Why You Need an EMR for PQRS

Every November, Medicare releases its Final Rule. And nestled among the many regulatory updates—like warm buns in a basket—are the PQRS requirements for the coming year. The 2016 Final Rule reveals that not much is changing for rehab therapy providers on January 1. But, even so, satisfying PQRS requirements is rarely a piece of cake—er, bite of bun? Anyway, as I was saying: The rules can seem convoluted, and adhering to them requires precise documentation. Here’s how an EMR can help you remain compliant in the following areas:

Tracking Progress

In 2016, eight measures apply to physical therapy, ten to occupational therapy, and a whopping one measure applies to speech-language pathology. And the reporting requirements are pretty strict, as Brooke Andrus explains in this article: “Each eligible professional (EP) must report on nine measures across three NQS domains for at least 50% of Medicare Part B FFS patients.” That means PTs and SLPs are automatically subject to the MAV process, which allows Medicare to review their data to ensure they’ve reported on the maximum number of available measures for their specialties. With all of these complexities in mind, how do you track your progress? And how do you know that you are reporting on all of the measures available to you?

Things can get really complicated when there’s that much data to account for, but the right EMR system makes the process simple by providing you with user-friendly reports that accurately display your progress. That way, you can adjust your processes as the year goes on. Sure beats trying to manually track all of that data.

Satisfying Measures Requirements

One of the potential time-sucks of reporting PQRS data properly is the need to document your measures. It can be difficult to remember which measures to report—and at which intervals. A great EMR will prompt you to report any necessary PQRS data at the right time (e.g., some measures are only reported at initial evaluation, while others require reporting at every visit). That way, you take the guesswork out of satisfactorily reporting, and you can always count on your documentation to be compliant.

Something to be aware of: as always, your bottom line depends on your compliance. When it comes to PQRS, you’re looking at a hefty 2% negative payment adjustment in 2018 if you don’t satisfactorily report on the measures that apply to your specialty in 2016. But, if you use an EMR, you don’t have to leave anything to chance. You’ll know exactly how many patients you’ve seen, which data you’ve reported, and how far you’ve progressed toward meeting the minimum requirements for reporting.

Submitting Data

Okay, so now you know that an EMR can help you easily track your PQRS data, satisfy the reporting requirements for all your measures, and avoid the penalty. But, I’ve yet to cover one very important part of this whole shebang: actually submitting your PQRS data to Medicare. Here’s the cold, hard truth: not every EMR is equipped to handle your data. So, make sure you look for an EMR with a certified CMS PQRS registry, meaning the system automatically compiles and submits your data to CMS on your behalf. No hassle necessary.

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Attempting to report on PQRS without an EMR is a lot like preparing a hearty meal without hot buns: sad and pointless. All kidding aside, keeping track of all of the regulatory changes on your own is enough to make your head spin. But the right EMR can help you avoid penalties, stay compliant, and cleanly submit data to CMS like a hot knife through butta’.


Speak and Spell: Sounding Out Common Healthcare Jargon

Imagine: It’s 1985 and you’re fresh out of batteries. And that—unfortunately—means your spelling mentor (housed in bright red plastic) is out of commission for the night. It looks like you’ll be going to bed early—and without the familiar, robotic voice of Speak & Spell to coax you into dreamland. Okay, so you’re probably wondering what an old-school children’s toy has to do with you—or this post. Well, that’s a great question, and the answer lies in the alphabet soup that makes up the modern glossary of healthcare jargon. As a PT, you’re bombarded with new terms that pop up left and right. In fact, with so many new vocab words and acronyms, you might not feel much different than you did as a child in our hypothetical ’80s drama—ready to call it a night. But luckily for you, the human mind doesn’t require batteries (yet) and you won’t have to go to bed early if you can’t make it through this list. With that being said, let’s get to sounding out a few of the most common healthcare jargon terms:

EHR: Electronic health record

Electronic health records (EHRs) are digital records that focus on the overall health of the patient. These systems typically include the patient records, notes, and other medical information that’s easily accessible across multiple specialties and healthcare organizations.

EMR: Electronic medical record

EHR and EMR might seem like interchangeable terms. However, the two are distinctly different. An electronic medical record (EMR) is a digital version of paper documentation. These records typically contain data that can be easily tracked and accessed within a practice. However, they’re not typically designed to integrate with systems in other settings (e.g., labs and specialty medical offices).

FLR: Functional limitation reporting

Floor? Flower? But, without the letters o, w, and e? Well, not quite. Functional limitation reporting (FLR) doesn’t really sound like any of those words. However, it does sound like The Centers for Medicare and Medicaid Services (CMS) will continue looking for new ways to inform the development rehab therapy payment structures—and FLR is part of these attempts. To satisfy FLR requirements, all eligible Medicare providers must report on their Medicare patients’ functional limitations to objectively demonstrate the connection between rehab therapy and patient progress.

HIPAA: The Health Insurance Portability and Accountability Act of 1996

HIPAA sounds a lot like the word hippo. But this law doesn’t spend its time snoozing underwater. Rather, it serves to maintain privacy policy standards in order to protect patients’ sensitive health information per the Privacy Rule. This rule impacts how “covered entities” (e.g., healthcare providers, clearinghouses, health plans, and business associates) handle protected health information (see PHI below).

PHI: Protected health information

“And I’m PHI, PHI falling.” Uh, not quite. Protected health information (PHI) is any health information—in any form—that could individually identify a patient. Typically, PHI refers to patient demographics, but it also includes a variety of other data points that healthcare professionals collect.

PQRS: Physician Quality Reporting System

You might find yourself (or the nearest five-year-old) reciting PQRS as you sing through the alphabet. Or, if you treat Medicare patients, you might find yourself cursing these four letters. PQRS is a CMS system that encourages eligible professionals and group practices to provide measurable data on their quality of care by reporting on a series of measures. As of 2015, practices that do not meet the standards for satisfactory reporting will incur a penalty that will negatively impact reimbursements rates in 2017. Fun, right?

As it turn out, you don’t actually need those glowing green letters to decode the latest healthcare jargon.


3 Signs Your EMR Fails to Scale

If you’re ready to start expanding your practice, you’ve probably spent a great deal of time making sure your staff is on board and getting your financials in order. But have you considered the impact your EMR might have on the success or failure of your expansion venture? Here are three signs your EMR isn’t built to support a growing clinic:

1. It makes you pay per patient or per visit.

If your EMR vendor charges you per chart or per visit, it’s impeding the growth of your business—and your bottom line. Under this kind of payment structure, increasing the number of patients your clinic treats means increasing the amount you pay your software vendor each month. Instead of working with a vendor that takes a bite out of each piece of your financial pie, look for one with a payment structure that allows you to pay per user.

2. It limits your number of users, records, or patients.

This one should be pretty obvious. If your EMR caps the number of users, records, or patients you can have, it also caps your clinic’s potential for growth. To keep up with your growth, switch to an EMR that makes it possible—and easy—to add patients, users, records, and clinic locations. Better yet—choose an EMR that offers volume-based discounts to growing practices.

3. It doesn’t give you access to crucial data.

To grow your practice, you need to be able to dig into your business metrics and identify areas where you may be missing out on revenue. Your EMR should provide you with valuable metrics on both your patients and your practice. Look for a multitude of reporting options that allow you to analyze all areas of your business, including:

  • inactive patients
  • patient cancellations and no-shows
  • claim statuses
  • units billed
  • number of patients per therapist
  • types of documents created
  • missed notes
  • referral sources

Additionally, look for an EMR that gives you insight into how regulations like FLR, PQRS, and MPPR are impacting your bottom line.

Behind every great clinic is a great EMR; can you say as much about your system? Make sure your EMR gives you the data space, financial freedom, and business intelligence you need to grow. Don’t settle for an EMR that penalizes you for being successful—or one that doesn’t allow you to be successful, period.


Give Yourself the Gift of EMR

The traditional gift-giving holidays are all behind us now—even Cupid has holstered his bow and arrow—but that doesn’t mean you can’t treat yourself to something really nice just because. Give yourself the gift of EMR this spring, and say goodbye to writing, filing, and lugging paper charts—a pain, whatever the season. And that’s not all. With the right EMR, you’ll get these other great gifts that just keep on giving, too:

Legible, Accessible, and Defensible Documentation

All physicians must transition to EMR by 2014, and there’s a reason for that: compared to paper charting, EMRs are better able to provide the medical community as a whole with legible, accessible, and defensible documentation. And that’s important for both patients and providers, especially as we continue to move further into this pay-for-performance, regulation-heavy healthcare environment. With an EMR, your documentation will better tell your and your patients’ stories. And you’ll never again have to sort through another towering stack of filing cabinets in search of a certain note, only to find that you can no longer read the chicken scratch that once passed for handwriting.

A Partner in Compliance

Each reporting regulation has its own unique—and often messy—set of requirements, but with the right EMR,  you’ve got a partner in compliance. Instead of stressing about all the hard-to-keep-straight details—like those for PQRS, functional limitation reporting, the 8-minute rule, and the therapy cap—you need only follow the built-in prompts and alerts to complete the requirements for the right patients, every time. Plus, your EMR can help you manage the transition to ICD-10.

Unmatched Safety and Security

Choose a cloud-based EMR, and your patient data will be safe and secure—always. You’ll have all the perks of the world’s leading data centers—like protection from natural disasters, digital video surveillance, biometric screening, and round-the-clock guards—and none of the cost or responsibility.

A Leg-Up on the Competition

For most physical therapists, referrals make up a large part of new business. With an EMR, you can maximize those referrals by tracking how many you receive and from whom. It’s a great way to identify those in your network who need a little more attention and those who deserve a big “thank you.” With an EMR, you can also display your clinic’s logo on all of your digital documents, so every note you send is a reminder to prospective referrers of your skills and professionalism. Talk about a big leg-up.

Now’s the perfect time to nix perilous paper—think of it as an extension of your annual spring cleaning—and make 2014 a year to remember with the best gift you, your clinic, and all the trees of the world could ask for: EMR.