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PQRI XML Output for CQM

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Contents

Summary

Functional Requirements

  • Add a button to the existing Report to export in the PQRI format
  • Enhance database, tables to include all elements (bold)
    • Submission-period-from-date
    • Submission-period-to-date
    • Submission method
    • Measure group
    • Provider - Name?
    • National Provider Identifier
    • PQRI measure
    • PQRI measure number - what if it's a NQF # or there are both PQRI and NQF?
    • Eligible instances (reporting denominator)
    • Meets performance (performance numerator)
    • Performance exclusion instances
    • Performance not met instances
    • Reporting rate
    • Performance rate

1. file_audit_data

Research Notes, need to merge with above

1. file_audit_data

The data in this section can be generated at the submit time and doesn'tneed to be in the database.

2. registry

This data needs to come from the datsbase and none of it is being captured.
The schema/GUI needs to be extended to capture this data.

3. measure-group

This data needs to come from the datsbase and is not being captured.
The schema/GUI needs to be extended to capture this data.

4. provider

npi: avaiable
tin: available
waiver-signed: not available
encounter-from/to-date: available
measure-group-stat: I don't believe this is can be generated at submission time today(correct me if I'm wrong)
pqri-measure
pqri-measure-number: There's a cqm_code in the clinical_rules table. But, I think we need pqri codes.
eligible-instances: This can be generated at submission time meets-performance-instances: This can be generated at submission time
performance-exclusion-instances: This can be generated at submission time
performance-not-met-instances: This can be generated at submission time
reporting-rate: This can be generated at submission time
performance-rate: This can be generated at submission time

Definitions

Measure Groups

Measures groups are subsets of PQRI measures that have in common a focus on a particular clinical condition or aspect of care. The denominator coding of the measures defines the condition or aspect of care.

There are about 7 measure groups identified by CMS: A = Diabetes Mellitis C = CKD D = Preventive Care E = Peri-operative Care F = Rheumatoid Arthritis G = Back Pain H = CABG The example in my XML was for "C" (CKD aka Chronic Kidney Disease)

Registry-Based Reporting

CMS will accept quality measure results on 2009 Physician Quality Reporting Initiative (PQRI) measures submitted by qualified registries on behalf of their participants. The 2008 CMS certified PQRI registries that submitted successfully for 2008 are approved for 2009.

Registries approved by CMS have met a list of criteria, including:

  • Report data by both National Provider Identifier and Taxpayer Identification Number.
  • Separate and report on Medicare Part B patients only.
  • Provide PQRI measure numbers and titles.
  • Ability to transmit data in a CMS-approved XML format.

Registries must agree to provide CMS access to review the Medicare beneficiary data on which 2008PQRI registry-based submissions are founded.

Eligible professionals whose quality measure results are successfully submitted on their behalf by a registry and who have satisfied the applicable criteria for satisfactorily reporting for either the January-December or July-December reporting period may earn an incentive payment equal to 2.0% of their total allowed charges for Medicare Physician Fee Schedule (MPFS) covered professional services furnished during the applicable reporting period.

Here are examples of a couple of CMS PQRI Certified Registries:

American Board of Family Medicine, Inc(www.theabfm.org)
NCAQ(ncqa.org)
Providence Physician Division(www.providence.org/oregon)

XML Example

<submission type="PQRI-REGISTRY" option="PAYMENT" version="2.0" xsi:noNamespaceSchemaLocation="Registry_Payment.xsd">
−
<file_audit_data>
<create-date>01-23-2009</create-date>
<create-time>23:01</create-time>
<create-by>RegistryA</create-by>
<version>1.0</version>
<file-number>1</file-number>
<number-of-files>1</number-of-files>
</file_audit_data>
−
<registry>
<registry-name>Model Registry</registry-name>
<registry-id>125789123</registry-id>
<submission-method>A</submission-method>
</registry>
−
<measure-group ID="C">
−
<provider>
<npi>1257894658</npi>
<tin>125789465</tin>
<waiver-signed>Y</waiver-signed>
<encounter-from-date>01-01-2009</encounter-from-date>
<encounter-to-date>12-31-2009</encounter-to-date>
−
<measure-group-stat>
<ffs-patient-count>2</ffs-patient-count>
<group-reporting-rate-numerator>20</group-reporting-rate-numerator>
<group-eligible-instances>30</group-eligible-instances>
<group-reporting-rate>100.00</group-reporting-rate>
</measure-group-stat>
−
<pqri-measure>
<pqri-measure-number>119</pqri-measure-number>
<eligible-instances>100</eligible-instances>
<meets-performance-instances>70</meets-performance-instances>
<performance-exclusion-instances>20</performance-exclusion-instances>
<performance-not-met-instances>10</performance-not-met-instances>
<reporting-rate>100.00</reporting-rate>
<performance-rate>88.00</performance-rate>
</pqri-measure>
</provider>
</measure-group>
</submission>