WIO 215 Summer Symposium 8/7/215 Update on Medicare Quality Reporting Programs and the IRIS Registry Women in Ophthalmology 215 Summer Symposium August 7, 215 Rebecca Hancock Manager, Quality & HIT Policy American Academy of Ophthalmology Agenda Medicare Quality Reporting Programs IRIS Registry What s Next: Future Quality Reporting 1
WIO 215 Summer Symposium 8/7/215 Medicare Quality Reporting Programs EHR Meaningful Use Created by the Health Information Technology for Economic and Clinical Health (HITECH) Act Intended to stimulate adoption of EHRs by providing financial incentives to physicians who demonstrate meaningful use of an EHR 2
WIO 215 Summer Symposium 8/7/215 EHR Meaningful Use Goals EHR Meaningful Use Physicians not using electronic medical records and failing to meet the Federal government s meaningful use regulations will see their Medicare physician payments cut These penalties are substantial: 1 percent in 215 2 percent in 216 3 percent in 217 3
WIO 215 Summer Symposium 8/7/215 EHR Meaningful Use Over half of ophthalmologists are receiving the 1 percent penalty this year Ophthalmology has received over $21 million in Meaningful Use incentive payments since start of program Meaningful Use: Recent Policy Developments CMS Proposed Rules: Proposed Modifications to Stages 1 and 2 Meaningful Use Stage 3 Congressional Action: Senate HELP Committee EHR Workgroup Flex IT Act 2 21st Century Cures Act 4
WIO 215 Summer Symposium 8/7/215 Ophthalmology & PQRS 213 PQRS: 7% of ophthalmologists participated Of those, 75% earned bonus Average bonus to ophthalmologists, $169 Ophthalmology earned $17.9 M in PQRS bonuses 28% ophthalmologists receiving 1.5% penalty this year 214 PQRS: 75% of respondents to Academy survey indicated they were participating or planned to participate in 214 PQRS 215 PQRS No more incentive. To avoid 2% penalty in 217: Report 9 measures across 3 domains for 5% of patients, Including 2 cross cutting measures (cross cutting measures required for claims and traditional registry reporting) QCDR Reporting requires reporting 9 measures on all patients, all payers, including 2 outcome measures Claims reporting not feasible for most ophthalmologists Cataract Measures Group still an option 5
WIO 215 Summer Symposium 8/7/215 Proposed: 216 PQRS Penalty remains at 2 percent Reporting requirements remain the same Cataract Measures Group still an option New Diabetic Retinopathy Measures Group Diabetes: Hemoglobin A1c Poor Control Diabetic Retinopathy: Documentation of Presence or Absence of Macular Edema and Level of Severity of Retinopathy Diabetic Retinopathy: Communication with the Physician Managing Ongoing Diabetes Care Diabetes: Eye Exam Documentation of Current Medications in the Medical Record Preventive Care and Screening: Tobacco Use: Screening and Cessation Intervention Preventive Care and Screening: Screening for High Blood Pressure and Follow-Up Documented Value-Based Modifier CMS is required to phase in VBM from 215-217 to adjust physician payments based on cost and quality VBM adjustments are based on PQRS participation 2 years prior to the VBM year 215 Groups of 1+ 216 Groups of 1+ 217 All Physicians 6
WIO 215 Summer Symposium 8/7/215 Value-Based Modifier 215 If at least 5% of eligible professionals (EPs) in a practice do NOT successfully participate in PQRS, and depending on your cost and quality score, penalties in 217 can reach up to: -2 percent for groups < 1 EPs* and solo practitioners -4 percent for groups > 1 EPs* * Calculation of practice size includes ODs, PAs, NPs Value-Based Modifier 215 Practices with 1-9 MDs / ODs that participate in PQRS in 215 will not have negative adjustments in 217 Practices with 1+ MDs / ODs that participate in PQRS in 215 may have negative adjustments in 217 7
WIO 215 Summer Symposium 8/7/215 Proposed: 216 VBM Penalty and bonus amounts remain the same Small groups and solo practitioners would be subject to penalty for high costs and low quality 215 Quality Reporting Programs: Bonuses Value-Based Modifier Incentives available to high quality / low cost practices EHR Incentive Program $4,-$8, per physician if started in the program prior to 214 8
WIO 215 Summer Symposium 8/7/215 215 Quality Reporting Programs: Penalties PQRS -2 percent in 217 Value-Based Modifier *based on 215 PQRS reporting and cost of care -2 percent in 217 (groups of <1 and solos) -4 percent in 217 (groups of >1 or more) EHR Incentive Program -3 percent in 217 Value Based Purchasing VBP 9 1 11 12 13 14 15 16 17 18 PQRS (Successful Participation ) (Not Participating ) EHR (Achieve MU) 2 2 1.5.5.5 *Beginning in 211, physicians can earn up to $44, for adoption of EHR/MU (Qualifying for EHR MU precludes e-prescribing bonus) -1.5-2 -2-2 (Not Achieving) -1-2 -3-3 to - 5 VBM (based on PQRS participation ) -1 to +2x (groups of 1+) -2 to +2x (groups of 1 or more) -4 to +4x (groups of 1 or more) -2 to +2x (groups of 1-9) TBD Potentially -4 (or more) Total Exposure 4% 4% 2.5% * +2% to -1% * +1.5% to -1.5% * +1% to -2% * -3.5% to +2x Potentially -6% Potentially -9% Potentially -9 to 11% 9
WIO 215 Summer Symposium 8/7/215 IRIS Registry Introduction to IRIS Registry IRIS Registry (Intelligent Research In Sight) is the nation s first comprehensive eye disease clinical database Enables ophthalmologists to use clinical data to improve care delivery and patient outcomes Helps practices meet requirements of the federal quality reporting programs Uses HIPAA-compliant methods to collect data from patient records directly from electronic health record (EHR) systems 1
WIO 215 Summer Symposium 8/7/215 Current Stats (July 1, 215) Contracted 8,846 physicians from 3,393 practices Total for EHR Integration 6,85 physicians from 1,912 practices Number of patient visits 31+ million, representing 1.3 million unique patients The Big Idea The impact big data will have on medicine The power of aggregated data can t be underestimated. There will be a rapid evolution of new types of scientific inquiry to include elements of correlation in addition to causation the power of big data! Aggregated data allows researchers to identify correlations related to outcomes and develop predictive risk assessment models and questions for further inquiry 11
WIO 215 Summer Symposium 8/7/215 The Big Idea What is unique about the IRIS Registry It is an outpatient registry with the ability to follow patients longitudinally using probabilistic matching (94%) o Other surgical registries record the short term evaluation of drugs, devices and procedures, but are unable to measure their impact on the natural course of the disease the IRIS Registry will! Big data will facilitate ophthalmic drug and device surveillance and the IRIS Registry can serve as the backbone for mandated FDA post-market studies Value of IRIS Registry Evaluate your own data Benchmark your outcomes against your practice colleagues or national averages Manage your patients at a population level Look at a specific group of patients based on conditions, risk factors, demographics or outcomes Identify trends and track interventions Answer specific clinical questions 12
WIO 215 Summer Symposium 8/7/215 Value of IRIS Registry Regulatory compliance benefits The IRIS Registry can report on your behalf to satisfy requirements o for PQRS o to report meaningful use clinical quality measures o to report on quality measures for the value-based modifier Reduces the reporting burden o The IRIS Registry is updated as needed and submits the data required to meet new criteria, with no extra work on your part o The Academy keeps you informed of any necessary clinical changes 13
WIO 215 Summer Symposium 8/7/215 Value of IRIS Registry Your data extracted from your EHR system IRIS Registry Your individual performance improvement dashboard Physician Quality Reporting System Meaningful use quality measure reporting Meaningful use stage 2 menu: report to registry Quality measures for value-based modifier IRIS Registry and Quality Reporting IRIS Registry supports several options to help practices succeed in quality reporting programs this year and avoid 217 penalties: IRIS Registry EHR System Integration Cataracts Measures Group Individual Measure Reporting via IRIS Registry Qualified Registry (no EHR) Individual Measure Reporting via IRIS Registry Qualified Clinical Data Registry (QCDR) (no EHR) Group Reporting Option 14
WIO 215 Summer Symposium 8/7/215 How IRIS Registry Works Data entry methods There are two ways to enter your data EHR integration with automatic uploads Web portal with manual entry EHR integration with automatic uploads FIGMD s System Integration (SI) Solution is designed to integrate with your EHR and enables you to seamlessly participate in the IRIS Registry without any workflow modification or interference The system integration solution is compatible with nearly any EHR system all versions, no matter how much customization you ve done How IRIS Registry Works Data entry methods How it works with your EHR The EHR system integration for the IRIS Registry involves the installation of a piece of interface software known as the Light Weight Connector This software is installed on a server in your practice and helps us interface with your EHR system in order to extract IRIS Registry data fields for reporting 15
WIO 215 Summer Symposium 8/7/215 How IRIS Registry Works Currently integrated with 34 EHR systems ChartLogic Compulink DoctorSoft eclinicalworks EyeDoc EMR Eyefinity ExamWRITER EyeMD EMR First Insight GE Centricity HCIT ifa systems imedicware Integrity IO Practiceware KeyChart EMR ManagementPlus MDIntelleSys MDoffice Medflow Medinformatix EHR NexTech NextGen SRS VersaSuite Vitera Intergy EHR WebChart by MIE How IRIS Registry Works Data entry methods Web portal Documentation in a medical practice is often done on paper at the point-ofcare; not all practices currently use EHR systems You can still participate in the IRIS Registry by manually entering your data in the online portal However, this method is much more time consuming than the EHR integration option 16
WIO 215 Summer Symposium 8/7/215 What s Next: Future Quality Reporting HR 2, Medicare Access and CHIP Reauthorization Act Repeals the problematic sustainable growth rate (SGR) methodology and Fundamentally changes the way Medicare determines and updates payments to physicians Incentivizes development and participation in Alternative Payment Models (APMs) 5% bonus 219-224 Establishes Merit Based Incentive Program (MIPS) 17
WIO 215 Summer Symposium 8/7/215 MIPS Effective January 1, 219 (217 performance year) Consolidates and replaces several existing incentive programs (PQRS, MU, VBM) Incentives would be based on composite score for each professional 4 Performance Categories Quality Resource Use Clinical Practice Improvement Activities MU of an EHR MIPS Weighting Performance based on: Quality measures 3% (5% - 219, 45% - 22) Resource use 3% (1% - 219, 15% - 22) Clinical practice 15% MU EHR 25% (15% if 75% qualify) Weights can change over time. When 75% of eligible achieve MU EHR, weight for that could be reduced to 15% to emphasize other categories. 18
WIO 215 Summer Symposium 8/7/215 MIPS Incentives Professionals with composite scores at the established threshold (mean/median) would receive no adjustment, higher scores receive higher adjustment, performance scores below the threshold would lead to a negative adjustment Adjustment factor plus or minus: 219 4% 22 5% 221 7% 222 9% An additional MIPS adjustment (up to 1%) could be earned for exceptional performance from 219-224 MIPS IRIS Registry will continue to support quality reporting The Secretary shall encourage the use of qualified clinical data registries in carrying out this subsection Academy is exploring and advocating to further align MIPS with IRIS participation 19