CMS: NOW AND LATER. AUGUST 19, 2016 Ryan E. Spikes, RN BSN, CHTS-IM/PW, CHTS, PCMH

Transcription

1 CMS: NOW AND LATER AUGUST 19, 2016 Ryan E. Spikes, RN BSN, CHTS-IM/PW, CHTS, PCMH

2 KEY TOPICS 2016 Meaningful Use Requirements What is MACRA? Who is Eligible? What is MIPS? How will Clinicians be Scored? What is APM? What are the APM Standards? When and How will it effect you?

3 2016 MEANINGFUL USE REQUIREMENTS # Measure Information Requirements 1 Security Risk Assessment Performed yearly to ensure practice addresses administration safeguards, physical safeguards, technical safeguards, policies, procedures, and organizational requirements 2 Use CDS to improve on high priority health conditions 5 clinical decision supports related to 4 or more clinical quality measures Drug-drug interaction enabled Drug- Allergy interaction enabled 3 Use CPOE for medication, laboratory, and radiology orders 60% of all medication orders 30% of all laboratory 30% of all radiology orders

4 2016 MEANINGFUL USE REQUIREMENTS # Measure Information Requirements 4 Electronically generate and transmit permissible prescriptions 5 EP s that transition or refer their patients to another care setting or provider must provide a summary of care record 6 EP s must provide patient-specific education resources to their patients 7 Ep s who receive patients from another care setting must perform a medication reconciliation 50% or more permissible prescription written by the EP must be checked with a drug formulary Summary of care record must be created by an EHR 10% or more of all patients must have a summary of care record Must provide education resources to 10% or more of all unique patients Must perform a medication reconciliation report for 50% or more of transitions of care

5 2016 MEANINGFUL USE REQUIREMENTS # Measure Information Requirements 8 Provide patients the ability to view online, download, and transmit their health information 9 Use secure electronic messaging to communicate with patients More than 50% of patients should have the ability to view, download, and transmit their health information At least 1 patient transmits to a third party EP has sent at least 1 electronic message or responded to 1 patient within 90 days 10 The EP is submitting public health data to a public health agency Be registered and submitting data to one public health registries and one specialized registry OR be registered and submitting data to 2 public health registries

6 MACRA QUALITY PAYMENT PROGRAM Changes how Medicare pays eligible providers or eligible hospitals who give care to Medicare beneficiaries Ends Sustainable Growth Rate Rewards providers for increasing quality of care Combines Medicare quality programs into one system

7 WHO IS ELIGIBLE? 2017 and May Broaden Clinician Groups Medicare Part B Physicians, Physician Assistants, Nurse Practitioners, Clinical Nurse Specialist, and Certified Nurse Anesthetists May Include: OT, PT, Speech Pathologist, Audiologists, Nurse Midwives, Clinical social workers, Clinical Psychologists, Dietitians / Nutritional Professionals

8 Who will NOT Participate in MIPS?

9 MACRA QUALITY PAYMENT PROGRAM Merit-Based Payment System (MIPS) OR Advanced Alternative Payment Models (APMs)

10 MIPS GOALS Aimed to improve quality based payment systems Gives Clinicians the ability to choose measures that are applicable to the care they provide Measures will emphasize on patient care and information access Reduce reporting and implement a scoring system that measures the type of care patients receive Scores will compute Medicare Adjustments

11 MIPS Performance Category Quality: Clinicians choose 6 measure to report based on the care they provide to patients. However they are required to choose one cross cutting measure, one outcome measure (if applicable), and one high quality measure relating to patient outcome. CMS will calculate 2 or 3 more measures based on claims. (PQRS and VBM) Advancing Care Information: Required to provide a numerator and denominator or a yes/ or no for each specific measure that fits their practice. Will receive a bonus point for participating in a public health registry. (Meaningful Use) Clinical Practice Improvement Activities: Reward physicians focusing on coordination of care, beneficiary engagement, and patient safety. Physicians will be required to choose from a specific list of 90 or more options. (PCMH) Resource Use/Cost: CMS will calculate claims data and volume MIPS Composite Performance Score (CPS) 80 to 90 Points based on volume and benchmarksh 100 Points 60 Points ½ points if participating in APMs Full point participating in medical homes Average score

12 MIPS How Providers Will Be Scored 25% 15% 10% 50% Cost Quality Improvement Activities Advancing Care Information

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14 Advancing Care Information BASE SCORE 50 POINTS

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16 SAMPLE EQUATION ADVANCING C ARE INFORMATION Calculated out of 100 or more points in category to get 25 composite points Example 1: Base points 40, Performance points 40, No Bonus Points =80 ACI Points 100 Possible points x 100 = 80% ACI performance 80% ACI Performance x 25% Composite Weight = 20 Composite Performance Points Example 2: Base Points 40, Performance points 73, 1 Bonus Point =114 ACI Point 100 Possible Points x 100 = 114% ACI Performance (maxed at 100%) 100% ACI Performance x 25% Composite Weight = 25 Composite Performance Points

17 MIPS ±4% ±5% ±7% ±9% First Year: Adjustments will be no more than 4% The positive or negative adjustments will increase over time Additional performance bonus is available for high performers, which can up to an additional 10%

18 ADVANCED ALTERNATIVE PAYMENT MODELS Provides an extra incentive for clinicians who want to take a step further in care transformation and accepts the risk for providing coordinated and high quality of care A clinician that meets or exceeds Advanced APM requirements MAY be excluded from MIPS Clinicians will receive a 5% Medicare Part B incentive Payment 2026 and later Clinicians will receive a higher incentive payment

19 APM DEFINED APM includes only these payment models run by CMS (not by commercial payers): CMS Innovation Center Model (other than a Health Care Innovation Award) Medicare Shared Savings Program (MSSP ACOs) Demonstration under the Health Care Quality Demonstration Program Demonstration required by federal law CMS defines MIPS APMs as a subclass of APMs which meet all: APM entities participate under an agreement with CMS APM entities include one or more MIPS eligible clinicians on an APM participation list APM bases payment incentives on performance on cost/utilization and quality measures

20 STANDARDS OF THE ADVANCED ALTERNATIVE PAYMENT MODELS Requires participates to accept a financial risk. CMS can withhold payment, reduce incentive rates, or require entity to make payments to CMS Total risk will be 4% of APM spending targets Marginal risk must be at least 30% Minimum loss will be no greater than 4% percent of the APM benchmark

21 STANDARDS OF THE ADVANCED ALTERNATIVE PAYMENT MODELS APM will base payment on quality measures that are evidence based At least one measure must be an outcome measure In the first year APM requires clinicians to use an EHR for 50% of patient encounters In the second year of APM requires clinicians to use an EHR for 75% of patient encounters

22 THE BIG PICTURE A direct node on the Georgia health information network is known as a Qualified Entity

23 SUPPORTS GEORGIA PROVIDERS & HOSPITALS EMR Implementatio n Resource & Support EHR Implementation Resource & Support Outreach, Education & Training MU Stages 1-3 Barrier Mitigation via value-added services Boots on the Ground Distance Learning Web based training Outreach, Education & Training HIT Center Cloud-based Technical Solutions HIT Infrastructure Lab Interface HIE outreach and education Meaningful Use Assistance Practice Management PCMH, ACOs Improve clinical outcomes Practice Management Research EHR adoption, Vendor utilization

24 State Agencies CMO Medicaid/GA Department of Community Health (DCH) GA Department of Public Health (DPH) GA Division of Families and Children Services (DFCS) GA Department of Juvenile Justice (DJJ) GA Department of Behavioral Health & Developmental Disabilities (DBHDD) Amerigroup Hospitals Regional HIEs Specialty Connection Emory Healthcare (Cerner) Grady Health System (Epic) Children s Healthcare of Atlanta (Epic) Gwinnett Medical Center (Relay) Georgia Health Connect (GaHC) (Liasion) HealtheConnection (Cerner) - GRAChIE/Chatham HealthLink (Cerner) Georgia Partnership for Telehealth (Azalea) 41 Providers connected; over 20,000 patients registered National Exchange South Carolina Health Information Exchange East Tennessee Health Information Network Alabama s One Health Record Texas (HIETexas) Veterans Health Administration

25 RESOURCES Centers for Medicare and Medicaid Services Office of the National Coordinator GA Department of Community Health GA Health Information Network GA-HITEC

26 CONTACT INFORMATION Ryan E. Spikes, RN

27 QUESTIONS?