SA Ignite to debut PQRS Assistant at HIMSS16, hopes to automate real-time quality tracking
SA Ignite plans to launch PQRS Assistant, a system that provides an automated way for provider organizations to track the various levels and scores for Medicare Part B payments, at HIMSS16.
The Physician Quality Reporting System is a quality reporting program from the Centers for Medicare and Medicaid Services that encourages individual eligible professionals and group practices to report information on the quality of care to Medicare. PQRS gives participating professionals and group practices the opportunity to assess the quality of care they provide to their patients, helping to ensure that patients get the right care at the right time, CMS said.
SA Ignite’s meaningful use system is used to automate attestation, the vendor said, and the company now is adapting meaningful use lessons learned to help providers respond to the increasing number of pay-for-performance models in healthcare, said Tom Lee, founder and CEO of SA Ignite.
“PQRS is a longstanding program and set of measures, but in recent years CMS has used PQRS to turn from pay-for-reporting to pay-for-performance in Medicare Part B,” Lee said. “In pay-for-reporting, providers just submit a number of measures and regardless of those values are incentivized in the same amount or avoid the same penalty. In Medicare Part B, the game has changed, and these measures now are used for pay-for-performance. Providers measure values and are rated against other peers across the country, and then are placed in different quality tiers, which directly affects their reimbursement.”
Currently, the CMS report card for Medicare Part B is not communicated to a provider organization until nine months after a performance year has concluded, Lee said. As such, there is no real-time monitoring of quality scores during a performance year.
“Our new PQRS Assistant system enables a provider organization to predict during a performance year what its CMS quality score will be based on, and as a result, the organization can make changes to its workflows to maximize its score while it still has a chance to make a difference,” Lee said. “The ultimate vision is combining our MU Assistant with our PQRS Assistant and have their predictive analytics focused on back-office score optimization.”
The CMS Merit-Based Incentive Payments System, or MIPS, for Medicare Part B starts in 2017, appears to bring together meaningful use and PQRS in a value-based payment model where providers will have a MIPS score.
Under MIPS, every provider organization will earn up to 100 points on a competitive scale to be able to gain up to a 27 percent bonus or lose up to a 9 percent penalty.
Lee said provider organizations can calculate the return on investment of this technology based on the new reality in healthcare.
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“These value-based rules are very complicated and change all the time, and in the absence of automation it’s very difficult to fulfill the new business processes,” he said. “You are left with people using very primitive tools like spreadsheets to try to manipulate data to try and comply with a payer’s requirements. Further, provider organizations now are forced to do even more with even less. Because of the complexity on the value-based side of payments, including population health efforts, things simply are getting more complicated with more money attached.”
When it comes to provider organization staff trying to cope with the new reality of value-based payments, the supply of qualified professionals, such as data analysts and compliance experts, who know how to optimize for value is getting out of balance with the demand, Lee said. “So you need technology that allows fewer people to do more,” he said.
This story is part of our ongoing coverage of the HIMSS16 conference. Follow our live blog for real-time updates, and visit Destination HIMSS16 for a full rundown of our reporting from the show. For a selection of some of the best social media posts of the show, visit our Trending at #HIMSS16 hub.