It s All About Revenue MIPS & Cardiology Best Practices JUSTIN T. BARNES

It s All About Revenue MIPS & Cardiology Best Practices JUSTIN T. BARNES PARTNER, IHEALTH INNOVATIONS CO-CHAIR, ACCOUNTABLE CARE COMMUNITY OF PRACTICE

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.

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

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

Cardiology Best Practices Avoid denials for: If 33207-62 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: 92941-LD 93458-26, 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

Value-based Care Initiatives & Incentives

MACRA, MIPS & APMs MACRA & MIPS: Healthcare Reform/Transformation Medicare Access & CHIP Reauth Act (MACRA) of 2015. 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+

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 2016-2019

MIPS performance categories A single MIPS composite performance score will factor in performance in 3 weighted categories on a scale of 0-100 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 2018. Replaces valuebased modifier.

MIPS performance categories A single MIPS composite performance score will factor in performance in 3 weighted categories on a scale of 0-100. 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

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

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: https://goo.gl/26wz1x 4. Staff success Secure inside expertise, involve and educate staff

Quality Payment Program Adjustment & Incentives Overview

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

Cardiology Cumulative Penalties For years 2019-22+, based on EC performance, physicians and practitioners can receive cumulative negative or positive payment adjustments.

Cardiology Specialty Measures Number of Cardiology Measures Included in Final Rule 20 16 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 1525 326 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

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 326 47 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

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 18-85 years of age who had a diagnosis of hypertension and whose blood pressure was adequately controlled (<140/90mmHg) during the measurement period CMS165v5 18 236 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 66 118 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 CMS145v5 70 7 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. CMS68v6 419 130 Patient Safety Process Yes Claims, EHR, Registry

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 CMS135v5 81 5 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 CMS144v5 83 8 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. CMS164v5 68 204 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 CMS69v5 421 128 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

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 CMS138v5 28 226 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 2152 431 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 40-75 years with a diagnosis of diabetes with a fasting or direct LDL-C level of 70-189 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

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 1789 458 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

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 427 222 N/A 424 219 N/A 428 223 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

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 423 218 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 422 217 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 425 220 Communication and Care Coordination Outcome Yes Registry

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 426 221 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 733 446 Patient Safety Outcome Yes Registry

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 1523 417 Patient Safety Outcome Yes Registry N/A 1540 346 Effective Clinical Care Outcome Yes Registry N/A N/A 437 Patient Safety Outcome Yes Claims, Registry N/A 119 445 N/A N/A 420 Effective Clinical Care Effective Clinical Care Outcome Yes Registry Outcome No Registry

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

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

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.

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

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

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.

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.

Questions or Comments? Justin T. Barnes Justin@iHealthInnovations.com @HITAdvisor @RevenueSherpa

Thank you!