understanding medicaid mu & mips · 2018-03-26 · 1 don’t participate, and receive a 4%...

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Understanding Medicaid MU & MIPS

David Heller

Industry & Government Affairs Manager


Agenda

• Overview

• Reporting & Eligibility

• Objectives & measures


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)


MIPS VS MEDICAID MUOVERVIEW


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


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


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


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.


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


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


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


REPORTING AND ELIGIBILITY


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


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


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


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


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


Eligible professional reporting

INDIVIDUAL


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


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


Medicaid Meaningful Use 2017 reporting

90 days for MU objectives for new and returning participants1

CQMs depends on the state2


Medicaid Meaningful Use 2018 reporting

Full calendar year1

CQMs depends on the state2


OBJECTIVES AND MEASURES


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


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


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


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.


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


Accept/requestsummaries of

care

PGHD

More public health

options

From 2017 to 2018: More, more, and more

29 I


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


Medicaid Meaningful Use Stage 3 (2018)Objective Measure Exclusions Threshold


Security Risk AnalysisY/N 0


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%


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%


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


Poll question

Would you like to be contacted by a sales representative to learn more about SuccessEHS?

a) Yes

b) No


SuccessEHS v9.0 Webinar

• Join us by clicking the link below:

• https://attendee.gotowebinar.com/register/7295079713007146241

https://attendee.gotowebinar.com/register/7295079713007146241


Resources

• Stage 3 Public Health Objective Specifications and Definitions

• https://qpp.cms.gov/

• Medicaid Payment Incentive Timeline

https://www.cms.gov/Regulations-and-Guidance/Legislation/EHRIncentivePrograms/Downloads/MedicaidEPStage3_Obj8.pdf

https://qpp.cms.gov/

https://www.healthit.gov/providers-professionals/ehr-incentive-payment-timeline

understanding medicaid mu & mips · 2018-03-26 · 1 don’t participate, and receive a 4%...

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