Advancing Care Information- The New Meaningful Use September 2017
ACO Announcements Reminders: ACO Notifications PECOS-Maintain active enrollment 2017 Patient Prospective Lists Upcoming provider/office manager meetings: CMP/IHA PRIMARY VALUE MEETING Internal Medicine, Family Practice and Office Managers Hilton Garden Inn, Airport September 28, 2017 Registration/Dinner 5:30pm 6:00pm Meeting 6:00pm 7:00pm CMP/HealthNow Best Practice Efficiency Meeting Internal Medicine, Family Practice and Office Managers CHARTC Building, Conference Room 1A, B & C 144 Genesee St (Elm/Oak) October 19, 2017 Registration/Dinner 5:30pm 6:00pm Meeting 6:00pm 7:00pm
Agenda Overlap with Medicare Shared Savings Program (ACO) Overview MACRA Advancing Care Information (ACI) New Meaningful Use Measures/Objectives/Scoring Q&A
Quality Measurement: Domains 31 quality measures are separated into the following four key domains that will serve as the basis for assessing, benchmarking, rewarding, and improving ACO quality performance: 1. Patient/Caregiver Experience 2. Care Coordination/Patient Safety 3. Preventive Health 4. Clinical Care for At Risk Population
ACO #11 Use of Certified EHR Technology Measure Description Percentage of ACO Eligible Clinicians who successfully meet the ACI Base Score requirements. Denominator All ECs who are participating in an ACO in the reporting year under the Shared Savings Program. Exclusions: physicians meeting low-volume threshold, physicians who are new to Medicare, ECs with ACI performance category reweighted to 0% Numerator ECs included in the denominator who successfully achieved the ACI Base Score for the reporting year corresponding with the performance year.
2017 Reporting Year ACO Quality Measure Benchmark Domain Measure Description 30th percentile 40 th percentile 50 th percentile 60 th percentile 70 th percentile 80 th 90 th percentile percentile Care Coordination/Patient Safety ACO-11 Use of Certified EHR Technology 30 40 50 60 70 80 90
What is MACRA? Medicare Access and CHIP Reauthorization Act Repealed the sustainable growth rate (SGR) Locks provider payments at a near zero growth rate Implementation is slated for January 1, 2019 Performance data from 2017 will be used for 2019 payment adjustments Created a new payment model, the Quality Payment Program (QPP) with 2 payment tracks Merit-Based Incentive Payment System (MIPS) Advanced Alternative Payment Models (Advanced APMs)
The 2 tracks of Quality Payment Program Advanced Alternative Payment Model Merit Based Incentive Payment System
Advanced Alternative Payment Models Participants required to use certified EHR technology (CEHRT) Must report and at least partially base clinician payments on quality measures comparable to MIPS Bear more than nominal risk for monetary losses CEHRT use Advanced APMs Financial Risk Quality Reporting
Current Advanced APMs Comprehensive ESRD Care Model Comprehensive Primary Care Plus Medicare Shared Savings Track 2 Medicare Shared Savings Track 3 Next Generation ACO Model Oncology Care Model Track 2
Advanced APM Sufficient Participation To earn the 5% incentive payment & be exempt from MIPS, participants must have sufficient participation in the Advanced APM (i.e., meet QP threshold) Participants that meet the Partial QP threshold do not receive the 5% incentive payment can choose to participate in MIPS and be subject to payment adjustment but are not required
Catholic Medical Partners ACO - Advanced APM CMP-ACO is a Track 3 Medicare Shared Savings Program and has been identified by CMS as an Advanced APM Up and downside Risk Quality measures (similar to MIPS) reported to CMS annually Require use of certified EHR technology Based on ECs attesting to the Advancing Care Information base measures. These reporting requirements, only apply to the 2017 reporting year and are subject to change in the future.
Merit-Based Incentive Payment System (MIPS) MIPS is a new program that replaces Physician Quality Reporting System (PQRS), Value-based Modifier (VM) and Meaningful Use. There are 4 performance categories in MIPS that eligible clinicians will be scored on: Cost Quality Improvement Activities, and Advancing Care Information Clinicians can report MIPS either as an individual or as a group
Who has to attest to MIPS? The MIPS eligible clinicians (ECs) include: Eligible Clinicians that have not been excluded due to Low volume threshold Newly enrolled in Medicare ECs that do not participate in Alternative Payment Models (APMs). ECs that participate in APMs that do not meet the requirements of Advanced APMs. ECs in Advanced APMs that do not meet participation thresholds necessary to be excluded from MIPS for a year (clinicians are not QPs or Partial QPs).
What do I need to do? CMP ACO Participant 1. CMS Letters- MIPS Eligible or Exempt Status Status of QP or Partial QP 2. Continue (or begin) Meaningful Use attestations (unless you are excluded) 3. Annual Quality Reporting Audits Non CMP ACO Participant 1. CMS Letters- MIPS Eligible or Exempt Status 2. Continue (or begin) Meaningful Use attestations (unless you are excluded) 3. Choose if participating individually or as group
ADVANCING CARE INFORMATION THE NEW MEANINGFUL USE
MIPS Category Advancing Care Information in 2017 Advancing Care Information: Replaces Meaningful Use (MU). In 2017, this category is 25% of the eligible clinician s final score Clinicians must use CEHRT to report on the measures This category provides some flexibility for the clinician to chose which measures to report
MIPS Category Advancing Care Information in 2017 Advancing Care Information: If EC does not have CEHRT they must submit an application to CMS to re-weight this category to 0% Insufficient internet connectivity Extreme and uncontrollable circumstances Lack of control over the availability of CEHRT ECs that qualify for automatic re-weighting Hospital-based MIPS clinicians, PAs, NPs, clinical nurse specialists, CRNA s, clinicians who lack face-to-face interactions with patients These ECs can still report this category and have it scored
Reporting ACI ECs can earn up to 155% in this category 50% - base score (required) 90% - performance score 15% - bonus score Anything over 100% will be capped at 100% In 2017, there are two measure set options for reporting: Advancing Care Information Objectives and Measures 2017 Advancing Care Information Transition Objectives and Measures The option that you will report is based on the edition of CEHRT that you are using.
Reporting ACI Performance data can begin any time from January 1-October 2, 2017. Data must be submitted to CMS by March 31, 2018. Depending on the data you submit, your 2019 Medicare payments will be adjusted up, down, or not at all: Not participating in the Quality Payment Program: If you don t send in any 2017 data, then you receive a negative 4% payment adjustment. Test: If you submit a minimum amount of 2017 data to Medicare (for example, one quality measure or one improvement activity for any point in 2017), you can avoid a downward payment adjustment. Partial: If you submit 90 days of 2017 data to Medicare, you may earn a neutral or positive payment adjustment and may even earn the max adjustment. Full: If you submit a full year of 2017 data to Medicare, you may earn a positive payment adjustment.
Reporting ACI In 2017, eligible clinicians can alternatively report the 2017 ACI transition objectives and measures if they have: 2015 CEHRT 2014 CEHRT A combination of 2014 and 2015 CEHRT Formerly Modified Stage 2 Meaningful Use Eligible clinicians can report the ACI objectives and measures if they have: 2015 CEHRT A combination of 2014 and 2015 CEHRT Formerly Stage 3 Meaningful Use GREEN = 2017 TRANSITION
ACI Measures Base Measures Required Measures for 50% Base Score Security Risk Analysis e-prescribing ACI Measures and Scores Provide Patient Access* Send Summary of Care* Request/Accept Summary Care* 2017 ACI Transition Measures and Scores Required Measures for 50% Base Score Security Risk Analysis e-prescribing Provide Patient Access* Health Information Exchange* *Note that these measures are also included as performance score measures and will allow a clinician to earn a score that contributes to the performance score category.
ACI Measures and Scores Measures for Performance Score ACI Measures- Performance Measures % Points Provide Patient Access* Up to 10% Send a Summary of Care* Up to 10% Request/Accept Summary Care* Up to 10% 2017 ACI Transition Measures and Scores Measures for Performance Score % Points Provide Patient Access* Up to 20% Health Information Exchange* Up to 20% Patient Specific Education Up to 10% View, Download, Transmit (VDT) Up to 10% Secure Messaging Up to 10% Patient-Generated Health Data Up to 10% Clinical Information Reconciliation Up to 10% Immunization Registry Reporting 0 or 10% View, Download, Transmit (VDT) Up to 10% Patient Specific Education Up to 10% Secure Messaging Up to 10% Medication Reconciliation Up to 10% Immunization Registry Reporting 0 or 10%
Performance Measure Scoring Calculated using numerators and denominators for measures, or by yes/no answers submitted. Potential total score is 90% Percentage score is determined by a performance rate Measures are worth a maximum of 10 percentage points, except for two measures reported under the 2017 transition measures, which are worth up to 20 percentage points. Performance Rates for Each Measure Worth Up to 10% Performance Rate 1-10 = 1% Performance Rate 11-20 = 2% Performance Rate 21-30 = 3% Performance Rate 31-40 = 4% Performance Rate 41-50 = 5% Performance Rate 51-60 = 6% Performance Rate 61-70 = 7% Performance Rate 71-80 = 8% Performance Rate 81-90 = 9% Performance Rate 91-100 = 10%
ACI Measures and Scores Requirements for Bonus Score *Report to 1 or more of the following public health and clinical data registries: ACI Measures- Bonus Measures % Points 2017 ACI Transition Measures and Scores Requirements for Bonus Score *Report to 1 or more of the following public health and clinical data registries: % Points Syndromic Surveillance Reporting Electronic Case Reporting Public Health Registry Reporting Clinical Data Registry Reporting 5% Syndromic Surveillance Reporting Specialized Registry Reporting Report certain improvement activities using CEHRT 5% 10% Report certain improvement activities using CEHRT 10%
ACI Measures- Security Risk Analysis Objective: Measure: Protect Patient Health Information Security Risk Analysis https://www.healthit.gov/providers-professionals/security-riskassessment-tool To meet this measure, eligible clinicians must attest YES to conducting or reviewing a security risk analysis and implementing security updates as necessary and correcting identified security deficiencies.
ACI Measures- Electronic Prescribing Objective: Measure: Electronic Prescribing Electronic Prescribing At least one permissible prescription written by the eligible clinician is queried for a drug formulary and transmitted electronically using CEHRT. Exclusion: Any eligible clinician who writes fewer than 100 permissible prescriptions during the 2017 performance period. What you need to do: Make sure that providers are e-prescribing all meds
ACI Measures- Patient Electronic Access Objective: Measure: Patient Electronic Access Provide Patient Access At least one patient seen by the 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 eligible clinicians discretion to withhold certain information. What you need to do: Determine if you need to set up patient portal Work with vendor to set up portal, if needed Begin or continue activating patients on the portal Monitor portal usage by running EMR reports
ACI Measures- Health Information Exchange Objective: Measure: Health Information Exchange Send a Summary of Care The 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 receiving health care clinician for and least one transition of care or referral. What you need to do: Talk with your EMR vendor about direct messaging functionality Set up direct messaging in EMR Begin collecting direct email addresses from other physicians so you can send direct messages. Monitor progress of sending messages electronically using EMR reports.
ACI Measures- Request/Accept Summary of Care* Objective: Measure: Health Information Exchange Request/Accept Summary of Care For at least one transition of care or referral received or patient encounter in which the eligible clinician has never before encountered the patient, the eligible clinician receives or retrieves and incorporates into the patient s record an electronic summary of care document. What you need to do: Talk with your EMR vendor about direct messaging functionality Set up direct messaging in EMR Begin collecting direct email addresses from other physicians so you can send direct messages. Monitor progress of sending messages electronically using EMR reports. Be sure you can accept electronic messages. *Included in Base and worth up to 10% for performance score (not included in transitional measures)
ACI Measures- Clinical Information Reconciliation Objective: Measure: Health Information Exchange Clinical Information Reconciliation For at least one transition of care or referral received or patient encounter in which the eligible clinician has never before encountered the patient, the eligible clinician performs clinical information reconciliation. The eligible clinician must implement clinical information reconciliation for the following three clinical information sets: (1) Medication. Review of the patient s medication, including the name, dosage, frequency, and route of each medication. (2) Medication allergy. Review of the patient s known medication allergies. (3) Current Problem list. Review of the patient s current and active diagnoses. What you need to do: Check with EMR on updated functionality to meet the measure. Perform electronic reconciliation of medications, medication allergies, and current problem list. Parse information into EMR
ACI Measures- Patient-Specific Education Objective: Measure: Patient Electronic Access Patient-Specific Education The 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 eligible clinician. What you need to do: Work with your vendor to understand how patient education is identified electronically from your EMR. Make sure that this education can be sent to the patient s portal.
ACI Measures- View, Download, Transmit (VDT) Objective: Measure: Coordination of Care Through Patient-Engagement View, Download, or Transmit (VDT) During the performance period, at least one unique patient (or patient-authorized representatives) seen by the eligible clinician actively engages with the EHR made accessible by the eligible clinician. An eligible clinician may meet the measure by either (1) view, download or transmit to a third party their health information; or (2) access their health information through the use of an API that can be used by applications chosen by the patient and configured to the API in the MIPS eligible clinician s CEHRT; or (3) a combination of (1) and (2). What you need to do: Determine if you need to set up patient portal Work with vendor to set up portal, if needed Encourage patients to use the portal to view their health information. (labs, medications, other results etc.) Monitor portal usage by running EMR reports
ACI Measures- Secure Messaging Objective: Measure: Coordinate Care Through Patient-Engagement Secure Messaging For at least one unique patient seen by the 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). What you need to do: Determine if you need to set up patient portal Work with vendor to set up portal, if needed Send messages to patients portals. Encourage patients to use portal to send office messages. Monitor portal usage by running EMR reports
ACI Measures- Patient-Generated Health Data Objective: Measure: Coordinate Care Through Patient-Engagement Patient-Generated Health Data Patient-generated health data or data from a non-clinical setting is incorporated into the CEHRT for at least one unique patient seen by the eligible clinician during the performance period. What you need to do: Contact your vendor for understanding of how to meet this measure.
ACI Measures- Immunization Registry Reporting Objective: Measure: Public Health and Clinical Data Registry Reporting Immunization Registry Reporting The eligible clinician is in active engagement with a public health agency to submit immunization data and receive immunization forecasts and histories from the public health immunization registry/immunization information system (IIS). What you need to do: Make sure that you have registered your intent to submit immunization data to NYSIIS on the NYSIIS website. https://commerce.health.state.ny.us/public/hcs_login.html
ACI Scoring-Example Base Score: Measure Result Required for Base Score Security Risk Analysis Yes Conduct risk assessment. E-Prescribing 30/750 At least 1 in the numerator* Provide Patient Access 250/750 At least 1 in the numerator* Health Information Exchange 650/750 At least 1 in the numerator* Fulfilled base score = 50% *Base score achieved because all measures with numerator/denominator have more than the requirement of 1 in the numerator.
Performance Score: ACI Scoring-Example Measure Num/Den Perf. Rate Percentage Score Provide Patient Access 250/750 33% 8% (worth 20%) Health Information Exchange View, Download, Transmit Total Performance = 49% 650/750 87% 18% (worth 20%) 475/750 63% 7% Secure Messaging 100/750 13% 2% Medication Reconciliation Patient Specific Education 250/750 33% 4% 0/750 0% 0% Immunization Registry Yes 10%
ACI Scoring- Example Bonus Score: No bonus measures reported. Total Bonus Score = 0%
ACI Scoring- Example Base Score 50% Performance Score 49% Bonus Score 0% Total Score = 99% *Earn 100% or more and receive the full 25 points for the Advancing Care Information Performance Category
Takeaways- CMP ACO Participant 1. Find out what version of CEHRT you have. 2. Contact EMR vendor to ensure all functionality to meet base score is ON. Patient Portal Direct Messaging Make sure you understand portal and direct messaging functionality in your EMR. 3. Decide what performance measures you will focus on. 4. Report at least the ACI Base Score measures (or transition measures) for ACO Quality, If not exempt from MIPS. Non CMP ACO Participant 1. Find out what version of CEHRT you have. 2. Contact EMR vendor to ensure all functionality to meet base score is ON. Patient Portal Direct Messaging Make sure you understand portal and direct messaging functionality in your EMR. 3. Decide what performance measures you will focus on. 4. Report MIPS ACI measures or 2017 Transition Measures for score of up to 25%.
QUESTIONS? THANK YOU FOR ATTENDING!
Announcements ACO Notifications PECOS-Maintain active enrollment 2017 Patient Prospective Lists Upcoming provider/office manager meetings: CMP/IHA PRIMARY VALUE MEETING Internal Medicine, Family Practice and Office Managers Hilton Garden Inn, Airport September 28, 2017 Registration/Dinner 5:30pm 6:00pm Meeting 6:00pm 7:00pm CMP/HealthNow Best Practice Efficiency Meeting Internal Medicine, Family Practice and Office Managers CHARTC Building, Conference Room 1A, B & C 144 Genesee St (Elm/Oak) October 19, 2017 Registration/Dinner 5:30pm 6:00pm Meeting 6:00pm 7:00pm Sheree M Love ACO Clinical Transformation Specialist sarnold@chsbuffalo.org (716)862-2453