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Understanding Medicaid MU & MIPS
David Heller
Industry & Government Affairs Manager
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Agenda
• Overview
• Reporting & Eligibility
• Objectives & measures
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Poll question
What are you participating in this year?
a) MIPS
b) Advanced APM
c) Other APM
d) Medicaid MU
e) Medicare MU (Part A)
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MIPS VS MEDICAID MUOVERVIEW
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ONC CEHRT supports different regulations and programs
MIPS (MACRA)
• Standard MIPS
• MIPS APMs
• Medical Homes
Medicaid EHR
Incentive Program
Advanced APMs
• CPC+
• MSSP Tracks 2 and 3
• Next Generation ACO
ONC Certification
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Policy timeline
2011
MACRA & Meaningful Use Stage 3
ACA (introduces MSSP)
Meaningful Use Stage 1
2012
2014
2015
2022+
2010
2017+
2006 PQRS
CPCi
Meaningful Use Stage 2
Value-based Modifier
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THE MEDICARE TIMELINE
2019201820172016
• Final performance period for MU/PQRS/VBM
• Payment year for 2014 performance period
MACRA activities
• Payment year MU/PQRS/VBM (2015 performance)
• Final payment year for MU/PQRS/VBM (2016 performance)
• First MIPS performance period
• Report on either ACI Transition Year (Modified Stage 2) objectives or ACI (Stage 3) objectives
• 4 reporting options
• Must begin reporting by Oct. 2
• Second performance period for MIPS
• Stage 3 only & 2015 CEHRT required
• Feedback report from CMS due in July
• May elect 90 day reporting period to account for CEHRT upgrades to 2015 ed.
• Payment year for 2017 MIPS performance period
• Performance period for 2021
• “ACI” objectives –same as Stage 3
Sunsetactivities
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A single MIPS composite performance score will factor in performance in four weighted categories on a scale of 0-100
MIPS at a glance
QUALITYRESOURCE USE/COST
CLINICAL PRACTICE IMPROVEMENT
ACTIVITES
ADVANCING CARE INFORMATION
Replaces PQRS. Accounts for 60% of total performance score in year
one.
Replaces VBM. Accounts for 0%
of total performance score in year
one.
Accounts for 15% of total performance score in year
one.
Replaces Medicare MU. Accounts for 25% of total performance score in year
one.
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MIPS payment adjustments
2022+
±4%
±5%
±7%
±9%
• The potential maximum adjustment % will increase each year from 2019 to 2022
Maximum Adjustments
• Composite Performance Score, clinicians will receive +/- or neutral adjustments up to the percentages shown here
Based on MIPS
2021
2020
2019
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1
2
3
Administered by the statesVary levels and years of participation based on state readiness, so program is staggered out over six year periods. States decide CQM reporting.
Incentives, not penaltiesSix years of incentives paid out, with the highest amount paid in year one for adoption and implementation. 2016 is the final year of entry, 2021 final year of incentives.
Three StagesWith Stage 2 and Stage 3 available in 2017, and Stage 3 mandatory beginning in 2018.
Medicaid Meaningful Use at a glance
10 I
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Medicaid Meaningful Use sample payment timeline
2018
$63,750
$8,500
$8,500
2019
2020
2021
2022+
2017
Total
2016 $21,250
$8,500
$8,500
$8,500
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REPORTING AND ELIGIBILITY
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Let’s define reporting
• Collect data during the “reporting period”
– 90 days or full calendar year
• Define date range in your system for reporting
• Report that data after the calendar year via:
– Attestation
– EHR
– Web interface
– Registry
• Usually February-March timeframe
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Eligible Professional vs Eligible Clinician
Medicaid EP MIPS EC
Today, physicians (MD/DO and DMD/DDS), PAS, NPS, clinical nurse specialists, certified registered nurse anesthetists.In the future, may include physical or occupational therapists, speech-language pathologists, audiologists, nurse midwives, clinical social workers, clinical psychologists, dietitians/nutritional professionals
Physicians (primarily of medicine and doctors of osteopathy), NPs, certified nurse-midwife, dentists, PAs
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MIPS does not apply to hospitals or facilities
Who is not eligible to participate in MIPS?
First year of Medicare
Part B participation
Below low patient volume
threshold
Certain participants in
Advanced APMs
Medicare billing charges ≤ $30,000 OR providers care for ≤ 100 patients in one year
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Who is eligible to participate in Medicaid Meaningful Use?
30% Medicaid patient volume
20% Medicaid patient
volume, and a pediatrician
Mainly in FQHC or RHC, 30% patient volume of needy
individuals
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Eligible clinician reporting
GROUP
A group, as defined by taxpayer identification number (TIN), would be
assessed as a group practice across all four MIPS performance categories
INDIVIDUAL VIRTUAL
To be implemented in future years
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Eligible professional reporting
INDIVIDUAL
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MIPS 2017 reporting options
Don’t participate, and receive a 4% negative adjustment rate in 20171
Submit one quality measure, one improvement activity, or the required ACI measures for at least 90 days and avoid a negative adjustment
Submit at least more than one quality measure, more than one improvement activity, or more than the required ACI measures for at least 90 days, and get no adjustment or a small positive one
Submit data to MIPS for the full year, and get a positive adjustment
2
3
4
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MIPS 2018 reporting options
ACI reporting is 90 days1
Improvement Activities reporting is 90 days
Cost and Quality reporting is for the full calendar year
Full participation in MIPS
2
3
4
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Medicaid Meaningful Use 2017 reporting
90 days for MU objectives for new and returning participants1
CQMs depends on the state2
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Medicaid Meaningful Use 2018 reporting
Full calendar year1
CQMs depends on the state2
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OBJECTIVES AND MEASURES
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MU to advancing care information (ACI)
Eliminated Clinical Provider Order Entry and Clinical Decision Support objectives
Removed redundant measures to alleviate reporting burden
Dropped “all or nothing” threshold for measurement, CQMs moved to Quality
Eliminated public health reporting as a requirement
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50
90
15
Bonus
Base score (must earn or ACI score is 0)
Performance score
Advancing Care Information: Scoring
Capped at 100% maximum, total points available
is 155
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Changes to Advanced Care Information
• Immunization registries are not required, part of the performance score (up to 10%)
• Public Health Reporting bonus increased to 5%
• Reduced reporting from 11 to 5 for the base score
• Only need to report a Y or numerator of 1
Interoperability
Required measures
Interop
Required measures CPIA
• Use CEHRT to meet one improvement activity can get up to 10% performance bonus
CPIA
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Medicaid Meaningful Use: Scoring
Pass
FailExceed all thresholds on all measures, and
pass to receive incentive dollars.
Do not exceed on a single threshold, and unless an exclusion applies to it, fail and
receive nothing.
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ACI & Stage 3Stage 3
ACI
Required in Stage 3’s Pass/Fail criteria
Connect to two registries
Exclusions do not count as connections
Requires “active engagement”
Active engagement means “moving towards sending
production data…”
Same set of measures
Performance score for immunization registries
Bonus score for all other registries
Not required
Public Health Reporting: ACI vs. Stage 3
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Accept/requestsummaries of
care
PGHD
More public health
options
From 2017 to 2018: More, more, and more
29 I
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Advancing Care Information: 2018 onwardObjective Measure Required Performance
Protect Patient Health Information
Security Risk Analysis
Y 0
Electronic Prescribinge-Prescribing
Y 0
Patient Electronic Access
Provide Patient AccessY Up to 10%
Patient-Specific EducationN Up to 10%
Coordination of Care Through Patient Engagement
View, Download or Transmit (VDT)N Up to 10%
Secure MessagingN Up to 10%
Patient-generated health dataN Up to 10%
Health Information Exchange
Send a Summary of CareY Up to 10%
Request/Accept Summary of Care Y Up to 10%
Clinical Information Reconciliation N Up to 10%
Public Health and Clinical Data Registry Reporting
Immunization Registry ReportingN 0 or 10%
Syndromic Surveillance ReportingN
Up to 5% bonus per measure, 15% maximum bonus allowed
Electronic Case ReportingN
Public Health Registry Reporting N
Clinical Data Registry ReportingN
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Medicaid Meaningful Use Stage 3 (2018)Objective Measure Exclusions Threshold
Protect Patient Health Information
Security Risk AnalysisY/N 0
Electronic Prescribinge-Prescribing
Y 60%
Clinical Decision Support (CDS)
CDS interventions related to four or more CQMs NA 4 interventions
Functionality implemented for drug-drug and drug-allergy interaction checks.
EP writes fewer than 100 medication orders
NA
Computerized Provider Order Entry (CPOE)
Record medications with CPOE EP writes fewer than 100 medication orders
60%
Record lab orders with CPOEEP writes fewer than 100 lab orders 60%
Record imaging orders with CPOE EP writes fewer than 100 imagingorders
60%
Patient Electronic Access
Provide access1) No office visits, or 2) 50% of
encounters in a county with low broadband availability
80%
Patient-specific education35%
Coordination of Care through Patient Engagement
View, Download or Transmit (VDT)
1) No office visits, or 2) 50% of encounters in a county with low
broadband availability
5%
Secure Messaging5%
Patient-generated health data5%
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Medicaid Meaningful Use Stage 3 (2018)Objective Measure Exclusions Threshold
Protect Patient Health Information
Security Risk AnalysisY/N 0
Electronic Prescribinge-Prescribing
Y 60%
Clinical Decision Support (CDS)
CDS interventions related to four or more CQMs NA 4 interventions
Functionality implemented for drug-drug and drug-allergy interaction checks.
EP writes fewer than 100 medication orders
NA
Computerized Provider Order Entry (CPOE)
Record medications with CPOE EP writes fewer than 100 medication orders
60%
Record lab orders with CPOEEP writes fewer than 100 lab orders 60%
Record imaging orders with CPOE EP writes fewer than 100 imagingorders
60%
Patient Electronic Access
Provide access1) No office visits, or 2) 50% of
encounters in a county with low broadband availability
80%
Patient-specific education35%
Coordination of Care through Patient Engagement
View, Download or Transmit (VDT)
1) No office visits, or 2) 50% of encounters in a county with low
broadband availability
5%
Secure Messaging5%
Patient-generated health data5%
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Medicaid Meaningful Use Stage 3 continuedObjective Measure Exclusions Threshold
Health Information Exchange
Send summaries of care Less than 100 transfers, or 50% or more encounters in a county with low
broadband availability50%
Receive summaries of care Fewer that 100 transitions or referrals received, or 50% or more encounters in
a county with low broadband availability
40%
Clinical information reconciliation Fewer than 100 transitions or referrals received 80%
Public Health Reporting
Immunization Registry Does not give immunizations, no registry in your jurisdiction, or no
registry that has declared readiness
Actively engage two registries
Syndromic Surveillance No that right kind of provider, no publichealth agency capable of receiving this
data, or no public health agency has declared readiness
Electronic Case Does not treat or diagnose reportable diseases, no public health agency
capable of receiving the data, or no public health agency has declared
readinessPublic Health Registry Does not treat diagnose diseases
association with the registry, no public health agency is capable of receiving
the data, or no public health agency has declared readiness
Clinical Data Registry Does not treat diagnose diseases association with the registry, no public health agency is capable of receiving
the data, or no public health agency has declared readiness
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Poll question
Would you like to be contacted by a sales representative to learn more about SuccessEHS?
a) Yes
b) No
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SuccessEHS v9.0 Webinar
• Join us by clicking the link below:
• https://attendee.gotowebinar.com/register/7295079713007146241
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Resources
• Stage 3 Public Health Objective Specifications and Definitions
• https://qpp.cms.gov/
• Medicaid Payment Incentive Timeline