All Provider Meeting December 14, 2016 1
Agenda • Call to order Richard Gough, MD • FIHN Q3 Performance Results Richard Gough, MD • Quality Reporting Timeline Jennifer Teeter • MACRA/MIPS Requirements Jennifer Teeter • MSSP reapplication Jennifer Teeter • 2017 Changes to Physician Fee Schedule Jennifer Teeter • MD Prescription Monitoring Richard Gough, MD • 2017 Meeting Schedule Richard Gough, MD • Getting on Top of HCCs Charlotte Kohler • Adjourn Richard Gough, MD 2
Third Quarter 2016 Contract Performance Medicare Shared Savings Program and FMH Employee Health Plan 3
FIHN MSSP Overall Dashboard 4
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FMH Employee Health Plan Overall Dashboard 9
Medicare Shared Savings Program 2016 Quality Measure Reporting Timeline 10
COMING SOON!!! FIHN provides Remote Access User Account Form to Practice(s) 12/01/16 thru 12/15/16 FIHN and Primaris (PQRS Vendor) confirm EHR Access with each practice 12/15/16 – 1/3/17 Patient List and Measures required received from CMS (approx. 4,216 patients) 1/3/17 FIHN and Primaris complete Audit 1/3/17 thru 3/10/17 11 FIHN submits Final Results to CMS 3/10/17
What can you do to help? • Continue to capture quality measures for 2016! • Document quality measures within structured fields • Determine what computer can be accessed during GPRO if abstractor staff needs to come on-site • Return User Access Form to FIHN quickly - talk with vendor, if necessary, for access to be granted • Advocate for rapid FIHN access with the vendor! • Provide information to FIHN abstractor regarding the location of clinical data within EHR – speeds up abstraction process if we know where to look! • Have office staff available to answer questions during 12 abstraction
MACRA/MIPS Requirements 13
MIPS Categories of Performance Measurement • Quality – 50% weight 2017, declines to 30% 2019, 60 points • Report minimum of 6 PQRS measures ACO participants receive the ACO Quality Reporting Score • Resource Use – 0% weight 2017, increases to 30% 2019 • Cost per beneficiary; Cost per episode, claim data used, no reporting ACO Participants meet through ACO cost goals • Clinical Practice Improvement – 20% weight, 40 points • 90 Activities to choose from, must report 4 activities ACO participants meet requirements through ACO activities • Advancing Care Information – 30%, 100 possible points 14 • EHR, electronic access and data exchange requirements ACO participants receive weighted average score for ACO providers
Advancing Care Information Scoring 15
Medicare Shared Savings Program Current Agreement Track 1 CY 2015 – 2017 Reapplication Decision 2017 for CY 2018 – 2020 16
Timeline - Based on 2017 Renewals • Notice of Intent to Apply (NOIA) Form Posted – April 1 • NOIA Submission Period – May 2 to May 31 • Application Form posted to CMS’ website – Spring • Application Submission Period – July 1 to July 29 • First Request for Information (RFI) – September 6 • Second RFI – October 5 • Third RFI – October 26 • Application Approval – Late Fall 17
Considerations for Future Discussion • Available Application Tracks 1-3 and Next Generation • Submit application for subsequent 3 year agreement • Realized benefits under first 3 year agreement: • Collaborative approach into value-based reimbursement • Reduced avoidable hospital utilization and improved cost • FY16 Operating Expenses $800,000 vs. shared savings $2.44M, $488,300 paid to FRHS for administrative costs • Measured and working to improve patient experience of care • Care management support for highest risk patients • Experience with value-based reimbursement to leverage with other commercial payors • Monitor State of Maryland alternative programs that may 18 offer MIPs exemption such as CPC+
Recently Announced 2017 Medicare Physician Fee Schedule Changes 19
Key changes Medicare Shared Savings Program Updated quality measures for Performance Year 2017 Beneficiary Assignment rules Audit Process Streamlined and more Robust Eligible Professionals flexibility to report separately from ACO Modified reimbursement for Chronic Care Management Telehealth Services additional codes and place of service code Appropriate Use Criteria for Advanced Imaging 20
Changes to MSSP 2017 Quality Measures 21
Changes to MSSP PY 2017 Quality Measures 22
Changes to MSSP PY 2017 Quality Measures 23
Changes to MSSP PY 2017 Quality Measures 24
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MD Prescription Monitoring Program 26
House Bill 437 On April 26, 2016, Governor Hogan signed into law HB 437 which includes the following legal changes: 1) Mandatory PDMP Registration for CDS Prescribers & Pharmacists by July 1, 2017 2) Mandatory PDMP Use by CDS Prescribers & Pharmacists by July 1, 2018 3) CDS Prescribers & Pharmacists May Delegate PDMP Data Access to healthcare staff on their behalf. Handout – Version III Maryland Prescription Monitoring Program 27 PDMP = Prescription Drug Monitoring Program
Other RX Policy Changes – DEA Renewal • Drug Enforcement Administration (DEA) announced changes to its current registration renewal process • Effective 1/1/2017 • Only ONE renewal notice sent 65 days prior to expiration. • Elimination of informal grace period that allowed registrants to file their renewal within 30 days after the expiration • A failure to file a renewal application by midnight EST of the expiration date will result in the retirement of the registrant’s DEA without reinstatement and would require a new application. 28
2017 FIHN Meeting Schedule 29
2017 All Provider and PCP POD All Provider Meeting PCP POD Meeting February 22, 2017 (6pm – 7:30pm) January 5, 2017 (6pm – 8pm) May 10, 2017 (7am – 8am) April 6, 2017 (6pm – 8pm) August 23, 2017 (6pm – 7:30pm) July 6, 2017 (6pm – 8pm) November 29, 2017 (7am – 8am) October 5, 2017 (6pm – 8pm) 30
Getting on Top of HCCs – Tips and Tricks December 14, 2016 For Frederick Regional Health System Kohler HealthCare Consulting, Inc. 410.461.5116
AGENDA Section I • Risk Adjustment Overview • How HCC Impacts You • Use of ICD-10 Codes • Tips • Also see Handout – AHIMA Diabetes Mellitus and Associated Manifestation - ICD- 10-CM Section II – Specific HCCs 1. Diabetes Mellitus and Associated Manifestations 2. Diseases of the Respiratory System 3. Cardiovascular Conditions 4. Mental and Behavioral Health Disorders 5. Chronic Kidney Disease (CKD) Cancer and Metastatic Diseases MANIFESTATIONS 6. 32
SECTION I RISK ADJUSTMENT OVERVIEW 33
Setting the Stage: Naming the Reason and the Frustration Why are we talking about HCCs (Hierarchical Condition Categories)? This is different than PQRS and Meaningful Use. Remember: This is based on diagnoses provided. Goal : Looking for ways to report as many coding/ reporting requirements as possible at the same time as billing. 34
Why are HCCs Important to You? Yes, it can impact the “bonus pool” payment. It does allow the following payers to understand the health conditions of the patient population you serve: – ACO – Managed Care Programs – Medicaid Managed Care Organizations (MCOs) the Affordable Care Act – to adjust the payment for these programs for commercial payers The only way they can get this information is from you and your Practice (though the billing and reporting). 35
What is Risk Adjustment? • Risk Scores • Risk Adjustment and Quality o CMS compiles the ICD-10 codes o Improving the coordination of submitted for each member care and demographic data into a o Ensuring chronically ill and predictive model complex patients receive the o Patient’s disease status is appropriate care reflected o Refining the accuracy of • Certain medical conditions outcome measurements to improve reimbursements • ESRD status • Interactions between certain conditions 36 36
Why Is Risk Adjustment Important? Financial and Clinical Allows CMS to Use of Data better predict and Obtained budget cost of care Mitigates impact of Supports delivery of potential adverse high-quality care selection Comparison of Impact bonus pools to performance and physicians and quality across commercial insurance organizations payer premiums 37 37
But There is a Real Clinical Side to HCCs Complete and accurate reporting allows for more meaningful data exchange between payer and providers to: – Identify potential new problems early; – Reinforce self-care and prevention strategies; – Coordinate care collaboratively; – Avoid potential drug-drug/disease interactions; – Improving the overall patient health care evaluation process; – Improving office practice patterns and communication among the patient’s health care team Commitment to risk adjustment will help providers meet their own CMS provider obligations supported by medical record documentation. 38
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