How to Integrate Strategic Quality Initiatives with PQRS Reporting: The QCDR Opportunity

written by Theresa Hush | September 25, 2014

France_in_XXI_Century._Helicopter

For 2014 and beyond, CMS has created a new mechanism for PQRS reporting—the Qualified Clinical Data Registry. QCDR reporting requirements are the same as for a traditional Registry utilizing individual measures:

  • A provider must report on at least nine measures.
  • These measures must represent at least three National Quality and Strategy (NQS) Domains.
  • Each of the nine measures must be completed for at least 50 percent of eligible patients or cases.

However, a QCDR has features that can bring more to PQRS performance and reporting. QCDRs are designed to foster improvement in the quality of care provided to patients.  A QCDR should be able to benchmark providers and risk-adjust patients, in addition to report measures.

Four characteristics distinguish a QCDR for PQRS reporting:

  1. More measures with better value for groups.  QCDRs have the ability to provide a wider variety of measures.  A QCDR’s measure library need not be limited to the selections CMS has defined for PQRS; QCDRs can report measures developed by other entities, including customized measures (with CMS approval).
  2. Application to a broader population of patients beyond Medicare.  QCDR Measures must encompass multiple payers, not just Medicare.
  3. Use of at least one outcomes-based measure.  Success cannot be achieved solely through reporting; whether performance is achieved will determine success.
  4. Individual reporting. There is no Group Practice Reporting Option for QCDR Reporting.

Although QCDR Reporting for PQRS may be more difficult than standard Registry Reporting for large groups, it offers unique opportunities to provider organizations. Here are four ways that a QCDR can help your organization achieve strategic alignment of quality initiatives, while optimizing PQRS and Value-Based Payment Modifier (VBPM) incentives:

1. Patient-Centered Medical Home (PCMH) Participants  

NCQA has developed six standards designed to improve patient care, including care coordination, population health management, and performance measurement. But PCMH alone does not fulfill PQRS requirements and could end up costing money in PQRS and VBPM penalties down the road. However, partnering with a QCDR that can report your PCMH measures for PQRS protects your organization from PQRS penalties, without duplicating your work for multiple programs.

2. Institutions Engaged in Research  

Organizations such as academic centers and specialty societies often have a huge investment in demonstrating outstanding clinical performance and effective clinical strategies for improving outcomes. These groups already compare providers and outcomes over time; reporting through a QCDR gives your group the opportunity to participate in PQRS in a manner that aligns your existing goals and data collection efforts.

3. Physicians Who Believe in “Real” Quality Measurement  

Physicians and practice staff often share disdain for PQRS as an administrative club that diverts resources, rather than a means to promote quality and improve care. QCDRs create an opportunity for your physicians to innovate and engage in quality measurement and improvement, adding valuable information to their practices and treatment approaches, and demonstrating how pay-for-performance should work.

4. Independent Practice Associations (IPA), Physician Hospital Organizations (PHO), and Health Systems Involved in Clinical Integration  

QCDRs allow organizations to develop a quality measurement and improvement program aimed at your full patient population, while offering PQRS reporting as an adjunct to that program. In particular, the use of customized measures over a broader population will enable your health system, IPA or PHO to adopt measures for a Clinical Integration or benchmarking program, as well as for PQRS reporting. This is one of the most significant advantages of using the QCDR—leveraging other important initiatives to improve patient outcomes.

Qualified Clinical Data Registries enable providers to innovate based on clinical measurement and performance. In keeping with a value-based purchasing environment, QCDRs can help you to rebalance measurement and reporting by examining population differences. Evaluate your goals and resources to determine whether QCDR reporting can benefit your physician group or health care system by integrating programs, potential revenues, and strategic opportunities.

Founded in 2002, ICLOPS has pioneered data registry solutions for improving population health. Our industry experts provide comprehensive PQRS Reporting with VBPM Consultation that helps you both report and improve your performance. ICLOPS is a CMS Qualified Clinical Data Registry.

Contact ICLOPS for a Discovery Session.

Image Credit: France in the Year 2000 (XXI century), “Sentinel Advanced in the Helicopter.” Paper cards/postcards by Jean-Marc Côté and other artists, France. The first cards were produced for the 1900 World Exhibition in Paris. This work is in the public domain in the United States because it was published (or registered with the U.S. Copyright Office) before January 1, 1923.