women in ophthalmology
TRANSCRIPT
WIO 2015 Summer Symposium 08/07/2015
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AMERICAN ACADEMY OF OPHTHALMOLOGY AMERICAN ACADEMY OF OPHTHALMIC EXECUTIVES
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Women in Ophthalmology 2015 Summer Symposium
August 7, 2015
Rebecca Hancock
Manager, Quality & HIT Policy
American Academy of Ophthalmology
Update on Medicare Quality Reporting Programs and the
IRIS® Registry
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Agenda
Medicare Quality Reporting Programs
IRIS Registry
What’s Next: Future Quality Reporting
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Medicare Quality Reporting Programs
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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
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EHR Meaningful Use Goals
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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 2015
• 2 percent in 2016
• 3 percent in 2017
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EHR Meaningful Use
Over half of ophthalmologists are receiving the 1 percent penalty this year
Ophthalmology has received over $210 million in Meaningful Use incentive payments since start of program
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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
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Ophthalmology & PQRS
2013 PQRS: • 70% of ophthalmologists participated
• Of those, 75% earned bonus
• Average bonus to ophthalmologists, $1690
• Ophthalmology earned $17.9 M in PQRS bonuses
• 28% ophthalmologists receiving 1.5% penalty this year
2014 PQRS: • 75% of respondents to Academy survey indicated they
were participating or planned to participate in 2014 PQRS
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2015 PQRS
No more incentive. To avoid 2% penalty in 2017:
• Report 9 measures across 3 domains for 50% 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
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Proposed: 2016 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
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Value-Based Modifier
CMS is required to phase in VBM from
2015-2017 to adjust physician payments
based on cost and quality
VBM adjustments are based on PQRS
participation 2 years prior to the VBM year
2015
Groups of 100+
2016
Groups of 10+
2017
All Physicians
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Value-Based Modifier 2015
If at least 50% of eligible professionals (EPs) in a practice do NOT successfully participate in PQRS, and depending on your cost and quality score, penalties in 2017 can reach up to:
• -2 percent for groups < 10 EPs* and solo practitioners
• -4 percent for groups > 10 EPs*
* Calculation of practice size includes ODs, PAs, NPs
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Value-Based Modifier 2015
Practices with 1-9 MDs / ODs that
participate in PQRS in 2015 will not
have negative adjustments in 2017
Practices with 10+ MDs / ODs that
participate in PQRS in 2015 may
have negative adjustments in 2017
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Proposed: 2016 VBM
Penalty and bonus amounts remain
the same
Small groups and solo practitioners
would be subject to penalty for high
costs and low quality
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2015 Quality Reporting Programs: Bonuses
Value-Based Modifier
• Incentives available to high quality / low
cost practices
EHR Incentive Program
• $4,000-$8,000 per physician if started in
the program prior to 2014
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2015 Quality Reporting Programs: Penalties
PQRS • -2 percent in 2017
Value-Based Modifier *based on 2015 PQRS reporting and cost of care
• -2 percent in 2017 (groups of <10 and solos)
• -4 percent in 2017 (groups of >10 or more)
EHR Incentive Program • -3 percent in 2017
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Value Based Purchasing VBP ’09 ’10 ’11 ’12 ’13 ’14 ’15 ’16 ‘17 ‘18
PQRS (Successful Participation)
2 2 1 .5 .5 .5
(Not Participating)
-1.5
-2
-2
-2
EHR (Achieve MU)
*Beginning in 2011, physicians can earn up to $44,000 for adoption of EHR/MU (Qualifying for
EHR MU precludes e-prescribing bonus)
(Not Achieving)
-1 -2 -3 -3 to -5
VBM (based on PQRS participation)
-1 to +2x (groups of
100+)
-2 to +2x
(groups of 10 or more)
-4 to +4x
(groups of 10 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%
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IRIS® Registry
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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
Introduction to IRIS Registry
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Contracted
• 8,846 physicians from 3,393 practices
Total for EHR Integration
• 6,805 physicians from 1,912 practices
Number of patient visits
• 31+ million, representing 10.3 million unique patients
Current Stats (July 1, 2015)
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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
The Big Idea
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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
The Big Idea
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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
Value of IRIS Registry
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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
Value of IRIS Registry
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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
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IRIS Registry and Quality Reporting
IRIS Registry supports several options to help practices succeed in quality reporting programs this year and avoid 2017 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
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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
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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
How IRIS Registry Works
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Currently integrated with 34 EHR systems
How IRIS Registry Works
• 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
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Data entry methods Web portal
• Documentation in a medical practice is often done on paper at the point-of-care; 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
How IRIS Registry Works
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What’s Next: Future Quality Reporting
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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 2019-2024
Establishes Merit Based Incentive Program (MIPS)
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MIPS
Effective January 1, 2019 (2017 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
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MIPS Weighting
Performance based on:
• Quality measures 30% (50% - 2019, 45% - 2020)
• Resource use 30% (10% - 2019, 15% - 2020)
• 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.
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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:
• 2019 4%
• 2020 5%
• 2021 7%
• 2022 9%
An additional MIPS adjustment (up to 10%) could be earned
for exceptional performance from 2019-2024
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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