Ben West CTO Health eFilings Effectively Complying with CMS Quality Data Management and Reporting Requirements

2 Presentation Objectives Review the three CMS reporting programs for Medicare Part B and how each could impact your healthcare organization Identify and evaluate the various methods of complying with the CMS reporting requirements Demonstrate how to utilize your own EHR data to effectively support all your population health initiatives

3 Healthcare Market Dynamics Relevant underlying themes are: Know The Population Engage Members Manage Outcomes Improve Patient Care Improve Health Reduce Costs Population Health Management CMS ComplianceTriple AIM

4 CMS Programs Addressing Themes Many think complying with PQRS is enough, but it isn’t

5 CMS Penalties are Significant For Part B Outpatient there are three specific reporting requirements By not complying or inaccurately submitting Quality Measure data, penalties will be automatically applied to all 2018 reimbursements

6 Practitioners Physician Assistant Nurse Practitioner Clinical Nurse Specialist Certified Nurse Midwife Clinical Social Worker Clinical Psychologist Registered Dietician Audiologists Who Has to Comply Medicare Physicians Doctors Therapists Physical Therapist Occupational Therapist Qualified Speech-Language Therapist

7 What are Clinical Quality Measures There are 64 Quality Measures that Medicare tracks for all Eligible Professionals –E.g.: CMS 122: Diabetes: Hemoglobin A1c Control What is the importance of Clinical Quality Measures (CQMs) –Per Medicare they are indications of the quality of care provided by physicians –It is the tool that CMS uses to measure how Providers are doing –They relate to the quality goals for health care, including effective, safe, efficient, patient-centered, equitable, and timely care Performance on these measure will be the determinant for satisfying compliance requirements as well as ability to benchmark well relative to peers

8 What is PQRS WHO WHAT IMPACT OF NOT COMPLYING Physician Quality Reporting System is a program to help improve health care quality and optimize health outcomes Quality Measures must be reported for each EP –Must report 9 measures across 3 NQS domains –Report a minimum of 50% of eligible Medicare Part B FFS patient visits for each measure Negative payment adjustments of 2% of Medicare billings are applied at the NPI level Eligible Professionals (EP) who provide services that are paid under or based on the Medicare Physician Fee Schedule (MPFS)

9 What is VBM Value Based Payment Modifier Program adjusts Medicare PFS payments to all eligible EPs based on the quality of care furnished compared to the cost of care –The adjustment is made on a per claim basis and is applied at the TIN level The adjustment is based on a quality-tiering methodology EP’s are benchmarked relative to their peers for the Quality Measures

10 What are eCQMs? As part of Meaningful Use attestation, all EP’s must submit eCQM’s Electronic Clinical Quality Measures are tools that help measure and track the quality of health care services provided by eligible professionals, eligible hospitals and critical access hospitals to ensure that our health care system is delivering effective, safe, efficient, patient-centered, equitable, and timely care. Eligible Professionals must submit a minimum of nine eCQMs covering at least three National Quality Strategy (NQS) domains. Hospitals must submit a minimum of four eCQMs for one quarter (Q3 or Q4) of CY 2016 but No NQS Domain distribution is required. To participate in the Medicare and Medicaid Electronic Health Record (EHR) Incentive Programs and receive an incentive payment, providers are required to submit CQM data from certified EHR technology.

11 How to Comply with CMS Reporting Requirements

12 Complying Can Be Complex and Costly

13 Types of Services Available Reporting electronically using an electronic health record (EHR) Qualified Registry Qualified Clinical Data Registry (QCDR) PQRS group practice via GPRO Web Interface CMS-Certified Survey Vendor Claims

14 Automated Services Enable Compliance Population Health Management EARN Incentives Quality Data Reporting AVOID Penalties Support Triple AIM’s Objectives

15 Completely Turn Key No Workflow Changes No IT Support No Admin Support End to End Solution Submit Extract Aggregate Criteria for Selecting a Service

16 Staff Resources Vary Significantly by Service

17 Major Differences in Filing Approaches ClaimsRegistryDSV 0/0 Measures Discarded (VBM) No MAV No Cross-Cutting Measures No coding errors (Ex: QDC & required diagnosis mismatch) Satisfies MU eCQMs

18 Data Submission Vendor A Data Submission Vendor can submit PQRS measure data to CMS in the required format WHAT WHO EHR Vendor: Collects clinical quality data directly from a CEHRT and submits it to CMS QCDR: Qualified Clinical Data Registry collects and submits quality measures data to CMS on EP’s behalf Dedicated DSV (e.g. Health eFilings) THINGS TO ASK Are you on the HL7 Clinical Quality Informatics Workgroup? Do you participate in the CMS quality reporting kaizens?

19 Ensure DSV Has Required Certifications Is the software an: “…to purchasers and other users that a system meets the technological capability, functionality, and security requirements adopted by HHS. Certification also gives providers and patients confidence that the Health IT products and systems they use are secure and can work with other systems to share information (interoperability).” Is the software certified for all 64 measures Is the company fully HIPAA compliant and adheres to all the standard protocols

20 One Submission For All 3 Programs Select a service provider who can support and file your data for all three programs

21 Comparison to Benchmarks MeasureYour ScoreOutcome Measure “Average” Range CMS 143: Glaucoma Optic Nerve Evaluation 85%Penalty86-100% CMS 2: Screening for Clinical Depression 1%Neutral0-68% CMS 68: Documentation of Current Medications 100%Neutral59-100% CMS 182: IVD: LDL Control 72%Incentive31-71%

22 Required Functionality of the Service Ability to integrate seamlessly with any MU-2 compliant EHR Service will calculate the best 9 measures –There are 27,000,000,000 different measure choices you can make. Don’t try to do it manually! Capability to benchmark all measures against the CMS database to optimize VBM submission Ultimately formats and electronically submits data to Medicare

23 Ability to Integrate Data from Multiple EHRs It is critical that the service has the ability to create a single record for each patient in order to effectively comply with an optimize your submission

24 Straight-Forward Administrative Process

25 Expectations for the Service Money Time Risk of Penalties Saves Guarantees CompletenessAccuracy Meeting Filing Deadline

26 How to Utilize EHR Data to Support Population Health Initiatives

PHM is the proactive application of strategies and interventions to defined groups of individuals across the continuum of care in an effort to improve the health of the individuals within the group at the lowest necessary cost The Consumerism of healthcare will require all Providers and healthcare organizations to focus on delivering the best quality of care at the most affordable rate ‒ Geisinger Health System is now offering “money back guarantees” on their services and performance Services are available that enable Providers and healthcare organizations to harness the data to effectively reduce cost and improve outcomes Gain Insights With Data in Your EHR Actionable Data for Population Health Management 27

Proactively Monitor Your Performance Monthly Updates Rolling YTD Results Tracks All Providers at Patient Level Tracks All Measures Exportable Files Access to Quality Measure Data Improves Outcomes 28

29 Opportunity to Maximize VBM Scores Optimizes VBM Ranking Supports Entities’ Quality Initiatives Inpatient and Outpatient Tracking Positively Impact Star Rating Penalty Avoidance Opportunity for incentive TIN level impact vs. PQRS at the EP level Consumerism of healthcare Increase potential for new patients Single tool for managing Medicare reimbursable programs Drilldown capability for managing performance to the patient level

30 Ben West QUESTIONS?