Download - Quirk Healthcare: 2014 HIT Road Map
2014 HIT Road Map Wednesday, February 12, 2014
Disclaimer: Nothing that we are sharing is intended as legally binding or prescrip7ve advice. This presenta7on is a synthesis of publically available informa7on and best prac7ces.
2014 – An Overview
• NextGen 5.8 and KBM 8.3 upgrades • ICD-‐10 • Meaningful Use Stage 1 (MU1)
• Meaningful Use Stage 2 (MU2)
• Physician Quality ReporQng System (PQRS)
• PaQent-‐Centered Medical Home (PCMH)
• Accountable Care OrganizaQons (ACOs)
OpQmal 2014 HIT Road Map
NextGen 5.8 Upgrade
• Prerequisite for KBM 8.3 upgrade • ICD-‐10, SNOMED, and MU2-‐ready • Log-‐in • Advanced Audit • Race, ethnicity, and language • PaQent status designaQon • Syndromic surveillance measure • Diagnosis module • PaQent educaQon • ePrescribing • PaQent informaQon bar
KBM 8.3Upgrade
• Non-‐KBM/KBM 8.1 or earlier • ICD-‐10 and MU-‐compliant • Upgrade cost and effort predicated on current KBM version
• Scope of conversion based on customizaQon, data mapping, and workflow changes
• Upgrade opQons – In-‐house – Outsource
Do You Have The Right Hardware?
• Windows OperaQng System • Windows workstaQons
• Server size • Development environment
• SQL Server • Separate SQL server for reports, HQM, and Advanced Audit
ICD-‐10
• October 1, 2014 • All enQQes covered by HIPAA affected • 14,000 ICD-‐9 codes grow to 68,000 ICD-‐10 codes • No impact on CPT codes • Version 5010 standards • Significant changes to clinical and revenue cycle systems
• Complex conversion to updated codes • System upgrades to expand data fields for longer codes • Staff retraining on new versions and codes
What Are ICD-‐10 Codes?
• Granular code set developed by WHO for: – Increased clinical accuracy – Improved disease tracking – Disease trending
• More ICD-‐10 codes compared to ICD-‐9
ICD-‐9 14,000 diagnosis codes 4,000 procedure codes 5 digit numeric codes
ICD-‐10 68,000 diagnosis codes 87,000 procedure codes
7 digit alphanumeric codes
Anatomy of ICD-‐10 Diagnosis Codes
• 3–7 digits • Digit 1 is alpha, including O and I but no U • Digit 2 is numeric • Digits 3–7 are alpha (not case sensiQve) or numeric • Decimal is aher third digit • Examples:
– A78 – Q fever – A69.21 – MeningiQs due to Lyme disease; and – S52.131a – Displaced fracture of neck of right radius, iniQal encounter for closed fracture
Anatomy of ICD-‐10 Procedure Codes
• 7 digits • Alpha (not case sensiQve) or numeric digits – O and I not used to avoid confusion with 0 and 1
• No decimal • Examples: – 0FB03ZX – Excision of liver percutaneous approach, diagnosQc; and
– 0DQ10ZZ – Repair upper esophagus, open approach
What is SNOMED?
• SystemaQzed Nomenclature of Medicine – Clinical Terminology
• InternaQonal standard for clinical terminology • Available through the NaQonal Library of Medicine • Enables communicaQon in common language
– Increased quality of paQent care across specialQes – Improved accuracy of paQent data analysis
• 19 “hierarchies” define the clinical concept • Increasing granularity • Very specific clinical concepts to define paQent condiQon • More complex than ICD-‐10 hierarchy
The ICD-‐10-‐SNOMED RelaQonship
• SNOMED CT has beoer clinical coverage than ICD • Number of codes:
– SNOMED CT (Clinical findings): 100,000 – ICD-‐9-‐CM: 14,000 – ICD-‐10-‐CM: 68,000
• ICD focus is staQsQcal – Less common diseases subsumed under general categories – Aher-‐the-‐fact codes
• SNOMED CT is clinically-‐oriented – Used during care – Clinical relevance and user-‐friendliness
• Clinically coded data generates ICD-‐10 code for billing
EffecQve ImplementaQon Strategy
Impact Analysis • IdenQfy current systems and work processes that use ICD-‐9 codes • Talk with payers about effect of ICD-‐10 implementaQon on provider contracts
Needs Assessment • Workflow and business process changes • Staff training • PracQce management vendor accommodaQons
Project Plan • ImplementaQon plan with clearing houses, billing services, and payers • Inventory systems and workflows • ConQngency plan for failed go-‐live
Budget • Time and costs related to implementaQon • Training • IT/IS upgrade • Assistance from outside vendor/consultant • PotenQal producQvity loss
Conversion • TransacQon tesQng using ICD-‐10 codes • Historic data conversion • Review coded data for claims reimbursement consistent with ICD-‐9 rates
Training
• AHIMA recommendaQon: no more than six months before compliance deadline
• Approximately 16 hours for ambulatory coders and 50 hours for hospital coders – Physician pracQce coders learn ICD-‐10 diagnosis coding only – Hospital coders learn both ICD-‐10 diagnosis and ICD-‐10
inpaQent procedure coding • Specialty-‐specific ICD-‐10 training • ICD-‐10 coding training integrated into credenQal
maintaining CEUs • ICD-‐10 resources and training materials available through
CMS, professional associaQons and socieQes
Meaningful Use
• Set of standards defined by the Centers for Medicare & Medicaid Services (CMS)
• Financial incenQves for using cerQfied EHR technology (CEHRT): – In a meaningful manner – For electronic exchange of health informaQon – Submit Clinical Quality Measures (CQM)
• Three stages – CreaQng informaQon – Exchanging informaQon – Focusing on improved outcomes
MU Stages
MU1
• InformaQon gathering • Two years – 90 days (Year 1) – Full year (Year 2)
• Different schedules for hospitals/CAHs and Eligible Providers (EPs) – Federal fiscal calendar (Hospitals/CAHs) – Calendar year (EPs)
MU2
• All EPs must meet MU1 – Two or three years
• Focus on advanced clinical procedures – Rigorous health informaQon exchange – Enhanced ePrescribing and lab results requirements
– ConQnuity of care across mulQple sesngs – Increased paQent and family engagement
• Improved paQent care
MU Structure
MU1
• 13 Core • 5/10 Menu • Total: 18
MU2
• 17 Core • 3/6 Menu • Total: 20
MU Requirements
• Adopt or upgrade newly cerQfied EHR • ReporQng – Medicare
• First year: Any 90 day reporQng period • Beyond first year: Calendar quarter
– Medicaid • Any 90 day reporQng period
• PaQent Portal
MU CalculaQons
• Denominator – All unique paQents – Subset of unique paQents
• Numerator – Number of unique paQents for whom required informaQon was recorded
Threshold = Numerator
Denominator
MU ReporQng
• ReporQng through aoestaQon – ObjecQves – Clinical Quality Measures
• ReporQng may be: – yes/no answers – numerator/denominator aoestaQon
• Exclusions – Menu objecQves not applicable to every pracQce
• Certain objecQves/measures require 80% of paQents with records in CEHRT
AoestaQon Checklist
• Ensure all EPs are properly registered • Run reports • Validate data • Complete aoestaQon worksheet
• Collect all supporQng documents
• Aoest before 3/31/2014 (MAO – 3/1/2014)
• Be prepared for audit
What is PQRS?
• Voluntary, individual reporQng program – Quality measures for services provided to Medicare beneficiaries
• Started in 2007 – Tax Relief and Health Care Act
• IncenQve payments for parQcipaQon through 2014
• Financial penalty for non-‐parQcipaQon aher 2014 • Measures based on combinaQons of CPT, ICD and paQent age at the Qme of the encounter
Provider ReporQng Methods
• Individual – EHR Direct Product that is CerQfied EHR Technology (CEHRT) – EHR data submission vendor that is CEHRT – Qualified PQRS Registry – ParQcipaQon through a Qualified Clinical Data Registry (QCDR) – Medicare Part B claims submioed to CMS
• Group PracQce ReporQng – GPRO Web Interface – Qualified PQRS Registry – EHR Direct Product that is CEHRT – EHR data submission vendor that is CERT – CMS-‐cerQfied survey vendor
*Group prac*ces repor*ng via GPRO must register for their selected repor*ng method by September 30, 2014.
Measure SelecQon
• Individual Measures – 110 Claims Based Measures
– 201 Registry Based Measures
– 64 EHR Measures
• Group Measures – 25 Measures Groups
• Domains – Clinical Process / EffecQveness
– PaQent Safety
– PopulaQon / Public Health
– Efficient Use of Healthcare Resources
– Care CoordinaQon
– PaQent and Family Engagement
Measure SelecQon
• Which measures should you choose? – Difficulty
– Relevance • Clinical condiQons usually treated – Cardiac, HTN, Diabetes, etc. • Types of care typically provided – e.g., prevenQve, chronic, acute
– Best performance
• 200 standardized quality measures
• Meet 50% threshold requirement – Choose a PQRS quality measure for services that are performed frequently. (This is the
minimum required to prevent penalty)
• IncenQve Payment or Avoid Penalty
• TransformaQve model for delivery of care • Espouses team-‐based approach – Comprehensive and conQnuous paQent-‐driven care
– Evidence based healthcare and best pracQces – Consistent high quality care
• RelaQonship-‐based • Whole person • Team-‐based
PCMH -‐ Overview
What TransformaQon Looks Like
• Constant innovaQon • Key data measurement and improvement targets
• Capitalizing the benefits of EHRs • Regular paQent communicaQon • ProacQvely scheduled paQent follow up • Expanded access to care • PaQent care plan coordinaQon
NCQA RecogniQon Process
• Complete self-‐assessment to idenQfy gaps • Ensure all P&Ps were in effect for at least 90 days
• Run reports • Collate all supporQng documents
• Submit applicaQon
• Builds off PaQent-‐Centered Medical Home – Coordinated care to ensure seamless transiQon between services and levels of care
• Formalizes PaQent-‐Centered Medical Neighborhoods – Brings together primary care physicians, specialists, and hospitals
• Reimbursement amount linked to quality • Launched in 2012
Accountable Care OrganizaQons (ACOs)
ACO Technology Infrastructure
Enterprise Revenue
Cycle Management
Electronic Health
Record
Health InformaQon Exchange InformaQcs
PaQent Engagement
Technology ConsideraQons
PaQent Engagement
Data AggregaQon
PopulaQon Health
Management
Privacy and Security
Clinical and AdministraQve Date Exchange
Performance Management
ReporQng Infrastructure Finances
Startup Costs by Beneficiaries
0
500,000
1,000,000
1,500,000
2,000,000
2,500,000
3,000,000
5,000 -‐ 15,000 16,000 -‐ 25,000 26,000+
Es:mated
Start Up Co
sts
Aligned Beneficiaries
IT Costs
0 100,000 200,000 300,000 400,000 500,000 600,000 700,000 800,000 900,000
1,000,000
5,000 -‐ 10,000
10,000 -‐ 15,000
15,000 -‐ 25,000
26,000+
Costs
Aligned Beneficiaries
Internal IT
External Vendor
