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PQRS is a Medicare (CMS) "quality" initiative. It imposes an immense number of complex mandates upon physicians, and requires an extremely complex reporting system, with the "stick" of reducing medicare payments. According to Medicare, the intent of PQRS is to improve quality. However, to me, it appears that the intent is to create penalties through creation of an impossible task for physicians to comply. The methodology is to create a gigantic burden for physician compliance. When they do not comply, then the reason given to the public is "quality". Clever.

I first learned of PQRS when I was sent a letter from CMS, complete with mispellings, saying that my practice's medicare payments would be reduced by 2% for all of 2015, because I had not participated in the PQRS process in 2013. This got my attention. After several weeks, I managed to create an online ID. This wasn't easy because nobody answered the telephones, returned messages or emails. CMS has many different ID's, numbers, and acronyms, user logins, and systems. The passwords typically have to be changed every 3 months.

Several months later, I attempted to locate a medicare site where I could comply with PQRS. It does not exist -- what there is instead is a gigantic number of cross-linked web-pages, without any method of uploading data. The reason is that there is a labyrinth of "registries", and commercial providers who maintain the "registries". We are not dealing here with a national registry - -we are dealing with a zillion little databases. There does not appear to be any health care purpose to these registries. Rather, it appears that these registries are just money-making endeavors. Probably run by people who understand these regulations. They exist only to make money from doctors being forced to do PQRS. OK.

Well, you have to start somewhere - -I selected the "PQRS wizard" site for an attempt to comply with PQRS. This site is all over the place, and #1 on google with paid advertising. They wanted $300. They said they were the "Turbo-tax" of PQRS. However, Turbo-tax doesn't ask for money until you are finished with preparing your taxes. These people are not as honest as Turbo-tax. Read on.

PQRS wizard collected my money, more than most other PQRS providers. Still, they looked slick. I paid my money and then we got into the specifics. About 2 hours later, I determined they wanted me to upload 14000 patient records to their registry. They provided me with a csv format template file to help. Thats a lot of records. This is not a "OK, it didn't work out, we will refund your money" type site. This is a "if you want to go back, pay us $150 and call our technical support" type site. In other words, progressive disclosure of lots of scary content.

PQRS is also simply a dishonest government mandate. It would be honest for the US government to just say that they don't have enough money to pay for medicare, so they are cutting payments by 2%. It is not honest to say that because I can't comply with these impossible requirements that it is my fault.

Hopefully someone will repeal PQRS. It does not add anything useful to our health care system. We doubt that many will be able to follow the steps below.

Complying with PQRS -- you need to be a database programmer.

To produce data for PQRS, you need data from your EMR chart notes, and you need billing data to provide billing codes. In other words, you either need to have an integrated EMR with notes and billing, or you have to somehow integrate together information from each. Or in other words, you need to be proficient with database programming to comply with PQRS.

We use a medical record system called "Amazing Charts". While it is "OK" overall, Amazing Charts does not do PQRS because it doesn't do billing. Furthermore, Amazing charts does not even come close to providing enough data in its utilities. For example, AC allows you to query for text in a particular field, but the patient list it provides doesn't include birthdates (which PQRS requires). AC doesn't export dates of service, it doesn't export CPT codes -- all of which are needed for PQRS. These have to come from your billing system.

So, to do PQRS with AC, you have to do some database operations - -you need to find the patients in AC relevant to PQRS, and then you have to stick in the missing fields from whatever database application you can find. In our case, there are three different data sources:

1. Amazing charts -- query to find patients relevant to PQRS

2. Amazing charts - -full demographics dump (to obtain the date of birth).

3. Billing application (in our case, Medisoft), to find patients medicare status.

Putting in the date of Birth.

To do this, you first start with a list of all of the patients you are reporting for the year in question (lets say 2014). You can get this from AC by finding all patients where you have something that you get with everyone -- for example, their medication list, and restrict the date to 2014. This produces a csv file.

Next, you dump from AC the full demographics database. This produces another csv file. This is done from the administrator options menu, not from the database menu (sigh).

Thirdly, you import both of these guys into Microsoft Access tables (or whatever database application you like -- such as mysql)

Next, you produce a "relationship" in Access (this is a type of join), and link together the patient-id's from the patient list with the demographics. Make sure your query shows the name and DOB.

Run this query, and export it as another excel file.

Thats it for the dates of birth.


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