It s All About Revenue MIPS & Cardiology Best Practices JUSTIN T. BARNES
|
|
- Randolph Bryant
- 6 years ago
- Views:
Transcription
1 It s All About Revenue MIPS & Cardiology Best Practices JUSTIN T. BARNES PARTNER, IHEALTH INNOVATIONS CO-CHAIR, ACCOUNTABLE CARE COMMUNITY OF PRACTICE
2 About Justin T. Barnes Justin is a nationally recognized business and policy advisor who also serves as Chairman Emeritus of the HIMSS EHR Association as well as Co- Chairman of the Accountable Care Community of Practice. He is also host of the weekly syndicated radio show This Just In. As a partner with ihealth, Justin assists healthcare providers with optimizing their revenue sources as well as navigating from traditional fee-for-service (FFS) models into evolving value-based payment & care delivery models. Justin has formally addressed and/or testified before Congress as well as the last two Presidential Administrations on more than twenty occasions since 2005 with statements relating to alternative payment & care delivery models, MACRA, value-based medicine, accountable care, interoperability, EHR meaningful use, consumerism and much more. Barnes is a regular public speaker on these issues and has appeared in more than 1,200 journals, magazines and broadcast media outlets.
3 The Changing Landscape in Healthcare Focus on optimization, efficiencies & economies of scale Look across organization and community for new revenue and higher profitability of current services - Optimize revenue cycle, new services & care delivery opportunities as well as new specialtyspecific program options Organizations of all sizes are working to make conducting business with their organization easier - Align processes, services and innovation to ensure that patients can easily access scheduling, appointments and, certainly, make payments
4 Optimize your Revenue Cycle Today Optimize documentation to mitigate issues and reduce risk Audit provider workflow Comprehensive documentation and notation (under-documenting; get paid for what you did) Assessments, questionnaires, evals, services, tests & screening All counts towards points in MIPS Random chart audits 10 per provider; monthly or bi-monthly Regular review of coding by expert billers Look for missing charges (consultation, no notes, wrong provider noted), down-coding, up-coding, wrong ICD- 10 codes, missing modifiers, etc All prevent rejections, denials & audits Keep the future in mind Optimize coding & EHR for PQRS, MIPS, APM & other Quality Reporting Initiatives Manage Credentialing Monitor par & non-par care providers - leverage a partner? Optimize Collections with eligibility verification, prior authorizations, etc Manage fee schedules - Analysis & financial analytics review should be performed every 6-12 months
5 Cardiology Best Practices Avoid denials for: If is denying because it was billed by another provider Resolution: Suggest working with the co-surgeon to bill their services with appropriate modifier 62 because both the surgeons are equally participating and performing distinct services. Inappropriate denials for: LD , XU denied for invalid use of modifier Resolution: verify these codes were used, these are appropriate reprocess claim If billing for 36225, ensure the appropriate anatomical MOD for the service (LT or RT) is used
6 Value-based Care Initiatives & Incentives
7 MACRA, MIPS & APMs MACRA & MIPS: Healthcare Reform/Transformation Medicare Access & CHIP Reauth Act (MACRA) of Phase-in an alternative payment model that leverages outcomes & quality-based payments with a reduced fee-for-service reimbursement. Final Rule released Oct.14 with 60-day comment period. Eligible physicians and clinicians will be given 4 options to comply with new payment schemes Option 1: Allows providers to report 1 quality or 1 IA or 5 ACI measures to avoid a negative payment adjustment Option 2: Allows providers to submit measure & activities data for 90 days - this means their first performance period could begin later than 1/1/17 to earn a neutral or small positive payment adjustment Option 3: Practices that are ready to go on 1/1/17 for the full 365 day quality reporting period in 2017 to earn a moderate positive payment adjustment Option 4: Participate in an advanced alternative payment model such as a Medicare Shared Savings ACO Track 2+
8 Medicare Access & CHIP Reauthorization Act (MACRA) incentives MIPS Only MIPS Payment Adjustment: ±4% - Year 1 ±5% - Year 2 ±7% - Year 3 ±9% - Year 4+ Non-Advanced APM MIPS payment adjustment + APM specific rewards Advanced APM 5% Medicare Part B incentive payment + APM specific rewards * Clinicians will earn a 0.5% fee schedule increase each year for
9 MIPS performance categories A single MIPS composite performance score will factor in performance in 3 weighted categories on a scale of Quality Advancing Care Information (ACI) Improvement Activities (IA) Resource Use/Cost Replaces PQRS. Accounts for 60% of total performance score in year one. Replaces Medicare MU. Accounts for 25% of total performance score in year one. Accounts for 15% of total performance score in year one. Begins in performance year Replaces valuebased modifier.
10 MIPS performance categories A single MIPS composite performance score will factor in performance in 3 weighted categories on a scale of Quality 60% Advancing Care Information (ACI) 25% Improvement Activities (IA) 15% Select : 20 Cardiology measure options 6 quality measures including: 1 outcome measure (if applicable) If not applicable, choose another high-priority measure Based on your EHR edition, select one option: Option 1: ACI Objectives and Measures (15 measures, 5 required) Option 2: 2017 ACI Transition Objectives and Measures (11 measures, 4 required) Select: Up to 4 improvement activities 93 to choose from Groups with less than 15 participants or those in a rural/health professional shortage area: Up to 2 activities
11 Key MIPS/ QPP Final Rule takeaways Pick your pace Highly flexible - You choose what objectives & measures best fit your practice, specialty & workflow It s not all or nothing - Partial credit & bonuses available to easily avoid penalties and to also increase payments
12 4-Point Plan for MACRA & MIPS Success 1. Financial success Stabilize & optimize revenue streams 2. Clinical success Focus on documentation, pop health & care coordination 3. Technical success Optimize health IT infrastructure & functionality enhancements Full article: 4. Staff success Secure inside expertise, involve and educate staff
13 Quality Payment Program Adjustment & Incentives Overview
14 Cardiology Expected Revenue & Adjustments Total Industry 36,128 clinicians included Positive payment adjustment 73.3%, $224 Million Negative payment adjustment 26.7%, $25 Million Average for 5 Clinician Cardiology Practice +/-$43,601 in 1 st Year
15 Cardiology Cumulative Penalties For years , based on EC performance, physicians and practitioners can receive cumulative negative or positive payment adjustments.
16 Cardiology Specialty Measures Number of Cardiology Measures Included in Final Rule Process Measures for Effective Clinical Care 3 Efficiency Measures 1 Intermediate Outcome Measure MEASURE NAME MEASURE DESCRIPTION emeasure ID NQF QUALITY ID NQS DOMAIN MEASURE TYPE HIGH PRIORITY MEASURE DATA SUBMISSION METHOD Atrial Fibrillation and Atrial Flutter: Chronic Anticoagulation Therapy Percentage of patients aged 18 years and older with a diagnosis of nonvalvular atrial fibrillation (AF) or atrial flutter whose assessment of the specified thromboembolic risk factors indicate one or more high-risk factors or more than one moderate risk factor, as determined by CHADS2 risk stratification, who are prescribed warfarin OR another oral anticoagulant drug that is FDA approved for the prevention of thromboembolism N/A Effective Clinical Care Process No Claims, Registry Cardiac Stress Imaging Not Meeting Appropriate Use Criteria: Preoperative Evaluation in Low Risk Surgery Patients Percentage of stress single-photon emission computed tomography (SPECT) myocardial perfusion imaging (MPI), stress echocardiogram (ECHO), cardiac computed tomography angiography (CCTA), or cardiac magnetic resonance (CMR) performed in low risk surgery patients 18 years or older for preoperative evaluation during the 12-month reporting period N/A N/A 322 Efficiency and Cost Reduction Efficiency Yes Registry
17 Cardiology Specialty Measures Continued MEASURE NAME MEASURE DESCRIPTION emeasure ID NQF QUALITY ID NQS DOMAIN MEASURE TYPE HIGH PRIORITY MEASURE DATA SUBMISSION METHOD Cardiac Stress Imaging Not Meeting Appropriate Use Criteria: Routine Testing After Percutaneous Coronary Intervention (PCI) Percentage of all stress single-photon emission computed tomography (SPECT) myocardial perfusion imaging (MPI), stress echocardiogram (ECHO), cardiac computed tomography angiography (CCTA), and cardiovascular magnetic resonance (CMR) performed in patients aged 18 years and older routinely after percutaneous coronary intervention (PCI), with reference to timing of test after PCI and symptom status N/A N/A 323 Efficiency and Cost Reduction Efficiency Yes Registry Cardiac Stress Imaging Not Meeting Appropriate Use Criteria: Testing in Asymptomatic, Low-Risk Patients Percentage of all stress single-photon emission computed tomography (SPECT) myocardial perfusion imaging (MPI), stress echocardiogram (ECHO), cardiac computed tomography angiography (CCTA), and cardiovascular magnetic resonance (CMR) performed in asymptomatic, low coronary heart disease (CHD) risk patients 18 years and older for initial detection and risk assessment N/A N/A 324 Efficiency and Cost Reduction Efficiency Yes Registry Care Plan Percentage of patients aged 65 years and older who have an advance care plan or surrogate decision maker documented in the medical record or documentation in the medical record that an advance care plan was discussed but the patient did not wish or was not able to name a surrogate decision maker or provide an advance care plan N/A Communication and Care Coordination Process Yes Claims, Registry Closing the Referral Loop: Receipt of Specialist Report Percentage of patients with referrals, regardless of age, for which the referring provider receives a report from the provider to whom the patient was referred CMS50v5 N/A 374 Communication and Care Coordination Process Yes EHR
18 Cardiology Specialty Measures Continued MEASURE NAME MEASURE DESCRIPTION emeasure ID NQF QUALITY ID NQS DOMAIN MEASURE TYPE HIGH PRIORITY MEASURE DATA SUBMISSION METHOD Controlling High Blood Pressure Percentage of patients years of age who had a diagnosis of hypertension and whose blood pressure was adequately controlled (<140/90mmHg) during the measurement period CMS165v Effective Clinical Care Intermediate Outcome Yes Claims, EHR, CMS Web Interface, Registry Coronary Artery Disease (CAD): Angiotensin- Converting Enzyme (ACE) Inhibitor or Angiotensin Receptor Blocker (ARB) Therapy - Diabetes or Left Ventricular Systolic Dysfunction (LVEF < 40%) Percentage of patients aged 18 years and older with a diagnosis of coronary artery disease seen within a 12 month period who also have diabetes OR a current or prior Left Ventricular Ejection Fraction (LVEF) < 40% who were prescribed ACE inhibitor or ARB therapy N/A Effective Clinical Care Process No Registry Coronary Artery Disease (CAD): Antiplatelet Therapy Percentage of patients aged 18 years and older with a diagnosis of coronary artery disease (CAD) seen within a 12 month period who were prescribed aspirin or clopidogrel N/A 67 6 Effective Clinical Care Process No Registry Coronary Artery Disease (CAD): Beta-Blocker Therapy-Prior Myocardial Infarction (MI) or Left Ventricular Systolic Dysfunction (LVEF <40%) Percentage of patients aged 18 years and older with a diagnosis of coronary artery disease seen within a 12 month period who also have a prior MI or a current or prior LVEF <40% who were prescribed beta-blocker therapy CMS145v Effective Clinical Care Process No EHR, Registry Documentation of Current Medications in the Medical Record Percentage of visits for patients aged 18 years and older for which the eligible professional attests to documenting a list of current medications using all immediate resources available on the date of the encounter. This list must include ALL known prescriptions, over-thecounters, herbals, and vitamin/mineral/dietary (nutritional) supplements AND must contain the medications' name, dosage, frequency and route of administration. CMS68v Patient Safety Process Yes Claims, EHR, Registry
19 Cardiology Specialty Measures Continued MEASURE NAME MEASURE DESCRIPTION emeasure ID NQF QUALITY ID NQS DOMAIN MEASURE TYPE HIGH PRIORITY MEASURE DATA SUBMISSION METHOD Heart Failure (HF): Angiotensin-Converting Enzyme (ACE) Inhibitor or Angiotensin Receptor Blocker (ARB) Therapy for Left Ventricular Systolic Dysfunction (LVSD) Percentage of patients aged 18 years and older with a diagnosis of heart failure (HF) with a current or prior left ventricular ejection fraction (LVEF) < 40% who were prescribed ACE inhibitor or ARB therapy either within a 12 month period when seen in the outpatient setting OR at each hospital discharge CMS135v Effective Clinical Care Process No EHR, Registry Heart Failure (HF): Beta-Blocker Therapy for Left Ventricular Systolic Dysfunction (LVSD) Percentage of patients aged 18 years and older with a diagnosis of heart failure (HF) with a current or prior left ventricular ejection fraction (LVEF) < 40% who were prescribed betablocker therapy either within a 12 month period when seen in the outpatient setting OR at each hospital discharge CMS144v Effective Clinical Care Process No EHR, Registry Ischemic Vascular Disease (IVD): Use of Aspirin or Another Antiplatelet Percentage of patients 18 years of age and older who were diagnosed with acute myocardial infarction (AMI), coronary artery bypass graft (CABG) or percutaneous coronary interventions (PCI) in the 12 months prior to the measurement period, or who had an active diagnosis of ischemic vascular disease (IVD) during the measurement period, and who had documentation of use of aspirin or another antiplatelet during the measurement period. CMS164v Effective Clinical Care Process No Claims, EHR, CMS Web Interface, Registry Preventive Care and Screening: Body Mass Index (BMI) Screening and Follow-Up Plan Percentage of patients aged 18 years and older with a BMI documented during the current encounter or during the previous six months AND with a BMI outside of normal parameters, a follow-up plan is documented during the encounter or during the previous six months of the current encounter Normal Parameters: Age 18 years and older BMI => 18.5 and < 25 kg/m2 CMS69v Community/Population Health Process No Claims, EHR, CMS Web Interface, Registry Preventive Care and Screening: Screening for High Blood Pressure and Follow-Up Documented Percentage of patients aged 18 years and older seen during the reporting period who were screened for high blood pressure AND a recommended follow-up plan is documented based on the current blood pressure (BP) reading as indicated CMS22v5 N/A 317 Community/Population Health Process No Claims, EHR, Registry
20 Cardiology Specialty Measures Continued MEASURE NAME MEASURE DESCRIPTION emeasure ID NQF QUALITY ID NQS DOMAIN MEASURE TYPE HIGH PRIORITY MEASURE DATA SUBMISSION METHOD Preventive Care and Screening: Tobacco Use: Screening and Cessation Intervention Percentage of patients aged 18 years and older who were screened for tobacco use one or more times within 24 months AND who received cessation counseling intervention if identified as a tobacco user CMS138v Community/Population Health Process No Claims, EHR, CMS Web Interface, Registry Preventive Care and Screening: Unhealthy Alcohol Use: Screening & Brief Counseling Percentage of patients aged 18 years and older who were screened for unhealthy alcohol use using a systematic screening method at least once within the last 24 months AND who received brief counseling if identified as an unhealthy alcohol user N/A Community/Population Health Process No Registry Statin Therapy for the Prevention and Treatment of Cardiovascular Disease Percentage of the following patients-all considered at high risk of cardiovascular events-who were prescribed or were on statin therapy during the measurement period: Adults aged >= 21 years who were previously diagnosed with or currently have an active diagnosis of clinical atherosclerotic cardiovascular disease (ASCVD); OR Adults aged >=21 years who have ever had a fasting or direct low-density lipoprotein cholesterol (LDL-C) level >= 190 mg/dl or were previously diagnosed with or currently have an active diagnosis of familial or pure hypercholesterolemia; OR Adults aged years with a diagnosis of diabetes with a fasting or direct LDL-C level of mg/dl N/A N/A 438 Effective Clinical Care Process No CMS Web Interface, Registry Tobacco Use and Help with Quitting Among Adolescents The percentage of adolescents 12 to 20 years of age with a primary care visit during the measurement year for whom tobacco use status was documented and received help with quitting if identified as a tobacco user N/A N/A 402 Community/Population Health Process No Registry
21 Non Specialty-Specific Quality Outcome Measures Number of General Quality Outcome Measures Included in Final Rule 19 MEASURE NAME MEASURE DESCRIPTION emeasure ID NQF QUALITY ID NQS DOMAIN MEASURE TYPE HIGH PRIORITY DATA SUBMISSION MEASURE METHOD Adult Kidney Disease: Catheter Use at Initiation of Hemodialysis Adult Kidney Disease: Catheter Use for Greater Than or Equal to 90 Days All-cause Hospital Readmission Children Who Have Dental Decay or Cavities Clinical Outcome Post Endovascular Stroke Treatment Percentage of patients aged 18 years and older with a diagnosis of End Stage Renal Disease (ESRD) who initiate maintenance hemodialysis during the measurement period, whose mode of vascular access is a catheter at the time maintenance hemodialysis is initiated Percentage of patients aged 18 years and older with a diagnosis of End Stage Renal Disease (ESRD) receiving maintenance hemodialysis for greater than or equal to 90 days whose mode of vascular access is a catheter The 30-day All-Cause Hospital Readmission measure is a riskstandardized readmission rate for beneficiaries age 65 or older who were hospitalized at a short-stay acute care hospital and experienced an unplanned readmission for any cause to an acute care hospital within 30 days of discharge. Percentage of children, age 0-20 years, who have had tooth decay or cavities during the measurement period Percentage of patients with a mrs score of 0 to 2 at 90 days following endovascular stroke intervention N/A N/A 329 Effective Clinical Care Outcome Yes Registry N/A N/A 330 Patient Safety Outcome Yes Registry N/A CMS75v5 N/A 378 N/A N/A 409 Communication and Care Coordination Outcome No Administrative Claims Community/Populati on Health Outcome Yes EHR Effective Clinical Care Outcome Yes Registry
22 Non Specialty-Specific Quality Outcome Measures Continued MEASURE NAME Functional Status Change for Patients with Elbow, Wrist or Hand Impairments Functional Status Change for Patients with Foot or Ankle Impairments Functional Status Change for Patients with General Orthopaedic Impairments MEASURE DESCRIPTION A self-report outcome measure of functional status (FS) for patients 14 years+ with elbow, wrist or hand impairments. The change in FS assessed using FOTO (elbow, wrist and hand) PROM (patient reported outcomes measure) is adjusted to patient characteristics known to be associated with FS outcomes (risk adjusted) and used as a performance measure at the patient level, at the individual clinician, and at the clinic level to assess quality A self-report measure of change in functional status (FS) for patients 14 years+ with foot and ankle impairments. The change in functional status (FS) assessed using FOTO's (foot and ankle) PROM (patient reported outcomes measure) is adjusted to patient characteristics known to be associated with FS outcomes (risk adjusted) and used as a performance measure at the patient level, at the individual clinician, and at the clinic level to assess quality A self-report outcome measure of functional status (FS) for patients 14 years+ with general orthopaedic impairments (neck, cranium, mandible, thoracic spine, ribs or other general orthopaedic impairment). The change in FS assessed using FOTO (general orthopaedic) PROM (patient reported outcomes measure) is adjusted to patient characteristics known to be associated with FS outcomes (risk adjusted) and used as a performance measure at the patient level, at the individual clinician, and at the clinic level by to assess quality emeasure ID NQF QUALITY ID N/A N/A N/A NQS DOMAIN Communication and Care Coordination Communication and Care Coordination Communication and Care Coordination MEASURE TYPE HIGH PRIORITY MEASURE DATA SUBMISSION METHOD Outcome Yes Registry Outcome Yes Registry Outcome Yes Registry
23 Non Specialty-Specific Quality Outcome Measures Continued MEASURE NAME MEASURE DESCRIPTION emeasure ID NQF QUALITY ID NQS DOMAIN MEASURE TYPE HIGH PRIORITY DATA SUBMISSION MEASURE METHOD Functional Status Change for Patients with Hip Impairments A self-report measure of change in functional status (FS) for patients 14 years+ with hip impairments. The change in functional status (FS) assessed using FOTO's (hip) PROM (patient- reported outcomes measure) is adjusted to patient characteristics known to be associated with FS outcomes (risk adjusted) and used as a performance measure at the patient level, at the individual clinician, and at the clinic level to assess quality N/A Communication and Care Coordination Outcome Yes Registry Functional Status Change for Patients with Knee Impairments A self-report measure of change in functional status for patients 14 year+ with knee impairments. The change in functional status (FS) assessed using FOTO's (knee ) PROM (patient-reported outcomes measure) is adjusted to patient characteristics known to be associated with FS outcomes (risk adjusted) and used as a performance measure at the patient level, at the individual clinician, and at the clinic level to assess quality N/A Communication and Care Coordination Outcome Yes Registry Functional Status Change for Patients with Lumbar Impairments A self-report outcome measure of change in functional status for patients 14 years+ with lumbar impairments. The change in functional status (FS) assessed using FOTO (lumbar) PROM (patient reported outcome measure) is adjusted to patient characteristics known to be associated with FS outcomes (risk adjusted) and used as a performance measure at the patient level, at the individual clinician, and at the clinic level by to assess quality N/A Communication and Care Coordination Outcome Yes Registry
24 Non Specialty-Specific Quality Outcome Measures Continued MEASURE NAME MEASURE DESCRIPTION emeasure ID NQF QUALITY ID NQS DOMAIN MEASURE TYPE HIGH PRIORITY DATA SUBMISSION MEASURE METHOD Functional Status Change for Patients with Shoulder Impairments A self-report outcome measure of change in functional status (FS) for patients 14 years+ with shoulder impairments. The change in functional status (FS) assessed using FOTO's (shoulder) PROM (patient reported outcomes measure) is adjusted to patient characteristics known to be associated with FS outcomes (risk adjusted) and used as a performance measure at the patient level, at the individual clinician, and at the clinic level to assess quality N/A Communication and Care Coordination Outcome Yes Registry Maternity Care: Elective Delivery or Early Induction Without Medical Indication at >= 37 and < 39 Weeks (Overuse) Operative Mortality Stratified by the Five STS-EACTS Mortality Categories Percentage of patients, regardless of age, who gave birth during a 12-month period who delivered a live singleton at >= 37 and < 39 weeks of gestation completed who had elective deliveries or early inductions without medical indication Percent of patients undergoing index pediatric and/or congenital heart surgery who die, including both 1) all deaths occurring during the hospitalization in which the procedure was performed, even if after 30 days (including patients transferred to other acute care facilities), and 2) those deaths occurring after discharge from the hospital, but within 30 days of the procedure, stratified by the five STAT Mortality Levels, a multi-institutional validated complexity stratification tool N/A N/A 335 Patient Safety Outcome Yes Registry N/A Patient Safety Outcome Yes Registry
25 Non Specialty-Specific Quality Outcome Measures Continued MEASURE NAME MEASURE DESCRIPTION emeasure ID NQF QUALITY ID NQS DOMAIN MEASURE TYPE HIGH PRIORITY DATA SUBMISSION MEASURE METHOD Rate of Open Repair of Small or Moderate Abdominal Aortic Aneurysms (AAA) Where Patients Are Discharged Alive Rate of Postoperative Stroke or Death in Asymptomatic Patients Undergoing Carotid Endarterectomy (CEA) Rate of Surgical Conversion from Lower Extremity Endovascular Revascularization Procedure Risk-Adjusted Operative Mortality for Coronary Artery Bypass Graft (CABG) Varicose Vein Treatment with Saphenous Ablation: Outcome Survey Percentage of patients undergoing open repair of small or moderate abdominal aortic aneurysms (AAA) who are discharged alive Percent of asymptomatic patients undergoing CEA who experience stroke or death following surgery while in the hospital Inpatients assigned to endovascular treatment for obstructive arterial disease, the percent of patients who undergo unplanned major amputation or surgical bypass within 48 hours of the index procedure Percent of patients aged 18 years and older undergoing isolated CABG who die, including both all deaths occurring during the hospitalization in which the CABG was performed, even if after 30 days, and those deaths occurring after discharge from the hospital, but within 30 days of the procedure Percentage of patients treated for varicose veins (CEAP C2-S) who are treated with saphenous ablation (with or without adjunctive tributary treatment) that report an improvement on a disease specific patient reported outcome survey instrument after treatment N/A Patient Safety Outcome Yes Registry N/A Effective Clinical Care Outcome Yes Registry N/A N/A 437 Patient Safety Outcome Yes Claims, Registry N/A N/A N/A 420 Effective Clinical Care Effective Clinical Care Outcome Yes Registry Outcome No Registry
26 Improvement Activities (IA) 93 Total Improvement Activities to choose from Choose 4 Medium Weight or 2 High Weight Achieving Health Equality-5 Behavioral & Mental Health-22 Beneficiary Engagement-23 Care Coordination-13 H Engagement of New Medicaid Patients and follow up Leveraging a QCDR for use of standard questionnaires Leverage QCDR to standardize Screening processes Participation in State Innovation Model Funded Activities H H Implementation of co-location PCP Implementation of integrated PCBH Model Depression Screening Diabetes Screening EHR Enhancement for BH data Capture MDD Prevention and Treatment Interventions Tobacco Use Unhealthy Alcohol Use Regular training in care coordination H Collection & Follow up on Patient Experience and Satisfaction Data Engagement of patients, family & caregivers in development of care plan Patient Portal Engagement Enhancements to practice websites/tools for patients with cognitive disabilities Use group visits for common chronic conditions Provide peer-led support for self-management H TCPI Participation Care Coordination Agreements to promote patient tracking across settings Care transitions documentation practice improvements Care transitions standard operational improvements CMS partner in Patients Hospital Engagement Network Implementation of improvements that contribute to more timely test results
27 Improvement Activities (IA) 93 Total Improvement Activities to choose from Choose 4 Medium Weight or 2 High Weight Emergency Response & Preparedness -2 Expanded Practice Access-4 Patient Safety & Practice Assessment- 21 Population Management-16 Participate in a 60-day or greater effort to support domestic or international needs Participation on disaster medical assistance team 6 months Provide 24/7 access to groups or eligible clinicians who have real-time access to patient medical records Additional improvements in access as a result of QIN/QIO TA Collection and use of patient experience and satisfaction data on access Use of telehealth services that expand practice access Consultation of the Prescription Drug Monitoring program Participation in CAHPS or other supplemental questionnaire Administration of the AHRQ Survey of Patient Safety Culture Implementation of analytic capabilities to manage total cost of care for practice population Implementation of antibiotic stewardship program H H H H H H H H H Anticoagulant management improvements Glycemic management services Participation in systematic anticoagulation program RHC, IHS or FQHC quality improvement activities Use of QCDR for feedback reports that incorporate population health Chronic care and preventative care management for empaneled patients
28 Advancing Care Information (ACI) Required Measures E Prescribing Health Information Exchange Provide Patient Access Security Risk Analysis Not Required if Transitioning to EHR in 2017: Send a Summary of Care Record Summary of Care Measure At least one permissible prescription written by the MIPS eligible clinician is queried for a drug formulary and transmitted electronically using certified EHR technology. The MIPS eligible clinician that transitions or refers their patient to another setting of care or health care clinician (1) uses CEHRT to create a summary of care record; and (2) electronically transmits such summary to a receiving health care clinician for at least one transition of care or referral. At least one patient seen by the MIPS eligible clinician during the performance period is provided timely access to view online, download, and transmit to a third party their health information subject to the MIPS eligible clinician's discretion to withhold certain information. Conduct or review a security risk analysis including addressing the security (to include encryption) of ephi data created or maintained by certified EHR and implement security updates as necessary and correct identified security deficiencies as part of the MIPS eligible clinician's risk management process. For at least one transition of care or referral, the MIPS eligible clinician that transitions or refers their patient to another setting of care or health care provider-(1) creates a summary of care record using certified EHR technology; and (2) electronically exchanges the summary of care record. For at least one transition of care or referral received or patient encounter in which the MIPS eligible clinician has never before encountered the patient, the MIPS eligible clinician receives or retrieves and incorporates into the patient's record an electronic summary of care document.
29 What It Will Take to Succeed Financially Close attention to the bottom line Providers can t afford to relinquish any of the money they ve earned Optimize operational efficiency as well as clinical and financial health Close attention to the nuts and bolts Optimized and comprehensive coding Claim creation, scrubbing and submission Denial management with root cause review, mitigation and resubmission Eligibility verification Authorization management Close analysis of payor contracts and variance rates Key performance indicator (KPI) monitoring
30 What It Will Take to Succeed Clinically Population health and care coordination the heart of new payment models Need to integrate data from clinical and financial sources Customize EHR and dashboards to capture, monitor and report on all key measures and factors Implement best practices where applicable to optimize your opportunity Monthly scorecard review for clinical and financial key performance metrics Care coordination across the care continuum to optimize outcomes Opportunities for patient engagement, education and empowerment
31 I Believe I personally believe that all care providers that intentionally and deliberately engage with new payment & care delivery models, and create the right partnerships, will have more opportunity in the future than they have today.
32 Additional Resources QPP.CMS.gov Provides an overview of the QPP including timelines, payment adjustments, MIPS and its performance categories & Advanced APMs. ihealthinnovations.com Review articles, past MACRA webinars & sign-up for upcoming specialty-specific QPP webinars. innovation.cms.gov View value-based payment (VBP) models across the country, search and find detailed information on VBP models happening in your state and region & share your ideas on future VBP models.
33 Questions or Comments? Justin
34 Thank you!
MACRA and MIPS. How Medicare Meaningful Use and PQRS are Changing
MACRA and MIPS How Medicare Meaningful Use and PQRS are Changing Link to recorded session: https://attendee.gotowebinar.com/recording/1305549490878052097 Presenting Today: Molly Goodhart Joined Quatris
More informationCalendar Year 2014 Medicare Physician Fee Schedule Final Rule
Calendar Year 2014 Medicare Physician Fee Schedule Final Rule Non-Facility Cap After receiving many negative comments on this issue from physician groups, along with the House GOP Doctors Caucus letter
More informationBenchmark Data Sources
Medicare Shared Savings Program Quality Measure Benchmarks for the 2016 and 2017 Reporting Years Introduction This document describes methods for calculating the quality performance benchmarks for Accountable
More informationImproving Quality of Care for Medicare Patients: Accountable Care Organizations
DEPARTMENT OF HEALTH AND HUMAN SERVICES Centers for Medicare & Medicaid Services Improving Quality of Care for Medicare Patients: FACT SHEET Overview http://www.cms.gov/sharedsavingsprogram On October
More informationCMS Quality Payment Program: Performance and Reporting Requirements
CMS Quality Payment Program: Performance and Reporting Requirements Session #QU1, February 19, 2017 Kristine Martin Anderson, Executive Vice President, Booz Allen Hamilton Colleen Bruce, Lead Associate,
More informationSVS QUALITY AND PERFORMANCE MEASURES COMMITTEE (QPMC) New Member Orientation
SVS QUALITY AND PERFORMANCE MEASURES COMMITTEE (QPMC) New Member Orientation 2017-2018 SVS QPMC Quality and Performance Measures Committee Policy and Advocacy Council (Chair Sean Roddy) Chair: Brad Johnson,
More informationFalcon Quality Payment Program Checklist- 2017
Falcon Quality Payment Program Checklist- 2017 DISCLAIMER: This material is provided for informational purposes only and should not be relied upon as legal or compliance advice. If legal advice or other
More information2017 Transition Into Value Based Care
2017 Transition Into Value Based Care Provider Meeting August 3 rd, 2017 Objectives Define MACRA, MIPS, and APM Overview of MIPS Performance Categories within the Quality Payment Program (QPP) Provide
More informationMeaningful Use Measures: Quick Reference Guide Stage 2 (2014 and Beyond)
Meaningful Use Measures: Quick Reference Guide Stage 2 (2014 and Beyond) Core Measures Required: All 17 objectives Objective: Requirement: Exclusions: Accomplish in Clinical 1. Computerized - Documenting
More informationMEANINGFUL USE STAGE 2
MEANINGFUL USE STAGE 2 PHASED-IN IMPLEMENTATION PROCESS DECEMBER 2014 - PREPARATION MONTH Start this process as early as possible WATCH VIDEO TRAINING SESSIONS: (Sessions available starting December 1,
More informationQuality Payment Program Year 2: 2018 MIPS Participation. An Introductory Guide for CRNAs in 2018
Quality Payment Program Year 2: 2018 MIPS Participation An Introductory Guide for CRNAs in 2018 Quality Payment Program (QPP) The Medicare Access and CHIP Reauthorization Act of 2015 (MACRA) established
More information2017 Transition Year Flexibility Advancing Care Information (ACI) Category Options
The Physicians Advocacy Institute s Medicare Quality Payment Program (QPP) Physician Education Initiative 2017 Transition Year Flexibility Advancing Care Information (ACI) Category Options Ad 1 P a g e
More informationAccountable Care and the Laboratory Value Proposition. Les Duncan Director of Operations Highmark Health - Home and Community Services
Accountable Care and the Laboratory Value Proposition Les Duncan Director of Operations Highmark Health - Home and Community Services Agenda The Goals and Status of Delivery System Reform and Alternative
More informationMeaningful Use: a Primer
Health Information Technology Extension Center of Los Angeles Meaningful Use: a Primer Mary Mitchell Director of Meaningful Use Defined as: What is Meaningful Use? A. Use of a certified EHR in a meaningful
More informationFast Facts 2018 Clinical Integration Performance Measures
IMPORTANT: LHP providers who do not achieve a minimum CI Score in 2018 will not be eligible for incentive distribution and will be placed on a monitoring plan for the 2019 performance year. For additional
More informationMOC Part IV: Your Guide to Making it Happen.
MOC Part IV: Your Guide to Making it Happen. Joseph P. Drozda, Jr., MD, F.A.C.C. Mercy, MO Paul D. Varosy, MD, F.A.C.C., FAHA, FHRS University of Colorado Denver School of Medicine, CO Disclosures Course
More informationQuality Measurement, Population Health and Payment Reform
Quality Measurement, Population Health and Payment Reform The Move from Volume to Value Dale W. Bratzler, DO, MPH, FACOI, FIDSA Professor, Colleges of Medicine and Public Health Associate Dean, College
More informationMinnesota Statewide Quality Reporting and Measurement System: Appendices to Minnesota Administrative Rules, Chapter 4654
This document is made available electronically by the Minnesota Legislative Reference Library as part of an ongoing digital archiving project. http://www.leg.state.mn.us/lrl/lrl.asp Minnesota Statewide
More informationHIT Incentives: Issues of Concern to Hospitals in the CMS Proposed Meaningful Use Stage 2 Rule
HIT Incentives: Issues of Concern to Hospitals in the CMS Proposed Meaningful Use Stage 2 Rule Lori Mihalich-Levin, J.D. lmlevin@aamc.org; 202-828-0599 Jennifer Faerberg jfaerberg@aamc.org; 202-862-6221
More informationBehavioral and Mental Health: High-Weighted. Behavioral and Mental Health: Medium-Weighted. Implementation of co-location PCP and MH services
Behavioral and Mental Health: High-Weighted Implementation of co-location PCP and MH services *Implementation of integrated PCBH model Integration facilitation, and promotion of the colocation of mental
More informationMinnesota Statewide Quality Reporting and Measurement System: Appendices to Minnesota Administrative Rules, Chapter 4654
Minnesota Statewide Quality Reporting and Measurement System: Appendices to Minnesota Administrative Rules, Chapter 4654 Minnesota Department of Health October 2011 Division of Health Policy Health Economics
More informationMACRA Quality Payment Program
The American College of Surgeons Resources for the New Medicare Physician System Table of Contents Understanding the... 3 Navigating MIPS in 2017... 4 MIPS Reporting: Individuals or Groups... 6 2017: The
More informationUnited Medical ACO Participation Criteria
United Medical ACO Participation Criteria Items Requiring Practice Reporting 1) Submission of Reports: Practices must report A,B, and C to UMACO A. Thirty-four ACO Quality Measures -See Appendix A B. Average
More informationAdvancing Care Information Performance Category Fact Sheet
Fact Sheet The Medicare Access and CHIP Reauthorization Act of 2015 (MACRA) replaced three quality programs (the Medicare Electronic Health Record (EHR) Incentive program, the Physician Quality Reporting
More informationAdvancing Care Information Measures
Participants: Advancing Care Information Measures In 2017, Advancing Care Information (ACI) measure reporting is optional for Nurse Practitioners, Physician Assistants, Clinical Nurse Specialists, CRNAs,
More informationAccelerating the Impact of Performance Measures: Role of Core Measures
Accelerating the Impact of Performance Measures: Role of Core Measures Mark McClellan, MD, PhD Director, Engelberg Center for Health Care Reform Senior Fellow, Economic Studies Leonard D. Schaeffer Chair
More informationMACRA Fall into Place. By Stephanie Cecchini, CPC, CEMC, CHISP, AAPC Fellow, AAPC MACRA Prof
MACRA Fall into Place By Stephanie Cecchini, CPC, CEMC, CHISP, AAPC Fellow, AAPC MACRA Prof About the Presenter https://www.linkedin.com/in/stephaniececchini 2 Introduction Love it Hate it Don t know a
More information2017/2018. KPN Health, Inc. Quality Payment Program Solutions Guide. KPN Health, Inc. A CMS Qualified Clinical Data Registry (QCDR) KPN Health, Inc.
2017/2018 KPN Health, Inc. Quality Payment Program Solutions Guide KPN Health, Inc. A CMS Qualified Clinical Data Registry (QCDR) KPN Health, Inc. 214-591-6990 info@kpnhealth.com www.kpnhealth.com 2017/2018
More informationShared Savings Program ACO Public Reporting Instructions. with Pre-Populated Template
Shared Savings Program ACO Public Reporting Instructions Introduction with Pre-Populated Template The purpose of this document is to provide ACOs participating in the Shared Savings Program with a public
More informationSIMPLE SOLUTIONS. BIG IMPACT.
SIMPLE SOLUTIONS. BIG IMPACT. SIMPLE SOLUTIONS. BIG IMPACT. QUALITY IMPROVEMENT FOR INSTITUTIONS combines the American College of Cardiology s (ACC) proven quality improvement service solutions and its
More informationUpdated 2017 Medicaid EHR Incentive Program Requirements For Eligible Providers (EP)
Updated 2017 Medicaid EHR Incentive Program Requirements For Eligible Providers (EP) 1 Illinois Health Information Technology Regional Extension Center (ILHITREC) SUPPORT PROVIDED BY ILHITREC: The Illinois
More informationImproving Clinical Outcomes
Improving clinical outcomes and reducing health care costs under the Affordable Care Act - are enhanced medication management strategies part of the solution? Sandra L. Baldinger, Pharm.D., M.S. Kenneth
More informationNational Hospital Inpatient Quality Reporting Measures Specifications Manual
National Hospital Inpatient Quality Reporting Measures Specifications Manual Release Notes Version: 4.4a Release Notes Completed: October 21, 2014 Guidelines for Using Release Notes Release Notes 4.4a
More information2016 MEANINGFUL USE AND 2017 CHANGES to the Medicare EHR Incentive Program for EPs. September 27, 2016 Kathy Wild, Lisa Sagwitz, and Joe Pinto
2016 MEANINGFUL USE AND 2017 CHANGES to the Medicare EHR Incentive Program for EPs September 27, 2016 Kathy Wild, Lisa Sagwitz, and Joe Pinto Agenda Meaningful Use (MU) in 2016 MACRA and MIPS (high level
More informationNEW JERSEY HOSPITAL PERFORMANCE REPORT 2012 DATA PUBLISHED 2015 TECHNICAL REPORT: METHODOLOGY RECOMMENDED CARE (PROCESS OF CARE) MEASURES
NEW JERSEY HOSPITAL PERFORMANCE REPORT 2012 DATA PUBLISHED 2015 TECHNICAL REPORT: METHODOLOGY RECOMMENDED CARE (PROCESS OF CARE) MEASURES New Jersey Department of Health Health Care Quality Assessment
More information04/03/2015. Quality Matters: How to Succeed with PQRS in A Short History of PQRS. Participate Or Else..
Quality Matters: How to Succeed with PQRS in 2015 Jeanne Chamberlin, MA, FACMPE Director, MSOC Health A Short History of PQRS 2007: 3 measures on 80% 2% Bonus 2012: 3 measures on 50% / 80% 0.5% Bonus Performance
More informationACO GPRO 2016 Ready to Report Basics GPRO ACO Random Sample Reporting January 17, 2017 to March 17, 2017
ACO GPRO 2016 Ready to Report Basics 2016 GPRO ACO Random Sample Reporting January 17, 2017 to March 17, 2017 ACO GPRO 2016 Ready to Report Basics What is an Accountable Care Organization (ACO)? Which
More informationMeaningful Use 2016 and beyond
Meaningful Use 2016 and beyond Main Street Medical Consulting May 12, 2016 Meaningful use, MACRA, MIPS? Whaaaaat? 1 Reporting Period and Timeline In 2016 all providers are required to use CEHRT versions
More informationPractice Implications for Accountable Care Organizations
Practice Implications for Accountable Care Organizations An Overview following the Final Rule Gregory M. Marsh, MPH, PMP December 14, 2011 Why CCME? Effective EHR/HIE Implementation will: Improve patient
More informationNational Patient Safety Goals & Quality Measures CY 2017
National Patient Safety Goals & Quality Measures CY 2017 General Clinical Orientation 2017 January National Patient Safety Goals 1. Identify Patients Correctly 2. Improve Staff Communication 3. Use Medications
More informationProposed Meaningful Use Incentives, Criteria and Quality Measures Affecting Critical Access Hospitals
Proposed Meaningful Use Incentives, Criteria and Quality Measures Affecting Critical Access Hospitals Paul Kleeberg, MD, FAAFP, FHIMSS Clinical Director Regional Extension Assistance Center for HIT (REACH)
More informationMinnesota Statewide Quality Reporting and Measurement System: Appendices to Minnesota Administrative Rules, Chapter 4654
This document is made available electronically by the Minnesota Legislative Reference Library as part of an ongoing digital archiving project. http://www.leg.state.mn.us/lrl/lrl.asp Minnesota Statewide
More information2017 Transition Year Flexibility Improvement Activities Category Options
The Physicians Advocacy Institute s Medicare Quality Payment Program (QPP) Physician Education Initiative 2017 Transition Year Flexibility Improvement Activities Category Options 1 P a g e Ad MEDICARE
More informationHere is what we know. Here is what you can do. Here is what we are doing.
With the repeal of the sustainable growth rate (SGR) behind us, we are moving into a new era of Medicare physician payment under the Medicare Access and CHIP Reauthorization Act (MACRA). Introducing the
More informationBeyond Meaningful Use: Driving Improved Quality. CHCANYS Webinar #1: December 14, 2016
Beyond Meaningful Use: Driving Improved Quality CHCANYS Webinar #1: December 14, 2016 Agenda The Current State Measuring Monitoring & Reporting Quality. Meaningful Use 2018 and Beyond The New Quality Payment
More informationTable of Contents 2017 MIPS GUIDE 12/29/2017
Table of Contents MIPS 2017 Overview... 3-5 MIPS Components:... 3 Determining Eligibility or Exclusion....3-4 Group or Individual Participation..4 Pick Your Pace.4 Starting Date 5 Quality... 6-26 Overview:...
More informationMIPS Collaborative: Clinical Practice Improvement Activities April 19, 2017 Francis R Colangelo, MD
MIPS Collaborative: Clinical Practice Improvement Activities April 19, 2017 Francis R Colangelo, MD Outline of Presentation Introduction Overview of MACRA/MIPS Clinical Practice Improvement Activities
More informationThe Society of Thoracic Surgeons
VIA EMAIL Practice Improvement and s Management Support (PIMMS) s Support The STS Headquarters 633 N Saint Clair St, Floor 23 Chicago, IL 60611-3658 (312) 202-5800 sts@sts.org STS Washington Office 20
More informationGetting Ready for the Maryland Primary Care Program
Getting Ready for the Maryland Primary Care Program Presentation to Maryland Academy of Nutrition and Dietetics March 19, 2018 Maryland Department of Health All-Payer Model: Performance to Date Performance
More informationPromoting Interoperability Measures
Promoting Interoperability Measures Previously known as Advancing Care Information for 2017 and Meaningful Use from 2011-2016 Participants: In 2018, promoting interoperability measure reporting (PI) is
More informationMACRA is Coming: Reimbursement for Quality and the Shift to Population-Based Care
MACRA is Coming: Reimbursement for Quality and the Shift to Population-Based Care AMERICAN NEUROLOGICAL ASSOCIATION October 17, 2017 Marc R. Nuwer, MD PhD Professor and Vice Chair UCLA Lyell K. Jones,
More informationUnder the MACRAscope:
Under the MACRAscope: G08: Under the MACRAscope: MIPS and EHRs Robert Tennant, MA Director, HIT Policy, MGMA Government Affairs rtennant@mgma.org Learning Objectives This session will provide you with
More informationDecoding the QPP Year 2 Quality Measure Benchmarks and Deciles to Maximize Performance
Decoding the QPP Year 2 Quality Measure Benchmarks and s to Maximize Performance Leila Volinsky, MHA, MSN, RN, PCMH CCE, CPHQ Senior Program Administrator New England Regional Lead Quality Payment Program
More informationSlide 1. Slide 2 Rural Princeton. Slide 3 Agenda Rural ACO RURAL ACOS CAN WORK AND LEAD THE WAY
Slide 1 RURAL ACOS CAN WORK AND LEAD THE WAY Nebraska Rural Health Association September 20, 2017 Slide 2 Rural Princeton Slide 3 Agenda Rural ACO Illinois Rural Community Care Organization (IRCCO)/Statewide
More informationMIPS Program: 2018 Advancing Care Information Category
MIPS Program: 2018 Advancing Care Category The 2018 Quality Payment Program (QPP) Year Two final rule continues to implement the programs authorized under the Medicare and CHIP Reauthorization Act of 2015
More informationChoosing Improvement Activities
Choosing Improvement Activities If you answer Yes to any of the questions, you may be eligible for the Improvement Activity listed. Do you remind pts of missed or overdue services? IA_PM_13 Do you have
More informationImproving quality of care during inpatient hospital stays
DEPARTMENT OF HEALTH & HUMAN SERVICES Centers for Medicare & Medicaid Services Room 352-G 200 Independence Avenue, SW Washington, DC 20201 Office of Communications FACT SHEET FOR IMMEDIATE RELEASE Contact:
More informationImprovement Activities: What You Have To Do
Learning Forum Fridays Countdown to MIPS Data Submission Webinar Series Improvement Activities: What You Have To Do Merit-based Incentive Payment System = MIPS Liem Tran Health Informatics Specialist Health
More informationOverview of Quality Payment Program
Overview of Quality Payment Program Policies for 2017 & 2018 Performance Years The Medicare program has transformed how it reimburses psychiatrists and other clinicians for providing services, under the
More informationJune 27, Dear Acting Administrator Slavitt:
June 27, 2016 Andrew Slavitt Acting Administrator Centers for Medicare & Medicaid Services Department of Health and Human Services Hubert H. Humphrey Building, Room 445-G 200 Independence Avenue SW Washington,
More informationImprovement Activities for ACI Bonus Measures
Improvement Activity Performance Category Subcategory Expanded Practice Activity Name Activity Improvement Activity Performance Category Weight Provide 24/7 access to eligible clinicians or groups, who
More informationMarch Data Jam: Using Data to Prepare for the MACRA Quality Payment Program
March Data Jam: Using Data to Prepare for the MACRA Quality Payment Program Elizabeth Arend, MPH Quality Improvement Advisor National Council for Behavioral Health CMS Change Package: Primary and Secondary
More informationMedicare & Medicaid EHR Incentive Program Final Rule. Implementing the American Recovery & Reinvestment Act of 2009
Medicare & Medicaid EHR Incentive Program Final Rule Implementing the American Recovery & Reinvestment Act of 2009 Conceptual Approach to Meaningful Use Improved Data capture and sharing Advanced Clinical
More informationTABLE H: Finalized Improvement Activities Inventory
TABLE H: Finalized Improvement Activities Inventory [We invited comments on the reassignment of improvement activities under alternate subcategories, and on the scoring weights assigned to improvement
More information3/29/2013. Effective ACO Compliance. Objectives THE HEALTH CARE DILEMMA: ARE ACOS THE ANSWER? HCCA Compliance Institute April 21, 2013
Effective ACO Compliance HCCA Compliance Institute April 21, 2013 Margaret Hambleton, MBA, CHC, CHPC Sr. Vice President, Chief Compliance Officer St. Joseph Health System 1 Objectives Understand Accountable
More informationFrom Surviving to Thriving in the QPP World
From Surviving to Thriving in the QPP World Today s Objectives Brief MACRA Overview Where are we going?: Advanced Alternative Payment Models (APMs) Where are we now? Merit Incentive-Based Payment System
More informationQuality Payment Program: The future of reimbursement
Quality Payment Program: The future of reimbursement Presented by Evan M. Gwilliam, DC MBA BS CPC CCPC NCICS CCCPC CPC-I MCS-P CPMA CMQP Executive Vice President 1 Dr. Evan Gwilliam Education Bachelor
More informationACO Information Required to be Published on ACO Website per CMS Regulations
ACO Name and Location SJFI, LLC dba Oklahoma Health Initiatives St. John Administration 1923 S. Utica Ave Tulsa, OK 74104 ACO Primary Contact Ann Paul, MPH ACO President OKHI@sjmc.org 918.744.2180 Organizational
More informationOlutoyin Abitoye, MD Attending, Department of Internal Medicine Virtua Medical Group New Jersey,USA
Olutoyin Abitoye, MD Attending, Department of Internal Medicine Virtua Medical Group New Jersey,USA Introduce the methods of using core measures to compare quality of health care US hospitals provide Have
More informationQuality Measurement and Reporting Kickoff
Quality Measurement and Reporting Kickoff All Shared Savings Program ACOs April 11, 2017 Sandra Adams, RN; Rabia Khan, MPH Division of Shared Savings Program Medicare Shared Savings Program DISCLAIMER
More informationTHE ALPHABET SOUP OF MEDICAL PAYMENTS: WHAT IS MACRA, VBP AND MORE! Lisa Scheppers MD FACP Margo Ferguson MT MSOM
THE ALPHABET SOUP OF MEDICAL PAYMENTS: WHAT IS MACRA, VBP AND MORE! Lisa Scheppers MD FACP Margo Ferguson MT MSOM THE REASON FOR CHANGE VOLUME TO VALUE Fee-for-service PAYMENT Bundled, Shared Patient FOCUS
More informationThe Evolving Landscape of Healthcare Payment: Incentive Programs and ACO Model Optimization. Quality Forum August 19, 2015
The Evolving Landscape of Healthcare Payment: Incentive Programs and ACO Model Optimization Quality Forum August 19, 2015 Ross Manson rmanson@eidebailly.com 701.239.8634 Barb Pritchard bpritchard@eidebailly.com
More informationMACRA Frequently Asked Questions
Following the release of the Quality Payment Program Interim Final Rule, the American Medical Association (AMA) conducted numerous informational and training sessions for physicians and medical societies.
More informationAdvancing Care Information- The New Meaningful Use September 2017
Advancing Care Information- The New Meaningful Use September 2017 ACO Announcements Reminders: ACO Notifications PECOS-Maintain active enrollment 2017 Patient Prospective Lists Upcoming provider/office
More informationQIN-QIO Sharing Call MIPS in the Real Word: How Your Peers Are Achieving Success. Wednesday, May 17, :00 4:00 PM ET
QIN-QIO Sharing Call MIPS in the Real Word: How Your Peers Are Achieving Success Wednesday, May 17, 2017 3:00 4:00 PM ET Meet Your Speakers Kelsey Baker, BA Quality Reporting Program Coordinator Healthcentric
More informationACO Name and Location. ACO Primary Contact. Organizational Information
ACO ame and Location Ascension Care Management Health Partners Indianapolis, LLC Previous Legal Business Entity ame: MissionPoint Indianapolis, LLC 523 Mainstream Dr ashville, Tennessee 37228-1238 ACO
More informationHere is what we know. Here is what you can do. Here is what we are doing.
With the repeal of the sustainable growth rate (SGR) behind us, we are moving into a new era of Medicare physician payment under the Medicare Access and CHIP Reauthorization Act (MACRA). Introducing the
More informationGoals & Challenges for Outpatient Quality Directors. Quality HealthCare Consulting, LLC CEO: Jennifer O'Donnell, MHA, PCMH-CCE
Goals & Challenges for Outpatient Quality Directors Quality HealthCare Consulting, LLC CEO: Jennifer O'Donnell, MHA, PCMH-CCE Objectives Learn a practical way for Quality Directors to align Quality Measures
More informationThe Quality Payment Program Overview Fact Sheet
Quality Payment Program The Quality Payment Program Overview Background On October 14, 2016, the Department of Health and Human Services (HHS) issued its final rule with comment period implementing the
More information10/10/2017. Mythbusters: Primary Care Edition (Expanding Opportunities) Amina Abubakar, PharmD, AAHIVP Olivia bentley, PharmD, CFts, AAHIVP
Mythbusters: Primary Care Edition (Expanding Opportunities) Amina Abubakar, PharmD, AAHIVP Olivia bentley, PharmD, CFts, AAHIVP 1 Disclosures Amina Abubakar, PharmD, AAHIVP, RX Clinic Pharmacy and Olivia
More informationQuality Measurement Approaches of State Medicaid Accountable Care Organization Programs
TECHNICAL ASSISTANCE TOOL September 2014 Quality Measurement Approaches of State Medicaid Accountable Care Organization Programs S tates interested in using an accountable care organization (ACO) model
More informationShared Savings Program ACO Public Report
ACO ame and Location Shared Savings Program ACO Public Report University of Health Alliance Accountable Care Organization, LLC 1227 E. Rusholme Street Davenport, 52803 ACO Primary Contact Primary Contact
More informationPhysician Quality Reporting System 2015: Good-bye Carrot, Hello Stick!
1 Introduction Physician Quality Reporting System 2015: Good-bye Carrot, Hello Stick! For a number of years, Medicare has been warning healthcare professionals that incentive payments associated with the
More information2017 Quality Reporting: Claims and Administrative Data-Based Quality Measures For Medicare Shared Savings Program and Next Generation ACO Model ACOs
2017 Quality Reporting: Claims and Administrative Data-Based Quality Measures For Medicare Shared Savings Program and Next Generation ACO Model ACOs June 15, 2017 Rabia Khan, MPH, CMS Chris Beadles, MD,
More informationNavicent Health Physician Group Risk-Based Payments: Assessment of Readiness and Performance for Multiple Reporting Requirements
Creating Clinically Integrated Health System-Based Medical Groups Collaborative Case Study Navicent Health Physician Group Risk-Based Payments: Assessment of Readiness and Performance for Multiple Reporting
More informationPromoting Interoperability Performance Category Fact Sheet
Promoting Interoperability Fact Sheet Health Services Advisory Group (HSAG) provides this eight-page fact sheet to help providers with understanding Activities that are eligible for the Promoting Interoperability
More informationDescribe the process for implementing an OP CDI program
1 Outpatient CDI: The Marriage of MACRA and HCCs Marion Kruse, RN, MBA Founding Partner LYM Consulting Columbus, OH Learning Objectives At the completion of this educational activity, the learner will
More informationMinnesota Statewide Quality Reporting and Measurement System: Appendices to Minnesota Administrative Rules, Chapter 4654
This document is made available electronically by the Minnesota Legislative Reference Library as part of an ongoing digital archiving project. http://www.leg.state.mn.us/lrl/lrl.asp Minnesota Statewide
More informationACO Name and Location. ACO Primary Contact. Organizational Information
ACO ame and Location Ascension Care Management Health Partners Indianapolis, LLC Previous Legal Business Entity ame: MissionPoint Indianapolis, LLC 523 Mainstream Dr ashville, Tennessee 37228-1238 ACO
More informationQPP in the Real Word: How Your Peers Are Achieving Success. Monday, September 25, :00 4:30 PM ET
QPP in the Real Word: How Your Peers Are Achieving Success Monday, September 25, 2017 3:00 4:30 PM ET Meet Your Speakers Leila Volinsky MHA, MSN, RN Senior Program Administrator-Quality Payment Program
More informationMIPS Program: 2017 Advancing Care Information Category (formerly known as Meaningful Use) Proposed Rule Guide
MIPS Program: 2017 Advancing Care Information Category (formerly known as Meaningful Use) Proposed Rule Guide On April 27, 2016, CMS released a proposed rule on the Quality Payment Program, which includes
More informationMIPS (Merit-based Incentive Payment System) Clinical Practice Improvement Activities
MIPS (Merit-based Incentive Payment System) Clinical Practice Improvement Activities Today we will cover: 2 General review of the Quality Payment Programs as per the final rule. Who is Eligible/Exceptions
More informationWELCOME. Kate Gainer, PharmD Executive Vice President and CEO Iowa Pharmacy Association
WHAT IS MACRA? WELCOME Kate Gainer, PharmD Executive Vice President and CEO Iowa Pharmacy Association WELCOME Anthony Pudlo, PharmD, MBA, BCACP Vice President of Professional Affairs Iowa Pharmacy Association
More informationSpecialty Practice in a Value Based Payment World. Sandra J Lewis MD FACC FAHA June 22, 2017
Specialty Practice in a Value Based Payment World Sandra J Lewis MD FACC FAHA June 22, 2017 From the Triple Aim to the Quadruple Aim A Practice Response to MACRA Thanks to Andrew P. Miller, M.D., FACC,
More informationTransforming Clinical Care: Why Optimization of Clinical Systems Can t Wait
Transforming Clinical Care: Why Optimization of Clinical Systems Can t Wait A White Paper March 2016 Impact Advisors LLC 400 E. Diehl Road Suite 190 Naperville IL 60563 1-800-680-7570 Impact-Advisors.com
More informationAdvancing Care Coordination Proposed Rule
Advancing Care Coordination Proposed Rule Released July 25, 2016 Erin Smith, JD VP and Executive Director, PACCR Jourdan Meltzer Research Associate, PACCR August 4, 2016 1 Presentation Overview Three new
More informationPeripheral Arterial Disease: Application of the Chronic Care Model. Marge Lovell RN CCRC BEd MEd London Health Sciences Centre London, Ontario
Peripheral Arterial Disease: Application of the Chronic Care Model Marge Lovell RN CCRC BEd MEd London Health Sciences Centre London, Ontario Objectives Provide brief overview of PAD Describe the Chronic
More informationTake Action Now to Avoid Medicare Penalties
Take Action Now to Avoid Medicare Penalties The Centers for Medicare and Medicaid Services (CMS) says over 33,600 psychiatrists provide services reimbursed under Medicare Part B. The Merit-based Incentive
More information2017 Physician Fee Schedule Impact on Medicare ACOs REGULATORY UPDATES
2017 Physician Fee Schedule Impact on Medicare ACOs REGULATORY UPDATES 2017 Physician Fee Schedule Impact on Medicare ACOs 1. Allowing ACO Participants to report PQRS separately from ACO 2. ACO Quality
More informationOphthalmology Meaningful Use Attestation Guide 2016 Edition Updated July 2016
Ophthalmology Meaningful Use Attestation Guide 2016 Edition Updated July 2016 Provided by the American Academy of Ophthalmology and the American Academy of Ophthalmic Executives (AAOE), the Academy's practice
More information