Over the past decade, quality reporting has proven to be a delicate process for medical service providers. Especially for those that provide anesthesia services to patients, quality reporting measures can be confusing because, while professionals want to report accurate information, there have been evolving categories and rules surrounding how to best report the use of anesthesia during a procedure.
By understanding the goal of quality reporting and the changes the concept has undergone since its inception in 2006, medical professionals will be better prepared to ensure that each doctor in their practice or hospital is fulfilling his or her obligations under the program. The result leads to more data about patient care that the industry can use to improve treatment services and overall efficiency.
How Did Quality Reporting Come to Be?
Quality reporting was introduced as the Physician Voluntary Reporting Program as a way for the Centers for Medicare and Medicaid Services (CMS) to be able to better track care given to benefit recipients in the United States. However, the program did not get off to a fruitful start, as there was no incentive for practitioners to participate and there were no specific reporting codes related to anesthesia services.
In 2006, the Physician Quality Reporting Initiative (PQRI) was established as part of the Tax Relief and Health Care Act in order to incentivize reporting and reward providers who reported relevant information on at least 80 percent of their eligible cases.
PQRI became the Physician Quality Reporting System (PQRS) in 2008, but there was an important change for anesthesia providers. Measure No. 30 in PQRI—Perioperative Care: Timely Administration of Prophylactic Parenteral Antibiotics—saw an update that resulted in providers failing to qualify for a bonus for not reporting the information accurately.
In addition, anesthesia practices that weren’t up to speed on the latest requirements were unaware that they were required to report PQRS measures for Certified Registered Nurse Anesthetists (CRNAs) and anesthesia assistants as well.
Quality Reporting Today and Beyond
As quality reporting has evolved over the years, new incentive-based approaches have been taken by CMS to ensure participation by providers. In 2015 the Value Based Payment Modifier (VM) system was established, removing bonus payments for providers and switching to a penalty structure.
Rather than earning a bonus, anesthesia practices now report quality metrics to avoid taking a loss of two-percent on eligible reimbursements. Physician groups consisting of 10 or more eligible practitioners can be assessed a four-percent penalty. The VM will be applied for 2017 and 2018 as the PQRS winds down, with reporting requirements from 2015 and 2016 applying to the potential payment adjustments for those offering anesthesia services.
As of January 1, 2019, the PQRS, VM, and Medicare Electronic Health Record Incentive Program will be merged and exist as three categories within the same system, rather than three separate quality reporting structures. The system, called the Merit Based Incentive Payment System (MIPS), will begin based on reporting measures from PQRS in 2017.
As anesthesia practices get ready to transition to MIPS, they should be familiar with Measure No. 76 when reporting claims-based codes for anesthesia. Additionally, Measure No. 130 (Documentation of Current Medications in the Medical Record) and Measure No. 317 (Preventive Care and Screening for High Blood Pressure) may apply for practices reporting E/M codes.
Learn more about quality reporting and best practices moving forward by contacting a representative of Strategy Anesthesia today at (323) 999-4963.