10/19/2015. Meaningful Use: Current and Future Environment. Agenda. MGMA Annual Conference Nashville, TN October 13, 2015

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1 Meaningful Use: Current and Future Environment MGMA Annual Conference Nashville, TN October 13, 2015 Agenda Current Environment Stage 2 Flexibility Final Rule Key challenge for practices A look Ahead at Stage 3 and MACRA ROI Issue Resources Q/A Current Environment 1

2 Payments and Penalties 1st Meaningful Use Annual Incentive Payments Year [.] TOTAL 2011 MCR $18,000 $12,000 $8,000 $4,000 $2,000 $0 $0 $44,000 MCD $21,250 $8,500 $8,500 $8,500 $8,500 $8,500 $0 $63, MCR $18,000 $12,000 $8,000 $4,000 $2,000 $0 $44,000 MCD $21,250 $8,500 $8,500 $8,500 $8,500 $8,500 $63, MCR $15,000 $12,000 $8,000 $4,000 $0 $39,000 MCD $21,250 $8,500 $8,500 $8,500 $17,000 $63, MCR $12,000 $8,000 $4,000 $0 $24,000 MCD $21,250 $8,500 $8,500 $25,500 $63, MCR $0 $0 $0 $0 MCD $21,250 $8,500 $34,000 $63, MCR $0 $0 $0 MCD $21,250 $ 42,500 $63,750 MCR = Medicare; MCD = Medicaid. MCD participants must begin participation by CMS Attestation Data (Aug 2015) At the time of the CMS August analysis: 305,130 EPs had attested successfully 60,004 for Stage 2 4,431 Hospitals had attested successfully for Stage 1 1,836 for Stage 2 Payments 2

3 The Penalty Phase Year/Program erx PQRS Meaningful Use Value Modifier % % % % -1.0% * -1.0% % -2.0% -2.0% % * Penalties will be greater for unsuccessful e-prescribers %** (each year) Amount TBD ** Penalty amount could increase up to 5% depending on meaningful use success rates and discretion of HHS 2015 CMS Estimated EP Payment Adjustments Payment Adjustment Amount EPs PERCENT $1 - $250 87,000 34% $250 - $1,000 55,000 21% $1,000 - $2,000 36,000 14% $2, ,000 31% N=256,000 EPs currently subject to 2015 payment adjustments MU Flexibility Final Rule 3

4 Pathway to Flexibility EP Stage 2 success minimal Significant pressure on CMS from MGMA and many others in a broad coalition Coalition helped introduce bipartisan Flex-IT Act requiring 90-day reporting Dr. Conway Jan 29 blog signal CMS Releases Proposed Rule April 10 Final rule no later than Aug comes out Oct.6 (after start of last 90-day reporting period) Final Rule Key Provisions Reducing the view, download and transmit threshold from 5% to one patient Reducing the secure messaging threshold from 5% to simply having the capability 90-day reporting period in In 2016, with the exception of EPs new to the program who will have a 90 day reporting period, all other EPs will be required to report for the entire year Those on Stage 1 will have a hybrid set of requirements Hospitals move to calendar year reporting The following objectives are no longer required to be reported: Record Demographics Record Vital Signs Record Smoking Status Clinical Summaries Structured Lab Results Patient List Patient Reminders Summary of Care Measure 1 Any Method Measure 3 Test Electronic Notes Imaging Results Family Health History 4

5 Final Stage 2 Requirements: Nine Core, One Public Health Stage Two Requirements 1. Protect Electronic Health Information Conduct or review a Security Risk Analysis 2. Clinical Decision Support (CDS) Implement 5 CDS interventions for 4+ CQMs or high-priority health conditions Enable and implement drug-drug and drugallergy interaction checks CQM = Clinical Quality Measures Stage Two Requirements 3. Computerized Provider Order Entry (CPOE) Use CPOE for 60%+ medication orders 30%+ lab orders 30%+ radiology orders 4. eprescribing 50%+ are queried for a drug formulary and transmitted electronically 5

6 Stage Two Requirements 5. Summary of Care EP who transitions or refers their patient to another setting of care or provider of care that uses CEHRT creates a summary of care record; and electronically transmits such summary to a receiving provider for 10%+ transitions of care and referrals 6. Patient Specific Education Patient-specific education resources identified by CEHRT are provided to patients for 10%+ of all unique patients with an office visit seen by the EP Stage Two Requirements 7. Medication Reconciliation EP performs medication reconciliation for 50%+ of transitions of care in which the patient is transitioned into the care of the EP Stage Two Requirements 8. Patient Electronic Access 50%+ of all unique patients seen by the EP during the reporting period are provided timely within 4 business days after the information is available to the EP online access to their health information At least one patient seen by the EP during the reporting period views, downloads, or transmits his or her health information to a third party 6

7 Stage Two Requirements 9. Secure Electronic Messaging During the reporting period, the capability for patients to send and receive a secure electronic message was fully enabled Proposed Stage Two Public Health and Clinical Data Registry (CDR) Reporting EP required to attest to any 2 of the following: 1.Immunization registry reporting (bi-directional) 2.Syndromic surveillance reporting 3.Case reporting 4.Public health registry reporting 5.Clinical data registry reporting Final Stage Two The EP is in active engagement (registered, testing, or production) with a public health agency to submit electronic public health data from CEHRT. EP must meet 2 of the following: Measure 1: the EP is in active engagement with a public heath agency to submit immunization data Measure 2: the EP is in active engagement with a public heath agency to submit syndromic surveillance data (menu previously) Measure 3: the EP is in active engagement to submit data to a specialized registry (menu previously) Exclusions are available for each measure. If no measures remain available, the EP can meet the objective by claiming applicable exclusions for all measures. 7

8 Stage 2 Requirements Clinical quality measures (no modification) 9 measures out of 64, covering at least three domains None are required but some are recommended Zero in the denominator is a positive response Can report through the PQRS Portal Note that the CQM reporting period can be different than the rest of MU Leading Cause of Failing an MU Audit Stage 2 Security RA Requirement Conduct or review a security risk analysis in accordance with the requirements under 45 CFR (a)(1), including addressing the encryption/security of data stored in CEHRT in accordance with requirements under 45 CFR (a)(2)(iv) and 45 CFR (d)(3), and implement security updates as necessary and correct identified security deficiencies as part of the provider s risk management process. 8

9 RA Challenges Although conducting a risk analysis has been required since 2005 (HIPAA Security final rule), not all practices have conducted one RA delves into areas of the practice that staff typically do not have expertise (i.e., network security, encryption) Many practices have focused on privacy, not RA One of the few MU requirements that the EHR vendor cannot completely address without significant practice input Hiring a consultant to conduct a RA is costly Risk Analysis Tips t Don t assume your RA will be conducted by your EHR vendor (without additional cost) Talk to colleagues-how did they conduct their RA? Do assume that you will be audited Document everything RA-related (hard-copy or e- binder) Review the available resources (i.e., MGMA, HHS) Consider outside help (especially for a narrow set of issues (i.e., mobile, security for remote access to EHR) Audits Three government agencies can audit a practice for RA s CMS (Figliozzi MU audits) OCR OIG (new) 9

10 Audit Tips Take them seriously! Make sure your contact point address/phone number is correct EPs should review their documentation for each measure and for every year an incentive payment was received Watch for an from Figliozzi (or OIG call)-that may be the method first used to contact you regarding an audit Consider a mock audit Documentation Retention Retain: Any electronic or paper documentation that supports your attestation Measure calculation reports supplied by the EHR Documentation that supports the values you entered for Clinical Quality Measures The practice s security risk analysis Dated screen shots that establish that the EPs successful met a particular measure Retain documentation to support the attestation for six years 2015 Reporting/Exceptions/ Attestation 10

11 Important Reporting Considerations In 2015, unlike in 2014, EPs do not have to report during a calendar quarter. Rather, you can choose any 90 days EPs can meet MU for any 90 days in 2015 but cannot attest until 2016 With the rule being released AFTER the last day of the final 90-day reporting period-cms seems to expect that EPs will have been collecting data based on proposed rule How to Avoid the 2017 Meaningful Use Penalty 2016 meaningful use penalty: -3.0% Three ways to avoid the penalty: 1. Successful meaningful user in New meaningful user in 2016: demonstrate MU for 90 consecutive days 3. Apply for a hardship exception by July 1 Infrastructure New eligible professionals Lack of face-to-face or telemedicine interactions and follow-up visits with patients EPs who practice at multiple locations and lack control over availability of the CEHRT for >50% of patient encounters Unforeseen circumstances New Hardship Exceptions CMS recently added two new FAQs: The first addresses the question of whether or not providers that have switched EHR vendors can apply for a hardship exception to avoid the Medicare payment adjustment. Answer: yes, EP may apply for an Extreme and/or Uncontrollable Circumstances hardship exception and if approved may be exempt from the payment adjustment. The second outlines the options (including applying for a hardship exception) EPs have when their EHR has been decertified. 11

12 2015 Challenges/Opportunities PH reporting requirements are different in final rule CMS may offer the unforeseeable circumstance hardship exception. We expect guidance to be released However, while this would help EPs avoid the 2017 penalty, they would not be eligible for any 2015 incentive payments 2015 Attestation Due to release of Stage 2 modifications rule CMS has closed the attestation website It will re-open Jan. 4, 2016 and be open until Feb. 29, 2016 The Future: Stage 3 and Beyond 12

13 Stage 3-the Big Picture Voluntary in 2017 for EPs 90-day reporting in 2017 Mandatory in 2018 for all EPs and all year reporting for most Significant push back from MGMA, other associations, Congress All calling for stage 3 to be delayed CMS opened up rule for an additional comment period Stage 3 crosses over into new administration Stage 3 looks a different than 2015 Stage 2 No core and menu measures, just options for many of the 8 reporting areas ( flexible measures) Reporting will be 1year (except for 1st year Medicaid) CQMs will be reported electronically; no chart abstraction or paper based measures Increased thresholds for many measures (i.e., back to 5% for VDT or API and SM) Patient-generated data from a nonclinical setting must be incorporated into the EHR for more than 5% of patients seen by the EP Removal of Measures Original measures that are removed are either topped out (i.e., standards have been widely adopted as best practices) or appear elsewhere in MU reporting and are considered redundant for reporting purposes. Same as 2015 Flex final rule list 13

14 Stage 3 Objectives 1. Protect Patient Health Information 2. Clinical Decision Support 3. Patient Access to Health Information (5%) 4. Health Information Exchange 5. Electronic Prescribing 6. CPOE 7. Coordination of Care Through Patient Engagement 8. Public Health & Clinical Data Registry Reporting Medicare Access and CHIP Reauthorization Act (MACRA) The Medicare Access and CHIP Reauthorization Act of 2015, or MACRA, will change how Medicare pays physicians. MACRA replaces the Sustainable Growth Rate (SGR) methodology Merit-based Incentive Payment System (MIPS) includes consolidated aspects of the Physician Quality Reporting System (PQRS), the Value- Based Payment Modifier (VM), and the Medicare Electronic Health Records (EHR) Incentive Program MU component 25% of MIPS The ROI Issue 14

15 Performing the ROI Calculation EP successful S = $38k (-sequestration) but maximum is $44k (-sequestration) for entire life of program (~$6k to upgrade your EHR for Stage 2 and then Stage 3) Additional issues to consider: What is the lost clinician productivity curve between stages? Does the technology meet your specialty needs? Is the MU-certified EHR meeting your individual practice needs: augmenting productivity, enhancing patient care, improving clinician satisfaction? If you decide NOT to pursue MU What are the penalties your EPs will face? Keep in mind two additional issues: New administration in 2016, MU program could change/end MACRA includes MIPS MU Tips Remove deleted measures from your dashboard Select the portal technology that best meets the needs of your practice/your patients Offer what the patients want (registration, scheduling, bill payment, lab results, refills, questions answered) Ensure seamless interaction with EHR/PM Consider switching EHRs to meet MU Stage 2 Develop a long-term IT and IT security strategy Look at patient engagement as a marketing tool 15

16 MU Tips Pick the right software for your practice, not necessarily the cheapest, or even one that meets MU Carefully review ROI (cost/penalties vs incentives) Remember that MIPS/APM intersect with MU Leverage your professional networks and learn from your colleagues MU will change over the next few months and years keep up or fall behind! Keep up on all MU changes through MGMA MGMA Resources: mgma.org/meaningfuluse Coming soon! MGMA overview of the 2015 MU modifications final rule Coming soon! MGMA overview of the Stage 3 final rule Meaningful Use FAQs: What MGMA Members are Asking Member-benefit webinar: Meaningful Use Stage 2 Webinar-CMS presents EHR Incentive Programs: Getting to Meaningful Use Webinar CMS walks participants through the Medicare and Medicaid EHR Incentive programs MGMA's Meaningful Use Incentive Program Checklist Thank you! Robert Tennant 16

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