Description: The Physician Quality Reporting System (PQRS) and Value-Based Modifier Program are important tools for helping ensure that Medicare patients receive quality care at each and every visit. But the reporting process is complicated, especially for specialty clinics, and inaccurate reporting can result in serious financial penalties.
Cambridge Eye Associates, an eye clinic with two locations in Cambridge, Minnesota, was at a crossroads in late 2015. While clinic staff were providing quality care that often went beyond traditional eye services—such as checking blood pressure and encouraging patients to stop smoking—they faced challenges with how to accurately and consistently collect and report this data to PQRS. They recognized that they needed help and turned for assistance to the Lake Superior Quality Innovation Network (QIN), the QIN-Quality Improvement Organization serving Minnesota, Michigan and Wisconsin.
The Lake Superior QIN started by meeting with clinic staff, from doctors to employees responsible for billing, to better understand their processes for reporting and to determine areas for improvement. One of the key areas that the analysis identified was the patient routing slip, a form that follows patients throughout their visit. The form was confusing and hard to read, and was leading to patient and billing data not being collected consistently by all the medical professionals at the clinic.
To help address this workflow problem, Lake Superior staff worked with the clinic to develop a new form with simplified PQRS descriptions, relocated codes and larger type that was easier to read in the clinic’s low-light environment. They also brought together all of the clinic’s staff to discuss the new form and the importance of accurate reporting. This inclusive process helped boost acceptance, understanding and adoption of the new workflow.
Results: The workflow redesign and new patient slip have been a success. For reporting PQRS via claims, providers are required to report nine measures across three national quality domains for 50 percent of their Medicare fee-for-service clients. As of February 2016, the clinic’s PQRS threshold reports show that all three eligible professionals at the clinic are not only meeting the 50 percent threshold, they are exceeding it, reporting on average 70 to 80 percent of all their Medicare Part B clients.