Quality in Patient Care Know It, Use It, Prove It, Oh My! Disclosures 5/18/2015. Jeff Michaels, OD, FAAO Andrew Archila, OD, FAAO
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1 Quality in Patient Care Know It, Use It, Prove It, Oh My! Jeff Michaels, OD, FAAO Andrew Archila, OD, FAAO Disclosures Dr. Michaels and Dr. Archila hold zero financial benefit to the products contained herein including to AOA MORE (optometry s registry) Dr. Michaels and Dr. Archila have no current financial disclosures The views expressed are those of the presenters and don t reflect the official policy or position of the Department of the Navy, Department of Defense, nor the US Government. Buying coffee is easy enough to understand You either have the currency to participate or you don t Do you have the right health care currency? Can you prove it? In Quality We Trust 1
2 A few simple questions Will Medicare funding last forever? Why? Aging of America? System paid on QUANTITY If you own a business Would you rather pay employees by quantity of service or quality of service? Many of us pay by quantity (hours worked) Some of us also pay by quality (bonuses) What is more important in ANY business: quantity of products sold or quality of products sold? Or both? CMS Game Changer 2015 HR2: Medicare Access and CHIP Reauthorization Act of 2015 (MACRA) Medicare severs Pay for Service Payments Service, Quality, EMR, Cost» PQRS» Meaningful Use» Physician Payment Modifier 2
3 Did MACRA Come Out of Left Field? Or has CMS been talking quality payment for years? CMS Quality Publications Roadmap for Implementing Value Driven Healthcare in the Traditional Medicare Feefor Service Program April 2007 CMS Roadmap for Value Driven Health Care CMS Goals for Value Based Purchasing Payment Incentives Medicare payments linked to quality and efficiency of care Effectiveness Care is evidence based and outcomes driven to better manage disease Transparency Value based payments give patients information on the quality, cost and safety of their healthcare 3
4 Consider Medicare s Fiscal Health 2008 Medicare Annual Report to Congress The Board of Trustees emphasizes the continuing financial pressures facing Medicare and urges the nation s policy makers to take steps to address these concerns. CMS Quality Publications Development of a Plan to Transition to a Medicare Value Based Purchasing Program for Physician and Other Professional Services December 2008 The who, what, where, when of transitioning Medicare to Pay for Performance CMS Quality Publications Development of a Plan to Transition to a Medicare Value Based Purchasing Program for Physician and Other Professional Services Goal Objective Primary Focus How Incentives Measures Data Public Reporting 4
5 MIPPA 2008 Medicare Improvements for Patients and Providers Act of 2008 Section 131(d) requires the HHS Secretary to develop a plan to transition Medicare to a Value Based Purchasing program for professional services that is based on efficiency and quality What is Value Based Purchasing? Value Based Purchasing = Pay for Performance MIPPA 2008 Medicare Improvements for Patients and Providers Act of 2008 Section 131(d) requires the HHS Secretary to develop a plan to transition Medicare to a Pay for Performance program for professional services that is based on efficiency and quality 5
6 PPACA 2010 Patient Protection and Affordable Care Act Directs the establishment of a number of Value Based Purchasing programs and payment bundling initiatives Physicians Hospitals & Ambulatory Surgery Centers $$ penalties in 2015 for not participating in PQRS ACA & Physicians Requires HHS Secretary to establish a payment modifier that provides for differential payment to physicians under the physician fee schedule based on the quality of care PPACA: Payment Modifier Begins January 1, 2015 for selected physicians and physician groups January 1, 2017 for all physicians ( This means ODs MACRA continues the Payment Modifier in
7 PQRS Optometry s start in the quality arena 2007 Voluntary 2015 Penalty for not participating MACRA continues PQRS requirements PQRS for ODs The Good News % submitted 6% paid % submitted 10% paid Afterwards, rules loosened to 50% threshold to qualify for payment % submitted 19% paid % submitted 20% paid % submitted 20% paid PQRS for ODs The Good News Specialties with the largest Number of Eligible Professionals Participating in PQRS through Claims Reporting (2013) Specialty Eligible Professionals Eligible Professionals who Participated Percent of Eligible Professionals who Participated Claims Individual Measures Emergency Medicine 34, % 50,051 Anesthesiology 40,527 26, % Physical/Occupational Therapy 49,006 24, % Nurse Anesthetist 46,266 23, % Family Practice 78,441 22, % Internal Medicine 76,041 21, % Radiology 31,213 19, % Physician Assistant 50,626 15, % Nurse Practitioner 62,216 13, % Optometry 33,698 12, % 7
8 PQRS for ODs The Good News Top 10 Specialties Earning a PQRS Incentive Claims Based Individual Measures (2013) Eligible Eligible Professionals Percent Who Specialty Professionals who who Qualified for an Qualified for an Participated Incentive Incentive Emergency Medicine 34,292 31, % Anesthesiology 26,914 20, % Nurse Anesthetist 23,484 17, % Physical/Occupational Therapy 24,308 15, % Radiology 19,980 14, % Family Practice 22,631 11, % Physician Assistant 15,383 10, % Internal Medicine 21,695 10, % Nurse Practitioner 13,100 7, % Optometry 12,646 6, % PQRS for ODs The Bad News! 20,326 ODs getting a pay cut by Medicare Because you didn t submit PQRS in % of all ODs are currently not ready for Medicare s new payment system that starts in 2019!! OMDs 28% receiving payment reduction in 2015 Why Optometry? DID YOU KNOW: there are 20 medical conditions that account for over 95% of Medicare's costs? 8
9 Medicare s 20 High Impact Conditions Acute myocardial infarction (AMI) Alzheimer's Disease and related disorders Atrial fibrillation Breast cancer Cataract Congestive heart failure (CHF) Chronic kidney disease Colorectal cancer Chronic obstructive pulmonary disease (COPD) Diabetes Endometrial cancer Glaucoma Hip/pelvic fracture Ischemic heart disease Lung cancer Major depression Osteoporosis Prostate cancer Rheumatoid arthritis and osteoarthritis Stroke/transient ischemic attack (TIA) Why Optometry? We are on the FRONT LINE for many of Medicare s most cost exhausting conditions! Enter PQRS Identified gaps in care in these most cost exhaustive conditions Reduce the gaps Improve outcomes Reduce costs 9
10 PQRS Under the Hood Glaucoma 2027F There is a significant gap in documentation patterns of the optic nerve for initial and follow up visits Even among glaucoma specialists!! PQRS Under the Hood Diabetes 2021F RAND Study 50% of diabetics get timely eye exams 19% had evidence of dilated eye exam 10
11 CMS Game Changer 2015 HR2: Medicare Access and CHIP Reauthorization Act of 2015 (MACRA) Medicare severs Pay for Service as the sole payment plan Combines PQRS, EMR use and Physician Payment Modifier to decide your reimbursement Merit based Incentive Payment System (MIPS) Game Changers Overview of MACRA Merit based Incentive Payment System (MIPS) New Medicare Payment System in 2019! Grades provider from performance categories Quality (30% of grade) Resource Use (30% of grade) Meaningful Use of EHRs (25% of grade) Clinical Practice Improvement Activities (15% of grade) 11
12 Overview of MACRA Merit based Incentive Payment System (MIPS) Grades provider from performance categories Quality (30% of grade) PQRS (registry) Resource Use (30% of grade) Yet to be determined metrics that define episodes of care Cost to provide care» It took you 4 visits with a glaucoma patient, is that normal Meaningful Use of EHRs (25% of grade) Registry in the Menu Set of MU1, MU2 and expected in MU3 Clinical Practice Improvement Activities (15% of grade) Registry use; care coordination; practice surveys; etc. Overview of NEW Medicare Payment System Merit based Incentive Payment System (MIPS) point scale 2019 Up to 12% additional payment 2022 Up to 27% additional payment Decreases in payment for those not meeting quality targets MACRA design is cost neutral Somebody loses! 59% Remember, 59% of ODs are not currently participating in PQRS! You have to get in the game PQRS MU Registry use Not just CMS! 12
13 Overview of NEW Medicare Payment System Medicare s move to Value Based Purchasing 85% of Medicare payments will move to valuebased purchasing categories 2 through 4 by percent by Category 1 fee for service with no link to quality Category 2 fee for service with link to quality» PQRS, Value based Modifier, erx, etc Category 3 alternative payment models built on fee forservice architecture» ACO s, etc. Category 4 population based payment Overview of NEW Medicare Payment System It is impossible to get maximum reimbursement without using a Registry! 13
14 Registry info AOA MORE Measures and Outcomes Registry for Eyecare What is? A registry! Database Systematic collection of data Captures data that can be analyzed Analyze to improve care and outcomes Not an EMR Data collected from multiple EMRs Even across different EMR vendors How helps you Helps in Answering Optometry s Questions: Kids under 5? Most common K ulcer? Diabetics? Myopia progression? Exams? 14
15 How helps you Measures Submits data to Medicare for you Info for PQRS is pulled from your EMR NO MORE FILING EXTRA CLAIM CODES!! CMS is phasing out claims-based PQRS Outcomes Profession-wide and individual OD Meaningful Use CMS has increased the need for a registry with each Stage Stage 3 criteria expected soon Expect registry-use to be emphasized How helps you Allows for Benchmark Comparisons Dashboard Creates Evidence-base 30,000+ ODs working together Assists in Advocacy Optometry writes its own script! CMS Top Registry Users by # (2013 data) Specialty Eligible Professionals Eligible Professionals who Participated Percent of Eligible Professionals who Participated Registry Individual Measures Internal Medicine 76,041 5, % Physical/Occupational Therapy 49,006 5, % Family Practice 78,441 4, % Dermatology 9,791 3, % Nurse Practitioner 62,216 3, % Physician Assistant 50,626 2, % Other Eligible Professional 38,052 2, % Radiology 31,213 2, % Ophthalmology 17,468 1, % Cardiology 18,851 1, % 15
16 Sunday, October 23, 2011 Guest Medical Editor: Arun D. Singh, MD Managing Editor: Susanne Medeiros Editors: Patty Ames, Peggy Denny and Chris McDonagh Writers: Lori Roniger, Jean Shaw, Mark Simborg and Annie Stuart Today s news from the Annual Meeting Opening Session features Academy s plans to shape the future in turbulent times Contacts: not the same old options Fifteen years after the Endophthalmitis Vitrectomy Study: Where are we now? The Great Debate tackles treatment of wet AMD How helps you Merit based Incentive Payment System (MIPS) New Medicare Payment System in 2019! Grades provider from performance categories Quality (30% of grade) Resource Use (30% of grade) Meaningful Use of EHRs (25% of grade) Clinical Practice Improvement Activities* (15% of grade) 70% of MIPS is tied to your use of a data registry! How Does work? Integrates with your Electronic Medical Record Additional vendors over the next 12 months Integration was key to allow ODs be ODs! No manual entry required or allowed 16
17 EMR PUSH Registry CMS/ PQRS/ etc Rollout this week at OM! President s Council House of Delegates Press release and conference at OM AOA Central in Exhibit Hall Sign up at AOA Central AOA Booth What if my vendor is not yet integrated? RevolutionEHR, Compulink Advantage and MaximEyes are currently integrated If these are not yours, signup anyway. Plan to integrate OfficeMate/ExamWRITER/Eyefinity EHR Practice Director EHR Crystal PM Others Demand? 17
18 Resources #1: go to AOA Central this weekend in Exhibit Hall aoa.org/more Comprehensive FAQ AOA NEWS articles Video education Cost? You DESERVE to be at the value based purchasing table $0 to members Registries cost upwards of $100 per month per doctor in other professions and optometry Screenshots 18
19 Submit Data Wizard Data Wizard Step 2 Data Wizard Step 3 19
20 Data Wizard Step 4 Data Wizard Step 5 My Patients 20
21 Help Screen PQRS PQRS details 21
22 Reports What Does the Future Hold? CMS has changed their paradigm are we as an Association ready for the future? The AOA is working to keep you at the table with VBP changes! Are you ready? 22
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