Transforming Healthcare through Data-Driven Solutions. Pay for Performance Solutions
|
|
- Aron Riley
- 8 years ago
- Views:
Transcription
1 Transforming Healthcare through Data-Driven Solutions Pay for Performance Solutions
2 Medicare Access and CHIP Reauthorization Act of 2015 MACRA Enacted April 15, /14/2015 Copyright Mingle Analytics 2
3 Agenda What do we already know about MIPS? What can/should we assume? What questions is Medicare asking us about MIPS? What do we want? How should it be set up? Post-Presentation your questions and comments to We will post answers and commentary on our 10/14/2015 Copyright Mingle Analytics 3
4 The Future of PQRS A System in Evolution 2016 (2018) is the Final Year in their current form: Physician Quality Reporting System (PQRS) Value Based Modifier (VBM) Quality Tiering Meaningful Use Merit-Based Incentive Payment System (MIPS) ((Quality Tiering + PQRS + VBM + EHR) + a b) x N Competition on a 100 point scale 30 quality points 30 resource use points 25 meaningful use points 15 practice improvement points Increasing Adjustments ±4% 2017 (2019) ±9% 2020 (2022) 10/14/ Mingle Analytics 4
5 MACRA, Section 101 Replaces the annual Medicare sustainable growth rate (SGR) adjustments to the Physician Fee Schedule With a new Merit-based Incentive Payment System (MIPS) Sunsets payment adjustments under Physician Quality Reporting System (PQRS) Value-Based Payment Modifier (VM) Electronic Health Records (EHR) Incentive Program Consolidates aspects of PQRS, VM, and EHR Incentive Program into the new MIPS Promotes the development of: Alternative Payment Models (APMs) Physician- focused payment models (PFPMs) 10/14/2015 Copyright Mingle Analytics 5
6 Published in the Federal Register 10/01/ CFR Part 414 [CMS-3321-NC] Request for Information Regarding Implementation of the Merit-based Incentive Payment System, Promotion of Alternative Payment Models, and Incentive Payments for Participation in Eligible Alternative Payment Models 10/14/2015 Copyright Mingle Analytics 6
7 Comment on the Implementation of MIPS Search for: Request Merit 10/14/2015 Copyright Mingle Analytics 7
8 The Merit-Based Incentive Payment System MIPS 10/14/2015 Copyright Mingle Analytics 8
9 1848(q) of the Act requires: MIPS applies to Medicare Part B payments starting January 1, 2019 Based on the 2017 Service and reporting year Assess annual composite performance of each MIPS EP annual composite performance score MIPS adjustment factor additional MIPS adjustment factor if indicated performance score a composite of: Quality resource use clinical practice improvement activities meaningful use of certified EHR technology 10/14/2015 Copyright Mingle Analytics 9
10 The Act requires the Secretary to consult with stakeholders identification of measures and activities for each of the four performance categories methodology to assess each MIPS Eligible Professional s Composite performance score This RFI Over 200 questions Nearly 30 topics 10/14/2015 Copyright Mingle Analytics 10
11 A Healthcare System in Transition - Programs in Evolution Fee For Service 10/14/ Mingle Analytics 11
12 Reasonable Assumptions The national goal is to push healthcare to higher value Sustainable Growth Rate adjustments were discontinued because they Did Not Work MIPS and related programs are proposed as more likely to work MIPS is designed to deliver equal amounts of reward and penalty We will be graded on a curve under MIPS 10/14/2015 Copyright Mingle Analytics 12
13 1. MIPS EP Identifier and Exclusions MIPS EP for the first 2 years Physician (doctors of medicine, osteopathy, dental surgery, dental medicine, podiatric medicine, optometry, and chiropracty) Physician Assistant (PA) Nurse Practitioner (NP) Clinical Nurse Specialist (CNS) Certified Registered Nurse Anesthetist (CRNA) MIPS Groups Any group that includes above professionals Virtual Groups: Small practices of 1-10 EPs band together Secretary has discretion to specify additional EPs starting in year 3 which may include Certified Nurse Midwife Clinical Social Worker Clinical Psychologist Registered Dietician or Nutrition Professional Physical or Occupational Therapist Speech-Language Pathologist Audiologist 10/14/2015 Copyright Mingle Analytics 13
14 Current Identifiers Program PQRS for Individual Reporting PQRS for Group Practice Reporting EHR Incentive Program VBM Pioneer ACO Identifier TIN - NPI TIN NPI TIN ACO-ID 10/14/2015 Copyright Mingle Analytics 14
15 Identifiers My thoughts The operative unit of delivery is the Practice PQRS has been working well with TIN and TIN-NPI Meaningful Use, at the NPI level is excessively complicated Special identifiers required for APM Virtual Groups 10/14/2015 Copyright Mingle Analytics 15
16 The Split TIN When some providers in a TIN are exempt from MIPS due to being part of a qualifying APM what safeguards should be in place to ensure that we are appropriately assessing MIPS EPs and exempting only those EPs that are not eligible for MIPS? 10/14/2015 Copyright Mingle Analytics 16
17 Virtual Groups Small Practices (1-10 EPs) to be able to elect to report as a Virtual Group elect for a performance period for a year allows a group's performance to be tied together 10/14/2015 Copyright Mingle Analytics 17
18 Virtual Groups My Thoughts Ask: What is the potential advantage to the group? What is the potential advantage to the Patients of the Group? What is the potential advantage to the Payer? 10/14/2015 Copyright Mingle Analytics 18
19 7 available mechanisms to report 1. Claims-based reporting 2. Qualified Registry reporting 3. Qualified Clinical Data Registry reporting 4. Direct EHR products 5. EHR Data Submission Vendor products 6. Consumer Assessment of Healthcare Providers and Systems (CAHPS) for PQRS 7. GPRO Web Interface 10/14/2015 Copyright Mingle Analytics 19
20 Mechanisms My Thoughts We have 8 years of development and evolution behind the current 7 mechanisms Hold back from dramatic change for 2 years while we adjust to MIPS All 7 should continue to evolve/improve All mechanisms should apply to all entities Measure Group type of sampling methodology available to groups Web Interface could be that methodology but is not as applicable beyond primary care / general medicine 10/14/2015 Copyright Mingle Analytics 20
21 Data Accuracy My Thoughts The SEVT Tool works reasonably well Enhance it with available known data sets Expect periodic testing against known standards 10/14/2015 Copyright Mingle Analytics 21
22 CEHRT My Thoughts Keep our eyes on the prize Goal is High Quality and Low Cost We don t want to stifle innovation Use of CEHRT is desirable Other tools should not be precluded EHRT that is not certified Paper based charting Meaningful use can have reduced emphasis Low benchmarks Let competition and innovation drive and define Meaningful Use 10/14/2015 Copyright Mingle Analytics 22
23 Resource Use My Thoughts Good foundation Alignment with Measures is desirable Episode measures Episode costs Topic specific measures (ie: CABG, Sinusitis) Topical Costs Cost of Drugs is a potent driver of overall costs and should be included 10/14/2015 Copyright Mingle Analytics 23
24 CLINICAL PRACTICE IMPROVEMENT ACTIVITIES Promoting Health Equity and Continuity Social and Community Involvement Achieving Health Equity, high quality for underserved populations, emergency preparedness and response integration of primary care and behavioral health 10/14/2015 Copyright Mingle Analytics 24
25 Clinical Practice Improvement Activities My Keep our eyes on the prize Goal is High Quality and Low Cost But we don t want to stifle Community Service Efforts to Achieve equity It can be difficult and unprofitable to a serve People with Multiple or severe diseases Cultural barriers or incompatibilities Inability to Pay Thoughts Permanent recurring credits Rural, underserved, or HPSA service Annual recurring efforts Maintenance of Certification Open to new Medicare / Medicaid / Uninsured patients Does practice profile match Census for underserved populations? Select Cost and Quality metrics stratified by race, ethnic, other Special improvement projects Standard selections Special projects by application 10/14/2015 Copyright Mingle Analytics 25
26 MEANINGFUL USE OF CERTIFIED EHR TECHNOLOGY 25 percent of the composite performance score under the MIPS based on performance in the meaningful use of certified EHR technology performance category Secretary has discretion to reduce the percentage weight not below 15 percent When estimate that the proportion of EPs who are meaningful EHR users is 75 percent or greater 10/14/2015 Copyright Mingle Analytics 26
27 Meaningful Use My Thoughts Keep our eyes on the prize Goal is High Quality and Low Cost We don t want to stifle innovation Meaningful use can have reduced emphasis Low benchmarks Let competition and innovation drive and define Meaningful Use Change Unit of Analysis from NPI to choice of TIN TIN - NPI 10/14/2015 Copyright Mingle Analytics 27
28 Other Measures The Secretary may choose to use measures that are used for a payment system other than the PFS 10/14/2015 Copyright Mingle Analytics 28
29 Other Measures My Thoughts Standardize and disseminate across programs measures that are meaningful and working 10/14/2015 Copyright Mingle Analytics 29
30 Performance Standards Secretary must consider when establishing performance standards Historical performance standards Improvement Opportunity for continued improvement. if there are not sufficient measures and activities applicable and available to each type of EP, assign different scoring weights (including a weight of zero) from those that apply generally under the MIPS. 10/14/2015 Copyright Mingle Analytics 30
31 Performance Standards - My Thoughts At the heart of the mission is to promote more cost effective care. Cost effectiveness is the comparative analysis of the cost per unit of quality. Cost Quality Comparison Valid comparisons (in decreasing order of priority) include: 1. Compare against nationwide benchmarks. 2. Compare in my community. What is community? Geographical (suitable for primary care and general medicine) Primary Care service area Hospital Service Area Tertiary Care Service Area Specialty Regional or National 3. Compare to self. Am I improving year to year? 10/14/2015 Copyright Mingle Analytics 31
32 Weighing Performance - My Thoughts 9 measures in 3 domains is a good Foundation Goal BUT We improve what we measure Watch for bias (distraction) introduced by measuring what is measurable Obeisance to arbitrary goals Every specialty, theoretically, has an ideal set of measures that defines what we want from the specialty Priorities can evolve over time 10/14/2015 Copyright Mingle Analytics 32
33 MIPS COMPOSITE PERFORMANCE SCORE AND PERFORMANCE THRESHOLD Secretary must assess the total performance of each MIPS EP based on performance standards in each of four performance categories scoring scale of 0 to 100 applicable to each performance year 10/14/2015 Copyright Mingle Analytics 33
34 Questions re Public Reporting Should we continue to use a minimum 20 patient threshold for public reporting through Physician Compare of quality measures in addition to assessing the reliability, validity and accuracy of the measures. Should we use, instead, a minimum reliability threshold. Should CMS include individual EP and group practice-level quality measure data stratified by race, ethnicity and gender in public reporting? 10/14/2015 Copyright Mingle Analytics 34
35 Public Reporting My Thoughts A reliability threshold seems to be what we want Stratification by race, ethnicity and gender will Increase complexity and cost of reporting Generate smaller, less significant measurements Introduce new errors and unreliability We should address Race, Ethnicity, Gender, and other types of equitable distribution of care with specific focused measures 10/14/2015 Copyright Mingle Analytics 35
36 Feedback Reports My Thoughts Routinely available to the vendor submitting the data for the year of submission Others by action / permission of the Practice Authorized Representative Cost and Quality contributions to attributable patients from other entities Equitable distribution measurement 10/14/2015 Copyright Mingle Analytics 36
37 Alternative Payment Models establishes incentive payments for EPs who are Qualified Providers (QPs) with respect to a year. a specified percent of an EP's payments must be attributable to an eligible alternative payment entity Models under section 1115A of the Act Not health care innovation awards Shared Savings Program demonstrations under the Health Care Quality Demonstration Program demonstrations required by federal law 10/14/2015 Copyright Mingle Analytics 37
38 An APM requires participants to use certified EHR technology provides for payment based on quality measures comparable to the MIPS quality measures Either bears financial risk for monetary losses under the APM that are in excess of a nominal amount Or is a medical home 10/14/2015 Copyright Mingle Analytics 38
39 On QP, Qualification, Incentive, Adjustment Bulk Sum Incentive Payments in years For any year as a QP 5% of prior year aggregate part B payments Partial QP Not Incentive Eligible Choose MIPS +/- Adjustment eligible if submitting Secretary can choose qualification by patient count rather than payment Year MC QP Qualification Thresholds (APM as % of Total Payments) All Payer QP MC Com Ins MC PQP % 20% % 20% Partial QP All Payer PQP MC Com Ins % 25% 50% 40% 20% 40% % 25% 50% 40% 20% 40% % 50% 75% 50% 20% 50% 10/14/2015 Copyright Mingle Analytics 39
40 Questions re APM Entities Should patient count or Charges be used to define thresholds? What does Nominal Risk mean? What does substantial Risk mean? What entities should/could be considered EAPM entities? What Quality Measures should apply to APM entities What should define CEHRT use for an APM 10/14/2015 Copyright Mingle Analytics 40
41 APM My thoughts There should be coordination of measures and mechanisms for all entities CEHRT should be encouraged but not demanded Let competition and innovation drive the model Health Information Exchange should be encouraged but not demanded Let competition and innovation drive the model 10/14/2015 Copyright Mingle Analytics 41
42 On Physician Focused Payment Models Increase the Transparency of Physician-Focused Payment Models Physician-focused Payment Model Technical Advisory Committee The Committee will review and provide comments and recommendations to the Secretary on PFPMs submitted by stakeholders 10/14/2015 Copyright Mingle Analytics 42
43 On Technical Assistance to Practices beginning in Fiscal Year 2016, Secretary required to engage entities such as quality improvement organizations regional extension centers regional health collaboratives to offer guidance and assistance to MIPS EPs in practices of 15 or fewer professionals. Priority is to be given to small practices located in rural areas, HPSAs, medically underserved areas, practices with low composite scores. focus on performance categories under MIPS how to transition to implementation of and participation in an APM. 10/14/2015 Copyright Mingle Analytics 43
44 Questions and Discussion Contact Information (866) /14/ Mingle Analytics 44
CMS is requesting information to aid in the planning and implementation of the MIPS in the following areas:
Summary of Medicare s Request for Information on the Provisions in MACRA which Allow for Implementation of Alternative Payment Models and a Merit-Based Incentive Payment System On September 28, 2015, the
More informationMACRA Overview and RFI
MACRA Overview and RFI HIT Joint Committee October 6, 2015 Kate Goodrich, MD MHS Director, Quality Measurement and Valuebased Incentives Group CMS Medicare Access and CHIP Reauthorization Act (MACRA) The
More informationSustainable Growth Rate (SGR) Repeal and Replace: Comparison of 2014 and 2015 Legislation
Sustainable Growth Rate (SGR) Repeal and Replace: Comparison of 2014 and 2015 Legislation Proposal 113 th Congress - - H.R.4015/S.2000 114 th Congress - - H.R.1470 SGR Repeal and Annual Updates General
More informationQUALITY BEGINNER. PQRS Training Module: QUALITY MEASUREMENT 101. Last Updated: August 2014
QUALITY 01 BEGINNER PQRS Training Module: QUALITY MEASUREMENT 101 Last Updated: August 2014 TRAINING MODULE OBJECTIVES Quality Measurement 101 is a training module for providers who are interested in learning
More informationClinical Quality Measures Physician Quality Reporting System 2014
Clinical Quality Measures Physician Quality Reporting System 2014 Marcela Reyes, CHTS- CP Sevocity Product Manager 877-777-2298!! www.sevocity.com! 2014 CQMs CQMs are no longer a core objective of the
More informationMedicare Program; Request for Information Regarding Implementation of the Merit
This document is scheduled to be published in the Federal Register on 10/20/2015 and available online at http://federalregister.gov/a/2015-26568, and on FDsys.gov DEPARTMENT OF HEALTH AND HUMAN SERVICES
More informationNavigating CMS Incentive Programs for Eligible Professionals Why It Matters and What You Need to Know. Dr. Paul Mulhausen, CMO
Navigating CMS Incentive Programs for Eligible Professionals Why It Matters and What You Need to Know Dr. Paul Mulhausen, CMO Objectives Better understand CMS Incentive Programs and payment adjustments
More information5/19/2016 MIPS AND MACRA: MAKING SENSE OF THE NEW REGULATIONS AND PAYMENT SYSTEMS. No Disclosures AMERICAN ASSOCIATION OF CLINICAL ENDOCRINOLOGISTS
MIPS AND MACRA: MAKING SENSE OF THE NEW REGULATIONS AND PAYMENT SYSTEMS 1 No Disclosures 2 1 To Better Understand the Future.. We must remember the past regarding physician payment. 3 THE SGR SGR=Sustainable
More informationImplications for I/T/U
Outpatient CMS Quality Measurement Programs Implications for I/T/U CAPT Michael Toedt, MD, FAAFP Acting Chief Medical Information Officer Office of Information Technology, Indian Health Service NIHB 2015
More information12/5/2014. What is PQRS? Performance Measurement Committee Practical Theater. Historical concerns with the program (continued)
What is PQRS? Navigating CMS Quality Initiatives: How to Successfully Report and Avoid Payment Adjustments Performance Measurement Committee Practical Theater A federally mandated Medicare Part B quality
More informationMIPS. ACR Issues Analysis of Proposed MACRA MIPS Rule
ACR Issues Analysis of Proposed MACRA MIPS Rule The Centers for Medicare and Medicaid Services (CMS) issued a proposed rule (CMS-5517-P) on April 27, 2016, to establish many of the provisions of Medicare
More informationPhysician Quality Reporting System (PQRS) And VBM (Value Based Modifier) A Primer on Present and Future Requirements
Physician Quality Reporting System (PQRS) And VBM (Value Based Modifier) A Primer on Present and Future Requirements Brett Bernstein, MD, AGAF Chief Quality Officer, Beth Israel Ambulatory Endoscopy Services
More informationThe Medicare Access and CHIP Reauthorization Act of 2015 (MACRA) Summary of SGR Repeal and Replacement Provisions
ACOG Government Affairs May 2015 The Medicare Access and CHIP Reauthorization Act of 2015 (MACRA) Summary of SGR Repeal and Replacement Provisions This landmark bipartisan legislation, signed into law
More informationThe ABCs of the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA)
The ABCs of the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA) Medicare Access and CHIP Reauthorization Act (MACRA) Repeals the Sustainable Growth Rate Moves to a payment system based on
More informationAllscripts CQS Planning for 2014 Webinar: FAQs
Allscripts CQS Planning for 2014 Webinar: FAQs Listed below are questions asked by attendees based on the CQS Planning for 2014 Webinars, held on May 8, May 28, and May 30, 2014. Answers are provided below.
More informationCMS QCDR (Qualified Clinical Data Registry) and Other Ways PPRNet Can Help with Value-Based Payment
CMS QCDR (Qualified Clinical Data Registry) and Other Ways PPRNet Can Help with Value-Based Payment Cara Litvin MD, MS Assistant Professor MUSC Department of Medicine Agenda Provide an update of the current
More informationPhysician Quality Reporting System (PQRS)
Physician Quality Reporting System (PQRS) Presenter: Alexandra Mugge 4 PQRS Overview CY2018 payment adjustments, based on PY2016 reporting: -2.0% MPFS Changes to PQRS Definition of eligible professional
More informationOverview of the EHR Incentive Programs and Merit-Based Incentive Payment System
Overview of the EHR Incentive Programs and Merit-Based Incentive Payment System Patrick M. Hamilton, MPA Health Insurance Specialist/Rural Health Coordinator Centers for Medicare & Medicaid Services Philadelphia
More informationMEDICARE ACCESS AND CHIP REAUTHORIZATION ACT (MACRA) MERIT-BASED INCENTIVE PAYMENT SYSTEM (MIPS) ADVANCING CARE INFORMATION PERFORMANCE CATEGORY
MEDICARE ACCESS AND CHIP REAUTHORIZATION ACT (MACRA) MERIT-BASED INCENTIVE PAYMENT SYSTEM (MIPS) ADVANCING CARE INFORMATION PERFORMANCE CATEGORY SUMMARY OF PROVISIONS Brief Synopsis MACRA sunsets the Electronic
More information2015 PQRS Requirements: What Eligible Professionals Need to Know to Avoid the PQRS Penalty in 2017
2015 PQRS Requirements: What Eligible Professionals Need to Know to Avoid the PQRS Penalty in 2017 Presented by: Camille Bonta, MHS Summit Health Care Consulting Physician Quality Reporting System What
More informationUnderstanding the Implications of Medicare s Physician Value-Based Payment Modifier
Understanding the Implications of Medicare s Physician Value-Based Payment Modifier D. Louis Glaser Katten Muchin Rosenman LLP 525 W. Monroe Chicago, Illinois Agenda Introduction PQRS v. VBPM VBPM Adjustments
More informationeprescribing Incentives, Benefits & Challenges Presentation By Director of Government Affairs
eprescribing Incentives, Benefits & Challenges Presentation By Director of Government Affairs eprescribing That s what it says: one tablespoonful, 300 times a day. Presentation Goals Appreciate the benefits
More informationCrosswalk of the Medicare Access and CHIP Reauthorization Act of 2015 (H.R. 2) April 21, 2015
Crosswalk of the Medicare Access and CHIP Reauthorization Act of 2015 (H.R. 2) April 21, 2015 ACP has developed a cross-walk analysis of legislation in the 114 th Congress to permanently repeal Medicare
More informationMedicare Incentive Payments Tip Sheet
Connecting America for Better Health s Tip Sheet This tip sheet identifies opportunities for certain providers to receive incentive payments for participating in important initiatives. In addition to the
More informationMedicare EHR Incentive Program, Physician Quality Reporting System and e-prescribing Comparison
Program, Physician Quality Reporting System and e-prescribing Comparison This tip sheet identifies opportunities for certain providers to receive incentive payments for participating in important initiatives.
More informationMedicare EHR Incentive Program Physician Quality Reporting System and Electronic Prescribing Incentive Program Comparison Last Updated: May 2013
EHR Incentive Program Physician Quality Reporting System and Electronic Prescribing Incentive Program Comparison Last Updated: May 2013 e: This tip sheet identifies opportunities for certain providers
More informationCMS PQRS and VBPM Incentive/Penalty Programs. Devin Detwiler Manager Quality Improvement Telligen
CMS PQRS and VBPM Incentive/Penalty Programs Devin Detwiler Manager Quality Improvement Telligen Free Resource to you Join our Network Engage providers and stakeholders in improvement initiatives through
More informationJune 27, 2016. Dear Mr. Slavitt:
Mr. Andrew M. Slavitt Acting Administrator Centers for Medicare & Medicaid Services Department of Health and Human Services Attention: CMS-5517-P Submitted electronically to: http://www.regulations.gov
More informationHow to Report Once for 2015 Medicare Quality Reporting Programs: Individual Eligible Professionals
Table of Contents How to Report Once for 2015 Medicare Quality Reporting Programs: Individual Eligible Professionals 3 How to Report Once for 2015 Medicare Quality Reporting Programs: Group Practices 5
More informationMedicare Access and CHIP Reauthorization Act of 2015 H.R. 2
Medicare Access and CHIP Reauthorization Act of 2015 H.R. 2 The American Medical Association and over 750 national and state-based physician and specialty organizations have gone on record in support of
More informationRepeal the Sustainable Growth Rate (SGR), avoiding annual double digit payment cuts;
Background Summary of H.R. 2: The Medicare Access and CHIP Reauthorization Act of 2015 SGR Reform Law Enacts Payment Reforms to Improve Quality, Outcomes, and Cost On April 16, 2015, the President signed
More informationMedicare Access and CHIP Reauthorization Act of 2015 Merit-Based Incentive Payment System and Alternative Payment Model Provisions
Medicare Access and CHIP Reauthorization Act of 2015 Merit-Based Incentive Payment System and Alternative Payment Model Provisions Department of Health & Human Services Centers for Medicare & Medicaid
More informationReporting Once for 2014 Medicare Quality Reporting Programs
Reporting Once for 2014 Medicare Quality Reporting Programs Use this tool* to learn how to report quality measures one time in 2014 in order to: Become incentive eligible for 2014 Physician Quality Reporting
More informationPhysician Quality Reporting System (PQRS) Qualified Clinical Data Registry (QCDR) QCDR Reporting Overview. Program Year 2014
Physician Quality Reporting System (PQRS) Qualified Clinical Data Registry (QCDR) QCDR Reporting Overview Program Year 2014 Disclaimers This presentation was current at the time it was published or uploaded
More informationSGR Repeal: What Are the Implications to Academic Medicine? Len Marquez Mary Wheatley April 17, 2015
SGR Repeal: What Are the Implications to Academic Medicine? Len Marquez Mary Wheatley April 17, 2015 Agenda SGR Eulogy High Level Issues in HR2 Important to Academic Medicine Overview of the SGR Replacement
More informationCMS Listening Session: Merit-Based Incentive Payment System (MIPS)
CMS Listening Session: Merit-Based Incentive Payment System (MIPS) Kate Goodrich, MD, MHS, Director, Center for Clinical Standards and Quality Pierre Yong, MD, MPH, MS, Acting Director, Quality Measurement
More informationAuditing PQRS & Meaningful Use To Maintain Compliance. Standard Disclaimer. Learning Objectives 12/2/2014
2014 NAMAS Conference Asheville, NC December 9, 2014 Auditing PQRS & Meaningful Use To Maintain Compliance Presented by David J. Zetter, PHR, CHCC, CPCO, CPC, CPC-H, PCS, FCS, CHBC, CMUP Standard Disclaimer
More informationAligning Meaningful Use CQM and PQRS Reporting for 2015
Aligning Meaningful Use CQM and PQRS Reporting for 2015 August 19, 2015 Introductions Marni Anderson Project Specialist, MetaStar manderso@metastar.com 608-441-8253 Laura Sawyer Clinical Application Coordinator,
More informationEHR Incentive Programs in 2010 & Beyond
CMS Listening Session: EHR Incentive Programs in 2018 & Beyond Kate Goodrich, MD, MHS, Director, Center for Clinical Standards and Quality Robert Anthony, Deputy Director, Quality Measurement & Value-Based
More informationOverview of Physician Payment System Reforms in the Medicare Access and CHIP Reauthorization Act of 2015 (H.R. 2)
Overview of Physician Payment System Reforms in the Medicare Access and CHIP Reauthorization Act of 2015 (H.R. 2) June 18, 2015 Prepared for The Health Collaborative akingump.com 2015 Akin Gump Strauss
More informationSGR Repeal and Medicare Provider Payment Modernization Act of 2015: Timeline of Implementation
SGR Repeal and Medicare Provider Payment Modernization Act of 2015: Timeline of Implementation 2015 2016 2017 2018 2019 2020 2021 2022 2023 2024 2025 2026+ Base Update Jan Jun: 0 July- Dec: 0.5 0.5% 0.5%
More informationCY 2016 Medicare Physician Fee Schedule Proposed Rule July 23, 2015
CY 2016 Medicare Physician Fee Schedule Proposed Rule July 23, 2015 2015, AAMC-UHC-FPSC Page 1 Audio: Housekeeping You will hear the audio through your computer speakers. Please make sure your computer
More informationCMS s framework for Value Modifier
CMS s framework for Value Modifier Relationship between quality of care, cost composites and the Value Modifier Clinical Care Patient Experience Population/ Community Health Patient Safety Care Coordination
More informationA Guidebook to the 2012 Physician Quality Reporting System
A Guidebook to the 2012 Physician Quality Reporting System Last Updated: February 2, 2012 Getting Started With PQRS The Patient Protection and Affordable Care Act made participation in Medicare s Physician
More informationMIPS Performance Scoring: Understanding How CMS Proposes to Calculate Performance Is Key to Preparing for MIPS Participation
MIPS Performance Scoring: Understanding How CMS Proposes to Calculate Performance Is Key to Preparing for MIPS Participation By Robert F. Atlas, Lesley R. Yeung, and M. Brian Hall IV June 2016 On May 9,
More informationA MACRA Overview. A web discussion with guests Ivy Baer, Gayle Lee, and Tanvi Mehta of AAMC
A MACRA Overview A web discussion with guests Ivy Baer, Gayle Lee, and Tanvi Mehta of AAMC An Affinity Group Brought to you by HFMA and Vizient Sponsored by Kaufman Hall June 6, 2016 Meeting Notes Plan
More informationClinical Quality Measures (CQMs) What are CQMs?
Clinical Quality Measures (CQMs) What are CQMs? What are CQMs? Clinical quality measures, or CQMs, are tools that help eligible providers (EPs) measure and track the quality of health care services provided
More informationHow to Avoid 2016 Negative Payment Adjustments for CMS Medicare Quality Reporting Programs. September 17, 2014
How to Avoid 2016 Negative Payment Adjustments for CMS Medicare Quality Reporting Programs September 17, 2014 The Medicare Learning Network This MLN Connects National Provider Call (MLN Connects Call)
More informationMACRA & APMs: More than Acronyms June 2, 2016
MACRA & APMs: More than Acronyms June 2, 2016 Agenda 1. Framework 2. CMS Quality Initiatives 3. MACRA - MIPS or APM? 4. Alternative Payment Models 5. Case Study 2 Alternative Payment Models Transitioning
More informationMedicare and Medicaid Programs; EHR Incentive Programs
Medicare and Medicaid Programs; EHR Incentive Programs Background The American Recovery and Reinvestment Act of 2009 establishes incentive payments under the Medicare and Medicaid programs for certain
More informationE-Prescribing Incentive Program How to earn an incentive in 2011 and avoid a penalty in 2012
E-Prescribing Incentive Program How to earn an incentive in 2011 and avoid a penalty in 2012 Presented via Webinar January 11, 2011 Mary Patton Wheatley Shaifali Ray Objectives for Today s Call Review
More informationThe Medicare Quality Reporting Programs: What Eligible Professionals Need to Know in 2016
The Medicare Quality Reporting Programs: What Eligible Professionals Need to Know in 2016 Modules Module 1: Medicare Access and CHIP Reauthorization Act (MACRA) Preview Module 2: 2016 Incentive Payments
More informationPhysician Compare. Virtual Office Hour Session. January 22, 2015
Physician Compare Virtual Office Hour Session January 22, 2015 Alesia Hovatter Health Policy Analyst Division of Electronic and Clinician Quality Quality Measurement and Health Assessment Group Center
More informationKey Information. QP or Partial QP Determination
HIMSS MACRA NPRM Fact Sheet Alternative Payment Models: Qualifying Alternative Payment Model Participant & Partial Qualifying Alternative Payment Model Participant Determination Key Information During
More informationMeaningful Use for Eligible Providers. Session One: ARRA Meaningful Use Overview
Meaningful Use for Eligible Providers Session One: ARRA Meaningful Use Overview How to Navigate This Session Articulate offers many features that may assist with using recorded training. Please check out
More informationMedicare Electronic Health Record Incentive Payments for Eligible Professionals Last Updated: May 2013
Medicare Electronic Health Record Incentive Payments for Eligible Professionals Last Updated: May 2013 The Medicare Electronic Health Record (EHR) Incentive Program provides for incentive payments to Medicare
More informationHOW TO UNDERSTAND YOUR QUALITY AND RESOURCE USE REPORT
HOW TO UNDERSTAND YOUR QUALITY AND RESOURCE USE REPORT CONTENTS A BACKGROUND AND PURPOSE OF THE MID-YEAR QUALITY AND RESOURCE USE REPORTS... 1 B EXHIBITS INCLUDED IN THE MID-YEAR QUALITY AND RESOURCE USE
More informationIncentives to Accelerate EHR Adoption
Incentives to Accelerate EHR Adoption The passage of the American Recovery and Reinvestment Act (ARRA) of 2009 provides incentives for eligible professionals (EPs) to adopt and use electronic health records
More informationCrosswalk: CMS Shared Savings Rules & NCQA ACO Accreditation Standards 12/1/2011
Crosswalk: CMS Shared Savings Rules & NCQA ACO Accreditation Standards 12/1/2011 The table below details areas where NCQA s ACO Accreditation standards overlap with the CMS Final Rule CMS Pioneer ACO CMS
More informationStage 2 Meaningful Use What the Future Holds. Lindsey Wiley, MHA HIT Manager Oklahoma Foundation for Medical Quality
Stage 2 Meaningful Use What the Future Holds Lindsey Wiley, MHA HIT Manager Oklahoma Foundation for Medical Quality An Important Reminder For audio, you must use your phone: Step 1: Call (866) 906-0123.
More informationCalendar Year 2014 Medicare Physician Fee Schedule Final Rule
Calendar Year 2014 Medicare Physician Fee Schedule Final Rule Non-facility Cap after receiving many negative comments on this issue from physician groups along with the House GOP Doctors Caucus letter,
More informationOverview of the Development and Implementation of CAHPS for ACOs and PQRS. Sandra Adams, RN, BSN Lauren Fuentes, MPH.
CAHPS for ACOs and PQRS Overview of the Development and Implementation of CAHPS for ACOs and PQRS Sandra Adams, RN, BSN Lauren Fuentes, MPH July 10-11, 2014 Agenda Overview of the Medicare Shared Savings
More information19 June 2014. 888.879.7302 www.greenwayhealth.com
Meaningful Use Timeline Changes and Penalties Explained By: Adele Allison, National Director of Industry and Government Affairs Greenway Health On May 20, 2014, CMS issued a proposed rule offering flexibility
More informationStage 2 Meaningful Use
Stage 2 Meaningful Use Stage 2 Topics Overview 2014 Reporting Changes Medicaid Provider Eligibility Measures Overview Core Objectives Comparison Menu Objectives Comparison Clinical Quality Measures 2 High
More informationMedicare Physician Reporting: Beyond PQRS. Mary Patton Wheatley Senior Specialist, AAMC August 17, 2011
Medicare Physician Reporting: Beyond PQRS Mary Patton Wheatley Senior Specialist, AAMC August 17, 2011 Who is the AAMC? The Association of American Medical Colleges (AAMC) serves and leads the academic
More informationMACRA: Medicare's Shift to Value-based Delivery & Payment Models. Presented by Amy Mullins, MD, CPE, FAAFP
MACRA: Medicare's Shift to Value-based Delivery & Payment Models Presented by Amy Mullins, MD, CPE, FAAFP Current State Over Utilization Volume over Value Fee for Service Silos of Care 2 Push Toward Value
More informationPay for Performance Solutions. A wholly owned subsidiary of
Pay for Performance Solutions A wholly owned subsidiary of Company Overview Balanced Improvement for Health Systems and Physician Practices Products and Services to Integrate People, Processes, and Technology
More informationMajor Changes in CY2015 MPFS Quality Provisions. Physician Compare
Major Changes in CY2015 MPFS Quality Provisions Physician Compare In addition to previously finalized Physician Quality Reporting System (PQRS) quality measure data to be publicly reported beginning in
More informationMeaningful Use Updates. HIT Summit September 19, 2015
Meaningful Use Updates HIT Summit September 19, 2015 Meaningful Use Updates Nadine Owen, BS,CHTS-IS, CHTS-IM Health IT Analyst Hawaii Health Information Exchange No other relevant financial disclosures.
More informationCMS Proposals for Quality Reporting Programs under the 2015 Medicare Physician Fee Schedule Proposed Rule. July 24, 2014
CMS Proposals for Quality Reporting Programs under the 2015 Medicare Physician Fee Schedule Proposed Rule July 24, 2014 Medicare Learning Network This MLN Connects National Provider Call (MLN Connects
More informationMACRA: Looking Ahead - Implications Across the Care Continuum. May 16, 2016/ 12:00-1:00 PM EST
MACRA: Looking Ahead - Implications Across the Care Continuum May 16, 2016/ 12:00-1:00 PM EST 1 Today s Presenter Melinda Hancock Partner, DHG Healthcare Leads a team in developing DHG Healthcare s next
More informationINCENTIVES FOR ADOPTION OF ELECTRONIC HEALTH RECORDS UNDER THE AMERICAN RECOVERY AND REINVESTMENT ACT
INCENTIVES FOR ADOPTION OF ELECTRONIC HEALTH RECORDS UNDER THE AMERICAN RECOVERY AND REINVESTMENT ACT 1 by: Jonathan R. Werne Under the American Recovery and Reinvestment Act of 2009 (the Act), Medicare
More informationThe EHR Incentive Program
The EHR Incentive Program Summary of the Centers for Medicare and Medicaid Services (CMS) Final Rule on Meaningful Use On July 13th, the Centers for Medicare and Medicaid Services (CMS) released its final
More informationBuilding Physician Leadership in Performance Improvement
Building Physician Leadership in Performance Improvement Dana Richardson, RN, MHA Director, PCPI Operations & Strategic Initiatives Dana.richardson@ama-assn.org 312-464-4074 Physician Quality Report* A
More informationQuality Reporting and Registry Update: Challenges and Strategies for Success. Heather Smith, PT, MPH September 13, 2014
Quality Reporting and Registry Update: Challenges and Strategies for Success Heather Smith, PT, MPH September 13, 2014 1 SETTING THE STAGE FOR TOMORROW 2014 American Physical Therapy Association. All rights
More informationMedicare Shared Savings Program Quality Measure Benchmarks for the 2015 Reporting Year
Medicare Shared Savings Program Quality Measure Benchmarks for the 2015 Reporting Year Release Notes/Summary of Changes (February 2015): Issued correction of 2015 benchmarks for ACO-9 and ACO-10 quality
More informationSection by Section Summary of The SGR Repeal and Medicare Beneficiary Access Improvement Act of 2013
Section by Section Summary of The SGR Repeal and Medicare Beneficiary Access Improvement Act of 2013 Title I Medicare Payment for Physicians Services Section 101. Short Title; Table of Contents. Section
More informationPublished July 2011. Part B
Electronic Prescribing (erx) Incentive Program Published July 2011 Part B IMPORTANT The information provided in this manual was current as of June 2011. Any changes or new information superseding the information
More informationThe Impact of Changing Federal Policies on Physician Reimbursement
The Impact of Changing Federal Policies on Physician Reimbursement Peter Margolis, MD, AGAF Chair elect, AGA Regulatory Work Group AGA Institute Practice Management & Economics Committee University Gastroenterology
More informationUnderstanding Value-Based Care & P4P. Presented by : Angel McGaritty-Davis RNC, CDP, CDONA, NHA Dr. Steven Bowman MD Denise Barter RPh, CPh, MBA
Understanding Value-Based Care & P4P Presented by : Angel McGaritty-Davis RNC, CDP, CDONA, NHA Dr. Steven Bowman MD Denise Barter RPh, CPh, MBA Denise Barter Angel McGarrity-Davis Dr. Steven Bowman Rph,
More informationPhysician Quality Reporting System What Neurosurgeons Need to Know for 2015
Physician Quality System What Neurosurgeons Need to Know for 2015 Prepared by the: American Association of Neurological Surgeons Congress of Neurological Surgeons For More Information Contact: Rachel Groman,
More informationAndy Slavitt Centers for Medicare & Medicaid Services
January 29, 2016 Andy Slavitt Centers for Medicare & Medicaid Services Wellcentive comment, Request for Information: Certification Frequency and Requirements for the Reporting of Quality Measures under
More informationMeaningful Use. Medicare and Medicaid EHR Incentive Programs
Meaningful Use Medicare and Medicaid Table of Contents What is Meaningful Use?... 1 Table 1: Patient Benefits... 2 What is an EP?... 4 How are Registration and Attestation Being Handled?... 5 What are
More information9/10/2015. Learning Objectives. Current State - Quality Measures. Playing the Quality Metrics Reporting Game. How are they measured?
Playing the Quality Metrics Reporting Game Joel V. Brill MD FACP Learning Objectives Recognize the distinction between reporting the individual measures and the group measures Identify how often measures
More informationMEANINGFUL USE STAGE 2 2015 FOR ELIGIBLE PROVIDERS USING CERTIFIED EMR TECHNOLOGY
MEANINGFUL USE STAGE 2 2015 FOR ELIGIBLE PROVIDERS USING CERTIFIED EMR TECHNOLOGY STAGE 2 REQUIREMENTS EPs must meet or qualify for an exclusion to 17 core objectives EPs must meet 3 of the 6 menu measures.
More informationHealth Care Financing: ACC/ ACO s, beyond the hype hope. Brian Seppi, MD, President, Washington State Medical Assn.
: ACC/ ACO s, beyond the hype hope Brian Seppi, MD, President, Washington State Medical Assn. Washington State Medical Association Health Care Financing Our vision Make Washington the best place to practice
More informationMore Meaningful Meaningful Use Solutions to help providers maximize reimbursements with minimal office disruption
More Meaningful Meaningful Use Solutions to help providers maximize reimbursements with minimal office disruption The information and materials provided and referred to herein are not intended to constitute
More information= AUDIO 8/20/2015. e Clinical Quality Reporting for Hospitals and Providers. An Important Reminder. Mission of OFMQ. Ashley Rhude RHIA, CHTS IM
e Clinical Quality Reporting for Hospitals and Providers Ashley Rhude RHIA, CHTS IM An Important Reminder For audio, you must use your phone: Step 1: Call (866) 906 0123. Step 2: Enter code 2071585#. Step
More informationPhysician Compare Virtual Office Hour Questions and Answers
Physician Compare Virtual Office Hour Questions and Answers The Physician Compare Virtual Office Hour session was held on January 22, 2015 via WebEx. The purpose of the session was to allow the Centers
More informationIdaho Medicaid EHR Incentive Program Acronyms and Terms
Idaho Medicaid EHR Incentive Program Acronyms and Terms Acronym Definition AIU Adopt, Implement, Upgrade ALOS Average Length of Stay ARRA American Recovery and Reinvestment Act of 2009 ATCB Authorized
More informationCMS Quality Measurement and Value Based Purchasing Programs Kate Goodrich, MD MHS Director, Quality Measurement and Health Assessment Group, CMS
CMS Quality Measurement and Value Based Purchasing Programs Kate Goodrich, MD MHS Director, Quality Measurement and Health Assessment Group, CMS American Urological Association Quality Improvement Summit
More informationEHR Incentive Payments Medicare and Medicaid Indiana
EHR Incentive Payments Medicare and Medicaid Indiana OPTIMIZING EHR PAYMENTS William Rees, CPA Director 317-713-7942 brees@blueandco.com EHR Regulations EHR Incentive Legislation: American Recovery and
More informationMedicaid EHR Incentive Program Dentists as Eligible Professionals. Kim Davis-Allen, Outreach Coordinator Kim.davis@ahca.myflorida.
Medicaid EHR Incentive Program Dentists as Eligible Professionals Kim Davis-Allen, Outreach Coordinator Kim.davis@ahca.myflorida.com Considerations Must begin participation by Program Year 2016 Not required
More informationThree Proposed Rules on EHRs:
Three Proposed Rules on EHRs: CMS 2015-2017 Modifications CMS Meaningful Use Stage 3 ONC s 2015 Edition Health IT (CEHRT) Lori Mihalich-Levin lmlevin@aamc.org Mary Wheatley mwheatley@aamc.org Ivy Baer
More informationSUMMARY OF HEALTH IT AND HEALTH DATA PROVISIONS OF H.R. 2, THE MEDICARE ACCESS AND CHIP REAUTHORIZATION ACT (MACRA)
SUMMARY OF HEALTH IT AND HEALTH DATA PROVISIONS OF H.R. 2, THE MEDICARE ACCESS AND CHIP REAUTHORIZATION ACT (MACRA) H.R. 2, the SGR Repeal and Medicare Provider Payment Modernization Act of 2015 was introduced
More informationDETAILED SUMMARY--MEDCIARE SHARED SAVINGS/ACCOUNTABLE CARE ORGANIZATION (ACO) PROGRAM
1 DETAILED SUMMARY--MEDCIARE SHARED SAVINGS/ACCOUNTABLE CARE ORGANIZATION (ACO) PROGRAM Definition of ACO General Concept An ACO refers to a group of physician and other healthcare providers and suppliers
More informationAndy Slavitt, MBA Acting Administrator Centers for Medicare & Medicaid Services Department of Health and Human Services Baltimore, MD 21244-8016
November 17, 2015 Andy Slavitt, MBA Acting Administrator Centers for Medicare & Medicaid Services Department of Health and Human Services Baltimore, MD 21244-8016 Re: CMS-3321-NC, Request for Information
More information2015 Physician Quality Reporting System (PQRS): Implementation Guide
2015 Physician Quality Reporting System (PQRS): Implementation Guide 1/15/2015; Revised Table of Contents Introduction... 3 PQRS Measure Selection Considerations... 6 Satisfactorily Report Measures...
More informationEHR Incentive Funding for Medicare and Medicaid
EHR Incentive Funding for Medicare and Medicaid Implementing the American Reinvestment & Recovery Act of 2009 Mike Stigler, FHFMA, CPA Director 502.992.3510 mstigler@blueandco.com EHR Incentives EHR Incentive
More informationSummary of the Proposed Rule for the Medicare and Medicaid Electronic Health Records (EHR) Incentive Program (Eligible Professionals only)
Summary of the Proposed Rule for the Medicare and Medicaid Electronic Health Records (EHR) Incentive Program (Eligible Professionals only) Background Enacted on February 17, 2009, the American Recovery
More information