ensure you meet important deadlines, receive critical information and enjoy personal local assistance through Primaris. These services are completely free of charge. Contact Sandy Pogones, Program Manager Physician Services at firstname.lastname@example.org or phone (573) 673-4531. Providers may also contact the QualityNet Help Desk at 866-288-8912 (available 7 a.m. to 7 p.m. CST Monday through Friday) or via e-mail at email@example.com.
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