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MACRA 2020 Overview

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Graphium Health Services

MACRA Compliance Charge Capture AnesthesiaEMR™ Full RCM

The easiest pathway to 2020 MACRA compliance for anesthesia practices. From paper data entry, to mobile iOS data entry, to full EMR integration, we have your data capture needs covered. Enjoy a claim submission process free of couriers, face sheets, and paper slips. With a fully electronic workflow, we help eliminate lost charges, reduce your billing fees, and provide real time analytics. The easiest to learn, easiest to use, and most intelligent Anesthesia EMR

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utilizes a one-of-a-kind, paper-like experience with integrated, self- service intelligence reporting. Our unified RCM platform brings the efficiency of a fully electronic workflow to your practice. Our RCM plan includes our iPad AnesthesiaEMR™ and Full RCM services.

30+ Installed States 250+ Installed Facilities 200+ Production Integrations 10,000+ Providers and Surgeons 300k+ of Daily Message Volume 150k+ MACRA 2017 case submissions 500k+ MACRA 2019 case submissions ~2.5 million cases processed

MACRA 2020 Overview

CMS estimates $933 million in payments adjustments for 2020 $433 million in positive payment adjustments (budget neutral) $500 million additional funds for “Exceptional Performers” https://qpp.cms.gov/about/resource-library Quick fact sheets, FAQs, etc. (Not anesthesia focused) 2020 Final Rule (996 pages)

CPS vs Payment Adjustment

CPS vs Payment Adjustment

MIPS 2018 Financial Results (All Participants)

2% 98% Incentive Penalty

CPS vs Payment Adjustment

CPS vs Payment Adjustment

CPS Adjustment 0 - 10

• 9%

11 - 40

• 6.8% - 0%

40 - 84 0% - 0.89% 85 - 100 1.42% - 6.25%

CPS vs Payment Adjustment

25 50 75 100 2017 2018 2019 2020 2021 Negative Positive Exceptional 45 60 80 85 30 75 15 70 3 70

Composite Performance Score

Performance Category Weight Comments Promoting Interoperability 0% Re-weighted to 0% for non-patient facing Cost 15% Unclear how it will be determined. No additional data submitted Improvement Activities 15% Annual attestation of activities performed over the reporting period Quality 70% CMS will ONLY count top 6 measures

Composite Performance Score

Performance Category Weight Comments Promoting Interoperability 0% Re-weighted to 0% for non-patient facing Cost 15% Unclear how it will be determined. No additional data submitted Improvement Activities 15% Annual attestation of activities performed over the reporting period Quality 70% CMS will ONLY count top 6 measures

Improvement Activities (15%)

>50% of EPs fulfill the activity during any continuous 90-day period 106 activities available

https://qpp.cms.gov/mips/explore-measures/improvement-activities?py=2020#measures 2 high-weighted activities 1 high-weighted activity and 2 medium-weighted activities At least 4 medium-weighted activities

Full credit End of year attestation

Improvement Activities (15%)

Weight Improvement Activity Title High Collection and follow-up on patient experience and satisfaction data on beneficiary engagement Medium Use of QCDR data for ongoing practice assessment and improvements High Use of QCDR for feedback reports that incorporate population health High Provide 24/7 access to eligible clinicians or groups who have real-time access to patient’s medical record. Medium Participation in an AHRQ-listed patient safety organization.

Quality Category (70%)

Best 6 measures will be counted Each measure will count from 0 - 10 points Performance Met for each measure compared to national average. Points per measure allocated based on your decile Performance Met

Participation Status and Reporting Options

Reporting Thresholds

Bill more than $90,000 for Part B covered professional services, and See more than 200 Part B patients, and Provide more than 200 covered professional services to Part B patients https://qpp.cms.gov/participation-lookup https://qpp.cms.gov/about/eligibility-determination-periods-and-snapshots?py=2020

2020 MACRA Measures

2019 MACRA MEASURES

ABG 7: Immediate Adult Post-Operative Pain ABG 16: Planned use of difficult airway equipment ABG 37: Pre-Operative Screening for Anesthetic Risk Factors AQI 59: Multimodal Pain Management AQI 61: Ambulatory Post-Discharge Patient Follow-Up AQI 62: Obstructive Sleep Apnea: Patient Education AQI 63: Neuromuscular Blockade: Documented Assessment of Neuromuscular Function Prior to Extubation AQI 64: Neuromuscular Blockade: Reversal Administered AQI 66: Obstructive Sleep Apnea: Mitigation Strategies MIPS 404: Anesthesiology Smoking Abstinence MIPS 430: Prevention of Post-Operative Nausea and Vomiting MIPS 424: Perioperative Temperature Management

2020 MACRA MEASURES

ABG 16: Planned use of difficult airway equipment ABG 38: Second Provider Present for difficult airway MIPS 404: Anesthesiology Smoking Abstinence MIPS 430: Prevention of Post-Operative Nausea and Vomiting MIPS 424: Perioperative Temperature Management MIPS 477: Multimodal Pain Management AQI 61: Ambulatory Post-Discharge Patient Follow-Up AQI 62: Obstructive Sleep Apnea: Patient Education AQI 48: Patient-reported experience with Anesthesia AQI 68: Obstructive Sleep Apnea: Mitigation Strategies

10 reported to CMS Only best 6 will count

40 OUTCOME MEASURES - MAJOR AND MINOR COMPLICATIONS

Cardiac arrest (unplanned) Myocardial ischemia Myocardial infarction Dysrhythmia requiring intervention Unexpected death Uncontrolled HTN Stroke, CVA, or coma Vascular injury (arterial/pneumothorax) Pneumothorax (related to anes) Aspiration Failed regional anesthetic Systemic local anesthesia toxicity Peripheral nerve injury following regional Wet tap Temperature <95.9 or 35.5 Reintubation (planned trial extubation) Reintubation (no trial extubation) Inadequate reversal Intractable N/V Unexpected postop ventilation Medication administration error Adverse transfusion reaction Anaphylaxis Opioid reversal required Wrong site surgery Wrong patient Wrong surgical procedure Unplanned hospital admission Unplanned ICU admission Dental trauma Visual loss MH Awareness under GA Unable to intubate Airway fire in OR Corneal abrasion Equipment malfunction Fall in OR Other Prolonged PACU stay

5 PROCESS/QUALITY MEASURES

Surgical safety checklist used Handoff protocol used Current medications documented in medical record PACU normothermia PACU pain control

For use outside of the MACRA program: Support OPPE Requirements Generate required Joint Commission Quarterly Quality reports

MACRA Measures: Key Points

ABG 16: Planned use of difficult airway equipment ABG 38: Second Provider Present for difficult airway MIPS 404: Anesthesiology Smoking Abstinence MIPS 430: Prevention of Post-Operative Nausea and Vomiting MIPS 424: Perioperative Temperature Management MIPS 477: Multimodal Pain Management AQI 61: Ambulatory Post-Discharge Patient Follow-Up AQI 62: Obstructive Sleep Apnea: Patient Education AQI 48: Patient-reported experience with Anesthesia AQI 68: Obstructive Sleep Apnea: Mitigation Strategies

MACRA Measures: Key Points

ABG 16: Planned use of difficult airway equipment ABG 38: Second Provider Present for difficult airway MIPS 404: Anesthesiology Smoking Abstinence MIPS 430: Prevention of Post-Operative Nausea and Vomiting MIPS 424: Perioperative Temperature Management MIPS 477: Multimodal Pain Management AQI 61: Ambulatory Post-Discharge Patient Follow-Up AQI 62: Obstructive Sleep Apnea: Patient Education AQI 48: Patient-reported experience with Anesthesia AQI 68: Obstructive Sleep Apnea: Mitigation Strategies Difficult Airway: The clinical situation in which a conventionally trained anesthesiologist experiences difficulty with face mask ventilation of the upper airway, difficulty with tracheal intubation, or both.

MACRA Measures: Key Points

ABG 16: Planned use of difficult airway equipment ABG 38: Second Provider Present for difficult airway MIPS 404: Anesthesiology Smoking Abstinence MIPS 430: Prevention of Post-Operative Nausea and Vomiting MIPS 424: Perioperative Temperature Management MIPS 477: Multimodal Pain Management AQI 61: Ambulatory Post-Discharge Patient Follow-Up AQI 62: Obstructive Sleep Apnea: Patient Education AQI 48: Patient-reported experience with Anesthesia AQI 68: Obstructive Sleep Apnea: Mitigation Strategies Second Provider: Capable healthcare provider whose only responsibility at the time of induction is to provide assistance for management of difficult airway. A dedicated second provider may include operating staff physician, certified registered nurse anesthetist, registered nurse, resident, or anesthesia technician.

MACRA Measures: Key Points

ABG 16: Planned use of difficult airway equipment ABG 38: Second Provider Present for difficult airway MIPS 404: Anesthesiology Smoking Abstinence MIPS 430: Prevention of Post-Operative Nausea and Vomiting MIPS 424: Perioperative Temperature Management MIPS 477: Multimodal Pain Management AQI 61: Ambulatory Post-Discharge Patient Follow-Up AQI 62: Obstructive Sleep Apnea: Patient Education AQI 48: Patient-reported experience with Anesthesia AQI 68: Obstructive Sleep Apnea: Mitigation Strategies No changes.

MACRA Measures: Key Points

ABG 16: Planned use of difficult airway equipment ABG 38: Second Provider Present for difficult airway MIPS 404: Anesthesiology Smoking Abstinence MIPS 430: Prevention of Post-Operative Nausea and Vomiting MIPS 424: Perioperative Temperature Management MIPS 477: Multimodal Pain Management AQI 61: Ambulatory Post-Discharge Patient Follow-Up AQI 62: Obstructive Sleep Apnea: Patient Education AQI 48: Patient-reported experience with Anesthesia AQI 68: Obstructive Sleep Apnea: Mitigation Strategies New Graphium Health Surveys Single electronic survey to be texted and/or emailed. 6 questions covering both measures

Graphium Health Surveys

Outpatient hospital or ASC is a required field for AQI 61

Graphium Health Surveys

Outpatient hospital or ASC is a required field for AQI 61

Graphium Health Surveys

Outpatient hospital or ASC is a required field for AQI 61 Select “Yes” if: You want us to send a survey Patient agrees to receiving a survey link via email and/or SMS

Outpatient hospital or ASC is a required field for AQI 61 Select “Yes” if: You want us to send a survey We must have either an email or a mobile number Graphium will send the survey the day after anesthesia or as soon as data entry makes information available to us. All completed survey results will be surfaced in MACRA Dashboard. Graphium QCDR Engine will evaluate survey results based on individual measure criteria, meaning not all surveys will necessarily count towards Performance Met. Patient agrees to receiving a survey link via email and/or SMS

Graphium Health Surveys

Graphium Health Surveys

Outpatient hospital or ASC is a required field for AQI 61 Select “Patient declines” if the patient does not want to be surveyed

Graphium Health Surveys

Outpatient hospital or ASC is a required field for AQI 61 Select “Patient declines” if the patient does not want to be surveyed Some clients already have a “Post-discharge status assessed” process (i.e. nurse phone call)

Graphium Health Surveys

Outpatient hospital or ASC is a required field for AQI 61 Select “Patient declines” if the patient does not want to be surveyed Select “Yes” if patient assessed. Some clients already have a “Post-discharge status assessed” process (i.e. nurse phone call)

Graphium Health Surveys

Outpatient hospital or ASC is a required field for AQI 61 Select “Patient declines” if the patient does not want to be surveyed Select “Yes” if patient assessed. Select “Not reachable” if patient doesn’t answer. Some clients already have a “Post-discharge status assessed” process (i.e. nurse phone call)

Graphium Health Surveys

Outpatient hospital or ASC is a required field for AQI 61 Select “Patient declines” if the patient does not want to be surveyed Select “Yes” if patient assessed. Select “Not reachable” if patient doesn’t answer. Select “No” if no contact attempted. Some clients already have a “Post-discharge status assessed” process (i.e. nurse phone call)

Graphium Health Surveys

Outpatient hospital or ASC is a required field for AQI 61 Select “Patient declines” if the patient does not want to be surveyed Select “Yes” if patient assessed. Select “Not reachable” if patient doesn’t answer. Select “No” if no contact attempted. Some clients already have a “Post-discharge status assessed” process (i.e. nurse phone call) This allows clients to get credit for AQI 61 without using Graphium survey

MACRA Measures: Key Points

ABG 16: Planned use of difficult airway equipment ABG 38: Second Provider Present for difficult airway MIPS 404: Anesthesiology Smoking Abstinence MIPS 430: Prevention of Post-Operative Nausea and Vomiting MIPS 424: Perioperative Temperature Management MIPS 477: Multimodal Pain Management AQI 61: Ambulatory Post-Discharge Patient Follow-Up AQI 62: Obstructive Sleep Apnea: Patient Education AQI 48: Patient-reported experience with Anesthesia AQI 68: Obstructive Sleep Apnea: Mitigation Strategies No changes.

Additional Resources

2020 MACRA Ready™ Manual (PDF file) 2020 MACRA Definition Summary page Video tutorial: 2020 MACRA Ready™ Paper Form Video tutorial: 2020 MACRA Ready™ Digital Form https://help.graphiumhealth.com/macra-2020-video-tutorial Video tutorials: 2020 MACRA Measures (coming soon) Future Webinars

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• Yes

2020 Simple

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