Pathology Quality Measures

 


Through the development of quality measures by the CAP, pathologists avoid Medicare payment penalties and earn bonuses when reported correctly. In 2016, for example, pathologists faced a combined $30.9 million in penalties from Medicare's quality programs if measures were not successfully reported. Previously, pathologists also earned $25 million in Medicare bonuses after reporting quality measures developed by the CAP and its Council on Government and Professional Affairs.

The Pathologists Quality Registry offers 17 quality reporting measures all developed by the CAP. Eight are Quality Payment Program (QPP) measures that can be reported using a registry or billing claims. The remaining nine are specific pathology measures approved by the CMS as qualified clinical data registry (QCDR) measures—exclusively available in the Pathologists Quality Registry.

Pathologists Quality Registry QCDR Measures

Pathologists Quality Registry QPP Measures

These measures can be reported to the CMS using the Pathologists Quality Registry, through billing/claims, and other registries.

QPP 99: Breast Cancer Resection Pathology Reporting Registry and Claims Specifications
QPP 100: Colorectal Cancer Resection Pathology Reporting Registry and Claims Specifications
QPP 249: Barrett Esophagus Pathology Reporting Registry and Claims Specifications
QPP 250: Radical Prostatectomy Pathology Reporting Registry and Claims Specifications
QPP 251: Evaluation of HER2 for Breast Cancer Patients Registry and Claims Specifications
QPP 395: Lung Cancer Reporting (biopsy/cytology specimens)** Registry and Claims Specifications
QPP 396: Lung Cancer Reporting (resection specimens)** Registry and Claims Specifications
QPP 397: Melanoma Reporting** Registry and Claims Specifications
Pathologists Quality Registry QCDR Measures

These measures can be reported to the CMS only with the Pathologists Quality Registry.

CAP1: Turnaround Time (TAT) - Standard Biopsies**
CAP2: Cancer Protocol Elements for Endometrium Completed
CAP3: Cancer Protocol Elements for Kidney Resection Completed
CAP4: Cancer Protocol Elements for Intrahepatic Bile Duct Completed
CAP5: Cancer Protocol Elements for Hepatocellular Carcinoma Completed
CAP6: Cancer Protocol Elements for Pancreas Resection Completed
CAP7: Helicobacter pylori Documentation Rate
CAP8: Turnaround Time (TAT) – Lactate**
CAP9: Turnaround Time (TAT) – Troponin**

** = outcome or high-priority measure

Resources

CAP Advocacy

The CAP advocates on behalf of pathologists regarding their options for quality reporting. While the CAP has created eight quality measures included in the current CMS quality program for pathologists, other measures in the current MIPS program may apply. In 2017, most specialties must report on a minimum of six measures (or all that apply).

The CMS has assured the CAP—in writing—that pathologists who have fewer than nine measures will only need to report on applicable measures, and pathologists with no applicable measures will not face PQRS penalties. CMS has said it will continue this policy through 2017, but has not provided that in writing. The CMS recommends that eligible professionals check with the QualityNet HelpDesk to make sure that no measures apply.

Professionals may Contact the Qualitynet Help Desk.
7:00 AM–7:00 PM CT Monday - Friday
email: qnetsupport@hcqis.org
Phone: 866-288-8912

Letter To CMS Acting Administrator Andy Slavitt On Physician Quality Reporting System (PQRS) And Value-based Modifier (VBM) Provisions Of Proposed Rule (CMS-1600-P)

Claims-Based Instruction Sheet

The CAP developed a Claims-Based Instruction Sheet to help you submit data for on a quality measures data via claims for MIPS under the Quality Payment Program. The corresponding 2017 QPP Reporting Codes can help on which codes to report.

Education

A number of resources exist to help pathologists navigate the rules for PQRS, understand their options for reporting, and successfully report measures.

Webinars

The 2016 Medicare Physician Fee Schedule's Impact on Pathology Services

STATLINE Articles