TalkingEMR can help you receive incentive PQRS payments and avoid nonparticipation penalties. Our Long Term Care clinicians correctly identified that there is a single ‘best’ strategy for participating in PQRS. We use the CAD Measures Group, which utilized year-end registry reporting. Read on to learn more.

Based on that strategy, TalkingEMR is designed to do the following:

• Automatically identifies which of your patients are eligible for PQRS. Our experience in the Long Term Care setting led us to the conclusion that the CAD measures group is the most achievable in the elderly population setting. The system will automatically notify you of patients that qualify for the CAD measures group, based on your ICD-9 code selection. If you choose to report, TalkingEMR prompts you with the appropriate questions. A report is generated at the end of the year that can be submitted to the registry sites so you can receive these incentives and avoid penalties.

What is PQRS?

The 2006 Tax Relief and Health Care Act required the establishment of a physician quality reporting system, including an incentive payment for eligible professionals who satisfactorily report data on quality measures.
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 and to avoid penalties, an eligible professional must meet the criteria for satisfactory reporting specified by CMS for a particular reporting period.
The incentives and penalties are as follows:

• 1% this year (2011)
• .5% for 2012-14
• <1.5%> in 2015
• <2.0%> thereafter

Time to Strategize: PQRS in the Long Term Care Setting

There are two overarching methods of PQRS participation – by use of individual measures, or use of a multiple related measures which are assembled into a Measures Group.  There are 30 individual measures out of 190 total that apply to 99304 – 99310. There are three measures groups out of 14 total.

There are distinct advantages to use of the Measures Group participation strategy – the clinician only has to submit data on a maximum of 30 unique patients during the year.  If individual measures are used, the threshold is 80% of eligible events (an event may be either per encounter or per patient, based on the measure’s definition).

In 2009 the only Measures Group that applied to Long Term Care was the Diabetes Measure Group. This was challenging because the patients were limited to those under the age of 76 and there had to be 30 consecutive patients with this measure. In 2010, CMS added two new measure groups:

• Coronary Artery Disease &
• Congestive Heart Failure

Both measures apply to all patients over 17 years of age so even low volume providers should be able to meet requirements. In 2010, the requirement that the 30 patients be ‘consecutive’ was dropped. Now, any 30 unique patients throughout the year are eligible (note that multiple providers can report on the same patient).

Our experience in the Long Term Care setting has led us to believe that the CAD measures group is the most achievable with our elderly population for the following reasons:

• Enough frequency of the CAD diagnosis to easily meet requirements
• Each measure can be reported successfully based upon a one-time encounter. Conversely, in Diabetes Mellitus hemoglobin A1C would need to be ordered in the diabetic measure. Cannot be reported concurrently.
• Contains no measures that require external source input for success (E.g. Diabetic eye exam)
• Registry reporting which allows concurrent review of your data integrity (scrubbing) giving you a higher chance for success

Conversely, we avoided the Diabetes Mellitus and Coronary Heart Failure measures for the following reasons:

• DM applies to patients under 75 years old
• DM requires ophthalmology exam
• HgbA1c – threshold may be too low for many Long Term Care patients to achieve
• CHF needs ejection fraction assessment which is not available in most Long Term Care facilities
• CHF requires a Left Ventricular Function assessment (e.g., echocardiography, nuclear test, or ventriculography) documented in the medical record

If you doubt our analysis, would you trust CMS data? Here is a table showing 2009 PQRS performance by reporting method:

How does it work?

With TalkingEMR, participation in PQRS is simple. TalkingEMR will automatically identify patients that are eligible for PQRS. The symbol signifies the patient meets the eligibility requirements:


After selecting your patient, click on the PQRS icon to open up the series of questions for the CAD group.

The questions appear as follows:

Once all questions are answered, the data will be stored and a report printed at the end of the year for registry reporting.