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Medicaid Meaningful Use and Alternative Payment Models: Connecting the Dots Lacey Vericker, RHIA, CPHIMS Outreach Supervisor

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Page 1: Medicaid Meaningful Use and Alternative Payment Models: … · 2017-05-23 · § Medicaid Meaningful Use (MU) • Modified Stage 2 and Stage 3 § Brief overview of alternative payment

MedicaidMeaningfulUseandAlternativePaymentModels:ConnectingtheDots

LaceyVericker,RHIA,CPHIMSOutreachSupervisor

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Objectives

§ MedicaidMeaningfulUse(MU)• ModifiedStage2andStage3

§ Briefoverviewofalternativepaymentmodelsandadvancedpaymentmodels

§ ExamplesofAPMsandadvancedAPMs§ HowdoAPMsandadvancedAPMsimpacttheMedicaidprovider?§ HowcanparticipationintheMedicaidMUprogramhelpqualifiedclinicianssuccessfullyparticipateinAPMs,advancedAPMs,MedicaidPCMHandMIPS?

§ Overviewofprogramyear2017MedicaidMUandupcomingchangesforStage3andprogramyear2018

§ WhatisAFMCdoingtohelpproviders?

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FrequentlyUsedAcronyms

§ MU:MeaningfulUse§ MIPS:Merit-BasedIncentivePaymentSystem§ APM:Alternativepaymentmodels§ A-APM:Advancedalternativepaymentmodels§ HIE:Healthinformationexchange§ ACI:Advancingcareinformation§ CDS:Clinicaldecisionsupport§ SRA:Securityriskanalysis§ CPOE:Computerizedproviderorderentry§ EHR:Electronichealthrecord§ CCD:Continuityofcaredocument§ TOC:Transitionofcare§ SOC:Summaryofcare§ VDT:View,downloadortransmit§ EP:Eligibleprovider§ API:Applicationprograminterface

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MedicaidMUHasNotGoneAway

• TheMerit-BasedIncentivePaymentSystem(MIPS)appliestocliniciansprovidingservicesunderMedicarePartB

• MIPSdoesnotreplacetheMedicaidEHRincentiveprogram,whichwillcontinuethroughprogramyear2021

• ClinicianswhoareeligiblefortheMedicaidEHRincentiveprogramwillcontinuetoattesttotheirrespectivestateMedicaidagenciestoreceivetheirincentivepayments

• EligiblecliniciansmustattestseparatelytoMIPSinadditiontoMedicaidMU

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Don’tMissOut

• TheMedicaidMUincentiveprogramwillcontinueuntil2021• 2016wasthelastyeartobegintheMedicaidMUprogram• Returningproviderswhomeet>30%patientvolumeandrequired

objectivescanstillattestuntil2021oruntiltheyhavereceivedsixincentivepaymentstotaling$63,750

• ReturningprovidersparticipatinginMedicaidMUprogramcanskipyearsandpickbackup

• ThelastyeartoattesttoMedicaidMUisprogramyear2021• AFMCcanhelpqualifiedproviderswithMedicaidMU,whichwillhelp

providerswiththeACIcategoryofMIPS(requiredforbothMIPSeligiblecliniciansandAPMparticipatingclinicians)

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MedicaidMUProgramYear2017

Reportingrequirements:• Minimum90-DayreportingperiodforMUobjectives• Minimum90-Dayreportingperiodforclinicalqualitymeasures

(CQM)

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MedicaidMUObjectives

§ ModifiedStage2§ Stage3§ Advancingcareinformation

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Objective1:ProtectPatientHealthInformation

§ Securityriskanalysismustbecompletedduringtheperformanceyear§ SRAhastobedoneforStage2andStage3

• RequirementforACIcategoryofMIPS• Noexclusions

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Objective2:ClinicalDecisionSupport(CDS)

• ImplementfiveclinicaldecisionsupportinterventionsrelatedtofourormoreCQMsatarelevantpointinpatientcarefortheentireEHRreportingperiod• Example:Creatingarulethatwillnotifytheproviderthatapatient

hasnothadainfluenzaimmunizationinoverayear• Implementthefunctionalityfordrug-druganddrugallergyinteraction

checksfortheentireEHRreportingperiod• Thisobjectiveisthesameforbothstages2and3• ThereisnotanequivalentmeasureforMIPS

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ModifiedStage2ComputerizedProviderOrderEntry(CPOE)

Measure1:MedicationOrdersMorethan60%ofmedicationorderscreatedbytheEPduringtheEHRreportingperiodarerecordedusingCPOE

Measure2:LaboratoryOrdersMorethan30% oflaboratoryorderscreatedbytheEPduringtheEHRreportingperiodarerecordedusingCPOE

Measure3:RadiologyOrdersMorethan30% ofradiologyorderscreatedbytheEPduringtheEHRreportingperiodarerecordedusingCPOE

• Exclusion:AnyEPwhowritesfewerthan100ordersduringtheEHRreportingperiod

• NotrequiredforACIinMIPS

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Stage3CPOE

Measure1:MedicationOrdersMorethan 60%ofmedicationorderscreatedbytheEPduringtheEHRreportingperiodarerecordedusingCPOE

Measure2:LaboratoryOrdersMorethan60%oflaboratoryorderscreatedbytheEPduringtheEHRreportingperiodarerecordedusingCPOE

Measure3:RadiologyOrdersMorethan60%ofradiologyorderscreatedbytheEPduringtheEHRreportingperiodarerecordedusingCPOE

• Exclusion:AnyEPwhowritesfewerthan100ordersduringtheEHRreportingperiod

• NotrequiredforACIinMIPS

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Objective4:ElectronicPrescribing

§ ModifiedStage2:50percentofallpermissibleprescriptionswrittenbytheEParequeriedforadrugformularyandtransmittedelectronicallyusingCEHRT

§ Stage3:60percentofallpermissibleprescriptionswrittenbytheEParequeriedforadrugformularyandtransmittedelectronicallyusingCEHRT

§ Exclusion:Iftheproviderwritesfewerthan100prescriptionsduringthereportingperiod

§ RequiredforACIcategoryinMIPS

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Objective5:HealthInformationExchange(HIE)

§ Formerlynamedtransitionsofcare(TOC)§ Incomingandoutgoingtransitions§ Whatisatransition?

• Atransitionisthemovementofapatientfromonesettingofcare(hospital,ambulatoryprimarycarepractice,ambulatory,specialtycarepractice,long-termcare,homehealth,rehabilitationfacility)toanother.AtaminimumthisincludesalltransitionsofcareandreferralsthatareorderedbytheEP.

§ WithcertainEHRs,youhavetomarkthepatientasatransitiontocapturethedenominatorbeforeyousendtheCCDdocumenttogetthenumerator

§ RequirementforACIcategoryofMIPS

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Objective5:HealthInformationExchange(HIE)

ModifiedStage2§ EPwhoreferstheirpatienttoanothersettingofcaremustuseCEHRTtocreateasummaryofcare(SOC)andelectronicallytransmitsuchSOCtoareceivingProviderfor10percent ofalloutgoingTOC

Exclusion:AnyEPwhotransfersapatienttoanothersettingofcareorrefersapatienttoanotherproviderfewerthat100timesduringtheEHRreportingperiod

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Objective5:HealthInformationExchange(HIE)

Stage3:Three-partmeasurethatincorporatesclinicalinformationreconciliation§ Sendmorethan50percentofoutgoingtransitionselectronically§ Incorporatemorethan40percentofincomingtransitionsintoyourEHRelectronically

§ Formorethan80percentoftransitionsornewpatients,aproviderhastoperformclinicalinformationreconciliation.Theprovidermustimplementclinicalinformationreconciliationforthefollowingthreeclinicalinformationsets:1. Medication2. Medicationallergy3. Currentproblemlist

Exclusions:§ AnyEPwhotransfersapatienttoanothersettingorrefersapatienttoanotherproviderfewerthan100timesduringtheEHRreportingperiod

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Objective6:PatientSpecificEducation

ModifiedStage2:Nochanges§ Patient-specificeducationresourcesidentifiedbyCEHRTareprovidedtopatientsformorethan10percent ofalluniquepatientswithofficevisitsseenduringtheEHRreportingperiod

Stage3§ Measureisincludedinthepatientelectronicaccesstohealthinformationobjective;rategoesupto35percent andtheEPmustprovideelectronicaccess tothesepatient-specificeducationresources

§ Exclusion:AnEPmayexcludefromthemeasureiftheyhavenoofficevisitsduringtheEHRreportingperiod.

§ ThismeasureisabonuspointforACIcategoryforMIPS

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Objective7:MedicationReconciliation– IncomingTransitions

§ Transitionofcare:Themovementofapatientfromonesettingofcare(hospital,ambulatoryprimarycarepractice,ambulatoryspecialtycarepractice,long-termcare,homehealthorrehabilitationfacility)toanotherExamples:• NewpatientneverbeforeseenbytheEP• PatienttransitioningbacktotheEPfromED,hospitalinpatientdischarge,SNF

• Provider’sdiscretion:EncounterwarrantsTOCvisit(notseeninthreeyears)

§ Demoninator:PatientencountermustbeidentifiedinEHRasanincomingTOCvisit

§ Numerator:EPmustreconcilepatient’smedicationsinencounter

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Objective7:MedicationReconciliation

Stage2:Nochanges§ EPperformsmedicationreconciliationformorethan50percentoftransitionsofcareinwhichthepatientistransitionedintothecareoftheEP.

§ Exclusion:AnyEPwhowasnottherecipientofanyTOCduringtheEHRreportingperiod

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Objective7:MedicationReconciliation

§ Stage3:ThismeasureisincludedintheHIEobjective,Measure3clinicalinformationreconciliation

§ BonuscreditforACIforMIPSCategory

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Dr.ChadRodgersHealthChat– PatientPortals

§ Dr.ChadRogers-AFMCChiefMedicalOfficer

§ https://www.youtube.com/watch?v=2xlHXBNt-yM

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Objective8:PatientElectronicAccess

Stage2:§ Measure1:>50%ofalluniquepatientsseenbytheEP

duringtheEHRreportingperiodwereprovidedtimelyaccesstoview,downloadortransmit(VDT)toathirdpartytheirhealthinformationwithinfourbusinessdaysofitbeingavailabletotheEPforeveryencounterwherethepatientisseenbytheEP

§ Measure2:>5%ofuniquepatients(ortheirauthorizedrepresentative)seenbytheEPduringtheEHRreportingperiodVDTtheirhealthinformationtoathirdparty

§ EPmustsatisfyandmeetthethresholdforbothmeasurestosatisfythisobjective.

§ RequirementforACICategoryofMIPS

PatientportalpostersandhandoutsareavailableontheAFMCwebsite

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CoordinationofCarethroughPatientEngagement

Stage3:ObjectivechangestitletoCoordinationofCarethroughPatientEngagement§ Measure1:Morethan5percent ofalluniquepatientsseenbytheEP(ortheirauthorizedrepresentatives)activelyengagewiththeelectronichealthrecordmadeaccessiblebytheproviderandVDTtoathirdpartytheirhealthinformation

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CoordinationofCarethroughPatientEngagement

§ Measure2:Morethan5percent ofalluniquepatientsseenbytheEP,asecuremessagewassentusingtheelectronicmessagingfunctionofCEHRTtothepatient(orthepatient’sauthorizedrepresentative)orinresponsetoasecuremessagesentbythepatientortheirauthorizedrepresentative

§ Measure3:Patient-generatedhealthdataordatafromanonclinicalsettingisincorporatedintotheCEHRTformorethan5percent ofalluniquepatientsseenbytheEPduringtheEHRreportingperiod

Patient-generatedhealthdataorhealthmonitoringtechnologyexamples:• Fitnesswatches• Wireless-connectedscales• Heartratemonitors• Bloodpressuremonitors

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Objective9:SecureMessaging

§ Stage2:5percenthavetosendorreceiveasecuremessagethroughthepatientportalto/fromapatientorpatientrepresentative

§ Stage3- Thismeasureistransitionedtocoordinationofcareobjective§ RequirementforACIcategoryinMIPS

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Objective10:PublicHealthReporting

§ ModifiedStage2§ Mustattesttotwomeasures§ Optionsare:

• Immunizationregistryreporting• Syndromicsurveillancereporting• Specializedregistry

§ Exclusions:Thereareexclusionsbuttheywillbeona-caseby-casebasis

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Objective10:PublicHealthReporting

§ Stage3• Mustattestto2measures• Optionsare

o Immunizationregistryreportingo Syndromicsurveillancereportingo Electroniccasereportingo Publichealthregistryreportingo Clinicaldataregistryreporting

• Exclusions:Thereareexclusionsbuttheywillbeona-caseby-casebasis

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ClinicalQualityMeasures

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§ Stillhavetoreportonnineclinicalqualitymeasures• Ninemeasuresoverthreedifferentdomains

§ SinceclinicalqualitymeasureswillbeapartofMIPS,youwillwanttoalignthesetwoprograms

§ CQMnumeratoranddenominatorswillcount,soyouwillwanttoreportyourbestnumbers

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AlternativePaymentModelsandAdvancedAPM

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AlternatePaymentModels(APM)

APMisagenerictermdescribingapaymentmodelinwhichproviderstakeresponsibilityforcostandqualityperformanceandreceivepaymentstosupporttheservicesandactivitiesdesignedtoachievehighvalue

Source:CMS

OnlysomeoftheseAPMswillbe“eligible”or“AdvancedAPMs”

CurrentAPMsInclude:• MSSPACOs,Track1• CompESRDCare(Non-

LDO)• OncologyCare(1-sided

risk)

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AdvancedAPMs

Source:CMS

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AdvancedAPMs

In2017,thefollowingareadvancedAPMs• ComprehensiveESRDcare(CEC)– Two-sidedrisk• ComprehensivePrimaryCarePlus(CPC+)• NextgenerationACOmodel• Sharedsavingsprogram– Track2• Sharedsavingsprogram– Track3• Oncologycaremodel(OCM)– Two-sidedrisk• Comprehensivecareforjointreplacement(CJR)paymentmodel–

Track1CEHRT

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MedicalHomeModels

Source:CMS

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WhatAboutArkansasMedicaidPCMH?

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§ ArkansasMedicaidPCMH– isitaneligible/advancedAPM?• ThegoalhasbeenforArkansasMedicaidPCMHtobecomeanadvanced APM by2019

• Plansarecurrentlyunderdevelopment

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ConnectingtheDots:HowDoesEverythingTieTogether?

PaymentModel

VBM

MUPQRS

AdvancedAlternativePaymentModel

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ACIvs.MedicaidMU

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ACI2017TransitionObjectivesandMeasures

1. Protectpatienthealthinformation2. e-Prescribing3. Healthinformationexchange4. Providepatientaccess5. Patient-specificeducation6. VDT(Portal)7. Securemessaging8. Medicationreconciliation9. Immunizationregistryreporting

Bonus:Syndromicsurveillance,specializedregistryreporting,andreportingIAsviaEHR

MedicaidMU2017ObjectivesandMeasures

1. Protectpatienthealthinformation2. Clinicaldecisionsupport3. CPOE(medications,labs,radiology)4. e-Prescribing5. Healthinformationexchange6. Patient-specificeducation7. Medicationreconciliation8. PatientportalaccessandVDT9. Securemessaging

PublichealthrReporting (tworequired)1. Immunizationregistryreporting2. Syndromicsurveillance3. Specializedregistry

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WhatisAFMCDoing?

§ Preparingtodelivertechnicalassistance§ EncouragingproviderstomakeprogresswithMUofCEHRTandelectronicexchangeofhealthinformation(interoperability)

§ Assistingpracticesstatewidewithqualityinitatives• MedicaidMU• HIPAAsecurityandprivacypolicies/securityriskanalysis• ArkansasMedicaidPCMHpracticetransformation• MSSPACOpracticetransformation• MIPStechnicalassistanceforeligiblecliniciansthroughtheTMFQIN-QIO

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Questions

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Resources

§ CMSqualitypaymentprogramslidesandresources• https://qpp.cms.gov

§ CMSspecsheets• https://www.cms.gov/regulations-and-guidance/legislation/ehrincentiveprograms/2016programrequirements.html

§ AFMCpatientportalhandouts• https://afmc.org/product/patient-engagement-patient-portal-poster/

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ContactInformation

§ Forfurtherassistance:• [email protected]• Call501-212-8616


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