Recent Legislative Changes: MU, PQRS, and MIPS

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1 Recent Legislative Changes: MU, PQRS, and MIPS Catherine Chuter Sr. Associate, athenahealth This event is live as of XYZ

2 2

3 Projected number of Medicare beneficiaries Source: CMS, 2013 Annual Report of the Boards of Trustees of the Federal Hospital Insurance and Federal Supplementary Medical Insurance Trust Funds, May 31, 2013, available at: 54M 56M 57M 59M 61M 63M 64M B -21B -25B -32B -42B -53B -64B Projected Medicare Feefor-service Payment Cuts per the ACA Source: CMS, 2013 Annual Report of the Boards of Trustees of the Federal Hospital Insurance and Federal Supplementary Medical Insurance Trust Funds, May 31, 2013, available at: 3

4 2018: 90% of Medicare payments tied to quality. 2020: 75% of commercial plans will be value-based. Jan

5 MACRA PCMH PQRS MIPS PQRS MU ICD-10 HCC ACA MSSP MU ACO ANSI APMs EHR IRM

6 6

7 News from Washington: April 16 th MACRA, H.R. 2, made law Medicare Access and CHIP Reauthorization Act Replaced SGR formula EHR Incentive Programs to be streamlined into one new payment system Incentivizes the shift to alternative, value-based payment models

8 MU PQRS VM MIPS MIPS takes over and replaces penalties from current programs -4% penalty +12% incentive Fully implemented with a much greater range of adjustments -9% penalty +27% incentive 8

9 2015 ICD PQRI starts 2015 PQRS penalties hit 2016 PQRS VM applies to all HCPs 2011 Meaningful Use Stage Meaningful Use Stage Meaningful Use penalties hit 2017 Start MIPS or APM

10 The Evolution of PQRS 74M Claims 119 M 4 MG Claims Registry 119 M 4 MG Claims Registry 175 M 13 MG Claims Registry EHR GPRO 198 M 14 MG Claims Registry EHR GPRO 225 M 22 MG Claims Registry EHR GPRO 260 M 22 MG Claims Registry DSV HER GPRO 287 M 25 MG Claims Registry EHR GRPO CSV CDR % BONUS +1.0% +0.5% +0.5% +0.5% PENALTY -1.5% -2.0% 2014 participation affects penalty in

11 LOW QUALITY HIGH PQRS Value-based Modifier Quadrants 0.0% Bonus payment Bonus payment -2.0% 0.0% Bonus payment -4.0% -2.0% 0.0% HIGH COST LOW

12 The Evolution of MU and Beyond 2015 Stage 1: Data capture and sharing Stage 2: Advanced processes Stage 3: Improved outcomes Meaningful Use is designed to create infrastructure that supports reform.

13 A quick comparison

14 MU versus PQRS Eligible providers PQRS Meaningful Use MEDICARE PHYSICIANS Doctor of Medicine X X Doctor of Osteopathy X X Doctor of Podiatric Medicine X X Doctor of Optometry X X Doctor of Oral Surgery X X Doctor of Dental Medicine X X Doctor of Chiropractic X X PRACTITIONERS Physician Assistant X Nurse Practitioner X Clinical Nurse Specialist X Certified Registered Nurse Anesthetist X Certified Nurse Midwife X Clinical Social Worker X Clinical Psychologist X Registered Dietician X Nutrition Professional X Audiologists X THERAPISTS Physical Therapist X Occupational Therapist X Qualified Speech-Language Therapist X

15 PQRS versus MU Number of measures PQRS 9 out of 287 measures Meaningful Use 20 out of 23 measures

16 PQRS versus MU Measurement style PQRS Report first. Then, performance against your peers. Meaningful Use Measure thresholds.

17 PQRS versus MU Penalties Upcoming Medicare Penalties Program Physician Quality Reporting System (PQRS) Value Based Modifier Program (VM) Meaningful Use/EHR Incentive Program -1.5% -2% -2% -2% TBD TBD -1% -2% ** -2% or -4% *** TBD TBD TBD -1% or -2% * -2% -3% -4% TBD TBD Penalty -3.5% or - 4.5% -6% -7% or -9% TBD TBD TBD *-2% in 2015 only applies to providers who failed Meaningful Use and erx thresholds

18 PQRS versus MU National success on the programs PQRS Meaningful Use Approximately 37% of eligible providers face a payment reduction for not reporting in More than 30% of providers will be penalized for not meeting requirements in 2013 and 2014.

19 We navigate regulatory change so practices don t have to Meaningful Use Stage 2 attestation National average: athenahealth clients: 33% 98.2% % of HCPs expecting PQRS penalties in 2015 National average: athenahealth clients: 40% 6.4% 19

20 Performance on Meaningful Use Stage 2 Behavioral measures Covering period: Q CPOE for Medication, Laboratory, and Radiology Orders 10. Clinical Lab Test Results 100% 89% 2. E-prescribing (erx) 3. Record Demographics 4. Record Vital Signs 5. Record Smoking Status 6. Clinical Decision Support Rule 7. Patient Electronic Access 80% 8. Clinical Summaries 9. Protect Electronic Health Information (N/A) 99% 99% 95% 99% 100% 99% 11. Patient Lists (N/A) 12. Preventive Care Reminders 75% 13. Patient-Specific Education Resources 92% 14. Medication Reconciliation 99% 15. Summary of Care 89% 16. Immunization Registry Data Submission 90% 17. Use Secure Electronic Messaging 33% Providers who satisfied required 3 of 6 menu measures: 98% 20

21 If provider is failing MU Patient Engagement measures, auto-launch registration upon check-in Three new workflows to register the patient when in-office

22 Performance on Meaningful Use Stage 2 Behavioral measures As of 12/31/ CPOE for Medication, Laboratory, and Radiology Orders 10. Clinical Lab Test Results 100% 100% 2. E-prescribing (erx) 3. Record Demographics 4. Record Vital Signs 5. Record Smoking Status 6. Clinical Decision Support Rule 7. Patient Electronic Access 8. Clinical Summaries 9. Protect Electronic Health Information (N/A) 100% 100% 99% 100% 100% 99% 100% 11. Patient Lists (N/A) 12. Preventive Care Reminders 100% 13. Patient-Specific Education Resources 100% 14. Medication Reconciliation 100% 15. Summary of Care 100% 16. Immunization Registry Data Submission 100% 17. Use Secure Electronic Messaging 99% Providers who satisfied required 3 of 6 menu measures: 100% 22

23 athenahealth s award-winning services can help you thrive through change 64,000+ providers on athenanet Clients ranging from 1 to 5,000+ providers 50 states and 104 medical specialties $11.7 billion in client collections per year Acquired Epocrates March, Best in KLAS #1 Overall Software Vendor #1 Overall Physician Practice Vendor #1 Patient Portal #1 Practice Management System (1-10, physicians) #2 EHR (1-10, physicians) Best in KLAS Awards: Software & Services, January, KLAS Enterprises, LLC. All rights reserved.

24 Meaningful Use Guarantee PQRS Guarantee MSSP ACO Guarantee

25 25

26 Ask a few key questions of your EHR vendor 1 Is your vendor able to deploy the 2014 Certified Edition to all clients at once? 2 How is your vendor monitoring your PQRS and MU performance? 3 Does the vendor provide MU/PQRS support and training as part of the regular pricing without additional fees? 4 Do they provide the required interfaces for free and without interruption? How many connections? When will they be available? 26

27 Thank you! This event is live as of XYZ

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