September 16, 2015 Antonio Vega Sandy Swallow A Quick Glance at Meaningful Use “Proposed” Modifications for 2015 and MIPS September 16, 2015 Antonio Vega Sandy Swallow

“Pending Review” Status Proposed Modified Stage 2 Changes mid-year and mid-program in the Final Rule

Proposed Modified Stage 2 Today’s Objectives Proposed Modified Stage 2 A Quick Glance: Program goals and long term program alignment Updated participation timeline Significant program changes for 2015 Medicare Incentives beyond 2017 MIPS

Proposed Modified Stage 2 Program Goals Proposed Modified Stage 2 Modified Stage 2 Goals Align with Stage 3 proposed rule Align reporting period with full calendar year for ALL Change reporting period to 90-day period in 2015 EH 10/1/2014 to 12/31/15 EP 1/1/15 to 12/31/15 Synchronize objectives and measures to reduce burden Remove redundant, duplicative, and topped out Modify patient action measures related to patient engagement

Timeline, Stages and Vendor Requirements Proposed Modified Stage 2 Long Term Program Alignment Timeline, Stages and Vendor Requirements 2015 All participants attest to modified version of Stage 2; with accommodations for Stage 1 Providers; 2014 CEHRT 2016 All EH and EP attest to modified version of Stage 2, at stage 2 thresholds; 2014 or 2015 CEHRT 2017 Attest to either modified version of Stage 2 or full version of Stage 3; 2014 or 2015 CEHRT 2018 Attest to full version of Stage 3 with 2015 CEHRT

Proposed Modified Stage 2 Stages of Meaningful Use Updated MU Timeline Proposed Modified Stage 2 First Payment Year Stages of Meaningful Use 2011 2012 2013 2014 2015 2016 2017 2018 2019 2020 2021 1 2 2 or 3 3 2* Everyone Moves to Stage 3 in 2018 * Special accommodations for Stage 1 providers

Proposed Modified Stage 2 Program Changes Proposed Modified Stage 2 9 Core Criteria 1 Public Health Criterion Applies to all eligible professionals, hospitals and critical access hospitals

MU Objectives 2015 -2017 Objective EP Measure EH Measure Protect Elec Health Info Conduct SRA/correct deficiencies Same Clinical Decision Support 5 rules related to 4+ CQM; drug/drug and drug/allergy interaction check CPOE >60% med, >30% lab, > 30% radiology eRx >50%; drug formulary query >10%; drug form. query Summary of Care Use CEHRT to create summary; >10% electronically transmit Patient Specific Education >10% unique patients Medication Reconciliation >50% transitions of care Patient Elec Access (VDT) >50% timely access; 1 patient VDT Secure Messaging Fully enabled n/a Public Health 5 measure options 6 measure options

Proposed Modified Stage 2 Removed Measures Proposed Modified Stage 2 Record Demographics Record Vital Signs Record Smoking Status Structured Lab Results Patient List Electronic Notes Imaging Results Family Health History Summary of Care Measure 1 and 3 Clinical Summaries (EP) Patient Reminders (EP) eMAR (EH) Advanced Directive (EH) Structure Labs to Ambulatory Providers (EH)

Proposed Modified Stage 2 Relaxed Measures Proposed Modified Stage 2 Objective Old Current Patient Electronic Access (View, Download or Transmit) Measure = 5% of the patients Measure = 1 patient Secure Messaging with Patients Yes/No, stating “functionality fully enabled” Public Health Objective and Clinical Data Registry Multiple One consolidate with 6 measures - EH must attest to 3 - EP must attest to 2

Modified Stage 2 Objectives Public Health and Clinical Data Registry (CDR) Reporting Attest to any 2 (EP) or 3 (EH)… 1. Immunization registry reporting (bi-directional) 2. Syndromic surveillance reporting 3. Case reporting 4. Public health registry reporting* 5. Clinical data registry reporting* 6. Electronic Reportable Laboratory Reporting https://www.idph.state.ia.us/meaningful_use.aspm *May choose to report to more than one registry to meet the number of measures required

Modified Stage 2 - Clinical Quality Measures 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 CQM reporting period can be different than the rest of MU

Accommodations for Stage 1 Providers You are attesting to Stage 1 in 2015… Stage 1 based on the same 10 objectives Attest to Stage 1 thresholds Will take an exclusion for the Stage 2 measures if there is no equivalent Stage 1 measure Menu objectives move to core objectives

Accommodations for Stage 1 Providers Objective Alternate Measure, Exclusion/Specifications Protect Elec Health Info None CDS Implement one CDS rule EP; no exclusion EH CPOE >30% med, exclusion for lab and radiology eRx >40 % EP; exclusion EH Stage 1 and Stage 2 did not intend to demonstrate as a Menu in Stage 2 Summary of Care Exclusion Pt-Specific Education Exclusion, if did not intend to demonstrate as a Menu objective in Stage 1 Med. Reconciliation Pt. Electronic Access Secure Electronic Messaging Public Health

Hospital-Based EPs Qualifications for Hospital-Based EPs Proposed Modified Stage 2 Qualifications for Hospital-Based EPs Include place of service 22 (outpatient) for those EPs considered hospital-based* EP is ineligible for incentive payment and payment adjustments if >90% covered professional services in sites of service identified as: POS 21 (inpatient) POS 22 (outpatient)* POS 23 (emergency room)

Proposed Modified Stage 2 Attestation Updates Proposed Modified Stage 2 Attestation will not begin until after January 1, 2016 In 2015 only - First time EH and EP participants will have until February 29, 2016 to attest; but may be subject to a payment adjustment on claims submitted prior to attestation to MU for an EHR reporting period in 2015

Payment Adjustments Facts Hardship Exceptions were due July 1, 2015 Lack of Infrastructure Unforeseen and/or Uncontrollable Circumstances Lack of Control over the Availability of Certified EHR Technology Lack of Face-to-Face Interaction Began in January 2015; 1% and increases every year until 2018 when government makes a decision Annual attestation required to avoid adjustment

Merit-Based Incentive Payment System (MIPS) Medicare Incentives Beyond 2017 Merit-Based Incentive Payment System (MIPS) Federal Quality Program combines PQRS, MU and VBM Replaces the SGR reimbursement formula Goal is to lower cost while improving quality of care by rewarding high-performers and penalizing low-performers based on a composite threshold score 2017 will be the first performance year

Eligibility for MIPS 2019 & 2020 (First two years) 2021 onward Physicians, PAs, Certified Registered Nurse Anesthetists, NPs, Clinical Nurse Specialists, Dentists, Podiatrist and Groups that include such professionals 2021 onward Dietitians, Midwives, Psychologist and most other healthcare professionals Excluded EPs Qualifying APM participants First year Medicare participation Low volume threshold exclusions MIPS DOES NOT apply to RHC or FQHC payments

Potential Annual Score 0-100 Points MIPS Assessment Categories Potential Annual Score 0-100 Points Quality 30 pts. Resource Use 30 pts. Meaningful Use 25 pts. Clinical Practice Improvement 15 pts.

Payment Alignment

Telligen QIN QIO Telligen: Quality Innovation Network-Quality Improvement Organization (QIN-QIO) for Colorado, Illinois and Iowa

IHIN Contact: Antonio Vega 515.362.8311 avega@telligen.com Thank you! QIN-QIO Contact: Sandy Swallow 515.223.2105 Sandy.swallow@area-d.hcqis.org telligenqinqio.com IHIN Contact: Antonio Vega 515.362.8311 avega@telligen.com This material was prepared by Telligen, the Medicare Quality Innovation Network Quality Improvement Organization, under contract with the Centers for Medicare & Medicaid Services (CMS), an agency of the U.S. Department of Health and Human Services. The contents presented do not necessarily reflect CMS policy. 11SOW-QIN-B4-9/2015-11239