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Advancing Care Information

David Heller

Industry & Government Affairs Manager


Agenda

• Overview

• Reporting

• Objectives for 2017 & 2018

• What’s next


Poll question

Have you ever attested for meaningful use?

a) Yes, for Stage 1 and Stage 2

b) Yes, for Stage 1 only

c) Yes, for Stage 2 only

d) No, because we were not subject to it

e) No, because we chose not to


OVERVIEW


A single MIPS composite performance score will factor in performance in four weighted categories on a scale of 0-100

Performance categories

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.


60%15%

25%

0%

Advancing Care Information

Quality

Clinical Practice Improvement Activities

MIPS scoring in 2017


Adjusted Medicare Part B payment to clinician

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

History Introduction Products

Closer to 1% per MGMA and CMS estimates


Key changes from current program (EHR Incentive):

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

Eliminated public health reporting as a requirement


MU ObjectiveStage

3Stage

2ACI

1. Protect Patient Health Information

2. Clinical Decisions Support (CDS)

3. Computerized Provider Order Entry (CPOE)

4. Electronic Prescribing (eRx)

5. Health Information Exchange

6. Patient Specific Education

7. Medication Reconciliation

8. Patient Electronic Access

9. Secure Electronic Messaging

10. Public Health Reporting

• ACI streamlines measures and emphasizes interop, information exchange and security measures.

• Customizable - clinicians can choose which best measures for their practice

• Flexible – multiple paths to success

• Aligned with other Medicare reporting programs. No need to report quality measures as part of this category.

Principal Changes from Medicare MU

ACI eliminates a couple of MU3 requirements while mirroring the balance of the others

MU VS. ACI

9 I


REPORTING


Medicaid MU goes on separately

Medicaid meaningful use

MIPS


ONC CEHRT supports different regulations and programs

MIPS (MACRA)

• Standard MIPS

• MIPS APMs

• Medical Homes

Medicaid EHR

Incentive Program

AdvanecdAPMs

• CPC+

• MSSP Tracks 2 and 3

• Next Generation ACO

ONC Certification


MACRA 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


MIPS 2017 reporting options

Don’t participate, and receive a 4% negative adjustment rate1

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


Which edition?

•2014 Certified Edition

2017 performance

period

•2015 Certified Edition

2018 performance

period


ACI reporting methods

CMS Web Interface

(groups of 25 ECs or more)

Qualified Clinical Data

Registry

Attestation

EHR


Eligible clinicians can participate in MIPS as an individual or group

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


OBJECTIVES FOR 2017 AND 2018


ACI’S OBJECTIVES

BUSINESS ECOSYSTEM

Protect Patient Health Information

(yes required)

Electronic Prescribing (numerator/

denominator)

Health Information Exchange

(numerator/denominator)

Coordination of Care Through Patient

Engagement (numerator/

denominator)

Public Health and Clinical Registry

Reporting

Patient Electronic Access (numerator/

denominator)

Advancing Care

Information


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


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


Advancing Care Information: 2017 Objective Measure Required Performance


Security Risk Analysis

Y 0

Electronic Prescribinge-Prescribing

Y 0

Patient Electronic Access

Provide Patient AccessY Up to 20%

View, Download or Transmit (VDT)N Up to 10%

Patient-Specific Education Patient-Specific Education N Up to 10%

Secure Messaging Secure Messaging N Up to 10%

Health Information Exchange Health Information Exchange Y Up to 20%

Medication Reconciliation Medication Reconciliation NUp 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 allowedSpecialized Registry Reporting

N


Advancing Care Information: 2018 onwardObjective Measure Required Performance


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


ACI scoring

A client passes their base score. They are actively engaged with a specialized registry, and used CEHRT to deliver all of their CPIA activities. The practice reconciles medications in the EHR for 50 out of every 100 patients.

What is their ACI score?


WHAT’S NEXT


Efficacy

Benchmarking

Patient outcomes

Scoring

Workflows


Interoperability

New call for measures

Use case: closing the

referral loop

Interoperability in non-office

settings


Poll question

Would you like a Greenway Health sales representative to contact you about:

a) Greenway EHRs

b) Greenway Patient Portal

c) Greenway Patient Messaging

d) Greenway Care Coordination Services


ADDITIONAL RESOURCES


Acronym cheat sheet

• ACI: Advancing Care Information• APM: Alternative Payment Model• CPIA: Clinical Practice Improvement Activities• EC: Eligible Clinician• HHS: The US Department of Health & Human Services• MACRA: Medicare Access & CHIP Reauthorization Act of

2015• MIPS: Merit-based Incentive Payment System• MU: Meaningful Use• NP: Nurse Practitioner• NPRM: Notice of Proposed Rulemaking• PA: Physician Assistant


Resources

• Quality Payment Program website

• Executive Summary of the Final Rule

• The Medicare Access and CHIP Reauthorization Act of 2015

• Comprehensive list of APMs

• Improvement Activities and APMs

https://qpp.cms.gov/

https://qpp.cms.gov/docs/QPP_Executive_Summary_of_Final_Rule.pdf

https://www.congress.gov/bill/114th-congress/house-bill/2/text

https://qpp.cms.gov/docs/QPP_Advanced_APMs_in_2017.pdf

https://qpp.cms.gov/docs/QPP_APMs_and_Improvement_Activities.pdf

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