Beyond Meaningful Use: Driving Improved Quality CHCANYS Webinar #1: December 14, 2016
Agenda The Current State Measuring Monitoring & Reporting Quality. Meaningful Use 2018 and Beyond The New Quality Payment Programs
2016 MEANINGFUL USE
2016 Reporting Periods EPs that are participating for the first time report 90 days If AIU the prior year If AIU in a prior year but never attested to MU All others have 90 day reporting period between January 1 through December 31 90 day reporting period is also in place for 2017
2016 Reporting Periods AIU has no reporting period (Adopt, Implement or Upgrade to CEHRT) If never participated in the MU program Requires a commitment to certified EHR Must prove eligible for the Medicaid program Note: Last year to AIU is 2016
2016 Stage 2 M : Meaningful Use Measures 1.Conduct Security and Risk Analysis, including encryption 2.Implement 5 clinical decision support interventions and drug/drug and drug/allergy interaction checks 3.Use CPOE- 60% medication, 30% lab and 30% radiology orders 4.E-Rx for 50% of prescriptions, with formulary queried 5.Provide summary of care document electronically for > 10% of transitions of care and referrals 6.Use EHR to provide education to more than 10% of patients 7.Medication reconciliation for 50% of transitions of care 6
2016 Stage 2 M : Meaningful Use Measures 8. Provide online access to health information in 4 days for more than 50% of patients and at least one patient views, downloads or transmits electronic information 9. Secure message sent to at least one patient seen by the EP 10. Engage with Public health- 2 or more from three choices 7
THE CHALLENGING MEASURES: 5, 8, 9 & 10
5. Health Information Exchange Measure Numerator Denominator Exclusions Stage 1 EPs The EP that transitions or refers their patient to another setting of care or provider of care must (1) use CEHRT to create a summary of care record; AND (2) electronically transmit the summary to a receiving provider for >10 % of transitions of care and referrals. The # of transitions of care and referrals in the denominator where a summary of care record was created using CEHRT and exchanged electronically Number of transitions of care and referrals during the period for which the EP was the transferring or referring provider. Any EP who transitions a patient or refers a patient to another provider less than 100 times during the EHR reporting period. same
8. Patient Electronic Access (first of two measures) Measure 1 Numerator Denominator Exclusions Stage 1 EPs >50% of all unique patients seen by the EP are provided timely access to view online, download, and transmit to a third party their health info, -EP may withhold certain information The number of patients in seen who have access to view, download and transmit their health info within four business days after the information is available to the EP. Number of unique patients seen by the EP during the EHR reporting period. Any EP who: Neither orders nor creates any of the information listed or Conducts 50% or more encounters in a county that does not have 50% or more of its housing units with 4Mbps broadband availability according to the latest information available from the FCC on the first day of the EHR reporting period. same
8. Patient Electronic Access (second measure, VDT ) CHANGE for 2017: 5% Measure 2 Numerator Denominator Exclusions Stage 1 EPs For reporting period in 2015 and 2016, at least one patient seen by the EP views, downloads or transmits to a third party his or her health information during the period. The number of patients in the denominator (or patientauthorized representative) who view, download, or transmit to a third party their health information. Number of unique patients seen by the EP during the EHR reporting period. Neither orders nor creates any of the information listed as part of the measures; or Conducts 50 percent or more of his or her patient encounters in a county that does not have 50 percent or more of its housing units with 4Mbps broadband availability according to the latest information available from the FCC on the first day of the EHR reporting period. same
9. Secure Electronic Messaging Measure Numerator Denominator Exclusions Stage 1 EPs For an EHR reporting period in 2016, for at least 1 patient seen by the EP during the EHR reporting period, a secure message was sent using the electronic messaging function of CEHRT to the patient, or in response to a secure message sent by the patient during the EHR reporting period. The number of patients in the denominator for whom a secure electronic message is sent to the patient, or in response to a secure message sent by the patient. Number of unique patients seen by the EP during the EHR reporting period. Any EP who has no office visits during the period, or who conducts 50% or more of his or her patient encounters in a county that does not have 50% or more of its housing units with 4Mbps broadband availability according to the latest information available from the FCC on the first day of the EHR reporting period. same
10. Public Health Reporting (Engage in 2 of the 3 choices) Measure Registries Exclusions Stage 1 EPs The EP is actively engaged with a public health agency to submit electronic public health data from CEHRT except where prohibited and in accordance with applicable law and practice 1. Immunization 2. Syndromic Surveillance 3. Special Registry 1. Does not administer any immunizations to any of the populations for which data is collected by its jurisdiction 2. Is not in a category of providers from which ambulatory syndromic surveillance data is collected by their jurisdiction 3. Does not diagnose or treat any disease or condition or collect relevant data that is required by a specialized registry in their jurisdiction --more-- same
Active Engagement One of these items must be true : 1. Completed Registration intent to submit data 2. Testing and Validation 3. Production validated and electronically submitting
MEASURING, MONITORING & REPORTING QUALITY
Measure Alignment UDS and CMS (MU) UDS Clinical Measures (Table 6b & 7) have been aligned with MU (Quality Payment Program) Health Center s should update the measures in their quality plan to include these new UDS & QPP Measures
Partial Listing Measure UDS PT H3 Mil. Hrts 124 Cervical Cancer Screening 2 165 Controlling High Blood Pressure 6 3 B x 122 Diabetes: Hemoglobin A1c Poor 7 2 Control 155 Weight Assessment and Counseling 8 for Nutrition and Physical Activity for Children and Adolescents 164 Ischemic Vascular Disease (IVD): 10 A x Use of Aspirin or Another Antithrombotic 130 Colorectal Cancer Screening 11 022 Preventive Care and Screening: Screening for High Blood Pressure and Follow-Up Documented x
CPS & CQR GE CPS includes access to a cloud-based reporting tool CQR In order for CQR to capture data accurately, you must update the mapping
Data Mappings
Data Validation Once your Data Mappings are complete you will want to validate your data Manually review charts of lists of patients that have not met the measures to determine if providers are entering data in specific fields or free text Review your data monthly
Quality Measures Reflect the EP s scope of practice CQMs must come from a Certified EHR Zero denominators can be reported Can select the same measures you use for Evidence Now, TCPI, Million Hearts, UDS or other programs
ATTESTATION
MEIPASS There were some technical difficulties with the new system, and ran into a defect Projecting that MEIPASS will reopen early 2017 (January or February). At that time when it reopens, health centers will be able to go in and attest for 2015 and 2016 back to back.
CHCANYS Support Updated Meaningful Use registration steps on our CHCANYS website, which will walk health centers through the steps to complete their MU/AIU registration for their providers. http://www.chcanys.org/index.php?src=ge ndocs&ref=meaningfuluseregistration&ca tegory=health%20care%20reform
Back Up in Case of Audit Expect to be audited sooner or later Audit Binder, electronic or paper Part A applies to all EPs (if group) Volume/encounters report Screen shots, etc. to support yes/no Security Risk Assessment Functions enabled: interaction alerts, CDS, Public Health Source documents for EHR license, reports, etc. Part B for each EP Reports for EPs that practice in multiple locations Dashboard screens or reports
THE FUTURE OF MEANINGFUL USE
Not Exactly! Not True for most of us here True for Medicare Part B Only
Required Upgrades 2011 Edition required CPS 10 2014 Edition required CPS 12 2015 Edition required starting 1/1/2018 CPS?
2018 Stage 3: Meaningful Use 1. Conduct Security and Risk Analysis, including encryption. 2. More than 60% prescriptions are e-rx 3. Implement 5 CDS interventions related to 4 CQMs & drug/drug 4. CPOE for >80% Med, >60% of lab and >60% of diag. imaging orders 5. >80% pts have access to VDT and >35% get education electronically 29
2018 Stage 3: Meaningful Use 6. Must meet two of these regarding electronic access: >10% of patients seen actually view, download or transmit >25% of patients seen are sent a secure message >5% of patients have data from outside the clinic in the EHR 7. Attest to three and must meet two: Electronic summary for >50% of outbound transitions >40% of incoming get summary from an outside source >80% of Incoming have reconciled: Meds, Allergies, Problems 30
2018 Stage 3: Meaningful Use 8. Engage with Public health- 2 or more from five choices 31
DRIVING IMPROVED QUALITY
HHS Core Strategies 1. Improving payment process to incentivize quality and value of care over simply quantity of services 2. Improving care delivery by providing clinical practice support, data and feedback reports to guide improvement and better decisionmaking 3. Making data more available and enabling the use of certified EHR technology to support care delivery
MACRA Medicare Access and CHIP Reauthorization Act of 2015 (MACRA)
The BIG deal about MACRA Changes how Medicare pays individual providers Focuses on value rather than volume Streamlines multiple quality programs MU, PQRS, VBPM Provides incentives and bonus payments for qualifying participation in Alternate Payment Models
QUALITY PAYMENT PROGRAM
MACRA Proposed Rule, May 2016- how to implement that law You can choose how you want to participate based on your practice size, specialty, location, or patient population. The Quality Payment Program has two tracks you can choose: Advanced Alternative Payment Models (APMs) or The Merit-based Incentive Payment System (MIPS)
Quality Payment Program Merit Based Incentive Payment (MIPS): Applies a performance score to provider payments (positive or negative) Based on 4 components Alternate Payment Models (APMs) Bonus payments for participating Can apply to a specific clinical condition condition, care episode or a populations Includes risk sharing (positive or negative) Advanced APMs Bigger bonus
Quality Payment Program If you decide to participate in an Advanced APM, through Medicare Part B you may earn an incentive payment for participating in an innovative payment model. If you decide to participate in MIPS, you will earn a performance-based payment adjustment.
The MIPS Pie Weighted Performance Categories [CATEGORY NAME] [VALUE] Resource Use (Cost) [VALUE] [CATEGORY NAME] [VALUE] [CATEGORY NAME] [VALUE]
Meaningful Use Changes to Advancing Care Information Meaningful Use Must report on all objective and measure requirements One-size-fits-all every measure reported and weighed equally All-or-nothing EHR measurement and quality reporting Misaligned with other Medicare reporting programs Advancing Care Information streamlines measures and emphasizes interoperability, information exchange, and security measures. Clinical Decision Support and Computerized Provider Order Entry are no longer required. Customizable Physicians or clinicians can choose which best measures fit their practice Flexible multiple paths to success Aligned with other Medicare reporting programs. No need to report quality measures as part of this category
MACRA Information www.qbb.cms.gov Regulations & Guidance Legislation EHR Incentive Programs 2016 Program Requirements CMS Specs for Each Measure: https://www.cms.gov/regulations-and- Guidance/Legislation/EHRIncentivePrograms/Downloads/2015EP_Tab leofcontents.pdf
EVALUATION/Q&A
CHCANYS Webinar Survey https://www.surveymonkey.com/r/bqr2qnz
Questions & Thoughts