PQRS 2016

OD Link does not ensure compliance with PQRS, but it helps.  In 2016 you need to report 9 PQRS measures covering at least 3 NQS domains and 1 cross-cutting measure.  CMS expects optometrists to report on the first six (12, 141, 14, 140, 19 and 117)  Outside of those eye related measures you must choose three additional making sure at least one of them is a cross-cutting measure.  Also make sure you have picked measures from three different domains.

PQRS penalty is applied two years after you report.  There is a 2% penalty on Medicare payments.  To avoid the 2018 PQRS payment penalty you must submit nine valid measures half the time that they apply during 2016.

OD Link can help by automatically pulling codes into the transaction for "Medicare" patients.

OD Link can help by automatically pulling codes into the transaction for "Medicare" patients.

OD Link pulls in the most common PQRS code that OD's almost always use for PQRS.  If modifiers are applicable you need to add them manually. (1P: Medical Reason, 2P: Patient Reason, 8P: Other Reason).  The most common PQRS codes are listed in FEES in OD Link.

#12 Primary Open-Angle Glaucoma (POAG): Optic Nerve Evaluation (Effective Clinical Care Domain)

#12 Primary Open-Angle Glaucoma (POAG): Optic Nerve Evaluation (Effective Clinical Care Domain)

#12 Percentage of patients aged 18 years and older with a diagnosis of primary open-angle glaucoma who have an optic nerve head evaluation during one or more office visits within 12 months.  This measure is to be reported a minimum of once per reporting period for patients seen during the reporting period.  It's anticipated that clinicians who provide the primary management of patients with primary open-angle glaucoma will submit this measure.

#141 Primary Open-Angle Glaucoma (POAG): Reduction of Intraocular Pressure by 15% OR Documentation of a plan of care (Communication and Care Coordination Domain)

#141 Primary Open-Angle Glaucoma (POAG): Reduction of Intraocular Pressure by 15% OR Documentation of a plan of care (Communication and Care Coordination Domain)

Percentage of patients aged 18 years and older with a diagnosis of primary open-angle glaucoma whose glaucoma treatment has not failed (the most recent IOP was reduced by at least 15% from the pre-intervention level) OR if the most recent IOP was not reduced by at least 15% from the pre-intervention level, a plan of care was documented within 12 months.

#14 Age-Related Macular Degeneration (AMD): Dilated Macular Examination (Effective Clinical Care Domain)

#14 Age-Related Macular Degeneration (AMD): Dilated Macular Examination (Effective Clinical Care Domain)

Percentage of patients aged 50 years and older with a diagnosis of age-related macular degeneration who had a dilated macular examination performed which included documentation of the presence or absence of macular thickening or hemorrhage AND the level of macular degeneration severity during one or more office visits within 12 months.  This measure is to be reported a minimum of once per reporting period for patients seen during the reporting period.  It is anticipated that clinicians who provide the primary management of patients with age-related macular degeneration will submit this measure.

#140 Age-Related Macular Degeneration (AMD): Counseling on Antioxidant Supplement (Effective Clinical Care Domain)

#140 Age-Related Macular Degeneration (AMD): Counseling on Antioxidant Supplement (Effective Clinical Care Domain)

Percentage of patients aged 50 years and older with a diagnosis of age-related macular degeneration or their caregiver(s) who were counseled within 12 months on the benefits and/or risks of the Age-Related Eye Disease Study (AREDS) formulation for preventing progression of AMD.

#19 Diabetic Retinopathy: Communication with the Physician Managing Ongoing Diabetes Care (Communication and Care Coordination Domain)

#19 Diabetic Retinopathy: Communication with the Physician Managing Ongoing Diabetes Care (Communication and Care Coordination Domain)

Percentage of patients aged 18 years and older with a diagnosis of diabetic retinopathy who had a dilated macular or fundus exam performed with documented communication to the physicia who manages the ongoing care of the patient with diabetes mellitus regarding the findings of the macular or fundus exam at least once within 12 months.  This measure is to be reported a minimum of once per reporting period for all patients with diabetic retinopathy seen during the reporting period.  It is anticipated that clinicians who provide the primary management of patients with diabetic retinopathy will submit this measure.

#117 Diabetes: Eye Exam (Effective Clinical Care Domain)

#117 Diabetes: Eye Exam (Effective Clinical Care Domain)

Percentage of patients 18 through 75 years of age with a diagnosis of diabetes (type 1 and type 2) who had a retinal or dilated eye exam by an eye care professional in the measurement period or a negative retinal or dilated eye exam (negative for retinopathy) in the year prior to the measurement period.

#226 Tobacco use: Screening and Cessation Intervention cross-cutting measure (Community/Population Health Group)

#226 Tobacco use: Screening and Cessation Intervention cross-cutting measure (Community/Population Health Group)

Percentage of patient aged 18 and older who were screened for tobacco use one or more times within 24 months AND who received cessation counseling intervention if identified as a tobacco user.

#130 Meds: Documentation of Current Medications in the Medical Record cross-cutting measure (Patient Safety Domain)

#130 Meds: Documentation of Current Medications in the Medical Record cross-cutting measure (Patient Safety Domain)

Percentage of visits for patients aged 18 years and older for which the eligible professional attests to documenting a list of current medications using all immediate resources available on the date of the encounter.  This list must include ALL knon prescriptions, over-the-counters, herbals, and vitamin/mineral/dietary (nutritional) supplements AND must contain the medications' name, dosage, frequency and route of administration.

#317 Blood pressure: Screening for High Blood Pressure and Follow Up Documented cross cutting measure (Community/Population Health Group)

#317 Blood pressure: Screening for High Blood Pressure and Follow Up Documented cross cutting measure (Community/Population Health Group)

Percentage of patients aged 18 years and older seen during the reporting period who were screened for high blood pressure AND a recommended follow-up plan is documented based on the current blood pressure (BP) reading as indicated.

#110 Influenza Immunization cross-cutting measure (Community/Population Health Domain)

#110 Influenza Immunization cross-cutting measure (Community/Population Health Domain)

 

Percentage of patients, aged 6 months and older, seen for a visit between October 1 and March 31 who received an influenza immunization, or who reported previous receipt of an influenza immunization.

Additional Resources (or just google it)

EHR Guru

AOA (must be logged into your account)

CMS (government)