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

NCHIMA 66th 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 federal

reporting programs:

– MU – PQRS

• Introduce new

programs:

– MIPS – MACRA

• Review two case

studies that show how the use of registries directly impacts the health

• f the patients

that are served by your organization

Metrics Measures Outcomes Standards Performance Resource 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
• ption 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 law1

1 Medicare Access and CHIP Reauthorization Act, HR2, 114th Congress.

sunsets at the end of 2018 sunsets at the end of 2018

Medicare Access & CHIP Reauthorization Act of 2015 (MACRA)

• It repeals the Sustainable Growth Rate (SGR) Formula

What does MACRA do?

• 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

Quality Resource use



Meaningful use of certified EHR technology





Clinical practice improvement activities *such as (PCMH)

21

These data are reported publicly at https://www.medicare.gov/physiciancompare

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.

MAXIMUM Adjustments

Adjustment to provider’ s base rate of Medicare Part B payment

Merit‐Based Incentive Payment System (MIPS)

22

4% 5%

7% 9% ‐4% ‐5% ‐7% ‐9%

2019 2020 2021 2022  onward

MIPS Scoring

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

• n:

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
• 2. Planned care
• 3. Risk stratified care

management

• 4. Patient engagement
• 5. Care coordination
• 6. Quality Improvement Efforts

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

• n 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: Denominator

— Building Registries for patients that are DUE for a service

• Generating a list of patients who have not received service
• r 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?

Sharing Data with your Practice Providers, Shareholders and Staff

• To provide meaningful information of

real value, it must be:

‐ Accessible ‐ Accurate ‐ Timely ‐ Complete ‐ Cost‐effective ‐ Flexible ‐ Relevant ‐ Simple ‐ Verifiable

Using the EHR to Measure Quality

Here are some clinical examples:

– Mammograms – Colorectal screenings – Pneumonia vaccines – Flu Vaccines during the flu season – Patients with intervascular disease with no lipid panel in the past year – Diabetic patients not seen in 6 months

IT Specialists are from Mars

Clinicians are from Venus

Women over 50 who have not received a mammogram

Baseline A family practice with a 34%

• verall compliance rate for

screening women for Cancer.

Data set for Women over 50 without a Mammogram in the past 5 years

Run Chart for This Example

0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100% Jun Jul Aug Sep Oct Nov Dec Jan Feb Mar Apr May Percentage of patients 2015‐2016

Patients over 50 who have received a mammogram in past 5 years

Practice Provider 1 Provider 2 Provider 3

Goal = 80%

Source: Patient EHR

Registry

Children screenings for Autism

Baseline:

A pediatric practice with a 62%

• verall compliance rate for screening

children for Autism.

Using the EHR to Measure Quality as a Spreadsheet

Percentage of Developmental Screens by Provider per Month

Jan‐15 Feb‐15 Mar‐15 Apr‐15 May‐15 Jun‐15 Jul‐15 Aug‐15 Sep‐15 Oct‐15 Nov‐15 Numerator 77 82 130 155 173 173 176 174 171 148 167 Denominator 124 129 187 194 197 202 206 201 198 177 198 Practice 62.1% 63.6% 69.5% 79.9% 87.8% 85.6% 85.4% 86.6% 86.4% 83.6% 84.3% Numerator 21 26 54 68 70 71 72 73 72 71 70 Denominator 29 35 75 75 77 79 78 79 77 77 77 Provider 1 72.4% 74.3% 72.0% 90.7% 90.9% 89.9% 92.3% 92.4% 93.5% 92.2% 90.9% Numerator 4 3 4 4 4 4 4 4 6 5 4 Denominator 6 5 5 5 5 5 5 5 8 6 5 Provider 2 66.7% 60.0% 80.0% 80.0% 80.0% 80.0% 80.0% 80.0% 75.0% 83.3% 80.0% Numerator 18 17 23 23 29 29 29 27 27 27 27 Denominator 28 27 36 34 33 34 37 33 33 34 33 Provider 3 64.3% 63.0% 63.9% 67.6% 87.9% 85.3% 78.4% 81.8% 81.8% 79.4% 81.8% Numerator 5 5 10 11 13 12 12 13 13 12 11 Denominator 9 8 14 16 17 18 18 20 20 20 19 Provider 4 55.6% 62.5% 71.4% 68.8% 76.5% 66.7% 66.7% 65.0% 65.0% 60.0% 57.9% Numerator 18 19 24 33 37 35 37 35 32 33 33 Denominator 27 28 31 38 42 43 45 41 38 40 42 Provider 5 66.7% 67.9% 77.4% 86.8% 88.1% 81.4% 82.2% 85.4% 84.2% 82.5% 78.6% Numerator 11 12 15 16 20 22 22 22 21 22 22 Denominator 25 26 26 26 23 23 23 23 22 22 22 Provider 6 44.0% 46.2% 57.7% 61.5% 87.0% 95.7% 95.7% 95.7% 95.5% 100.0% 100.0% Hedis Goal: 91% 91.0% 91.0% 91.0% 91.0% 91.0% 91.0% 91.0% 91.0% 91.0% 91.0% 91.0%

Using the EHR to Measure Quality as a Graph

Registry Registry

Share Data With your Practice and Patients

Reporting is required for NCQA programs such as Patient Centered Medical Home (PCMH) and Patient Centered Specialty Practices (PCSP)

Data is CRUCIAL to the success in this new world of health care reimbursement… …and Data are the and !

Resources

For more information about QRUR, Quality‐tiering and Value Modifiers:

‐ http://www.cms.gov/Medicare/Medicare‐Fee‐for‐Service‐ Payment/PhysicianFeedbackProgram/2014‐QRUR.html

For more information about PQRS: ‐ https://www.cms.gov/Medicare/Quality‐Initiatives‐Patient‐Assessment‐

Instruments/PQRS/index.html?redirect=/PQRS/

For more information about Meaningful Use (MU):

‐ http://www.hrsa.gov/healthit/meaningfuluse/MU%20Stage1%20CQM/whatis.ht ml

For more information about MACRA/MIPS:

‐ https://www.cms.gov/Medicare/Quality‐Initiatives‐Patient‐Assessment‐ Instruments/Value‐Based‐Programs/MACRA‐MIPS‐and‐APMs/MACRA‐MIPS‐and‐ APMs.html