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PQRS and Neurosurgery: The Need to Know

ratGuest post from Anand Veeravagu, MD (left)
Chief Neurosurgery Resident
Department of Neurosurgery Stanford University Medical Center
Former White House Fellow
Stanford, CA
John Ratliff, MD, FAANS, FACS (right)
Co-Director, Division of Spine and Peripheral Nerve Surgery
Department of Neurosurgery Stanford University Medical Center
Stanford, CA

pqrsIt is changing, yet again. The 2015 Medicare Physician Fee Schedule mandates changes in the Physician Quality Reporting System (PQRS) that will significantly affect every neurosurgeon. For the past eight years, PQRS has been a voluntary federal program that provided Medicare incentive payments to physicians that supplied quality data to the Centers for Medicare & Medicaid Services (CMS). However, beginning with the 2015 reporting year, these incentive payments will be replaced by a two percent cut in Medicare payments — which will be applied in 2017 to those who fail to satisfy PQRS reporting requirements this year.

Unfortunately, surgeon participation has gotten a lot harder. Physicians are now required to report nine different PQRS measures, from three unique quality domains, including one cross-cutting measure. Additionally, these measures must be reported in 50 percent of Medicare recipients. Selecting appropriate measures may prove difficult, as many PQRS metrics are not applicable to neurosurgery.

Keep in mind that it is important to report some measures, even if you can’t easily reach the nine PQRS measure requirement. Under the Measures Applicability Validation (MAV) process, if do the following you may not face a cut in 2017:

  • Report some measures;
  • Not enough relevant/applicable measures exist; and
  • Report one cross-cutting measure.

Cross-cutting measures include general topics such as:

  • Medication Reconciliation;
  • Advance Care Planning;
  • Documentation of Current Medications;
  • Pain Assessment and Follow-up; and
  • Tobacco Use.

In addition to PQRS-related cuts, neurosurgeons face cuts — up to four percent — under the Value-Based Payment Modifier (VM), which measures quality and resource use/cost. This brings the total potential financial loss to six percent, and this is before we even consider any cuts under the Electronic Health Record meaningful use program.

Rest assured, the AANS and CNS are working hard in a number of ways to help neurosurgeons meet this challenge. For example, in collaboration with the NeuroPoint Alliance (NPA), leaders of the AANS/CNS Neurosurgery Quality Council (formerly the AANS/CNS Quality Improvement Workgroup) — Tony Asher, MD and Jack Knightly, MD, in particular — have established a National Neurosurgery Quality and Outcomes Database (N²QOD) platform that Medicare will recognize as a qualified clinical data registry (QCDR). This will allow surgeons participating in N²QOD to satisfy their PQRS requirements. In addition, the NQC is exploring the option of developing neurosurgery-specific measures.

Yes, this is all terribly confusing. Fortunately, the AANS/CNS Washington Office has developed an outstanding PQRS summary, “Physician Quality Reporting System: What Neurosurgeons Need to Know for 2015.” As our practice world evolves with the changing healthcare environment, we will continue to work to keep you informed and try to create reasonable options for fulfilling these mandates.

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