The Centers for Medicare and Medicaid Services (CMS) has added a new quality measure this year related to electronic health records for speech-language pathologists participating in the Physician Quality Reporting System (PQRS).
PQRS, a voluntary incentive payment program for health care professionals who provide services to Medicare beneficiaries, is designed to support improvements in quality of care by tracking of practice patterns. Medicare-enrolled eligible health care providers who participate in PQRS by reporting on approved quality measures are eligible for an incentive payment at the end of the year. In 2011, this incentive payment is 1% of all allowable Medicare charges for the year. Audiologists and SLPs are eligible to participate in the program.
Eight of ASHA's adult National Outcomes Measurement System (NOMS) functional communication measures (FCMs) are classified as PQRS quality measures that SLPs can report. Further information on these measures is available at ASHA's NOMS webpage.
New this year is Measure 124, "Health Information Technology (HIT): Adoption/Use of Electronic Health Records (EHR)." This measure, which can be reported via a claims form, documents whether a provider has adopted and is using health information technology. Full specifications are available on the CMS website (click on "2011 PQRS Measure Specifications Manual for Claims and Registry Reporting of Individual Measures and Release Notes" and find Measure 124).
To report measure 124, the eligible professional must have adopted and used a certified, PQRS-qualified, or other acceptable EHR system:
Other EHR systems that are not certified or qualified must be able to:
- Manage a medication list.
- Manage a problem list.
- Manually enter or electronically receive, store, and display laboratory results as discrete searchable data elements.
- Meet basic privacy and security elements.
Further information is available in the measure specifications at the CMS website.
All PQRS measures have a numerator and denominator. The numerator describes the action required by the measure for reporting and performance. A denominator describes all the eligible patients for a measure. For Measure 124, the numerator requires documentation of a patient encounter that substantiates use of a certified, PQRS-qualified, or other acceptable EHR system. The numerator must include one of two G-codes:
- G8447: Patient encounter was documented using an EHR system that has been certified by an Authorized Testing and Certification Body (ATCB).
- G8448: Patient encounter was documented using a PQRS-qualified EHR or other acceptable system.
In the denominator, an SLP must record at least one of the following CPT codes:
- 92506 (valuation of speech, language, voice, communication, and/or auditory processing).
- 92507 (treatment of speech, language, voice, communication, and/or auditory processing disorder; individual).
- 92526 (treatment of swallowing dysfunction and/or oral function for feeding).
For an example of a completed claims form, see Appendix D of the 2011 PQRS Implementation Guide at the CMS website.
Providers who participate successfully in PQRS in 2011 can expect a lump-sum bonus payment from CMS at some point in 2012. Measures reported on claims are collected in two reporting periods: Jan. 1–Dec. 31 or July 1–Dec. 31. Providers must report on at least three PQRS measures; if a provider does not report on three measures, CMS has a measure-applicability validation process to determine if the provider could have reported on other measures. For each measure reported, PQRI participants must report on 50% of their patients who would fit into that measure.