Criteria for Determination of Satisfactory Reporting for Group

70.2.1 – Criteria for Determination of Satisfactory Reporting for Group Practices and Process for Reporting under the GPRO (Rev. 10, Issued: 07-27-12, Effective: 10-29-12, Implementation: 10-29-12) For purposes of determining whether a group practice satisfactorily submits Physician Quality Reporting System quality measures data for a particular program year, each selected group practice is required to complete this data collection web-interface for a specified number of quality measures. The quality measures are grouped into disease modules plus a series of patient care measures. Data from the January 1st through October 29th NCH file for the program year (10 months) is used by CMS to randomly assign Medicare beneficiaries to each physician group practice TIN. Medicare beneficiaries are retrospectively assigned to the TIN based on a determination by CMS that the group practice provided the plurality of office or other outpatient services to the beneficiary (with a minimum of at least two visits) in the 10-month period. Furthermore, part-year and managed care patients are not considered since CMS would have incomplete claims data for these beneficiaries and group practices may not have had sufficient time to impact the quality of their care. In 2011, for each disease module or patient care measure, the selected Physician Quality Reporting System GPRO I practice was required to complete the data collection web-interface for the first 411 consecutively assigned and ranked Medicare beneficiaries. Assigned beneficiaries will be limited to those Medicare FFS beneficiaries with Medicare Part B for whom Medicare is the primary payer. If the pool of eligible assigned beneficiaries was less than 411 for any module/measure, then the group practice was required to report on 100% (all) of the assigned beneficiaries for that module/measure to satisfactorily participate in the Physician Quality Reporting System GPRO I. The reporting mechanism, reporting period, and criteria for satisfactory reporting under the GPRO I for 2011 are summarized in the Table 6 below. Table 6: 2011 Physician Quality Reporting System Process for Physician Group Practices to Participate as Group Practices and Criteria for Satisfactory Reporting of Data on Quality Measures by Group Practices for GPRO I 34 Reporting Mechanism Reporting Criteria Reporting Period A pre- populated data collection web- interface provided by CMS • Report on all measures included in the data collection web-interface (26 measures); and • Complete the web-interface for the first 411 consecutively ranked and assigned beneficiaries in the order in which they appear in the group’s sample for each disease module or patient care measure. If the pool of eligible assigned beneficiaries is less than 411, then report on 100% of assigned beneficiaries. January 1, 2011– December 31, 2011 In addition, for 2011, GPRO II groups were required to report on a specified number of individual measures and measures groups depending on the group practice's size. For individual measures reporting, GPRO II groups were required to report on a specified percentage of patients. To satisfactorily report measures groups for the 2011 Physician Quality Reporting System GPRO II, the group practice need only report on the minimum number of patients specified in Table 9 for their group size. In addition, since we did not have the ability to determine whether the registries can ensure that only unique patients are counted, GPRO II groups were required to report the 2011 Physician Quality Reporting System data via claims unless the only measures groups that apply to the practice are one of the four registry-only measures groups. Group practices that must report on one of the four registry-only measures groups in order to meet the criteria for satisfactory reporting were able to use the registry- reporting mechanism to submit all of their 2011 Physician Quality Reporting System data via the registry reporting mechanism. The reporting mechanism, reporting period, and criteria for satisfactory reporting under the GPRO II for 2011 are summarized in the Table 7 below. 35 Table 7: 2011 Physician Quality Reporting System Process for Physician Group Practices to Participate as Group Practices and Criteria for Satisfactory Reporting of Data on Quality Measures by Group Practices for GPRO II Group size (number of eligible professionals) Number of measures groups required to be reported Minimum number of Medicare Part B patients in denominator for satisfactory reporting of measures groups Number of individual measures required to be reported Percent of Medicare Part B patients in denominator for satisfactory reporting of individual measures via claims (%) Percent of Medicare Part B patients in denominator for satisfactory reporting of individual measures via registries (%) 2-10 1 35 3 50 80 11-25 1 50 3 50 80 26-50 2 50 4 50 80 51-100 3 60 5 50 80 101-199 4 100 6 50 80 In 2012, the GPRO II reporting option was eliminated, leaving a single GPRO reporting option. However, CMS finalized two different satisfactory reporting criteria under the GPRO for groups comprised of 25-99 eligible professionals and groups comprised of 100+ eligible professionals. With respect to the criteria for satisfactory reporting for groups comprised of 25-99 eligible professionals, for each disease module or patient care measure, the selected Physician Quality Reporting System GPRO practice must complete the data collection web-interface for the first 218 consecutively assigned and ranked Medicare beneficiaries. Assigned beneficiaries will be limited to those Medicare FFS beneficiaries with Medicare Part B for whom Medicare is the primary payer. If the pool of eligible assigned beneficiaries was less than 218 for any module/measure, then the group practice is required to report on 100% (all) of the assigned beneficiaries for that module/measure to satisfactorily participate in the Physician Quality Reporting System GPRO. With respect to the criteria for satisfactory reporting for groups comprised of 100+ eligible professionals, for each disease module or patient care measure, the selected Physician Quality Reporting System GPRO practice must complete the data collection web-interface for the first 411 consecutively assigned and ranked Medicare beneficiaries. Assigned beneficiaries will be limited to those Medicare FFS beneficiaries with Medicare Part B for whom Medicare is the primary payer. If the pool of eligible assigned beneficiaries was less than 411 for any module/measure, then the group practice was required to report on 100% (all) of the assigned beneficiaries for that module/measure to satisfactorily participate in the Physician Quality Reporting System GPRO. 36 The reporting mechanism, reporting period, and criteria for satisfactory reporting under the GPRO for 2012 are summarized in the Table 8 below. Table 8: 2012 Criteria for Satisfactory Reporting of Data on Quality Measures by Group Practices for theGPRO Group Size Reporting Mechanism Reporting Criteria Reporting Period 25-99 eligible professionals A submission web interface provided by CMS • Report on all measures included in the web-interface (29 measures); and • Populate the data field for the first 218 consecutively ranked and assigned beneficiaries in the order in which they appear in the group’s sample (with an over-sampler of 327) for each disease module or patient care measure. If the pool of eligible assigned beneficiaries is less than 218, then report on 100% of assigned beneficiaries. January 1, 2012– December 31, 2012 100+ eligible professionals A submission web interface provided by CMS • Report on all measures included in the web-interface (29 measures); and • Populate the date fields for the first 411 consecutively ranked and assigned beneficiaries in the order in which they appear in the group’s sample (with an over-sample of 616) for each disease module or patient care measure. If the pool of eligible assigned beneficiaries is less than 411, then report on 100% of assigned beneficiaries. January 1, 2012– December 31, 2012