Criteria for Determination of Satisfactory Reporting of Individual

70.1.2 – Criteria for Determination of Satisfactory Reporting of Individual Measures for Registry-based Reporting (Rev. 10, Issued: 07-27-12, Effective: 10-29-12, Implementation: 10-29-12) In addition to the option of reporting on individual quality measures or on measures groups, eligible professionals, beginning with the 2008 Physician Quality Reporting System, also have the option of reporting Physician Quality Reporting System quality measures information to CMS via a qualified registry instead of submitting the quality measures data on claims (see §50). The criteria for determining whether an eligible professional satisfactorily reports data on Physician Quality Reporting System quality measures for reporting via a registry are different from the criteria for satisfactory reporting via claims. 27 When registry-based reporting of Physician Quality Reporting System quality measures data was introduced in the 2008 Physician Quality Reporting System, there were two reporting periods available for registry-based reporting of individual measures: the 12-month reporting period beginning January 1, 2008 and the 6-month reporting period beginning July 1, 2008. To qualify to earn a 2008 Physician Quality Reporting System incentive payment through registry-based reporting of individual measures, each eligible professional had to meet the following criteria for satisfactory reporting: • Report at least 3 individual Physician Quality Reporting System measures; and • Report each measure on at least 80 % of the Medicare Part B FFS patients to whom the measure applies. These criteria were applicable to both 2008 reporting periods for registry-based reporting. Consequently, there were 2 reporting options for registry-based reporting of individual measures. No changes have been made to the criteria for registry-based reporting of individual measures until the 2011 program year. For the 2011 Physician Quality Reporting System, measures with a zero percent performance rate will not be counted. That is, if the recommended clinical quality action is not performed on at least 1 patient for a particular measure or measures group reported by the eligible professional via a registry or EHR, we will not count the measure (or measures groups) as a measure (or measures group) reported by an eligible professional. The 2012 Physician Quality Reporting System retained the 2011 reporting criteria for the 12- month reporting period. The reporting options continue for registry-based reporting for the 2012 Physician Quality Reporting System of individual measures are summarized in Table 3 below. Table 3: 2012 Criteria for Satisfactory Reporting of Individual Quality Measures through Registries Reporting Criteria Reporting Period • Report at least 3 Physician Quality Reporting System measures; and • Report each measure for at least 80% of Medicare Part B FFS patients to whom the measure applies. • Measures with a zero percent performance rate will not be counted. January 1, 2012 – December 31, 2012 For registry-based reporting of measures groups, there were 2 reporting periods available when registry-based reporting of measures groups was first introduced in the Physician Quality Reporting System for 2008: the 12-month reporting period beginning January 1, 2008 and the 6- month reporting period beginning July 1, 2008. For the 2008 Physician Quality Reporting System, there were 2 reporting options available for registry-based reporting of measures groups for the 12-month reporting period. An eligible professional could either: 28 • Report on at least one measures group for at least 30 consecutive patients to whom the measures of the measures group apply; OR • Report on at least one measures group for at least 80% of Medicare Part B FFS patients to whom the measures of the measures group apply. For the 2008 Physician Quality Reporting System, there were 2 reporting options available for registry-based reporting of measures groups for the 6-month reporting period. An eligible professional could either: • Report on at least one measures group for at least 15 consecutive patients to whom the measures of the measures group apply; OR • Report on at least one measures group for at least 80% of Medicare Part B FFS patients to whom the measures of the measures group apply. There are 2 differences between the 2008 criteria for registry-based reporting of measures groups and the 2009 criteria. The first difference is the elimination of the reporting option based on reporting for at least 15 consecutive patients for the 6-month reporting period. The second difference is the addition of a minimum sample size requirement for eligible professionals reporting on at least 80% of applicable Medicare Part B FFS patients. Identical to the 2009 criteria for claims-based submission of measures groups discussed in §70.1.1 above, eligible professionals reporting in 2009 on 80% of applicable Medicare Part B FFS patients for the 12- month reporting period were required to have at least 30 applicable patients. Eligible professionals reporting in 2009 on 80% of applicable Medicare Part B FFS patients for the 6- month reporting period were required to have at least 15 applicable patients. The 2010 criteria for registry-based reporting of measures groups are similar to the 2009 criteria except for 2 differences. First, CMS eliminated the requirement that the 30 patients be seen consecutively to allow an eligible professional to report on any 30 patients seen during the reporting period. The second difference is that CMS reduced the minimum sample size requirement for eligible professionals reporting on at least 80% of applicable Medicare Part B FFS patients to 15 and 8 for the 12-month and 6-month reporting periods, respectively. For the 2011 Physician Quality Reporting System, measures within a measures group with a zero percent performance rate will not be counted. Furthermore, in registry-based reporting, in contrast to prior program years, the minimum patient numbers or percentages must be met by Medicare Part B FFS patients exclusively and not non-Medicare Part B FFS patients. For reporting measures groups via registry under the 2012 Physician Quality Reporting System, CMS retained all 3 of the 2011 reporting options for the 6 and 12-month reporting periods described above. Therefore, the 2012 Physician Quality Reporting System criteria for satisfactory reporting that each eligible professional must meet to qualify to earn an incentive payment through registry-based reporting of measures groups in 2012 are summarized in Table 4 below. 29 Table 4: 2012 Criteria for Satisfactory Reporting of Measures Groups through Registries Reporting Criteria Reporting Period • Report at least one measures group (measures groups with a zero percent performance rate will not be counted); and • Report each measures group for at least 30 patients Medicare Part B FFS patients to whom the measures in the measures group apply. Measures within a measures group with a zero percent performance rate will not be counted. January 1, 2012 – December 31, 2012 • Report at least one measures group (measures with a zero percent performance rate will not be counted); and • Report each measures groups for at least 80 % of Medicare Part B FFS patients to whom the measures in the measures group applies; but • Report each measures group on at least 15 Medicare Part B FFS patients during the reporting period to which the measures group applies. • Measures within a measures group with a zero percent performance rate will not be counted. January 1, 2012 – December 31, 2012 • Report at least one measures group; and • Report each measures group for at least 80 % of Medicare Part B FFS patients to whom the measures in the measures group applies; but • Report each measures group on no less than 8 Medicare Part B FFS patients seen during the reporting period to which the measure group applies. • Measures within a measures group with a zero percent performance rate will not be counted. July 1, 2012 – December 31, 2012