meaningful use & pqrs in healthcare

This event is live as of XYZ

Thriving Through Change: Meaningful Use and PQRS

Catherine ChuterSr. Associate, athenahealth

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Source: CMS, “2013 Annual Report of the Boards of Trustees of the Federal Hospital Insuranceand Federal Supplementary Medical Insurance Trust Funds,” May 31, 2013, available at:http://downloads.cms.gov/files/TR2013.pdf;

3

Projected Medicare Fee-for-service Payment Cuts per the ACA

2014 2015 2016 2017 2018 2019 2020

Projected number of Medicare beneficiaries

54M 56M 57M 59M 61M 63M 64M

-14B -21B -25B -32B -42B -53B -64B

Source: CMS, “2013 Annual Report of the Boards of Trustees of the Federal Hospital Insuranceand Federal Supplementary Medical Insurance Trust Funds,” May 31, 2013, available at: http://downloads.cms.gov/files/TR2013.pdf

2018: 90% of Medicare

payments tied to quality.

2020: 75% of commercial plans will be value-based.

Jan 2015. http://www.hhs.gov/news/press/2015pres/01/20150126a.html

ACO

PCMHPQRSMIPS

MSSP

MUEHR

HCCICD-10

ANSIAPM

s

MACRA

ACA

IRM

PQRSMU

2007PQRI starts

2016PQRS VM applies to all HCPs

2011Meaningf

ul Use Stage 1

2014Meaningf

ul Use Stage 2

2017Start

MIPS or APM

2015Meaningf

ul Use penalties

hit

2015ICD-10

2015PQRS

penalties hit

SGR Repeal bill

SGR repeal bill (MARCA) represents continuation of the shift toward value

Source: The Medicare Access and CHIP Reauthorization Act of 2015; Advisory Board analysis.

2. APM participants who are close to but fall short of APM bonus requirements will not qualify for bonus but can report MIPS measures and receive incentives or can decline to participate in MIPS.

Merit-Based Incentive Payment System1

2020: -5% to +15%

2019: -4% to +12%

2022 and on: -9% to +27%

2021: -7% to +21%

2018: Last year of separate MU, PQRS, and VBM penalties

2019 - 2024: 5% participation bonus

2019 - 2020: 25% Medicare revenue requirement

2021 and on: Ramped up Medicare or all-payer revenue requirements

1. Positive adjustments may be scaled by a factor of up to 3 times the negative adjustment to ensure budget neutrality. Actual positive adjustments may be lower than numbers shown here. In addition, top performers may earn additional adjustments of up to 10 percent.

Advanced Alternative Payment Models2

PQRS Overview

10

The Evolution of PQRS

2007 2008 2009 2010 2011 2012 2013 2014 2015 2016

• 74M • Claims

• 119 M • 4 MG• Claims• Registry

• 119 M• 4 MG• Claims• Registry

• 175 M• 13 MG• Claims• Registry• EHR• GPRO

• 198 M• 14 MG• Claims• Registry• EHR• GPRO

• 225 M• 22 MG• Claims• Registry• EHR• GPRO

• 260 M• 22 MG• Claims• Registry• DSV• HER• GPRO

• 287 M• 25 MG• Claims• Registry• EHR• GRPO• CSV• CDR

+2.0% +1.0

% +0.5%

+0.5%

+0.5%

-1.5%-2.0%

BONUS PENALTY

2014 participation affects penalty in

2016.

QU

ALIT

Y

COST

HIG

HLO

W

HIGH LOW

0.0%

-2.0%

-4.0% -2.0%

0.0%

Bonus paymen

t

Bonus paymen

t

Bonus paymen

t

0.0%

PQRS Value-based Modifier Quadrants

Meaningful Use Overview

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Meaningful Use is designed to create infrastructure that supports reform

Stage 1:Data capture and sharing

Stage 2:

Advanced processes

Stage 3:

Improved outcomes

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Stage 2 has more core measures, fewer menu measures, and higher thresholds

Stage 1 Stage 2

5 of 9

Menu

13

Core

Higher thresholds

3 of 6 Menu

17 Core

A comparison…

MU versus PQRS Eligible providers

PQRS Meaningful UseMEDICARE PHYSICIANSDoctor of Medicine X XDoctor of Osteopathy X XDoctor of Podiatric Medicine X XDoctor of Optometry X XDoctor of Oral Surgery X XDoctor of Dental Medicine X XDoctor of Chiropractic X XPRACTITIONERSPhysician Assistant XNurse Practitioner XClinical Nurse Specialist XCertified Registered Nurse Anesthetist XCertified Nurse Midwife XClinical Social Worker XClinical Psychologist XRegistered Dietician XNutrition Professional XAudiologists XTHERAPISTSPhysical Therapist XOccupational Therapist XQualified Speech-Language Therapist X

• Federally Qualified Health Centers (FQHCs)

• Hospitals

• Independent Labs

• Rural Health Clinics

• Ambulance providers

• Ambulatory Surgical Centers (ASCs)

Who is not “eligible” for PQRS?

PQRS versus MU Number of measures

9 out of

287 measures

PQRS Meaningful Use

20 out of

23 measures

PQRS versus MU Measurement style

Report first.

Then, performance against your

peers.

PQRS Meaningful Use

Measure thresholds.

PQRS versus MU Penalties

Upcoming Medicare Penalties

Program 2015 2016 2017 2018 2019 2020

Physician Quality Reporting System (PQRS)

-1.5% -2% -2% -2% TBD TBD

Value Based Modifier Program (VM)

-1% -2%** -2% or -4%*** TBD TBD TBD 

Meaningful Use/EHR Incentive Program

-1% or -2%* -2% -3% -4% TBD TBD

Penalty -3.5% or -4.5% -6% -7% or

-9% TBD TBD TBD 

*-2% in 2015 only applies to providers who failed Meaningful Use and eRx thresholds

PQRS versus MU National success on the programs

Approximately

37% of eligible providers face a payment reduction for not reporting in 2013.

PQRS Meaningful Use

More than 30% of providers will be penalized for not meeting requirements in 2013 and 2014.

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2013 VM Results from CMS

Of

1,010

participating groups …

Only

106provided enough data for CMS to calculate both

quality and cost.

Of those, only

13%

earned an incentive payment for 2015.

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athenahealth’s award-winning services can help you thrive through

change

23“2013 Best in KLAS Awards: Software & Services,” January, 2014. © 2014 KLAS Enterprises, LLC. All rights reserved. www.KLASresearch.com

#1 Overall

Software Vendor

#1 Overall

Physician Practice Vendor

#1 PatientPortal

#1 Practice

Management System(1-10, 11-75 physicians)

#2 EHR

(1-10, 11-75 physicians)

2013 Best in KLAS

• 64,000+ providers on athenaNet®

• Clients ranging from 1 to 5,000+ providers

• 50 states and 104 medical specialties

• $11.7 billion in client collections per year

• Acquired Epocrates March, 2013

We navigate regulatory change so you don’t have to

Meaningful Use Stage 1 attestation

Meaningful Use Stage 2 attestation

NATIONAL AVERAGE

70%

ATHENAHEALTHCLIENTS

95.8%

NATIONAL AVERAGE

33%

ATHENAHEALTHCLIENTS

98.2%

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Performance on Meaningful Use Stage 2 Behavioral measures

Covering period: Q1 2014

100%

89%

99%

99%

99%

100%

99%

95%

80%

1. CPOE for Medication, Laboratory, and Radiology Orders

2. E-prescribing (eRx)

3. Record Demographics

4. Record Vital Signs

5. Record Smoking Status

6. Clinical Decision Support Rule

7. Patient Electronic Access

8. Clinical Summaries

9. Protect Electronic Health Information (N/A)

10. Clinical Lab Test Results

11. Patient Lists (N/A)

12. Preventive Care Reminders

13. Patient-Specific Education Resources

14. Medication Reconciliation

15. Summary of Care

16. Immunization Registry Data Submission

17. Use Secure Electronic Messaging

75%

92%

99%

89%

90%

33%

98%

Providers who satisfied required 3 of 6 menu measures:

If provider is failing MU Patient Engagement measures, auto-launch registration upon check-in

Three new workflows to register the patient when in-office

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Performance on Meaningful Use Stage 2 Behavioral measures

As of 12/31/2014

100%

100%

100%

100%

100%

99%

99%

1. CPOE for Medication, Laboratory, and Radiology Orders

2. E-prescribing (eRx)

3. Record Demographics

4. Record Vital Signs

5. Record Smoking Status

6. Clinical Decision Support Rule

7. Patient Electronic Access

8. Clinical Summaries

9. Protect Electronic Health Information (N/A)

10. Clinical Lab Test Results

11. Patient Lists (N/A)

12. Preventive Care Reminders

13. Patient-Specific Education Resources

14. Medication Reconciliation

15. Summary of Care

16. Immunization Registry Data Submission

17. Use Secure Electronic Messaging

99%

100%

Providers who satisfied required 3 of 6 menu measures:

100%

100%

100%

100%

100%

100%

100%

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PQRS success with athenahealth

1For enrollment, we look at our network data to determine the best 9 measures for each specialty.

2Once enrolled, we track the performance of each HCP and adjust enrollment based on performance.

3Our software provides real-time visibility into performance to ensure you are on track.

We navigate regulatory change so you don’t have to

% of HCPs expecting PQRS penalties in 2015

NATIONAL AVERAGE

37%

ATHENAHEALTHCLIENTS

6.4%

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Ask a few key questions ofyour EHR vendor

Is your vendor able to deploy the 2014 Certified Edition to all clients at once?1

How is your vendor monitoring your PQRS and MU performance?2

Does the vendor provide MU/PQRS support and training as part of the regular pricing without additional fees?3Do they provide the required interfaces for free and without interruption? How many connections? When will they be available? 4

How can I switch if

2015 requires full-year reporting?

Meaningful Use Guarantee

ICD-10 Guarantee

PQRS Guarantee

MSSP ACO Guarantee

This event is live as of XYZ

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This event is live as of XYZ

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