NCHIMA 66 th Annual Meeting Transforming Health Care Through the - PowerPoint PPT Presentation

NCHIMA 66 th Annual Meeting

Transforming Health Care Through the Use of Information Technology Andrew Kurecki, BSN, RN EHR Application Specialist Community Care of Western North Carolina

Objectives • Describe Population Management • Review two case • Review federal studies that show reporting programs: how the use of – MU registries directly – PQRS impacts the health • Introduce new of the patients that are served by programs: your organization – MIPS – MACRA

Metrics Measures Standards Outcomes Resource Performance Use

History of Health Care in America • Fee for Service Model • Patients only see physicians when sick • Doctor visits incident to illness or injury • Re‐active more than pro‐active • Data was used mostly for documenting encounters, reporting revenue, reporting provider productivity, and safety statistics

Population Health Management • Moves care from Volume‐Based (Episodic Care) to Value‐Based (Continuous care) • Focus on the entire patient population to support health: 1. It provides additional support to patients with chronic conditions 2. It improves access to care through patient portals, extended hours, and different type of encounters 3. Proactively reach out to patients in need of services 4. Coordinate patient care between primary care providers and specialists, urgent care centers, hospitals, and pharmacies

The Institute of Health Improvement’s Triple Aim Initiative Safe Effective Patient Centered Efficient Timely Equitable

Alphabet Soup of Reporting Data  ACA  PQRS  MU  VBM  APM  MSSP  PCMH  PCSP  QRUR  ACO  NC HIE  MIPS  MACRA  VBPM

Physician Quality Reporting System ‐ PQRS 2016 • 281 measures in the PQRS measure set • 3 new measures groups: Multiple Chronic Conditions; Cardiovascular Prevention (Million Hearts); and Diabetic Retinopathy • Qualified Clinical Data Registry (QCDR) reporting option for groups • 2018 PQRS payment adjustment is the last adjustment that will be issued under PQRS • Starting in 2019, adjustments to payment for quality reporting will be made under the new Merit‐Based Incentive Payment System (MIPS)

PQRS Reporting Through Claims • Requirement is to report 9 measures covering at least 3 National Quality Strategy (NQS) domains • Patient Safety • Person and Caregiver‐Centered Experience and Outcomes • Communication and Care Coordination • Effective Clinical Care • Community/Population Health • Efficiency and Cost Reduction

Meaningful Use – The 5 Pillars 1. Improve Quality, Safety, efficiency and reduce health disparities 2. Engage patients and families in their health 3. Improve population and public health 4. Improve care coordination 5. Ensure privacy and security of Personal Health Information (PHI)

Meaningful Use (MU) • Meaningful Use Stage 1 (July 2010) ‐ Data capture and sharing • Meaningful Use Stage 2 (August 2012 ) ‐ Advanced Clinical Processes (HIE, eRx, Lab and Image reporting) • Meaningful Use Stage 2 – Modified (October 2015) ‐ Includes 10 final objectives • Meaningful Use Stage 3 (being finalized now) ‐ Aligns with National health care objectives ‐ Focus on Triple Aim = reduced cost, improved access, improved quality ‐ Promote interoperability and health information exchange

On April 16, 2015 the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA) was signed into law 1 sunsets at the end of 2018 sunsets at the end of 2018 1 Medicare Access and CHIP Reauthorization Act, HR2, 114th Congress.

Medicare Access & CHIP Reauthorization Act of 2015 (MACRA) What does MACRA do? • It repeals the Sustainable Growth Rate (SGR) Formula • It changes the way that Medicare rewards clinicians for value over volume • It streamlines multiple quality programs under the new Merit‐Based Incentive Payments System (MIPS) and • It provides bonus payments for participation in eligible Alternative Payment Models (APMs)

Start with your QRUR Report • QRUR indicates how you will fare under Medicare's Value‐Based Payment Modifier (VBPM) program • High Quality and Cost Scores = BONUS! • Low Quality and Cost Scores = PENALTIES! • That is, IN ADDITION to PQRS and MU penalties of up to 9%! • Solo physicians and groups with fewer than 10 providers will be subject to the VBPM starting in 2017 based on their 2015 performance data

Value Based Practice Modifiers ( VBPMs) • VBPM : A budget‐neutral program created under the Affordable Care Act that increases OR decreases Medicare payments based on physician’s cost and quality scores as compared to the national average. • The quality and cost data contained in the 2014 Annual QRURs are used to calculate the 2016 Value Modifier. • CY 2015 is the performance period for the Value Modifier that will be applied in 2017

1. Alternative Payment Models (APMs) 2. Merit Based Incentive Program (MIPS)

Alternative Payment Models • Medicare Shared Savings Programs (MSSP) ‐ Accountable Care Organizations(ACOs) • Those participating in various Capability Maturity Model Integration (CMMI) demonstrations ‐ like the Bundled Payment for Care Improvement Initiative. • APM participants aren’t subject to MIPS requirements

Merit‐based Incentive Payment System (MIPS) • Beginning in 2019, MIPS consolidates Meaningful Use (MU), Physician Quality Reporting System (PQRS), and Value Based Modifier (VBPM) into one program

A single MIPS composite performance score will factor in performance in 4 weighted performance categories :  MIPS   Composite Performance Score Resource Meaningful Clinical Quality use use of practice certified EHR improvement technology activities *such as (PCMH) These data are reported publicly at https://www.medicare.gov/physiciancompare 21

How Much Can MIPS adjust payments • Based on the MIPS composite performance score, physicians and practitioners will receive positive, negative, or neutral adjustments up to percentages below. 9% 7% 4% 5% Adjustment to provider’ s MAXIMUM Adjustments base rate of Medicare Part B payment ‐4% ‐5% ‐7% ‐9% 2019 2020 2021 2022  onward Merit‐Based Incentive Payment System (MIPS) 22

MIPS Scoring Physicians will be assessed, and receive payment adjustments, based on a composite score (1‐100) based on:

Clinical Performance Improvement • A professional who is in a practice that is a “certified” Patient Centered Medical Home (PCMH) will be given the highest score for the Clinical Practice Improvement (CPI) portion of the MIPS score (15 points) • American Association of Family Physicians (AAFP) is advocating for functionality, not necessarily certification. • The National Committee of Quality Assurance’s (NCQA’s) PCMH & PCSP recognized practices are eligible for full CPI credit 1. Access 4. Patient engagement 2. Planned care 5. Care coordination 3. Risk stratified care 6. Quality Improvement Efforts management

Preparing for MIPS in 2016 • Obtain a copy of the QRUR for your organization from CMS ‐ Identifies current state of quality and resource use. • Meet 2016 deadlines for reporting to CMS • Optimize MU and PQRS/VBM Quality efforts ‐ 75% of 2017 MIPS score • Decide which options your organization will chose to earn Clinical Practice Improvement Points such as PCMH/PCSP recognition. ‐ This counts for 15% of 2017 MIPS score • Develop and implement best practices. Share data with your organization’s stakeholders so they can act to improve scores 2016 is a rehearsal year for at least 75% of MIPS

Payment Reform is Here In this new world of reimbursement based on quality, not quantity, Data is King! Accurate data is crucial for reimbursement and regulatory compliance with CMS and all other payors. It is also the key to improving the health of our communities.

The Value of Data • Higher reimbursement rates for high performing practices based on reports • Higher Medicare reimbursement under the MIPS and MACRA programs – Changing the way that Medicare rewards practices which focus on Value over Volume

Using the EHR to Measure Quality • Using the Reporting Modules in the EHR: — Canned Reports ‐ provided by vendor for Meaningful Use (MU) reporting and/or PQRS reporting — Building Custom Reports to provide meaningful data • Consider population to be reported on • Population who have received Service: Numerator • Total population eligible for service: Denominat or — Building Registries for patients that are DUE for a service • Generating a list of patients who have not received service or need additional support for outreach will improve performance .

Data Thinking Steps to make your data useful: 1. Ask the Question – as you build your reports, • Focus on specific questions that you are trying to answer. Don’t try to boil the ocean. 2. Define your structure – getting it to “apples to apples” so you can do the math • How is the data currently formatted and what challenges will this create? 3. Analysis of the data – determining what really matters • What methods are best suited to arrive at answers that users can trust? 4. Involvement of key stakeholders – putting data to use: right place, time, people, presentation • Who will share the results and how will they be used?