by Joy Rios, MBA, CHTS-PW
Foreword by Tom S. Lee, PhD, CEO & Founder, SA Ignite
This practical, action-oriented guidebook by Joy Rios, MBA, CHTS-PW will help healthcare professionals navigate the new industry landscape, where providers are paid for reporting quality measures and will receive payment adjustments based on their performance rates.
Healthcare is moving from a pay-for-service model to a pay-for-performance model. Many – in fact, arguably most – healthcare professionals do not understand how this will happen. It’s being introduced gradually through the Physician Quality Reporting System (PQRS) and the Value-based Modifier Program. Neither program is very well understood in the industry, yet if providers choose not to participate, they will start to see significant penalties – up to 9% reductions in Medicare reimbursements, depending on the size of the provider’s organization and their participation in other incentive programs. What’s more is that each provider’s quality results – whether good or bad – will be publicly available online as part of the Physician Compare program.
To avoid those penalties, healthcare professionals across the country must navigate the complex quality reporting system or pay the price. This book will help you learn the system and then work it.
ABC’s of PQRS gives you a full spectrum of content:
- Discussion of how the program came to be, to put PQRS in context
- Providing explicit examples of penalty scenarios
- Addressing the various ways to report (Registry, EHR, QCDR, Web Interface, Claims, and CAHPS)
- Examines how other quality programs are interrelated with PQRS – specifically the Value-based Modifier Program (VM)
If you are unclear about the program requirements, confused about how to start, are having difficulty knowing which measures to report, or you don't understand how PQRS reporting will affect your future reimbursements, this book is for you. Who else should read this book?
Anyone responsible for reporting PQRS for an eligible professional or a group practice, including,
- Healthcare and IT consultants – those who support and advise eligible professionals.
- Medical billers or coders – those responsible for reporting the doctor's quality information
- Practice Managers and Practice Administrators
- Meaningful Use project managers (since there is some overlap with quality measures)
- Eligible Professionals – anyone who is eligible for the program and wants to understand it better
- Doctors who will be assessed on the quality of care they provide
Read this book to gain clarity, confidence and comprehension to PQRS Reporting. Acquire the tools so you feel more capable and bring a more strategic mindset to your quality reporting.
Joy Rios, MBA,CHTS-PW, is a California native who has lived on both coasts of the US as well as in between. She is a health IT enthusiast, with a passion for technology and sustainability. In fact, one of her first jobs involved prepping and scanning patient records for microfilm storage. She is both curious and persistent--traits that have led her to travel to far-off destinations, and also to study the complexities of the changing healthcare landscape. In her ongoing pursuit to make sense of the transformative healthcare initiatives, Joy is intent on sharing her findings. She creates curricula and regularly trains healthcare professionals on the EHR Incentive (Meaningful Use), PQRS, and Value-based Payment Programs through online workshops; she writes regularly for various health IT publications; and she Tweets regularly at @askjoyrios.
Joy holds a BA in English, an MBA with a focus on sustainable business practices, and is a Certified Healthcare Technology Specialist with a focus on Practice Workflow. She lives in San Diego with her husband.
