cms: now and later - azalea health · 2017-09-12 · cms: now and later august 19, 2016 ryan e....
TRANSCRIPT
CMS: NOW AND LATER
AUGUST 19, 2016
Ryan E. Spikes, RN BSN, CHTS-IM/PW, CHTS, PCMH
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?
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
2016 MEANINGFUL USE REQUIREMENTS
# Measure Information Requirements
4 Electronically generate and transmit
permissible prescriptions
50% or more permissible prescription
written by the EP must be checked with a
drug formulary
5 EP’s that transition or refer their patients to
another care setting or provider must
provide a summary of care record
Summary of care record must be created by
an EHR
10% or more of all patients must have a
summary of care record
6 EP’s must provide patient-specific education
resources to their patients
Must provide education resources to 10%
or more of all unique patients
7 Ep’s who receive patients from another care
setting must perform a medication
reconciliation
Must perform a medication reconciliation
report for 50% or more of transitions of
care
2016 MEANINGFUL USE REQUIREMENTS
# Measure Information Requirements
8 Provide patients the ability to view online,
download, and transmit their health
information
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
9 Use secure electronic messaging to
communicate with patients
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
• 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
MACRA QUALITY PAYMENT PROGRAM
WHO IS ELIGIBLE?
2017 and 2018
Medicare Part B Physicians, Physician Assistants,
Nurse Practitioners, Clinical Nurse Specialist, and
Certified Nurse Anesthetists
2019+ May Broaden Clinician Groups
May Include: OT, PT, Speech Pathologist, Audiologists,
Nurse Midwives, Clinical social workers, Clinical
Psychologists, Dietitians / Nutritional Professionals
Who will NOT Participate in MIPS?
MACRA QUALITY PAYMENT PROGRAM
Merit-Based Payment
System
(MIPS)
Advanced Alternative
Payment Models
(APMs)
OR
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
MIPS
Performance Category MIPS Composite
Performance Score
(CPS)
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)
80 to 90 Points based on
volume and
benchmarksh
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)
100 Points
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)
60 Points
½ points if participating
in APMs
Full point participating in
medical homes
Resource Use/Cost: CMS will calculate claims data and volume Average score
MIPS
10%
50%15%
25%
How Providers Will Be Scored
Cost
Quality
Improvement Activities
Advancing Care Information
BASE SCORE – 50 POINTS
Advancing Care Information
SAMPLE EQUATIONADVANCING CARE 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
40+40+0=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
40+73+1=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
MIPS
2019
±4%
2020
±5%
2021
±7%
2022+
±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%
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
• 2019-2026 Clinicians will receive a 5% Medicare Part B incentive Payment
• 2026 and later Clinicians will receive a higher incentive payment
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
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
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
A direct node on the
Georgia health
information network is
known as a Qualified
Entity
THE BIG PICTURE
MU Stages 1-3
Barrier Mitigation via value-added
services
EHR
Implementation
Resource &
Support
•Boots on the Ground
•Distance Learning
•Web based training
Outreach, Education & Training
•Lab Interface
•HIE outreach and education
•Meaningful Use Assistance
HIT Infrastructure
•PCMH, ACOs
•Improve clinical outcomes
Practice Management
•EHR adoption, Vendor utilizationResearch
HIT Center
EMR Implementation Resource &
Support
Cloud-based Technical Solutions
Practice Management
Outreach, Education &
Training
SUPPORTS GEORGIA PROVIDERS & HOSPITALS
• 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
• 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)
• South Carolina Health Information Exchange • East Tennessee Health Information Network• Alabama’s One Health Record®
Texas (HIETexas) Veterans Health Administration
State Agencies
CMO
Hospitals
NationalExchange
Regional HIEs
Specialty Connection
41 Providers
connected;
over 20,000
patients registered
RESOURCES
• Centers for Medicare and Medicaid Services
• www.cms.gov/ehrincentiveprograms
• http://go.cms.gov/QualityPaymentProgram
• Office of the National Coordinator
• www.healthit.gov
• GA Department of Community Health
• http://dch.georgia.gov/medicaid-ehr-incentive-program
• GA Health Information Network
• www.gahin.org
• GA-HITEC
• www.ga-hitec.org
QUESTIONS?