PQRS Simplified

This blog post comes from WebPT copywriters Charlotte Bohnett and Erica Cohen. 

PQRS is a royal pain in the you-know-what. We know. We don’t like it anymore than you do. But because CMS has now made it mandatory, we’re all for making the best of it. So how do you make peace with PQRS? Nail down the basics.

What is PQRS?

In an effort to improve quality of reporting in the healthcare industry, the Center for Medicare and Medicaid Services (CMS) created the Physician Quality Reporting System (PQRS), previously known as PQRI. PQRS mandates that physical therapists, occupational therapists, and qualified speech-language therapists meet the criteria for satisfactory reporting despite the word “physician” in the title. Beginning in 2013, non-compliance will result in penalties, which CMS will assess as fines (starting at 1.5% of your fee schedule) in 2015. However, if you are compliant, you will earn a 0.5% incentive payment on your total allowed charges during your reporting period.

How do I stay compliant?

To ensure compliance, therapists should complete a PQRS form with at least three applicable outcome measures for every Medicare patient. Here are some of WebPT’s other available measures:

BMI Screening and Follow-up (Measure #128)

This measure requires you to document patient BMI (Body Mass Index). WebPT completes the calculation for you as long as you enter the patient weight and height. If the patient is outside of a normal range, you must document a follow-up plan. CMS requires you complete this measure once per reporting period for each Medicare patient.

Diabetic Foot & Ankle Care; Neurological Evaluation (Measure #126)

Patients with diabetes mellitus need appropriate foot and ankle care to prevent ulcerations and infections to reduce the number and severity of amputations. CMS requires you to implement a follow-up treatment plan after assessment.

Diabetic Foot & Ankle Care; Ulcer Prevention/Footwear Evaluation (Measure #127)

You can only use this measure for patients over the age of 18 who have been diagnosed with diabetes mellitus. If your patient meets this criteria, you will need to evaluate him or her for proper footwear and sizing.

Pain Assessment Prior to Initiation of Therapy (Measure #131)

To satisfy this measure, you will need to document an assessment of pain, including location, intensity, and description. This measure also requires you to document a follow-up plan for pain management. CMS requires you to perform this measurement for each initial examination or reexamination you complete during the reporting period.

Documentation and Verification of Medications (Measure #130)

To use this measure, you must document the medications your patient is currently taking with patient or authorized representative verification. CMS requires you to complete this measurement on each examination and/or reexamination during the reporting period.

Falls Risk Assessment (Measure #154)

This is a two-part measure you need to use in conjunction with #155. In order to use this measure, your patient must be 65 years of age or older and have a history of falls (either two or more in the past year or one with injury). CMS requires you to complete this measure once per reporting period.

Falls Risk Assessment & Plan of Care (Measure #155)

In order to use this measure, your patient must be 65 years of age or older and you must screen him or her using Measure #154. CMS requires you to report this measure once per reporting period, at minimum.

What are the reporting methods?

There are two different methods for reporting PQRS: claims-based (manual submission) or registry-based (automatic submission). WebPT can help your clinic achieve success regardless of which option you choose, but there are some definite benefits associated with registry-based. Here’s why claims-based reporting doesn’t work in the long-term from WebPT Product Marketing Specialist, Mike Mannheimer:

“Claims-based reporting is a manual process. It adds work for therapists and staff. If you participate in claims-based reporting, you have to report on at least 50% of patients for CMS to consider you successful. If you miss this mark due to human error, you are simply out of luck.”

WebPT’s registry-based option manages most of PQRS for you. Because we merge PQRS with standard documentation, therapists simply report their PQRS measures directly within the patient record. We then aggregate that data, compile it into a digital form, and submit it to CMS. So, after you set up registry-based reporting for your clinic, you document, and we take care of the rest. Ultimately, the biggest perk of registry-based reporting is that it ensures you never forget PQRS.

Sounds helpful, right? Contact your WebPT Success Rep to learn more about this option and how it can work with your clinic.