GA-HIMSS Community of Practice Meaningful Use, MACRA, HIE and Interoperability QPP Resources

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Presenters Phoebe Nelms, CMUP Liz Hansen, CMUP, CHSP, CHSA, PCMH CCE Lisbeth McPherson Hansen   Liz Hansen is an industry consultant, with over 25 years of experience in Information Technology within the ambulatory and acute Healthcare settings. A recognized expert in Meaningful Use assessment, project management and attainment, she serves as a Meaningful Use Specialist and Senior Advisor to the Georgia Health Information Technology Extension Center (GA-HITEC). Liz has assisted over 150 local practices in their successful efforts to achieve Meaningful Use Stage 1, in addition to providing guidance in EHR selection, portal development and Stage 2 readiness. She is also certified as a PCMH Content Expert and an ICD-10 Project Manager. Liz serves on the Executive Board of the Georgia Chapter of the Health Information and Management Systems Society (GA-HIMSS), and is in her fifth year as a member of the GA-HIMSS Board of Directors. She has served as a member of the national HIMSS Meaningful Use Stage 3 Task Force, the HIMSS Chapter Leader Task Force, the Georgia HIE Task Force, the Georgia Health Information Network (GaHIN) and is a member of the Georgia ICD-10 Collaborative. Liz is a frequent speaker and subject matter expert at professional seminars on the topics of Meaningful Use, EHR Utilization, HIPAA Cyber Security Requirements and Social Media Management in the Healthcare Environment. Phoebe Nelms is a Certified Meaningful Use Professional and serves as the Program Manager for Technical Outreach with GA-HITEC.  She is a member of The Healthcare Information and Management Systems Society (HIMSS). She works with GA-HITEC’s team to develop and create production of public information materials to further the national agenda for Health IT and delivers virtual and onsite education, outreach and technical assistance to providers in support of Meaningful Use attestations.  Outreach activities also include the coordination of GA-HITEC’s webinars, and onsite (Morehouse School of Medicine) Privacy and Security Workshop focused on the HIPAA Security Risk Assessment. Phoebe is in process of becoming a Certified MACRA-MIPS Healthcare professional (CMHP) to assimilate and disseminate program requirements for Medicare Part B eligible clinicians.   Phoebe Nelms, CMUP Program Manager, Technical Outreach GA-HITEC, National Center for Primary Care Morehouse School of Medicine Liz Hansen, CMUP, CHSP, CHSA, PCMH CCE HealthIT Consultant, GA-HITEC

Objectives Overview of MACRA’s Quality Payment Program Review of Available Resources Quality Payment Program Website Small, Underserved & Rural Support Resources

What is MACRA? http://www.medconverge.com/2016/07/19/macra-what-is-it-all-about/

Medicare Access and CHIP Reauthorization Act What is MACRA? Medicare Access and CHIP Reauthorization Act Historic Medicare reform law Bipartisan legislations signed April 16, 2015 Final Rule released October 14, 2016 by CMS Creates a new framework for provider reimbursement Consolidates existing quality reporting programs Budget neutral SRG (Sustainable Growth Rate) Each year, Congress passed temporary “doc fixes” to avert cuts (no fix in 2015 would have meant a 21% cut in Medicare payments to clinicians) Fee-for-service (FFS) payment system, where clinicians are paid based on volume of services, not value. MACRA replaces the SGR with a more predictable payment method that incentivizes value. Consolidated PQRS, Meaningful Use and Value Based Modifier.

Why was new legislation needed? Medicare is the main driver of future federal spending increases Medicare is large enough to use as a vehicle to drive the US healthcare delivery system away from the fee-for- service model toward the quality and value-based reimbursement model

How is MACRA Implemented? MACRA creates Medicare payment reform through the Quality Payment Program (QPP) The Quality Payment Program is designed to make patients healthier by incentivizing clinicians to focus on quality. It’s not just about reporting. This new program gives clinicians new tools and resources to help them give patients the best possible outcomes. https://qpp.cms.gov

How is MACRA Implemented? MACRA is the legislation QPP is the framework to achieve MACRA goals MIPS and APMs provide for the measuring and reporting systems

The Quality Payment Program has two tracks How is MACRA Implemented? The Quality Payment Program has two tracks OR Creates the Quality Payment Program (QPP) QPP has two tracks – Advanced Alternative Payment Models (APMs) Merit-based Incentive Payment System (MIPS) Combines parts of the following into MIPS; Sustainable Grown Rate (SRG) Physician Quality Reporting System (PQRS) Value-based Payment Modifier (VBM) Replaces Meaningful Use (Medicare only)

APMs – Alternative Payment Models APMs Overview APMs – Alternative Payment Models An Alternative Payment Model (APM) is a payment approach that gives added incentive payments to provide high-quality and cost-efficient care. APMs can apply to a specific clinical condition, a care episode, or a population. Advanced APMs are a subset of APMs, and let practices earn more for taking on some risk related to their patients' outcomes. They may earn a 5% incentive payment by going further in improving patient care and taking on risk through an Advanced APM.  Advanced APMs must meet the following requirements:  Be CMS Innovation Center models, Shared Savings Program tracks, or certain federal demonstration programs  Require participants to use certified EHR technology  Base payments for services on quality measures comparable to those in MIPS  Be a Medical Home Model expanded under Innovation Center authority or require participants to bear more than nominal financial risk for losses. The final rule with comment period defined the risk requirement for an Advanced APM to be in terms of either total Medicare expenditures or participating organizations’ Medicare revenue (which may vary significantly). This enhanced flexibility allows for the creation of more Advanced APMs tailored to physicians and other clinicians, such as advanced practice nurses, generally, and small practice participation in particular. What happens if I am in an Advanced APM? Once you're in an Advanced APM, you'll earn the 5% incentive payment in 2019 for Advanced APM participation in 2017 if: You receive 25% of your Medicare Part B payments through an Advanced APM or See 20% of your Medicare patients through an Advanced APM If you leave the Advanced APM during 2017, you should make sure you've seen enough patients or received enough payments through an Advanced APM to qualify for the 5% bonus. If you haven't met these thresholds, you may need to submit MIPS data to avoid a downward payment adjustment.

Performance based payment adjustment categories MIPS Overview Performance based payment adjustment categories 60% 15% 25% 0% How Does MIPS Work? You earn a payment adjustment based on evidence-based and practice-specific quality data. You show you provided high quality, efficient care supported by technology by sending in information in the following categories: Quality, Improvement Activities, Advancing Care Information and in future years, Cost. qpp.cms.gov

Positive payment adjustment Reputation – compared to other providers QPP Reporting Impact Incentives Penalties Positive payment adjustment Reputation – compared to other providers Early adopters get ahead on workflow and establish base line Negative payment adjustment Reputation – compared to other providers More pressure as thresholds and negative payments increase What is Physician Compare? The Centers for Medicare & Medicaid Services (CMS) provides this site to givephysicians and other clinicians the latest resources and information about Physician Compare, a website designed to help consumers make informed choices about the health care they receive through Medicare. https://www.cms.gov/medicare/quality-initiatives-patient-assessment-instruments/physician-compare-initiative/

MACRA TIMELINE with Payment Adjustments Eligible Clinicians above the performance threshold will receive positive payment adjustments corresponding to the diagram starting in 2019. Eligible Clinicians who fall within the lowest 25% of the performance threshold will experience payment reductions. Exceptional performers receive additional positive adjustments from a $500M fund that will be available each year from 2019 to 2024. 2017: MIPS reporting begins 2019: MIPS payments begin

When Does it Start? Program begins January 1, 2017 Flexible start date for data collection Final submission of performance data by March 31, 2018

Support Resources QPP Website QPP Helpline Local Support for Large and Small Practices Professional Societies HIMSS MGMA ACO Quality Improvement Organization (QIO/QIN/PTN) Regional Extension Center Participate in available webinars (National, local, HIMSS, RECs, HIEs, etc.) Initiate Community of Care / Community of Practice meetings Use professional society resources Review and analyze MU and Quality reports Patient Engagement Playbook Participate in TCPI and/or PCMH GA-HITEC assistance Determine which track is best for your practice Determine risk GA-HITEC supporting Technical Assistance for ACI Allocation of $20 million/year from 2016-2020 to small practices to provide technical assistance regarding MIPS performance criteria or transitioning to an APM Is your EHR certified? If so, is it the 2014 or 2015 edition? Does your vendor support Medicare quality reporting? Do you meet requirements for small, rural, non-patient-facing accommodations? Do you/ can you participate in a qualified clinical data registry? Review your PQRS and QRUR reports and determine areas for improvement?

Premier Resource – QPP Website Utilize the Quality Payment Program Website https://qpp.cms.gov/ General Information on the Quality Payment Program Measure requirements and options Resource library: Webinars, educational programs and support documentation Let’s take a look at navigating this site Participate in available webinars (National, local, HIMSS, RECs, HIEs, etc.) Initiate Community of Care / Community of Practice meetings Use professional society resources Review and analyze MU and Quality reports Patient Engagement Playbook Participate in TCPI and/or PCMH GA-HITEC assistance Determine which track is best for your practice Determine risk GA-HITEC supporting Technical Assistance for ACI Allocation of $20 million/year from 2016-2020 to small practices to provide technical assistance regarding MIPS performance criteria or transitioning to an APM Is your EHR certified? If so, is it the 2014 or 2015 edition? Does your vendor support Medicare quality reporting? Do you meet requirements for small, rural, non-patient-facing accommodations? Do you/ can you participate in a qualified clinical data registry? Review your PQRS and QRUR reports and determine areas for improvement?

Support for Small Practices Practices with 15 or fewer clinicians and practices in rural and health professional shortage areas are a crucial part of the health care system. The Quality Payment Program provides options designed to make it easier for you to report on your performance and qualify for incentives. Physicians in small practices who report their performance can do just as well as mid-sized or larger practices. We expect the number and percentage of small practices participating in the Quality Payment Program to increase and exceed participation in legacy programs (for example, PQRS) because of the reduced reporting burden, increasing usability of technology, and stepped-up technical assistance. There are a number of other flexibilities in the final rule with comment period to help small practices, including exemptions for low volume practices, allowances for patient-centered medical homes, and increased technical assistance. MACRA also provides $20 million each year for five years to fund training and education for Medicare clinicians in individual or small group practices of 15 clinicians or fewer and those working in underserved areas. Beginning December 2016, local, experienced organizations will use this funding to help small practices select appropriate quality measures and health IT to support their unique needs, train clinicians about the new improvement activities and assist practices in evaluating their options for joining an Advanced APM. Providing these tools to help physicians and other clinicians in small practices and practices in underserved areas navigate new programs is key to making sure they are able to focus on what is most important: the needs of their patients. https://qpp.cms.gov/docs/QPP_Support_for_Small_Practices.pdf

Small, Underserved & Rural Support Small practices with 15 or fewer clinicians, including those in rural locations, health professional shortage areas, and medically underserved areas are a crucial part of the health care system. The Medicare Access and CHIP Reauthorization Act of 2015 (MACRA) provides direct technical assistance to help individual Merit-based Incentive Payment System (MIPS) eligible clinicians and small practices in these settings participate in the Quality Payment Program. https://qpp.cms.gov/docs/QPP_Support_for_Small_Practices.pdf Practices with 15 or fewer clinicians and practices in rural and health professional shortage areas are a crucial part of the health care system. The Quality Payment Program provides options designed to make it easier for you to report on your performance and qualify for incentives. Physicians in small practices who report their performance can do just as well as mid-sized or larger practices. We expect the number and percentage of small practices participating in the Quality Payment Program to increase and exceed participation in legacy programs (for example, PQRS) because of the reduced reporting burden, increasing usability of technology, and stepped-up technical assistance. There are a number of other flexibilities in the final rule with comment period to help small practices, including exemptions for low volume practices, allowances for patient-centered medical homes, and increased technical assistance. MACRA also provides $20 million each year for five years to fund training and education for Medicare clinicians in individual or small group practices of 15 clinicians or fewer and those working in underserved areas. Beginning December 2016, local, experienced organizations will use this funding to help small practices select appropriate quality measures and health IT to support their unique needs, train clinicians about the new improvement activities and assist practices in evaluating their options for joining an Advanced APM. Providing these tools to help physicians and other clinicians in small practices and practices in underserved areas navigate new programs is key to making sure they are able to focus on what is most important: the needs of their patients.

Small, Underserved & Rural Support This initiative is comprised of local, experienced organizations that will help clinicians in small and rural practices: Select and report on appropriate measures and activities to satisfy the requirements of each performance category* under MIPS Engage in continuous quality improvement Optimize their health information technology (HIT) Evaluate their options for joining an Advanced Alternative Payment Model (APM) Providing this support to clinicians will help them navigate the Quality Payment Program, while making sure they are able to focus on the needs of their patients. *Quality, Cost, Improvement Activities, and Advancing Care Information Practices with 15 or fewer clinicians and practices in rural and health professional shortage areas are a crucial part of the health care system. The Quality Payment Program provides options designed to make it easier for you to report on your performance and qualify for incentives. Physicians in small practices who report their performance can do just as well as mid-sized or larger practices. We expect the number and percentage of small practices participating in the Quality Payment Program to increase and exceed participation in legacy programs (for example, PQRS) because of the reduced reporting burden, increasing usability of technology, and stepped-up technical assistance. There are a number of other flexibilities in the final rule with comment period to help small practices, including exemptions for low volume practices, allowances for patient-centered medical homes, and increased technical assistance. MACRA also provides $20 million each year for five years to fund training and education for Medicare clinicians in individual or small group practices of 15 clinicians or fewer and those working in underserved areas. Beginning December 2016, local, experienced organizations will use this funding to help small practices select appropriate quality measures and health IT to support their unique needs, train clinicians about the new improvement activities and assist practices in evaluating their options for joining an Advanced APM. Providing these tools to help physicians and other clinicians in small practices and practices in underserved areas navigate new programs is key to making sure they are able to focus on what is most important: the needs of their patients. https://qpp.cms.gov/docs/QPP_Support_for_Small_Practices.pdf

SURS Small, Underserved & Rural Support Georgia Practices with 15 or fewer clinicians and practices in rural and health professional shortage areas are a crucial part of the health care system. The Quality Payment Program provides options designed to make it easier for you to report on your performance and qualify for incentives. Physicians in small practices who report their performance can do just as well as mid-sized or larger practices. We expect the number and percentage of small practices participating in the Quality Payment Program to increase and exceed participation in legacy programs (for example, PQRS) because of the reduced reporting burden, increasing usability of technology, and stepped-up technical assistance. There are a number of other flexibilities in the final rule with comment period to help small practices, including exemptions for low volume practices, allowances for patient-centered medical homes, and increased technical assistance. MACRA also provides $20 million each year for five years to fund training and education for Medicare clinicians in individual or small group practices of 15 clinicians or fewer and those working in underserved areas. Beginning December 2016, local, experienced organizations will use this funding to help small practices select appropriate quality measures and health IT to support their unique needs, train clinicians about the new improvement activities and assist practices in evaluating their options for joining an Advanced APM. Providing these tools to help physicians and other clinicians in small practices and practices in underserved areas navigate new programs is key to making sure they are able to focus on what is most important: the needs of their patients. https://qpp.cms.gov/docs/QPP_Support_for_Small_Practices.pdf

Small, Underserved & Rural Support Alliant Quality is the Quality Innovation Network-Quality Improvement Organization (QIN-QIO) for Georgia and North Carolina. Alliant Health Solutions companies are making health care better in seven states.  Practices with 15 or fewer clinicians and practices in rural and health professional shortage areas are a crucial part of the health care system. The Quality Payment Program provides options designed to make it easier for you to report on your performance and qualify for incentives. Physicians in small practices who report their performance can do just as well as mid-sized or larger practices. We expect the number and percentage of small practices participating in the Quality Payment Program to increase and exceed participation in legacy programs (for example, PQRS) because of the reduced reporting burden, increasing usability of technology, and stepped-up technical assistance. There are a number of other flexibilities in the final rule with comment period to help small practices, including exemptions for low volume practices, allowances for patient-centered medical homes, and increased technical assistance. MACRA also provides $20 million each year for five years to fund training and education for Medicare clinicians in individual or small group practices of 15 clinicians or fewer and those working in underserved areas. Beginning December 2016, local, experienced organizations will use this funding to help small practices select appropriate quality measures and health IT to support their unique needs, train clinicians about the new improvement activities and assist practices in evaluating their options for joining an Advanced APM. Providing these tools to help physicians and other clinicians in small practices and practices in underserved areas navigate new programs is key to making sure they are able to focus on what is most important: the needs of their patients. http://www.alliantquality.org/content/quality-payment-program-qpp

Small, Underserved & Rural Support Funding for direct technical assistance to local, experienced organizations Help for small and rural practices to engage in continuous quality improvement Assistance to evaluate options for joining an Advanced Alternative Payment Model Support to navigate the Quality Payment Program GA-HITEC is funded to provide support in partnership with Alliant Practices with 15 or fewer clinicians and practices in rural and health professional shortage areas are a crucial part of the health care system. The Quality Payment Program provides options designed to make it easier for you to report on your performance and qualify for incentives. Physicians in small practices who report their performance can do just as well as mid-sized or larger practices. We expect the number and percentage of small practices participating in the Quality Payment Program to increase and exceed participation in legacy programs (for example, PQRS) because of the reduced reporting burden, increasing usability of technology, and stepped-up technical assistance. There are a number of other flexibilities in the final rule with comment period to help small practices, including exemptions for low volume practices, allowances for patient-centered medical homes, and increased technical assistance. MACRA also provides $20 million each year for five years to fund training and education for Medicare clinicians in individual or small group practices of 15 clinicians or fewer and those working in underserved areas. Beginning December 2016, local, experienced organizations will use this funding to help small practices select appropriate quality measures and health IT to support their unique needs, train clinicians about the new improvement activities and assist practices in evaluating their options for joining an Advanced APM. Providing these tools to help physicians and other clinicians in small practices and practices in underserved areas navigate new programs is key to making sure they are able to focus on what is most important: the needs of their patients. https://qpp.cms.gov/docs/QPP_Support_for_Small_Practices.pdf

Small, Underserved & Rural Support https://www.surveymonkey.com/r/QPPHELP Register for SURS Complete short survey Representatives will make contact Practices with 15 or fewer clinicians and practices in rural and health professional shortage areas are a crucial part of the health care system. The Quality Payment Program provides options designed to make it easier for you to report on your performance and qualify for incentives. Physicians in small practices who report their performance can do just as well as mid-sized or larger practices. We expect the number and percentage of small practices participating in the Quality Payment Program to increase and exceed participation in legacy programs (for example, PQRS) because of the reduced reporting burden, increasing usability of technology, and stepped-up technical assistance. There are a number of other flexibilities in the final rule with comment period to help small practices, including exemptions for low volume practices, allowances for patient-centered medical homes, and increased technical assistance. MACRA also provides $20 million each year for five years to fund training and education for Medicare clinicians in individual or small group practices of 15 clinicians or fewer and those working in underserved areas. Beginning December 2016, local, experienced organizations will use this funding to help small practices select appropriate quality measures and health IT to support their unique needs, train clinicians about the new improvement activities and assist practices in evaluating their options for joining an Advanced APM. Providing these tools to help physicians and other clinicians in small practices and practices in underserved areas navigate new programs is key to making sure they are able to focus on what is most important: the needs of their patients. https://www.surveymonkey.com/r/QPPHELP

Additional Resources TCPI – free support for Practice Transformation and MACRA Patient Centered Medical Home (PCMH) Assistance also available for practices >15 providers Practices with 15 or fewer clinicians and practices in rural and health professional shortage areas are a crucial part of the health care system. The Quality Payment Program provides options designed to make it easier for you to report on your performance and qualify for incentives. Physicians in small practices who report their performance can do just as well as mid-sized or larger practices. We expect the number and percentage of small practices participating in the Quality Payment Program to increase and exceed participation in legacy programs (for example, PQRS) because of the reduced reporting burden, increasing usability of technology, and stepped-up technical assistance. There are a number of other flexibilities in the final rule with comment period to help small practices, including exemptions for low volume practices, allowances for patient-centered medical homes, and increased technical assistance. MACRA also provides $20 million each year for five years to fund training and education for Medicare clinicians in individual or small group practices of 15 clinicians or fewer and those working in underserved areas. Beginning December 2016, local, experienced organizations will use this funding to help small practices select appropriate quality measures and health IT to support their unique needs, train clinicians about the new improvement activities and assist practices in evaluating their options for joining an Advanced APM. Providing these tools to help physicians and other clinicians in small practices and practices in underserved areas navigate new programs is key to making sure they are able to focus on what is most important: the needs of their patients. https://qpp.cms.gov/docs/QPP_Support_for_Small_Practices.pdf

Path to Success Participate in available webinars (HIMSS, REC, HIE, SURS) Use professional society resources Educate staff Initiate Community of Care / Community of Practice meetings Determine appropriate track (MIPS vs APM) Determine method of reporting Determine reporting period target Determine risk Review and analyze MU and Quality reports Select Improvement Activity “best” suited for your practice Determine where you are now, make a plan, work your plan Participate in TCPI Certify for PCMH SURS and Large Practice assistance Utilize your QPP Website Participate in available webinars (National, local, HIMSS, RECs, HIEs, etc.) Initiate Community of Care / Community of Practice meetings Use professional society resources Review and analyze MU and Quality reports Patient Engagement Playbook Participate in TCPI and/or PCMH GA-HITEC assistance Determine which track is best for your practice Determine risk GA-HITEC supporting Technical Assistance for ACI Allocation of $20 million/year from 2016-2020 to small practices to provide technical assistance regarding MIPS performance criteria or transitioning to an APM Is your EHR certified? If so, is it the 2014 or 2015 edition? Does your vendor support Medicare quality reporting? Do you meet requirements for small, rural, non-patient-facing accommodations? Do you/ can you participate in a qualified clinical data registry? Review your PQRS and QRUR reports and determine areas for improvement?

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Latest Update http://www.medconverge.com/2016/07/19/macra-what-is-it-all-about/

Questions / Discussion Thank You!

References State Public Health http://www.astho.org/StatePublicHealth/What-Does-MACRA-Mean-for-Health-Officials/1- 27-17/ CMS Quality Payment Program https://qpp.cms.gov/about/resource-library Google Images https://www.google.com/search?q=google+images&source=lnms&tbm=isch&sa=X&ved=0ahUKEwiWxtew0rv UAhWJwiYKHd8fCPMQ_AUICigB&biw=1017&bih=679 Physician Compare https://www.cms.gov/medicare/quality-initiatives-patient-assessment- instruments/physician-compare-initiative/ MIPS Scoring Methodology Overview https://www.cms.gov/Medicare/Quality-Initiatives-Patient-Assessment- Instruments/Value-Based-Programs/MACRA-MIPS-and-APMs/MIPS-Scoring-Methodology-slide-deck.pdf

Thank you for your participation and input! GA-HIMSS Community of Practice Meaningful Use, MACRA, HIE and Interoperability Recording of session available http://ga.himsschapter.org/cop-interoperability Next Meeting: August 16, 12:00 Let us know what you want to hear or if you would like to contribute Additional CoPs available through GA-HIMSS Thank you for your participation and input!

Path to Success Participate in available webinars (HIMSS, REC, HIE, SURS) Use professional society resources Educate staff Initiate Community of Care / Community of Practice meetings Determine appropriate track (MIPS vs APM) Determine method of reporting Determine reporting period target Determine risk Review and analyze MU and Quality reports Select Improvement Activity “best” suited for your practice Determine where you are now, make a plan, work your plan Participate in TCPI Certify for PCMH SURS and Large Practice assistance Utilize your QPP Website Participate in available webinars (National, local, HIMSS, RECs, HIEs, etc.) Initiate Community of Care / Community of Practice meetings Use professional society resources Review and analyze MU and Quality reports Patient Engagement Playbook Participate in TCPI and/or PCMH GA-HITEC assistance Determine which track is best for your practice Determine risk GA-HITEC supporting Technical Assistance for ACI Allocation of $20 million/year from 2016-2020 to small practices to provide technical assistance regarding MIPS performance criteria or transitioning to an APM Is your EHR certified? If so, is it the 2014 or 2015 edition? Does your vendor support Medicare quality reporting? Do you meet requirements for small, rural, non-patient-facing accommodations? Do you/ can you participate in a qualified clinical data registry? Review your PQRS and QRUR reports and determine areas for improvement?