Table of Contents 2017 MIPS GUIDE 12/29/2017

Transcription

1 Table of Contents MIPS 2017 Overview MIPS Components:... 3 Determining Eligibility or Exclusion Group or Individual Participation..4 Pick Your Pace.4 Starting Date 5 Quality Overview:... 6 Quality AOA MORE Registry Submission AOA MORE enrollment 6-7 AOA Management Setup..8-9 AOA More Quality Measures Table Guidelines for Entering Quality data in Practice Director for Registry Submission AOA Submission Trial and Production Submission Run Use AOA MORE Registry Dashboard to track progress.20 OR (You will follow directions for Registry OR Claims Submission) Quality Claims Submission Claims Quality Measures Table Guidelines for Entering Quality data in Practice for Claims Submission Tracking Progress with CQM Verfication Report Example Quality Component Score..26 Clinical Practice Improvement Activities (CPIA) Overview..27 CPIA Measures...27 Reporting CPIA.27 Example CPIA Componenet Score.28 Advancing Care Information (ACI) Overview Performance Score Table ACI Objectives and Measures Table Practice Director Support

2 Base and Performance Measure Instructions Security Risk Analysis...32 Electronic Prescribing Health Information Exchange Provide Patient Access Medication Reconciliation Patient Specific Education Secure Messaging View Download Transmit (VDT) Tracking ACI progress ACI Transition Report ACI Transition Verification Report Example Scoring for ACI 72 Resource Use/Cost in Calculating Your Final Score in Public Reporting.75 Practice Director Support

3 MIPS Overview In 2017 the Centers for Medicare and Medicaid Services (CMS) is changing the way it pays doctors. The new system is called the Merit-Based Incentive Program (MIPS). MIPS combines 4 programs into one. PQRS, Meaningful Use, Value Based Modifier, and a new category Clinical Practice Improvement. CMS is making this change to: Streamline Reporting Standardize Measures Eliminate Duplicate Reporting Incentivize care that focuses on improved quality outcomes CMS will grade providers on a scale of to determine your payment for providing services; this is known as your MIPS Final Score and is based on 4 components: Quality This is basically PQRS/CQM/eCQM, as you currently know it. This area holds a 60% weight on your final score Clinical Practice Improvement Activities (CPIA) This is new in This area holds a 15% weight on your final score Advancing Care Information (ACI) This is basically Meaningful Use, as you know it with more flexibility. This area holds a 25% weight on your final score Resource Use This area holds a 0% weight in 2017 Determine Eligibility: You are eligible to participate in MIPS if: You are a Physician, Physician Assistant, Nurse Practitioner, Clinical Nurse Specialist, or Certified Registered Nurse Anesthetist You bill more than $30,000, in Medicare Part B allowed charges OR more than 100 Medicare patients. * If you bill less than or equal to $30,000 in Medicare Part B allowed charges OR less than or equal to 100 Medicare patients you are exempt. This means you will not get positive or negative reimbursements Practice Director Support

4 *CMS is going to be looking at two billing periods to determine if you are eligible for the exclusion. If you are under$30,000 or 100 patients in EITHER period you will be eligible for MIPS exclusion 9/1/2015 8/31/2016 or 9/1/2016-8/31/2017 * If you have not received an eligibility letter from CMS, you can check your eligibility online If 2017 is your first year submitting claims to Medicare, you are not eligible to participate Once you determine Eligibility then decide if you will participate as a Group or Individually. Group or Individual Participation You decide whether you want to participate as an Individual or as a Group. Once you select how you are going to participate everyone must follow that route Individual Payment adjustment is based on your performance. An individual is defined as a single NPI tied to a single Tax Identification Number Group Payment adjustments are based on the group performance. A group is defined as 2 or more clinicians (NPI s) who share a common Tax Identification Number. When calculating the threshold for participation the total of all providers allowable charges must be more than $30,000 or 100 Medicare Patients There is NO registration or enrollment you simply begin participating The next step is to select your Pace for Pick your Pace Pick Your Pace in 2017 provides flexibility and options. We recommend choosing the Full Participation Option to maximize your reimbursements Full Participation - Report for a full 90-day period or more. You may earn up to a 4% payment increase on all Medicare Part B claims in 2019 Partial Participation Report for a full 90-day period or more and report more than one quality measure, or more than one improvement activity, or more than the required measures in advancing care information performance category. Successful partial participation you may earn a small payment increase on all Medicare Part B claims in 2019 Practice Director Support

5 Test Participation Report one measure in quality performance category; or one activity in the clinical practice improvements category; or report the required base measures of the advancing care category. You will avoid a payment decrease on all Medicare Part B claims in 2019 Don t participate If you choose not to participate you will receive a 4% negative adjustment on all Medicare Part B claims in 2019 The final step is to begin participating according to the pace you have selected. Starting Date If you are ready you can begin January 1, If you aren t ready to begin January 1, you can choose to start anytime between January 1 and October 2, Whenever you start you will need to send in your performance data by March 31, 2019 Practice Director Support

6 Quality Providers will report on 6 quality measures including an outcome measure. If you cannot report an outcomes measure, you must report on high priority measure. Each measure counts for 0-10 points. You can earn Bonus points on some measures and also for reporting more than one outcomes or high priority measure. For maximum reimbursements you must report on 50% of your patients across all payers for at least 90 days. Quality measures are represented in many ways CQM, ecqm, PQRS, CMS. Quality is worth 60% weight on your composite score The quality category within Practice Director can be reported on via AOA MORE Registry or Claims (You cannot mix claims and registry you must select one or the other). We recommend using the Registry for reporting and submission. Registry Submission: Free for AOA Members Electronic PQRS Submission Helps you to maximize reimbursements under MIPS in 2017 and on You will receive points for each measure that you perform: 0 Points if you do nothing 3 Points for submitting ANY data per measure (you get 3 points just for trying) 4-10 Points if you submit greater than or equal to 20 eligible patients and record proper findings Bonus Points: 2 points for each additional outcome measure 1 point for each additional high priority measure The points are not calculated on a 1 to 1 ratio, i.e. if you do 90% you may not get 9 points, you may get more or less since benchmarking is used. Benchmarking compares your results versus other providers and the technology you are using (ie submission through Registry may be worth more than claims) The first step in Quality is to decide whether you are going to use Registry (p.6-19) or Claims (p.20-25) reporting. Once you have determined the method use the directions below to record your data in Practice Director Practice Director Support

7 Quality AOA MORE Registry Submission Complete enrollment with AOA MORE if you have not already done so by going to the AOA MORE website When the website launches select the ENROLL button located on the right side of the screen Follow the prompts to complete registration If you have questions on whether or not you have registered or on how to register you can click the HELP DESK button and a member of the AOA MORE team will follow up with you Practice Director Versions and after contain access to AOA MORE. To verify your version from Practice Director: Select Help Select About Practice Director The About dialog will open Verify that Build # is equal or greater than Practice Director Support

8 If the build # is equal or greater than you can complete the AOA Management setup with in Practice Director If the build # is less than you can run the CDU to update Practice Director to the most recent version AOA Management Setup AOA Management Setup is a one-time step. Once you are on version or greater you can setup Practice Director to communicate with AOA MORE Registry. The information below is also covered in Training Video 28.1 AOA Registry Menu Items, located at training.practicedirector.com. You can contact Practice Director Support if you are unsure of your online training Username and Password. Log into Practice Director Select EHR Options Select AOA Registry Select AOA Management Practice Director Support

9 The AOA Management dialog will open (All fields are required for submission) 1. Practice Director will keep the first four dates updated for you. 2. Click on the lookup to select any AOA provider to be the Legal Authenticator. The authenticator assumes legal responsibility of the generated QRDA Category I files being submitted to the AOA Registry. Select the date that the selected provider took responsibility. 3. Click on the lookup to select any AOA provider to be the Custodian. The custodian represents the organization that is in charge of maintaining the generated QRDA Category I files being submitted to the AOA Registry 4. Submission Date & Time - For the Day you can select between Wednesday or Thursday for submission. AOA requires the AOA Registry End Date to be prior to the weekly submission deadline. AOA releases the weekly provider white list on Wednesday at noon and the AOA weekly submission deadline is Friday at 5:00pm. The default selection is Wednesday. You may specify any time for submission after 6:00pm on Wednesday or Thursday. 5. Select Enable 6. Select Save Once saved your information will transfer to AOA MORE Registry per your setup specified in AOA Management Practice Director Support

10 Practice Director and AOA MORE are structured to report on the following measures: Measure Name Closing the Referral Loop: Receipt of Specialist Report Measure Description 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 emeasure ID CMS50v5 NQF N/A Additional Info Bonus Points High Priority 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 CMS165v5 18 Bonus Points Outcome & High Priority Preventive Care and Screening: Tobacco Use: Screening and Cessation Intervention 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 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 CMS138v5 28 Diabetes: Eye Exam Percentage of patients years of age with diabetes who had a retinal or dilated eye exam by an eye care professional during the measurement period or a negative retinal exam (no evidence of retinopathy) in the 12 months prior to the measurement period CMS131v5 55 Diabetes: Hemoglobin A1c (HbA1c) Poor Control (>9%) Percentage of patients years of age with diabetes who had hemoglobin A1c > 9.0% during the measurement period CMS122v5 59 Bonus Points, Outcome & High Priority Primary Open- Angle Glaucoma (POAG): Optic Nerve Evaluation Percentage of patients aged 18 years and older with a diagnosis of primary open-angle glaucoma (POAG) who have an optic nerve head evaluation during one or more office visits w/in 12 months CMS143v5 86 Practice Director Support

11 Measure Name Diabetic Retinopathy: Documentation of Presence or Absence of Macular Edema and Level of Severity of Retinopathy Measure Description Percentage of patients aged 18 years and older with a diagnosis of diabetic retinopathy who had a dilated macular or fundus exam performed which included documentation of the level of severity of retinopathy and the presence or absence of macular edema during one or more office visits within 12 months emeasure ID NQF CMS167v5 88 Additional Info Diabetic Retinopathy: Communication with the Physician Managing Ongoing Diabetes Care Percentage of patients aged 18 years and older with a diagnosis of diabetic retinopathy who had a dilated macular or fundus exam performed with documented communication to the physician who manages the ongoing care of the patient with diabetes mellitus regarding the findings of the macular or fundus exam at least once within 12 months CMS142v5 89 Bonus Points High Priority 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-the-counters, herbals, and vitamin/mineral/dietary (nutritional) supplements AND must contain the medications' name, dosage, frequency and route of administration. CMS68v6 419 Bonus Points High Priority Guidelines for entering Quality data within Practice Director for Compliance Users will notice that you no longer have to enter PQRS codes in coding/final. By following the documentation guidelines below, you will satisfy the requirement for data calculation. We recommend completing as many measures as you can, CMS will take your top 6 scoring measures. The guidelines below will not show all coding possibilities. To see the full listing of code sets, please see the Measures Help tab within EHR Options>AOA Registry>AOA ecqm Help. Each of these measures is also reviewed in our training videos located at: Practice Director Support

12 NQF 0050 Closing of Referral Loop: receipt of specialist report Video 28.5 Any patient who has been referred out, regardless of age Medical or 92002, 92004, 92012, and coding Referral saved to exam o Select Patient Exam and select Edit o Scan the letter from the specialist we referred o Under the Documents/Referrals click Add o Import the scanned letter o Under referral type choose the Clinical Consultation Report Under Referral Documents you then MUST choose the outgoing referral NQF 0018 Hypertension: BP Measurement (only if BP controlled the numerator will be populated) Video 28.6 Patient age during measure period Has an completed office visits recorded (Medical 99xxx) during measurement period in Coding/Final Must have 2 visits within the year Hypertension diagnosis recorded in ICD-10 in Coding/Final <= 6 months start after start of measurement period in Coding/Final Or Diagnosis of Essential Hypertension ends before the start of the measurement period Record controlled range of Systolic <140 and Diastolic < 90 BP in Vitals section of the EHR NQF 0028 Preventive Care and Screening: Tobacco Use: Screening and Cessation Intervention Video 28.7 Patient age 18 years and older At least 2 office visits recorded (Medical 99xxx or 92xxx) in Coding/Final within 24 months Smoking status selected in Respiratory section of ROS o If a non-smoker, this is all that is needed o If a current smoker, will need a Cessation Counseling code recorded (99406 or 99407) o Denominator Exception, if you select the Tobacco Use Status as Unknown, then you will be able to select a Medical Reason for Not Done Practice Director Support

13 NQF 0055 Diabetes Eye Exam Video 28.2 Patients Patient has a diabetes diagnosis in Coding/Final Has had a retinal or dilated eye exam during the reporting period, or a negative retinal exam with no evidence of retinopathy 12 months prior 92xxx or 99xxx codes PD Fundoscopy section of exam completed (dilated method, etc.) NQF 0059 Diabetes: Hemoglobin A1C Poor Control Video 28.3 Patients years old CPT Must be 99xxx Patient has diabetes diagnosis in Coding/Final (E10.xxx, E11.xxx, E13.xxx) Has had hemoglobin A1C >9% during the reporting period Results from hemoglobin test entered as Lab Result in Practice Director EHR Options>Optometry>Lab Test Reports. One of the following LOINC codes , , will import with the lab result Lab Results show that A1C is still not controlled and is still >9% You want this measure to have small percentage NQF 0086 POAG: Optic Nerve Evaluation Video 28.8 Patients 18 and older At least 2 office visits recorded (99xxx or 92xxx) in reporting period in Coding/Final POAG dx code recorded in Coding/Final (H40.xxx) Cup to Disc Ratio results recorded in Disc Assessment section Appearance recorded in Disc Assessment section Denominator Exception, if not done record in Disc Assessment by selecting checkbox and Medical Reason drop down Practice Director Support

14 NQF 0088 Diabetic Retinopathy Examination Video 28.9 Patient 18 years and older At least 2 office visits recorded (99xxx or 92xxx) within reporting period in Coding/Final Diabetic Retinopathy dx recorded in Coding/Final (E08.3xx, E09.3xx, E10.3xx, E11.3xx, E13.3xx) PD EHR Macular Edema and Retinopathy Severity (Severity cannot be normal) fields completed in the Posterior Segment section. Denominator Exception located in Posterior Segment select Evaluation not Performed and then select Medical or Patient Reason NQF 0089 Diabetic Retinopathy Communication Video Patients 18 years and older CPT 92xxx or 99xxx NQF 0088 is met Create Referral letter and save to EHR, including the Posterior Segment section in report Denominator Exception located in Posterior Segment select one of the Findings not communicated, and then the Medical or Patient Reason NQF 0419 Documentation of Current Medication in the Medical Record Video Patients 18 years and older At least 1 office visit recorded (92xxx or 99xxx) in Coding/Final Add all current medications to the erx portal Check the Documented all current medications box in Current Medication section of EHR Denominator Exception, Current Medications, if not done, select Documenting all Current Medications was not done and then Select the Medical Reason from the drop down. Practice Director Support

15 AOA Submission Trial and Production Submission Run Practice Director has given the user two options for verifying information that has been or will be transmitted to the AOA. AOA Trial Submission Run will allow you to view and or save the results of the data that would be sent in the Submission Run. This will allow you to verify that all anticipated patients are going to be transmitted to AOA. If any problems are detected you can resolve them before the Production run occurs. Trial Submission Run Select EHR Options Select AOA Registry Select AOA Trial Submission Run 1. Provider select the desired provider from the drop down 2. The date fields are pre-populated with the dates setup in AOA Management, you can override any date by clicking on the calendar 3. Destination Leave empty (this is for the Practice Director support team to troubleshoot file problems if needed). 4. Select OK to save You will see the AOA Trial Submission Run dialog showing the progress. You can wait or select Run in Background so that you can continue to work Practice Director Support

16 Once the run is complete the results will display on the screen or in the tray (if you selected Run in Background) Practice Director Support

17 1. The Provider, ecqm Reporting Period, and AOA Registry Reporting Period will display 2. Each NQF will display with the numerator and denominator counts that will be sent to AOA MORE in the Production Run To see the patients that make up the counts you can go to EHR Options>AOA Registry>AOA ecqm Verification Report 3. If there are any patients that will not push up their names and the issue will be listed, if no problems you will see No problematic patient QRDA I data was detected 4. You will see a list of patients that have been seen by the provider since the last submission. 5. You can select Save to Save the report locally and then you can print from the saved location if desired Production Submission Run Report The Production Submission Run Report is used to view what was sent to the AOA during the weekly run. The Report will show you if there are any patients that were not transmitted and will list the reason why. You can use this report to fix the data before the next scheduled upload. To run the Production Submission Run Report Select EHR Options Practice Director Support

18 Select AOA Registry Select AOA Production Submission Run Reports The AOA Production Submission Run Report dialog will open In the upper left hand side of the screen you will see a list of Provider Names and the Submitted Date. The user is able to sort by the Provider and or the Submitted Date by clicking on the header. * Note Run Information is only retained for 90 days To view details about a specific Provider and Submitted Date, select the desired information. Once selected data about the run will display on the right side of the screen Practice Director Support

19 Practice Director Support

20 1. The Provider, ecqm Reporting Period, and AOA Registry Reporting Period will display 2. A list of each NQF will display along with the submitted Numerator and Denominator counts To see the patients that make up the counts you can go to EHR Options>AOA Registry>AOA ecqm Verification Report 3. This area lists any patients that had errors and could not be submitted. Before the next AOA submission you will want to resolve the errors 4. Select Save to save the report locally. Once saved locally, the information can be printed Use the AOA MORE Registry dashboard to track your progress The AOA will provide you will access to an online dashboard that will allow you to track your progress for each measure Practice Director Support

21 Quality Claims Submission Practice Director is structured to report on the following measures for claims based reporting: Measure Name Closing the Referral Loop: Receipt of Specialist Report Measure Description 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 emeasure ID NQF PQRS CMS50v5 N/A None Additional Info Bonus Points High Priority 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 CMS165v5 18 G8752 or G8753 Bonus Points Outcome & High Priority 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 F or 1036F Diabetes: Eye Exam Percentage of patients years of age with diabetes who had a retinal or dilated eye exam by an eye care professional during the measurement period or a negative retinal exam (no evidence of retinopathy) in the 12 months prior to the measurement period CMS131v5 55 Diabetes: Hemoglobin A1c (HbA1c) Poor Control (>9%) Percentage of patients years of age with diabetes who had hemoglobin A1c > 9.0% during the measurement period CMS122v5 59 Bonus Points, Outcome & High Priority Practice Director Support

22 Measure Name Measure Description emeasure ID NQF PQRS Additional Info Primary Open- Angle Glaucoma (POAG): Optic Nerve Evaluation Percentage of patients aged 18 years and older with a diagnosis of primary open-angle glaucoma (POAG) who have an optic nerve head evaluation during one or more office visits w/in 12 months CMS143v F Diabetic Retinopathy: Documentation of Presence or Absence of Macular Edema and Level of Severity of Retinopathy Percentage of patients aged 18 years and older with a diagnosis of diabetic retinopathy who had a dilated macular or fundus exam performed which included documentation of the level of severity of retinopathy and the presence or absence of macular edema during one or more office visits within 12 months CMS167v5 88 None Diabetic Retinopathy: Communication with the Physician Managing Ongoing Diabetes Care Percentage of patients aged 18 years and older with a diagnosis of diabetic retinopathy who had a dilated macular or fundus exam performed with documented communication to the physician who manages the ongoing care of the patient with diabetes mellitus regarding the findings of the macular or fundus exam at least once within 12 months CMS142v F + G8397 or G8398 Bonus Points High Priority 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-the-counters, herbals, and vitamin/mineral/dietary (nutritional) supplements AND must contain the medications' name, dosage, frequency and route of administration. CMS68v6 419 G8427 or G8430 or G8428 Bonus Points High Priority Practice Director Support

23 Guidelines for entering Quality data within Practice Director for Compliance Users will continue to document these measures as they always have in the Practice Director EHR Final/Coding Section. Insurance Billers will continue to select the PQRS codes for claims submission on the Invoice Screen. We recommend completing as many measures as you can, CMS will take your top 6 scoring measures. The guidelines below will not show all coding possibilities. To see the full listing of code sets, please see the Measures Help tab within EHR Options>Clinical Quality Measures>CQM Help Each of these measures is also reviewed in our training videos located at: training.practicedirector.com NQF 0018 Hypertension: BP Measurement (only if BP controlled the numerator will be populated) Video 11.2 Patient age during measure period Has an completed office visits recorded (Medical 99xxx) during measurement period in Coding/Final Hypertension diagnosis recorded in Coding/Final <= 6 months start after start of measurement period in Coding/Final Or Diagnosis of Essential Hypertension ends before the start of the measurement period Record controlled range of Systolic <140 and Diastolic < 90 BP in Vitals section of the EHR NQF 0028 Preventive Care and Screening: Tobacco Use: Screening and Cessation Intervention Video 11.4 Patient age 18 years and older At least 2 office visits recorded (Medical 99xxx or 92xxx) in Coding/Final Practice Director Support

24 Smoking status selected in Respiratory section of ROS o If a non-smoker, this is all that is needed o If a current smoker, will need a Cessation Counseling code recorded (99406 or 99407) NQF 0050 Closing of Referral Loop: receipt of specialist report Video 11.5 Any patient who has been referred out, regardless of age 92xxx codes do NOT count Referral saved to exam Complete the referral loop by importing the referral report back into the EHR. NQF 0419 Documentation of Current Medication in the Medical Record Video 11.9 Patients 18 years and older At least 1 office visit recorded (92xxx or 99xxx) in Coding/Final Add all current medications to the ERx portal Check the Documented all current medications box in Current Medication section of EHR NQF 0086 POAG: Optic Nerve Evaluation Video 11.6 Patients 18 and older At least 2 office visits recorded (99xxx or 92xxx) in reporting period in Coding/Final POAG dx code recorded in Coding/Final Optic Nerve Head Evaluation recorded (2027F) in Coding/Final Cup to Disc Ratio results recorded in Disc Assessment section Appearance recorded in Disc Assessment section NQF 0088 Diabetic Retinopathy Examination Video 11.7 Patient 18 years and older At least 2 office visits recorded (99xxx or 92xxx) within reporting period in Coding/Final Diabetic Retinopathy dx recorded in Coding/Final Macular or Fundus Exam recorded (2021F) in Coding/Final PD EHR Macular Edema and Retinopathy Severity (Severity cannot be normal) fields populated in the Posterior Segment section. NQF 0089 Diabetic Retinopathy Communication Video 11.8 Practice Director Support

25 Patients 18 years and older NQF 0088 is met Create Referral letter and save to EHR, including Posterior Segment section in report Finding communicated to physician recorded (5010F) in Coding/Final NQF 0024 Weight Assessment and Counseling for Children and Adolescents Video 11.3 Patients 3-17 years old Office visit recorded (Medical 99xxx) Numerator 1 Height/Weight/BMI documented Code for BMI Numerator 2 Counseling for Nutrition indicated, codes recorded in Coding/Final (97802, 97803, 97804) Numerator 3 Activity Counseling entered in Vital Signs section NQF 0421 Preventive Care and Screening: BMI Screening and Follow-up (Adult) Video N1 >= 65 (normal BMI range >23 <30) At least 1 office visit recorded (99xxx) Weight and height recorded in EHR Vitals section If abnormal BMI, Follow-up Management Plan recorded (97804, 98961, G8417 for > normal or G8418 for < normal) OR Create Referral Letter including Vitals section N2 age (normal range18.5 <25) At least 1 office visit recorded (99xxx) Weight and height recorded in EHR Vitals section If abnormal BMI, Follow-up Management Plan recorded (97804, 98961, G8417 > normal or G8418 < normal) OR Create Referral Letter including the Vitals section Important Information about CQM Numerator Counts As of October 1, 2016, the ICD10 list was updated for diagnosing patients. However, the value sets used to determine/calculate the Clinical Decision Support interventions and the Clinical Practice Director Support

26 Quality Measures have NOT been updated to include the newly released ICD10 codes. Because of this, both your system interventions may trigger and your CQM counts may have lower numerators. We have contacted the governing bodies asking for the new value sets. We have not yet received responses. Once the new value sets are released and implemented, the system will accurately include all entered data/patients in these counts/interventions. Please continue to enter your exam data as needed. Understanding that if you entered a new POAG or Diabetes ICD10, those will get counted correctly as soon as we receive the updated value sets. Tracking Reporting Via Claims Tracking of success is not as thorough with this method. You are not able to see your percentages as you can with the AOA MORE Registry method The Clinical Quality Measures Verification Report located in EHR Options. Once you run the report select the Measure Results Tab to see each measure, and the patients that make up that measure. Training Video 11.1 Example Composite Score Quality Regardless of the Submission/Reporting Method that you select at the end of the year you will receive a score as outlined on page 6 of this document for each CQM completed and submitted Measure Score Points Diabetic Eye Exam 90 9 POAG 90 9 Diabetic Retinopathy Communication 80 7 Controlling BP (outcome) 75 9 Closing Referral Loop Documentation of current Meds 90 7 Diabetic Retinopathy +/- and Level 90 9 Total Points 60 Practice Director Support

27 CLINICAL PRACTICE IMPROVEMENTS ACTIVITIES (CPIA) CPIA are a new component to Medicare in CPIA are activities in your practice that help the public. Participation with AOA MORE Registry is encouraged, as it will help you to meet this measure CPIA accounts for 15% weight on your total MIPS Performance Score There are 40 total points available in this area. If your practice has 15 or fewer Providers you can report on 1 High weighted CPIA for 40 points, or 2 Medium weighted CPIA each for 20 points for a minimum of 90 days If you have more than 15 Providers you can report on 2 high-weighted CPIA for 20 points each or for 4 medium-weighted CPIA for 10 points each for a minimum of 90 days Reporting on CPIA Reporting will be completed at the end of the year via attestation portal provided by the CMS. Attestation will be in the form of Yes or No. You should keep documentation of what actions you took. If you use AOA MORE Registry, attestation is as easy as saying Yes and documentation is that you used AOA MORE Registry CPIA Measures There are a total of 92 different activities provided by the CMS. The complete list of measures can be located on the CMS website Practice Director recommends using AOA MORE Registry to meet the CPIA requirement. In the future, they will add more measures. High Weight CPIA: Use AOA MORE to report local practice patterns - Use your data to learn how you treat and manage patients Allow 24/7 access to clinicians Medium Weight CPIA Use AOA MORE to show outcome comparisons across specific population - Compare your data vs aggregate of all data in AOA MORE for glaucoma and more Use AOA MORE to promote standard practice uses - Compare your data vs aggregate of all data in AOA MORE dashboard Use AOA MORE to track patient safety Collect Patient experience and satisfaction data Close referral loop: provide reports to referred from physicians Timely communication of test results Practice Director Support

28 Engage patients and families in decision making CMS and AOA are still working on details for how AOA MORE will help you with the measures Example Composite Score CPIA Office with fewer than 15 providers completes two medium weight activities: Use AOA MORE to show outcome comparisons across specific population 20pts Use AOA MORE to promote standard practice uses 20pts Point total 40pts Practice Director Support

29 ADVANCING CARE INFORMATION (ACI) ACI is what you used to know as Meaningful Use. This area is worth 25% of your overall MIPS Performance Score. Scoring is based on Base Score + Performance Score + Bonus Score = Total ACI Score. Earn a 100 or more percent and receive the full 25%. This is where flexibility comes in the Base, Performance, and Bonus score will come out to more than 100% if you fully participate and get maximum scores. The Base Score is all or nothing and is worth 50 points. There are 4 base measures. With each Base Measure there is no minimum percentage to achieve, you must answer Yes or have at least a 1 in the numerator in order to meet the base score for all four measures. The Performance Score is based on how often you perform the measure and is worth up to 90 points. There are 7 Performance measures. The higher your performance rates the better your performance score is. Measures with Higher Performance Rate Percentage are worth more points (see third column below) Performance Rate Performance Score Performance Score Measures up to 20% Bonus Score Receive up to a 15% bonus Receive 5% bonus for submitting to a Clinical Data Registry (AOA MORE) Receive up to 10% bonus for CPIA Measures 24/7 Clinician Access and Close Referral Loop Practice Director is 2014 CEHRT therefore you will use the 2017 ACI Objectives and Measures. There are 4 Base Measures and 7 total Performance Measures Practice Director Support

30 MEASURE NAME MEASURE DESCRIPTION OBJECTIVE NAME REQUIRED FOR BASE SCORE PERFORM ANCE SCORE WEIGHT Security Risk Analysis Conduct or review a security risk analysis in accordance with the requirements in 45 CFR (a)(1), including addressing the security (to include encryption) of ephi data created or maintained by certified EHR technology in accordance with requirements in 45 CFR (a)(2)(iv) and 45 CFR (d)(3), and implement security updates as necessary and correct identified security deficiencies as part of the MIPS eligible clinician's risk management process. Protect Patient Health Information Yes 0 e-prescribing At least one permissible prescription written by the MIPS eligible clinician is queried for a drug formulary and transmitted electronically using certified EHR technology. Electronic Prescribing Yes 0 Health Information Exchange 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. Health Information Exchange Yes Up to 20% Provide Patient Access 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. Patient Electronic Access Yes Up to 20% Practice Director Support

31 MEASURE NAME MEASURE DESCRIPTION OBJECTIVE NAME REQUIRED FOR BASE SCORE PERFORM ANCE SCORE WEIGHT Medication Reconciliation The MIPS eligible clinician performs medication reconciliation for at least one transition of care in which the patient is transitioned into the care of the MIPS eligible clinician. Medication Reconciliation No Up to 10% Patient- Specific Education The MIPS eligible clinician must use clinically relevant information from CEHRT to identify patient-specific educational resources and provide electronic access to those materials to at least one unique patient seen by the MIPS eligible clinician. Patient Specific Education No Up to 10% Secure Messaging For at least one unique patient seen by the MIPS eligible clinician during the performance period, a secure message was sent using the electronic messaging function of CEHRT to the patient (or the patient-authorized representative), or in response to a secure message sent by the patient (or the patient-authorized representative) during the performance period. Secure Messaging No Up to 10% View, Download, or Transmit (VDT) At least one patient seen by the MIPS eligible clinician during the performance period (or patient-authorized representative) views, downloads or transmits their health information to a third party during the performance period. Patient Electronic Access No Up to 10% Practice Director Support

32 BASE AND PERFORMANCE MEASURE INSTRUCTIONS The instructions below are the same instructions you have been using for the past 3 years. The only change is that there is no minimum threshold amount to meet. Security Risk Analysis Base Required: Yes (Must Attest Yes) Performance Score Weight: 0 Measure: Conduct or review a security risk analysis in accordance with the requirements in 45 CFR (a)(1), including addressing the security (to include encryption) of ephi data created or maintained by certified EHR technology in accordance with requirements in 45 CFR (a)(2)(iv) and 45 CFR (d)(3), and implement security updates as necessary and correct identified security deficiencies as part of the MIPS eligible clinician's risk management process. Attestation Format: Yes/No Eligible professionals (EPs) must attest YES to conducting or reviewing a security risk analysis and implementing security updates as needed to meet this measure. Instructions: Print off the Security Risk Analysis worksheet available on the Client Documentation website. ysis_worksh eet.pdf Fill out and keep on file. If you had done this in a previous Stage of MU, you must review your saved Security Risk Analysis worksheet yearly and update if necessary. Sign and date the date of review Practice Director Support

33 Electronic Prescribing erx Base Required: Yes (Must attest with at least 1 in the Numerator) Performance Score Weight: No 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. No Exclusions Attestation Format: Numerator/Denominator Numerator: Number of prescriptions in the denominator generated, queried for a drug formulary and transmitted electronically using Certified EHR Technology PD: Entry of prescriptions within Dr First that are signed and sent will count in this measure. Each prescription entered, signed, and sent, not just the first one per patient. Pending prescriptions or prescriptions that are only signed will not count in the numerator. See instructions below Note: Prescriptions for scheduled drugs (controlled substances) do NOT count in either numerator or denominator of this measure since they cannot be sent electronically Denominator: Number of prescriptions written for drugs requiring a prescription in order to be dispensed other than controlled substances during the EHR reporting period; or Number of prescriptions written for drugs requiring a prescription in order to be dispensed during the EHR reporting period PD: Entry of prescriptions within Dr First that are signed, or signed/sent will count for this measure. Pending prescriptions will not affect count Instructions: To enter a drug prescription into Practice Director s e---prescribing portal: 1. Be logged in as a provider 2. If you are not in the EHR module already go to the EHR Options> E---Prescribing 3. Verify the patient that is displayed is the patient you are intending to create and send a drug prescription for 4. If not click the spyglass to search for the correct patient. 5. Click the Launch E---Prescribing button 6. If you are already in the EHR module and have a patient selected you can just click the Launch E-Prescribing button Practice Director Support

34 Create and transmit the drug prescription (for detailed instructions once in Practice Director s e--- Prescribing portal please read the Practice Director e---prescribing portal documentation) *Note: Any prescription transmitted electronically through a different e---prescribing system will not be automatically calculated or tracked. They will need to be manually tracked for attestation. Practice Director Support

35 Health Information Exchange Base Required: Yes (Must attest with at least 1 in the Numerator) Performance Score Weight: Up to 20% Measure: 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. Summary of Care Record A summary of care record must include the following elements: 1. Patient name 1. Referring or transitioning provider's name and office contact information (EP only) 2. Procedures 3. Encounter diagnosis 4. Immunizations 5. Laboratory test results 6. Vital signs (height, weight, blood pressure, BMI) 7. Smoking status 8. Functional status, including activities of daily living, cognitive and disability status 9. Demographic information (preferred language, sex, race, ethnicity, date of birth) 10. Care plan field, including goals and instructions 11. Care team including the primary care provider of record and any additional known care team members beyond the referring or transitioning provider and the receiving provider 12. Reason for referral 13. Current problem list (EPs may also include historical problems at their discretion) 14. Current medication list * 15. Current medication allergy list * *Note: An EP must verify that the fields for current problem list, current medication list, and current medication allergy list are not blank and include the most recent information known by the EP as of the time of generating the summary of care document. No Exclusions Attestation Format: Numerator/Denominator Practice Director Support

36 Numerator: The number of transitions of care and referrals in the denominator where a summary of record was created using CEHRT and exchanged electronically PD: Patients who were referred through a transition of care out of the provider s care to another provider who also had a Summary of Care report generated and sent electronically. NOTE: only valid CCDAs can be sent electronically. (Send electronically using Portal and then EHR Options>TOC>Save CCDA>Care Document check sent electronically). See instructions below Denominator: Number of transitions of care and referrals during the EHR reporting period for which the EP was the transferring or referring provider. PD: Patients who were referred through a transition of care out of the provider s care to another provider. Instructions To Provide a Summary of Care: Go to EHR Options select Transition of Care The Transition of Care dialog will open 1. Use the spyglass to select your desired patient if they are not already displaying Practice Director Support

37 2. Click on the arrow next to Save, Select Save as C-CDA You will receive the following message To create a valid CCDA, the Problems List must be coded with SNOMED---CT. Would you like to convert the Problems List to SNOMED---CT before saving the CCDA? Select Yes A new dialog will open and show you the ICD-10 code and the corresponding SNOMED-CT code. You can check the Remember this association box to have it remember this grouping. Select OK. The system will repeat this process until all ICD-10 have been matched to SNOMED- CT Practice Director Support

38 The Save C-CDA dialog will open; select the destination for where you want to save your C-CDA. Select Save The View screen will open To transmit electronically: 1. Select Care Document Tab 2. Select the patient you wish to transfer (only patients with Sent status can be transferred) (Optional) When the Tab opens Click on the file name header to put the patient s in alphabetical order to make it easier to find desired patient. 3. Select Transfer TOC button Practice Director Support

39 The Transfer Transition of Care using Direct Transfer dialog will open 1. Click on the Spyglass in the From field to select the provider that is sending. A dialog will open showing you Providers with their Direct Address. Select the provider and then click OK 2. Click on the Spyglass in the To field to select the provider you are sending to. A Provider Directory dialog will open you can use any criteria or any combination of criteria to locate a Providers Direct address. In this example I searched by Portal ID and 3 results were returned. Select the desired provider and then click OK Practice Director Support

40 3. Enter a Subject for the message. IMPORTANT Protected Health Information (PHI) under HIPAA must not be included in a message s subject line 4. You can add a message to your 5. The CCDA will already be attached select Add Attachment if you want to send anything else such as EHR Report or Images 6. Select Send Message to Send Practice Director Support

41 You will receive a message notifying you that the message has been successfully sent When you view the Care Documents tab the Electronic Copy will now have a checkmark in it so show Electronically Sent Completing the above steps will increase your numerator Practice Director Support

42 Provide Patient Access Base Required: Yes (Must attest with at least 1 in the Numerator) Performance Score Weight: Up to 20% Measure: 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. No Exclusions Attestation Format: Numerator/Denominator Patient Electronic Access: Numerator: The number of patients in the denominator who have timely (within 4 business days after the information is available to the EP) online access to their health information to View download, and transmit to a third party PD: Patients will count in this numerator if, within four days of a visit (saved EHR), they have registered within the patient portal and their registration has been linked to their file within PD (Patient menu>patient Portal Mgmt.). They do NOT have to actually view their information within the portal they just have to have access. See instructions below Denominator: Number of unique patients seen by the EP during the EHR Reporting period PD: Unique patients seen in the period. Patient has an exam saved as completed, completed non---billable, or invoiced in system during reporting period Contact Practice Director Support to request Patient Portal Activation. Support will send you a provider link and a patient link once enabled One time Setup for each Provider in your Practice Create your Provider Portal account Select Patient Menu Select Patient Portal Select User Administration Practice Director Support

43 When the Patient Portal User Management Screen opens select the Preferences Tab 1. Select Enable Portal Communications 2. Check the show in the Patient Portal checkbox for the Provider/s you want to display on Portal. In the NPI column make sure your Provider has a unique NPI, if they do not enter one in Provider Management before saving 3. Select Save 4. Select Close You will receive confirmation when the data has successfully saved You will then need to register your Provider. From PD Select Patient Portal Select Register Provider Practice Director Support

44 When the Register New Account page opens add the following information: User Name Password (must contain upper and lowercase letters and a number or symbol) Confirm Password NPI number Address (If you do not enter an address the office will have to verify your account in Practice Director Confirm Direct Address Confirm Select your name from the provider list Select Register once completed Practice Director Support

45 Instructions At some point during the patient visit you may register the patient or have them register themselves for Patient Portal Access. We recommend doing this with them in the office to ensure that they complete the steps. Once the exam is saved, as Completed or Completed Non-Billable the information will be available to Patient on the portal Go to your Patient Portal Link: Example &usertype Have the Patient Select Register in the right corner Practice Director Support

46 The Register New Account page will open Have the patient fill in the required Fields: User Name Password (Must contain upper, lowercase, and numeric value) Confirm Password First Name Last Name Birthdate Gender Zip Home or Cell Phone is optional (If you are over 18 years of age your must be unique). If you use the patient will receive an with a link that they must select to activate. If you do not use the office will need to verify the patient. Select your Provider Select Register Practice Director Support

47 The user will receive a confirmation that the account has been created. If was not specified they will see this confirmation Practice Director Support

48 If user used address they will see this confirmation And they will receive an activation The user does not have to click on the link to activate the account in order to satisfy this measure, however they must activate before they can access their information. In order for the MU numerator count to increase, the staff must import the newly registered patient into PD in order to link the Portal Account and Practice Director Account. This must be done within 4 days of the patient DOS To link the accounts: Select Patient Menu Practice Director Support

49 Select Patient Portal Select User Administration When the Patient Portal User Management screen opens 1. Select the User Management Tab 2. Select the desired patient from the left side of the screen 3. If there is a matching patient in the system the patient will display to the right of the screen 4. Select Link The Import New Patient dialog will open 1. The left side will display portal information 2. The right side will display PD information. You are also able to edit any information on the right by selecting the field and then typing. Note this will update the portal also 3. You can select Sync on the PD information side to override the current Demographic information with what the patient entered on the portal Practice Director Support

50 4. If you do not wish to Sync you can select OK to link the Portal and PD account. Or once you have selected to Sync the Portal information to the PD you can select OK You will receive a message that the patient has been successfully imported Practice Director Support

51 Medication Reconciliation Base Required: No Performance Score Weight: Up to 10% Measure: The MIPS eligible clinician performs medication reconciliation for at least one transition of care in which the patient is transitioned into the care of the MIPS eligible clinician. Attestation Format: Numerator/Denominator Numerator: Number of transitions of care in the denominator where medication reconciliation was performed PD: Patients within the denominator (had a Transition of Care into the provider s care) who had a medication reconciliation performed during the transition. (EHR Options>TOC>Import>Medication Reconciliation performed for manual and on screen reconciliation performed when an electronic summary of care was received). See instructions below Denominator: Number of transitions of care during the EHR reporting period for which the EP was the receiving party of the transition PD: All patients that had either a manual or an electronic summary of care imported into PD during the reporting period. (EHR Options>TOC>import). Instructions: To indicate the patient was received from another setting of care or provider: Select EHR Options Menu> Transition of Care When the Transition of Care dialog opens use the spyglass to select the desired patient if they are not displaying Select Import Practice Director Support

52 The Transition of Care Type dialog will open You can select to Import the Transition of Care from a CCDA or to manually enter a received Transition of Care 1 Importing Transition of Care 2. Select Import Transition of Care button and Select OK 3. The import C---CDA dialog will open select the saved C---CDA File Select Open Practice Director Support

53 4. The Import CCDA Reconciliation dialog will open. Go through each of the tabs, Problems, Medications, and Allergies and reconcile the data in each 5. The left side of the screen for each Tab displays the Active List (what is in your system currently) and Imported List (information that is being imported) 6. Select Auto Match at the bottom of the screen to let the system find matches 7. Highlight an item from Imported List and if there is a match in Active List it will highlight it also 8. Select Merge to merge the items to the Reconciled List 9. A dialog will pop up with both medications side by side; if they are the exact same and you want to continue select OK. If they don t match select Cancel and move them each independently 10. Once complete select OK Practice Director Support

54 11. The medications will display on the right side as merged 12. Repeat for all Tabs (You will not be able to finish until all are reconciled) Add the selected Active and/or Imported from the patient s reconciled list (located at top and bottom of screen) Exclude the selected Active and/or imported from the patient s reconciled list (located at the top and bottom of screen) Merge entries from both lists to the patient s reconciled list 13. The Reconciliation Review dialogue will open 14. Select Submit when you are ready to finish Practice Director Support

55 You will be returned to TOC screen Select the red X in upper left corner to close Manually Receive Transition of Care 1. Select Manually enter a received Transition of Care 2. The Care Received Date will default to today, use the calendar to select another date if desired. 3. Check the Medication Reconciliation Performed Box if you have done this 4. Select OK To perform the medication reconciliation: You can perform the medication reconciliation by comparing medications that are reported by patient or other physician with your list if you are not using Practice Director s e-prescribing portal. Practice Director Support

56 Patient Specific Education Base Required: No Performance Score Weight: Up to 10% Measure: The MIPS eligible clinician must use clinically relevant information from CEHRT to identify patient-specific educational resources and provide electronic access to those materials to at least one unique patient seen by the MIPS eligible clinician. Attestation Format: Numerator/Denominator Numerator: Number of patients in the denominator who were provided patient-specific education resources identified by the Certified EHR Technology PD: This numerator will populate when a patient has been given some piece of education within the system (EHR Options>Patient Education>either info button or other entered education with the date provided within the reporting period). See instructions below Denominator: Number of unique patients with office visits seen by the EP during the EHR reporting period PD: Unique patient seen in the period. Patient has an exam saved as completed, completed non-billable, or invoiced in the system during the reporting period. Instructions: To identify and provide patient-specific education resources: Go to the EHR menu >Patient Education OR Click on the Patient Education button in the Final section of the EHR after you have saved the EHR When the Patient Education window opens if the desired patient is not displaying click on the Practice Director Support

57 spyglass to select the desired patient 1. You will see a list of all diagnoses, medication, and lab results that the patient is associated with in the Patient Condition column located to the left side. You will also see this image for Info Button this indicates that additional information is available from Medline Plus. Click on the Info Button to see the details available 2. Condition Type shows whether the condition is a Lab Result, Diagnostic, or Medication 3. Education Resource this field stays blank until you click on the Info Button. Once the Info button has been selected the wording Info Button will populate in the field 4. Provided Allows you to check to indicate that you shared this information with your patient, by showing on screen, printing, or ing. 5. Date Provided Once provided box is checked this field will populate with today s date. You can double click on the date to adjust it to the correct date Viewing Info Button 1. Click on the Info Button Practice Director Support

58 2. Medline Plus window will open, from here you can: A. Click on the link and show your patient the information and print it for them from the linked website B. Click Launch System Viewer to print the content of this screen. It will open in your browser and you can print as you normally would from the Internet Practice Director Support

59 Once you have shared the data with the patient you can close the window you will be returned to the Patient Education Window The Education Resource field will now be filled in with Info button Check the Provided field and then adjust the date if needed by double clicking in the date field Select Save in the lower right corner to finish Secure Messaging Base Required: No Performance Score Weight: Up to 10% Measure: For at least one unique patient seen by the MIPS eligible clinician during the performance period, a secure message was sent using the electronic messaging function of CEHRT to the patient (or the patient-authorized representative), or in response to a secure message sent by the patient (or the patient-authorized representative) during the performance period. Attestation Format: Numerator/Denominator Numerator: The number of patients in the denominator for whom a secure electronic message is sent to the patient (or patient-authorized representative), or in response to a secure message sent by the patient (or patient-authorized representative) Denominator: Number of unique patient seen by the EP during the EHR reporting period If you have not setup your provider portal yet, see pages Provider Portal Activation Practice Director Support

60 Instructions for Logging into Provider Portal 1. Launch your Provider Portal by going to your browser and entering your portal address Or From PD Select Patient Portal Select Launch Portal 2. Select Log in, from the upper right corner 3. Enter your User Name and Password Practice Director Support

61 Instructions for Sending and Receiving Messages 1. Once logged in you will be on the Secure Messaging screen 2. Patient Names that are available to message will display to the left side of the screen. Select the patient that you wish to message 3. In the field at the bottom of the screen enter your message to the patient 4. Select Send once completed 1. The sent message will display on the screen with the date and time sent, the provider that sent the message, and the message Practice Director Support

62 2. When the patient responds, the message will display at the top of the list Selecting a Patient displays all communication with that patient and allows you to send new messages Directions for Patient to send message: Have your patient log on with their user name and password Practice Director Support

63 1. Once logged in the patient will be on the Secure Messaging screen 2. Providers that are available to message will display to the left side of the screen 3. Messages that have been received and sent will display on right side of the screen with the most recent message on top 4. Enter message that you want to send 5. Select Send Practice Director Support

64 View, Download, or Transmit (VDT) Base Required: No Performance Score Weight: Up to 10% Measure: At least one patient seen by the MIPS eligible clinician during the performance period (or patient-authorized representative) views, downloads or transmits their health information to a third party during the performance period. Attestation Format: Numerator/Denominator Numerator: The number of unique patients (or their authorized representatives) in the denominator that have viewed online, downloaded, or transmitted to a third party the patient s health information PD: Patients will count in this numerator if they have actually viewed their health information (CCDA) through the patient portal. So, if a patient has registered as a user for the portal, their account has been linked to their PD account and they have actually viewed the CCDA information in the portal, they will count. See instructions below Denominator: Number of unique patient seen by the EP during the EHR reporting period PD: Unique patients see in the period. Patient has an exam saved as completed, completed non---billable, or invoiced in system during reporting period Threshold: The resulting percentage must be more than 1 (one) patient in order for an EP to meet this measure Instructions At some point during the patient visit you may register the patient or have them register themselves for Patient Portal Access. We recommend doing this with them in the office to ensure that they complete the steps. Once the exam is saved, as Completed or Completed Non---Billable the information will be available to Patient on the portal Use the directions on pages if you have not already registered and linked your patient. If you have already done this for Provide Patient Access you do not need to have them register and linked again. Patient Access to Portal The patient can now access their information from the portal and must View, Download, or Transmit the information Practice Director Support

65 Have your patient go to the Patient Portal Link: Example &usertype Have the user log on with their user name and password Once logged in they will select Patient Health Information The patient Consolidated CCDA will display on the screen. All the patient has to do is view this page in order for it to increase the numerator The patient may also choose to Download or Transfer the CCDA Practice Director Support

66 Tracking ACI in Practice Director A new report has been added under EHR Options>Meaningful Use, the 2017 Advancing Care Information (ACI) Transition Report can be used to see how you are doing at meeting the base and performance scores. The Verification Report has also been updated to show the patients that make up each measure Advancing Care Information (ACI) Transitions Report This report will run the same way that the Meaningful Use Reports run, and is in the same dialog To Run the ACI Report: Select EHR Options>Meaningful Use>Meaningful Use Report The Meaningful User Reporting Periods dialog will open From this dialog you can do the following: 1. Select Add to create a new report for a desired date range, provider, and stage Practice Director Support

67 2. Select a Saved Report to View, Edit, or Delete 1. Add: The Select Reporting Period dialog will open The current year will be defaulted as the date range. You can change the date range to any desired range by clicking on the calendar icons 1. Provider Select the desired provider from the drop down 2. Start Click on the calendar icon to select a start date for the desired reporting period 3. End Click on the calendar icon to select an end date for the desired reporting period 4. Stage The default is 2017 Advancing Care Information (ACI) Transition (Everyone participating in MIPS will use 2017 Advancing Care Information (ACI) Transition for attestation in 2017). The previous Stage 1, Stage 2, 2015 and 2016 Modified Stage 2 Reports are still available to view. 5. Select OK to view the Report The report will open: 1. The header will display the name of the report that you are viewing 2. Period will display the period you are running the report for Practice Director Support

68 3. Provider will display the provider you are running the report for 4. On the left side of the report, the measures/objectives are named within the grey headers. A description displays underneath. 5. On the right side of the screen, System, Calculated, and Required display. System displays the system calculated numerator and denominator. Keep in mind that for MIPS you need at least 1 in the numerator for each Base Measure Calculated displays the system calculated percentage. For Performance measures the higher the percentage, the more points you will earn Required indicates Yes or No. Yes indicates that it is required for your Base score 6. Selecting Save will save your date range on the Meaningful Use dialog. Once Save is selected you will be returned to the Meaningful Use dialog 7. View Report will launch the printable version in another dialog. If you select View Report your can then select the printer icon to print or the disc icon (in the upper left corner) to save to your computer Practice Director Support

69 *** We recommend saving the report that you attest with to your computer*** Printable View You can use the amounts in the calculated field to estimate your points. For the four required Base measures you need to have a Yes or a 1 indicated in the numerator. For the Performance measures you can use the table on page 28 to estimate your points. 2. Select a Saved Report You can select a saved Report to view and or print From the Meaningful Use Reporting Periods dialog: Double click on the desired report, the saved MU report will open or Select the desired report and then select View Report, the saved MU report will open Practice Director Support

70 Each time you view the report or the printable report the values are automatically recalculated, so the Advancing Care Report is always up to date Advancing Care Information (ACI) Transition Verification Report You can use the verification report to find the patient name, date of birth (Age) and whether they are included in the numerator and or denominator so that you know the patients that are counting for each objective If a patient is only displaying in the numerator or denominator you can then determine why they do not fall into both To Run the Verification Report: Select EHR Options>Meaningful Use>Verification Report Practice Director Support

71 The Meaningful Use Measures dialog will open You can run the report for a saved provider and period, or run a new report for provider and period. You may also select if you want to run for all measures or just specific measures. Once you run you may save the search for quicker location Running New Report 1. Leave the Preset field blank 2. Select the desired Provider from the drop down 3. The stage is defaulted to 2017 Advancing Care Information (ACI) Transition, you can select another report from the drop down if desired 4. Select desired Start and End date by clicking on the calendars or use the current year default dates 5. You can select specific measure by control or command click, if you do not select measure(s) the report will calculate for ALL 6. Select Search Report Results will display at the bottom of the dialog 7. Select an objective to view the details. 8. Once selected the upper right side of the screen will display what makes up the numerator and denominator. The system calculated numerator and denominator, the percent, and whether it is required for the Base measure 9. The lower right side will display Patient Name, Date of Birth (Age), check mark indicate in Numerator and/or Denominator to indicate that they count for the measure. 10. You can Select Save to save the report so this criteria will appear in the Preset for selection next time. Practice Director Support

72 Example Scoring for Advancing Care Information (ACI) as outlined on pages You have completed all 4 of the base requirements = 50pts You select the following 6 measures and have the following performance: Measure/Objective Performance Points Health Information Exchange 10% 11 Provide Patient Access 51% 16 Medication Reconciliation 50% 5 Patient Specific Education 10% 1 Secure Messaging 5% 1 VDT 5% 1 Total Performance 35 You submit data to AOA MORE Registry = 5 You complete CPIA Close Referral Loop = 5 Base 50 + Performance 35 + Bonus 10 = 95 ACI Score 95% of 25 max points = total Points Practice Director Support

73 RESOURCE USE OR COST IN 2017 Cost replaces Value-Based Modifier. This area is worth 0% of your overall MIPS Performance Score in It will start counting in 2018 Cost measure represents the Medicare payments (for example, payments under the Physician Fee Schedule, IPPS, etc.) for the items and services furnished to a beneficiary during an episode of care No data submission is required; this amount is derived from adjudicated claims In 2017 CMS will be tracking this amount for each provider and will provide feedback to providers so they can see how they will be impacted in future years. Information about your cost is available to you via CMS Quality and Resource Use Report (QRUR) on a CMS portal Payment/PhysicianFeedbackProgram/Obtain-2013-QRUR.html CALCULATING YOUR FINAL SCORE IN 2017 Quality + Cost + CPIA +ACI = MIPS Composite Score Threshold score to determine payment and penalty is determined by CMS each year - If Composite Score is above the CMS threshold provider will get a bonus - If the Composite Score is below the CMS threshold provider will get a penalty (pay reduction) The thresholds for 2017 are below: Final Score Payment Adjustment 70 points Positive adjustment Eligible for exceptional performance bonus minimum of additional 0.5% 4-69 points Positive adjustment Not eligible for exceptional performance bonus 3 points Neutral payment adjustment (NO increase or decrease) 0 points Negative payment adjustment of -4% 0 points = does not participate Practice Director Support

74 Example Scoring for Quality from page 25 Measure Score Points Diabetic Eye Exam 90 9 POAG 90 9 Diabetic Retinopathy Communication 80 7 Controlling BP (outcome) 75 9 Closing Referral Loop Documentation of current Meds 90 7 Diabetic Retinopathy +/- and Level 90 9 Total Points 60 Example Scoring for CPIA from page 27 Office with fewer than 15 providers completes two medium weight activities: Use AOA MORE to show outcome comparisons across specific population 20pts Use AOA MORE to promote standard practice uses 20pts Point total 40pts Example Scoring for Advancing Care Information (ACI) from page 68 You have completed all 4 of the base requirements = 50pts You select the following 6 measures and have the following performance: Measure/Objective Performance Points Health Information Exchange 10% 11 Provide Patient Access 51% 16 Medication Reconciliation 50% 5 Patient Specific Education 10% 1 Secure Messaging 5% 1 VDT 5% 1 Total Performance 35 You submit data to AOA MORE Registry = 5 You complete CPIA Close Referral Loop = 5 Base 50 + Performance 35 + Bonus 10 = 95 ACI Score 95% of 25 max points = total Points Practice Director Support

75 This total will be compared against the Threshold Score to determine if you get a positive or negative payment adjustment. With the thresholds for 2017 and the examples used throughout the document, this provider would receive a positive payment adjustment and be eligible for performance bonus. PUBLIC REPORTING MIPS data and the final score will be available for public reporting on Physician Compare website to allow patients to make informed decisions about the provider that they select. Practice Director Support