Living With Quality Measures

Collecting and reporting clinical information to public and private health insurers has become a fact of life for those of us in medicine. It’s no less burdensome for anesthesiologists and certified registered nurse anesthetists than it is for other types of medical specialists and advanced practice nurses.

Topping the list for many of us are the quality metrics we’re required to collect and report as part of Medicare’s Physician Quality Reporting System, or PQRS.  PQRS started in 2007 and formerly was known as Physician Quality Reporting Initiative, or PQRI.

As a condition of Medicare reimbursement, PQRS asks physicians to collect and report data on the subset of 254 different quality measures  that apply to what they do for patients. According to the American Association of Nurse Anesthetists, there are as many as 19 different measures (three anesthesia-specific and 16 non-anesthesia specific) this year that apply to anesthesiologists and CRNAs depending on the specialty or clinical setting.

PQRS is a claims-based system that collects mostly process data—what you did for the patient—rather than outcomes data—what happened after you did it. Of the 19 measures identified by the AANA, 16 are process metrics and three are outcomes metrics. As clinicians, we know collecting and reporting PQRS data isn’t about the quality of care we provide. As administrators, we know that collecting and reporting PQRS data is about getting reimbursed for the services we provide.

Knowing what PQRS is—and isn’t—is the first step in learning how to cope with the system’s data collection and reporting requirements. We all want to get paid accurately for what we do, and that perspective should be incentive enough to comply with the requirements.

Yet, at the same time, we don’t want the requirements to detract from the volume and quality of anesthesia services we provide to patients. So the second step in learning how to cope with PQRS is education. Anesthesiologists and CRNAs must educate themselves on the measures they must report. The type and number of PQRS measures can change each year. Consequently, staying on top of what needs to be reported is crucial.

The third step in learning how to cope with PQRS is accurate and complete clinical documentation by anesthesiologists and CRNAs of the care and services they provided to patients in the patients’ medical records, whether they’re electronic or paper. The data necessary to meet the reporting requirements can be extracted directly from the medical record if it’s there, eliminating the need to manually comb through the record looking for the information.

At NorthStar, we do that for our anesthesiologists and CRNAs automatically. We extract what they’ve documented in patient records and report that information directly to PQRS. Third parties like outside billing companies also offer that reporting service to anesthesiologists and CRNAs.

Accepting the purpose of quality measures, staying educated and up to date on quality measures and providing the clinical documentation to support quality measures are three ways to cope with the current reporting requirements. They’re also an effective strategy for anesthesiologists and CRNAs to prepare for the next generation of quality metrics, and that’s the Qualified Clinical Data Registry, or QCDR, reporting system.

The QCDR, which Medicare introduced last year, is an alternative to PQRS that relies on outcomes measures rather than process measures to track the performance of physicians and other clinicians. NorthStar is evaluating whether we will stay with PQRS or transition to QCDR in 2016.

Collecting and reporting quality measures isn’t going away. Anesthesiologists and CRNAs should not see such requirements as just another hoop they need to jump through. They should embrace them as opportunities to learn about themselves and use them to take better care of patients.