macra webinar - ehr integration services€¦ · macra is the most significant change to the...
TRANSCRIPT
June 20, 2018
“Transitioning to Value-Based Care”
MACRA Webinar
• Founded in 2006
• Approximately 55 FTEs | Industry Savvy & Experienced
• 394 Clients | 45 States
• ByteSized Solutions – Strategic Partner
• Perfect Practice Alliance formed in 2015
• Company’s Culture revolves around Family, Faith & Fun!
BRIEF HISTORY OF EHR INTEGRATION SERVICES
“Our human approach to healthcare technology delivers best-in-class technology combined with years of practical healthcare experience to allow healthcare professionals to focus on the delivery of patient care and less on technology.”
– Craig Luce
FAMILY
INTEROPERABILITY
Clinical Data & EHR
Financial Data& Practice Management
Population Health Management
Connected Devices
Healthcare Interfaces
Government ReportingMIPS/MACRA
Integrated Workflow
Front Office &Patient Experience
IMPROVING PERFORMANCE ACROSS CARE SETTINGS
FRONT DESK APPLICATIONS
5
CLINICAL & PRACTICE MANAGEMENT WORKFLOW
BACK OFFICE PRODUCTIVITY
HEALTH INFORMATIONTECHNOLOGY
IT
Medical Practices are complex organizations that deliver care in a multitude of settings. EHRIS recognizes this challenging requirement and strives to provide solutions that will work across all care settings.
Advisory Services“We can’t solve problems by using the same kind of thinking we used when we created them.”– Albert Einstein
Advisory Services• Transition to value-based payment agreements• Determine cost control strategies • Determining the most lucrative attestation mechanism• Establish plans for "Other Payer APMs" in CY 2019• Manage financial risk through population health and risk stratification• Address high cost beneficiaries, HCC scores and QRUR ancillary tables
Clinical Project Management• Physician Governance Structures• Acquisition Management• Software Conversions• Population Health Systems / Dashboards• ACO Management• Quality Management• Clinical Protocols• Physician Incentive Plans
SERVICES
Agenda
1. A different perspective on MACRA
2. Value-Based Payment Transition
3. MACRA as the Foundation to Value-Based Care
4. 8 steps to Value-Based Payment Risk Mitigation
5. Onboarding Provider Implications in MACRA
6. The Future of MACRA
Change in Perspective
Quality over Quantity?
No, value-based care is high quality efficient care that improves patient outcomes based on the services rendered
Value Received for Services Rendered
Outcomes
Quality
Cost
• Improve Outcomes
• Reduce Use
• Care Coordination
• Preventive Screening
• Reduce Unnecessary Treatment
• Prevent Exacerbations
Mission Statement
Joining Next Generation ACO
17
MACRA is the most significant change to the physician fee schedule in 26 years. – American Hospital Association
In 2018, CMS estimates up to 250,000 1 physicians will risk 8% of their Medicare revenue to become a Qualifying Participant (QP) out of a total of 604,006 physicians. 2 These QPs will receive a lump sum 5% incentive yearly through performance year 2022.
Medicaid and Medicare Advantage programs will become eligible as Advanced APMs in 2019 and commercial payers in 2020.
Beginning in 2026, the Physician Fee Schedule will increase to .75% for QPs and decline to .25% for non-qualifying providers.3
1. https://www.federalregister.gov/d/2017-24067/p-1882. https://www.federalregister.gov/d/2017-24067/p-41843. https://www.federalregister.gov/d/2017-24067/p-4147
Value-Based Payment Transition
MACRA Foundation to Value Based Care
Where do we begin?
1. Maximize the capability of the EHR platform
2. Focus on closing clinical quality gaps at the point of care
3. Provide meaningful and actionable feedback to the clinicians
4. Align organization roles and responsibilities
5. Understand the cost and quality of the care delivered
6. Focus on care coordination for high risk patients
7. Partner with community healthcare organizations
8. Determine the level of risk the organization can manage
“Risk comes from not knowing what you’re doing.” – Warren Buffett
• Align workflow to address eCQMs, clinical decision support and clinical protocols• CMS states “We encourage the use of EHR to collect data whenever possible. We intend to
reduce the number of claims-based measures in the future”1
• 70% of claims are topped out 2, which, based on the topped out timeline, will remove 52 of the existing 74 claims based measures 3 by 2021
• Ensure clinical data is captured and codified for use in dashboards and population health tools• Establish clinical protocols to evaluate cost and outcomes for Diabetes, COPD, CAD and HF
• Clinicians need real-time or near real-time feedback on care gaps• Feedback needs to be meaningful and actionable• Present measure improvements as outcomes improving patient lives
EHR Tools (at the point of care)
Actionable
Feedback
Align Organization
Roles
• All organization initiatives must be reviewed for the impact to quality performance through change control
• Cross-functional resources must work together to achieve quality initiatives• Clinical operations knows best how to integrate software into workflow and process which also
ensures accountability• Tracking quality initiative performance must be operationalized
Value-Based Payment Risk Management
“Risk comes from not knowing what you’re doing.” – Warren Buffett
COST
Value-Based Payment Risk Management
2016 QRUR Report• Understand beneficiary cost attribution to your TIN• Evaluate Hierarchical Conditions Categories (HCC)
beneficiary score and associated costs• Evaluate cost of care for beneficiaries with Diabetes, COPD,
CAD and HF • Evaluate admitting hospital episode admissions and
associated costs2017 MACRA Report (July 2018)
• Feedback for 2017 expected similar to QRUR • Must be evaluated to understand cost implications for 2018
performanceCommercial Payer Reports and Data Exports
• Utilize claim based reports to understand cost of care
How do we evaluate cost?
“Risk comes from not knowing what you’re doing.” – Warren Buffett
Care Coordination
Community
Partnerships
Managing Risk
Value-Based Payment Risk Management
• Care coordination must focus on high risk populations• Utilizing risk stratification to align targeted care coordination programs will improve quality and reduce
exacerbations• Codified clinical data collected through clinical workflow satisfying eCQM is available for risk stratification
and prediction for patient populations• Predictive analytics can further refine care coordination programs
• Beneficiary cost to a certain is out of your control so partnering with an ACO helps to manage the level of risk exposure
• Understand the cost of services being attributed to your TIN by other providers and hospitals• Look for opportunities for partnerships, acquisitions and hospital agreements that control costs• Evaluate social determinate implications and opportunities with payers
• Determine the level of risk management that is feasible• Evaluate opportunities to establish ACO’s or join an existing Advanced APM• Evaluate options to establish an Advanced APM• Define a plan to prepare and move into risk bearing agreements• Prepare for Other Payer Advanced APMs in 2019 and beyond
Provider Onboarding Management
Key Points
1. Provider payment adjustments for previous performance years will follow the provider to the new TIN/NPI
2. QP incentives will also follow to the new TIN/NPI if the CMS-588EFT application reflects the new TIN information
1
1. https://www.federalregister.gov/d/2016-25240/p-5908
The Future of MACRA
• 2015 CEHRT will be required in 2019
• Cost will increase to 30% in the MIPS track
• Removal of topped out or underperforming quality measures associated with the “Measures that Matter” initiative
• Alignment of physician and hospital quality measures
• Hospital based physician reporting alignment
• Focus on interoperability based objectives
• Reducing reporting burden with direct EHR reporting
• APMs are here to stay
Where is your organization?
Where are you?
MACRA“Transitioning to Value-Based Care”
Questions?
