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 PROGRAMS               MU, PQRS, VBM, MIPS

                                                                                   MU

                             Medicare EHR Incentive Payment Schedule for Eligible Professionals

Payment Amounts

If a Medicare Eligible Professional Qualifies to Receive First Payment in 2011

If a Medicare Eligible Professional Qualifies to Receive First Payment in 2012

If a Medicare Eligible Professional Qualifies to Receive First Payment in 2013

If a Medicare Eligible Professional Qualifies to Receive First Payment in 2014

If a Medicare Eligible Professional Qualifies to Receive First Payment in 2015

Payment

$18,000

 

 

 

 

Amount for 2011 Will Be

 

 

 

 

 

Payment Amount for 2012 Will Be

$12,000

$18,000

 

 

 

Payment Amount for 2013 Will Be

$8,000

$12,000

$15,000

 

 

Payment Amount for 2014 Will Be

$4,000

$8,000

$12,000

$12,000

 

Payment Amount for 2015 Will Be

$2,000

$4,000

$8,000

$8,000

 

Payment Amount for 2016 Will Be

 

$2,000

$4,000

$4,000

 

Total Payment Amount Will Be

$44,000

$44,000

$39,000

$24,000

 

A qualifying Eligible Professional (EP) will receive an incentive payment equal to 75 percent of Medicare allowable charges for covered professional services furnished by the EP in a payment year, subject to maximum payments.

For eligible professionals (EPs), incentive payments for the Medicare EHR Incentive Program will be made approximately four to eight weeks after an EP successfully attests that they have demonstrated meaningful use of certified EHR technology. However, EPs will not receive incentive payments within that timeframe if they have not yet met the threshold for allowed charges for covered professional services furnished by the EP during the year. Payments will be held until the EP meets the $24,000 threshold in allowed charges for the calendar year in order to maximize the amount of the EHR incentive payment they receive. Medicare EHR incentive payments are based on 75% of the estimated allowed charges for covered professional services furnished by the EP during the entire calendar year. If the EP has not met the $24,000 threshold in allowed charges by the end of calendar year, CMS expects to issue an incentive payment for the EP in March of the following year (allowing two months after the end of the calendar year for all pending claims to be processed). 
 

                         THE LAST YEAR TO QUALIFY FOR INCENTIVE WAS 2014. GOAL NOW IS TO AVOID PENALTIES

Physician Quality Reporting System

For each program year, CMS implements Physician Quality Reporting through an annual rulemaking process published in the Federal Register

Eligible professionals who satisfactorily report quality-measures data for services furnished during a PQRS reporting period are eligible to earn an incentive payment equal to a percentage of the eligible professional's estimated total allowed charges for covered Medicare Part B Physician Fee Schedule (PFS) services provided during the reporting period.

Below are the authorized incentive payment amounts for each program year:
  • 2010 PQRS – 2.0%
  • 2009 PQRS – 2.0%
  • 2008 PQRS – 1.5%
  • 2007 PQRS – 1.5% subject to a cap

The Affordable Care Act authorized incentive payment through 2014:

  • 2011 PQRS – 1.0%
  • 2012 PQRS – 0.5%
  • 2013 PQRS – 0.5%
  • 2014 PQRS – 0.5%
                                 THE LAST YEAR FOR INCENTIVE WAS 2014. GOAL NOW IS TO AVOID PENALTIES


PQRS AND CQM MEASURES

Recommended CQMs for Eye Care Practices

Measure No.

Measure Title and Description

Domain

TBD

Closing the Referral Loop: Receipt of Specialist Report

Percentage of patients with referrals, regardless of age, for which the referring provider receives a report from the provider to whom the patient was referred.

Care Coordination

NQF 0018

Controlling High Blood Pressure

Percentage of patients 18-85 years of age who had a diagnosis of hypertension and whose blood pressure was adequately controlled (<140/90mmHg) during the measurement period.

Clinical Process/Effectiveness

NQF 0022

Use of High-Risk Medications in the Elderly

Percentage of patients 66 years of age and older who were ordered high-risk medications. Two rates are reported.

  1. Percentage of patients who were ordered at least one high-risk medication.
  2. Percentage of patients who were ordered at least two different high-risk medications.

Patient Safety

NQF 0028

Preventive Care and Screening: Tobacco Use: Screening and Cessation Intervention
Percentage of patients aged 18 years and older who were screened for tobacco use one or more times within 24 months AND who received cessation counseling intervention if identified as a tobacco user.

Population/Public Health

NQF 0055

Diabetes: Eye Exam

Percentage of patients 18-75 years of age with diabetes who had a retinal or dilated eye exam by an eye care professional during the measurement period or a negative retinal exam (no evidence of retinopathy) in the past 12 months prior to the measurement period.

Clinical Process/Effectiveness

NQF 0086

Primary Open Angle Glaucoma (POAG): Optic Nerve Evaluation

Percentage of patients aged 18 years and older with a diagnosis of POAG who have an optic nerve head evaluation during one or more office visits within 12 months.

Clinical Process/Effectiveness

NQF 0088

Diabetic Retinopathy: Documentation of Presence or Absence of Macular Edema and Level of Severity of Retinopathy Percentage of patients aged 18 years and older with a diagnosis of diabetic retinopathy who had a dilated macular or fundus exam performed within included documentation of the level of severity of retinopathy and the presence or absence of macular edema during one or more office visits within 12 months.

Clinical Process/Effectiveness

NQF 0089

Diabetic Retinopathy: Communication with the Physician Managing Ongoing Diabetes Care
Percentage of patients aged 18 years and older with a diagnosis of diabetic retinopathy who had a dilated macular or fundus exam performed with documented communication to the physician who manages the ongoing care of the patient with diabetes mellitus regarding the findings of the macular or fundus exam at least once within 12 months.

Clinical Process/Effectiveness

*NQF 0101

Falls: Screening for Future Fall Risk

Percentage of patients 65 years of age and older who were screened for future fall risk during the measurement period.

Patient Safety

NQF 0419

Documentation of Current Medications in the Medical Record

Percentage of specified visits for patients aged 18 years and older for which the eligible professional attests to documenting a list of current medications to the best of his/her knowledge and ability. This list must include ALL prescriptions, over-the- counters, herbals, and vitamin/mineral/dietary (nutritional) supplements and must contain the medication’s name, dosage, frequency and route of administration.

Patient Safety

NQF 0421

Preventative Care and Screening: Body Mass Index (BMI) Screening and Follow-Up
Percentage of patients aged 18 years and older with a documented BMI during the encounter or during the previous six months, AND when the BMI is outside of normal parameters, a follow-up plan is documented during the encounter or during the previous six months of the encounter. Normal Parameters: Age 65 years and older BMI ≥ 23 and < 30; Age 18-64 years BMI ≥ 18.5 and < 25.

Population/ Public Health

NQF 0564

Cataracts: Complications within 30 Days Following Cataract Surgery Requiring Additional Surgical Procedures
Percentage of patients aged 18 years and older with a diagnosis of uncomplicated cataract who had cataract surgery and had any of a specified list of surgical procedures in the 30 days following cataract surgery which would indicate the occurrence of any of the following major complications: retained nuclear fragments, endophthalmitis, dislocated or wrong power IOL, retinal detachment, or wound dehiscence.

Patient Safety

NQF 0565

Cataracts: 20/40 or Better Visual Acuity within 90 Days Following Cataract Surgery
Percentage of patients aged 18 years and older with a diagnosis of uncomplicated cataract who had cataract surgery and no

  
No Sign Up or Pre-Registration

Individual eligible professionals do not need to sign-up or pre-register in order to participate in the  Physician Quality Reporting. However, to qualify for a  Physician Quality Reporting incentive payment an eligible professional must meet the criteria for satisfactory reporting specified by CMS for a particular reporting period.

Note: The Physician Quality Reporting program requirements and measure specifications for the current program year may be different from the Physician Quality Reporting program requirements and measure specifications for a prior year. Eligible professionals are responsible for ensuring that they are using the Physician Quality Reporting documents for the correct program year.

REGISTRY PARTICIPATION

Feb. 29 is the Deadline to Meet 2016’s Meaningful Use of EHRs Public Health Objective

If you have not already done so please sign up for your specialized registry.

OD practices:

AOA MORE provides support for the meaningful use public health objective for specialized registry reporting. For program year 2016 (reporting in 2017), participants are required to meet two public health objectives, unless an exclusion applies. To actively engage with MORE for the 2016 program year, you must enroll by February 29th. For More Information Click Here.

Click here for a list of current and prospective vendors.
Additional EHR vendors are being added with each new release of AOA MORE.  Enroll even if your vendor is not yet listed.

Call 1.800.365.2219 Email: qualityimprovement@aoa.org

MD Practices

  • About the IRIS® Registry

    The American Academy of Ophthalmology IRIS® Registry (Intelligent Research in Sight) is the nation's first comprehensive eye disease clinical registry. The Academy developed it as part of the profession's shared goal of continual improvement in the delivery of eye care.

    The IRIS® Registry is the only specialty society-sponsored eye care specialized registry. Active engagement with the IRIS Registry enables ophthalmologists to satisfy meaningful use Public Health Objective 10, Measure Option 3, Specialized Registry Reporting. Because the IRIS® Registry is the only eye care specialized registry, it is the only specialized registry that the Academy recommends to its members. All ophthalmologist members of the Academy have access to the registry as a free member benefit.

  • Contact the IRIS® Registry

    American Academy of Ophthalmology
    IRIS® Registry
    655 Beach St.
    San Francisco, CA 94109

    Phone:+1.415.561.8540
    irisregistry@aao.org.

    Whom to contact 

    PQRS questions: pqrs@aao.org
    Technical support: aao.websupport@figmd.com


Eye Care providers face an immediate, critical deadline if they intend to meet meaningful use’s public health objective in 2016. Feb. 29 is the last day for providers to begin active engagement with a clinical data registry or public health agency. This is required within 60 days of the start of your reporting period. Because meaningful use is an all-or-nothing program, failing to do so could result in a 4-percent penalty in 2018. Additionally, eye care providers in seven states (below) must also register with their state’s syndromic surveillance system. In all cases, Registry participation can help achieve meaningful use success.

The public health objective has three measure options. The Centers for Medicare & Medicaid Services says that if a physician is excluded from one measure, they must meet or exclude from the remaining measures in order to meet the objective. If the physician qualifies for multiple exclusions, with fewer than two remaining available measures, they can meet the objective by meeting the one remaining available measure.

Almost all Eye Care providers are excluded from Measure Option 1: Immunization Registry Reporting, because our profession doesn’t administer immunizations.

Most Eye Care providers are also excluded from Measure Option 2: Syndromic Surveillance Reporting. This is because most states are not accepting registrations or data from eyesore providers. However, seven states — Kentucky, New Mexico, North Dakota, Ohio, Virginia, Wisconsin, and Wyoming — are accepting Eye Care providers for syndromic surveillance reporting.

Eye care providers in these states must register with their state public health agency for syndromic surveillance reporting by Feb. 29, or within 60 days of the start of their reporting period.

VALUE BASED MODIFIER

Early results of the first year of the value-based modifier program show that there are big financial rewards for large-group practices that performed well, and a 1 percent penalty for those that did not. The Centers for Medicare & Medicaid Services recently released first year program results for practices with 100 or more providers. The program bases its results on cost of resources and quality performance. The results indicate that of the 127 group practices that elected to participate in the program in 2013, 11 failed to achieve program success.

The results show that of the 127 group practices that elected to participate in 2013:

    102 groups will not receive a penalty or a bonus because of insufficient data or average quality and cost scores,

    14 groups, which represent 7,700 physicians, will receive a bonus, and

    11 groups will receive a penalty.

The bonus level is 4.98 percent, and high performing physicians could earn a bonus of up to two times as much. None of the physician practices achieved the maximum bonus, which is 9.96 percent.

All groups and solo practitioners will be phased into the value-based program by 2017.

Physicians in groups with fewer than 10 providers will not be subject to a penalty under the program in 2017 if they successfully participate in the Physician Quality Reporting System this year.

A key to avoiding a penalty is to successfully participate in PQRS. Please access your Quality Resources and Use Reports that were released last year to ensure they understand how they might fare under the value-based modifier program.

Merit-Based Incentive Payment System (MIPS)

The MIPS is a new program that combines parts of the Physician Quality Reporting System (PQRS), the Value Modifier (VM or Value-based Payment Modifier), and the Medicare Electronic Health Record (EHR) incentive program into one single program based on:

  • Quality
  • Resource use
  • Clinical practice improvement
  • Meaningful use of certified EHR technology

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