1. Macra/mips: Advancing clinical information
Jim Whitfill, M.D.
Chief Medical Officer, Innovation Care Partners
Clinical Associate Professor, Departments of Internal Medicine and Biomedical Informatics University of Arizona College of Medicine- Phoenix

2. Disclosures President of Lumetis LLC
Managing Partner Opting Back In LLC
Speaker for Arizona HFMA, Fuji, Hitachi, Healthcare Informatics, ConneX Group, ACR, RSNA, SIIM
Board Member Society of Imaging Informatics in Medicine

3. Key Concepts
MACRA calls for physician payments under Medicare Fee for Service to be impacted by Merit Incentive Payment System (MIPS)
MIPS has one significant component called Advancing Clinical Informatics that focuses on the use of Health IT
ACI is a new attempt at measuring adoption of health IT that builds on Meaningful Use but with a different methodology

4. May 3, 2016
MIPS brings threats of fee schedule cuts and incentives based on scores
Most providers are required to participate in MIPS in 2017
First reporting period 1/1/2017 to 12/31/2017
Payments adjusted in based on performance in the period
MIPS is budget neutral so any incentives are paid for via cuts to other providers
However there is a budget exempt $500 million dollars for “exceptional” performance in the first 5 years
The Advisory Board
Health Care Cheat Sheet Series
MACRA: Educational Briefing for IR Professionals, April 2016

5. MIPS Score: 2017 Quality Category Advancing Care Information Category*
60% of score in 2017; replaces the Physician Quality Reporting System
Advancing Care Information Category*
25% of score in year 1; formerly Meaningful Use for providers
Clinical Practice Improvement Activities Category
15% of score in year 1
*For clinicians who do not meet these category requirements, CMS proposes reweighting the score to 0 and recalculating the other categories.
Participants
MIPS applies to Medicare Part B clinicians, including physicians, physician assistants, nurse practitioners, clinical nurse specialist, and certified registered nurse anesthetists.
All Medicare Part B clinicians will report through MIPS during the first performance year, which begins January 2017.
Cost Category* 0% of score in year 1; replaces the Value Modifier Program, also known as Resource Use)

6. Advancing Care Information (ACI)
The Advancing Care Information (ACI) performance category replaces the Medicare Electronic Health Record (EHR) Incentive Program for eligible professionals, also known as Meaningful Use.
The ACI Score is calculated from 3 factors:
Base Score – 50 points; Required
Performance Score—90 points; Optional
Bonus Score—15 points; Optional
Maximum “points” = 150 but no additional credit after 100
Under MIPS, there are four connected pillars that affect how you will be paid by Medicare – Quality, Clinical Practice Improvement Activities (referred to as “Improvement Activities”), Certified EHR Technology (referred to as “Advancing Care Information”), and Resource Use (referred to as “Cost”). At its core, the Quality Payment Program is about improving the quality of patient care.

7. Reporting for ACI
Option 1: 2017 ACI Transition Objectives and Measures
Requires 2014 OR 2015 EHR certification or a mix of 2014/2015
More flexible
Very similar to Stage 2 MU
Option 2: Advancing Care Information Objectives and Measures
Requires 2015 EHR certification OR a mix of 2014/2015 certification

8. Advancing Care Information (ACI)
Base Score (Required)
Contributes 50 points to ACI score
Base score means you have to do each item at least once
Goal is to ensure the EHR can do support the activity
This means at least 1 electronic prescription is sent, at least 1 patient accesses information via a portal etc.
In addition, EHRs must meet ONC CEHRT 2014 or 2015 requirements.
The base score Advancing Care Information measures are:
Security Risk Analysis
e-Prescribing
Provide Patient Access
Health Information Exchange
ICP’s InnovationExchange technology is not a certified HIE under MIPS
Send a Summary of Care (2015 Certification Only)
Request/Accept Summary of Care (2015 Certification Only)
It is important to note that some of the base score measures can also contribute towards the performance score.

9. Base Measures

10. Advancing Care Information (ACI)
Performance Score (Optional)
Contributes 90 points to ACI score
Mostly calculated using the numerators and denominators submitted for each measure
Measures how well the practice is adopting the technology

11. Performance Measures

12. Advancing Care Information (ACI)
Bonus Score (Optional)
Contributes 15% of ACI score
5% Bonus: Reporting “yes” to 1 or more additional public health and clinical data registries beyond the Immunization Registry Reporting measure.
10% Bonus: Reporting “yes” to the completion of at least 1 of the specified Bonus Category Improvement Activities using CEHRT.

13. Public Health/CDR Reporting
Syndromic Surveillance Reporting (2014 and 2015)
Specialized Registry Reporting (2014)
Electronic Case Reporting (2015)
Public Health Registry Reporting (2015)
Clinical Data Registry Reporting(2015)

14. Arizona Department of Health Services Capability for Submission of EHR Data

16. Three Tiers of Reporting; Deadline is 3-31-2018
Test
Submit 4 (2014) or 5(2015) of the base score measures
Partial
Submit for 90 days (Oct 2 is the last date to start)
Full
Submit for the entire year

17. How to Avoid MIPS Reporting and/or ACI Reporting
New to Medicare
Bill less than $30,000 Medicare Allowed or see less than 100 Medicare patients per year
Significantly participating in a AAPM
Not required to report ACI if you lack face to face interaction with patients or are a NP, PA, CRNA
No EHR? Consider applying for a hardship exemption
No internet access; uncontrollable circumstances; lack of control

18. Key Concepts
ACI is a new attempt at measuring adoption of health IT that builds on Meaningful Use but with a different and more flexible methodology
ACI has base categories which measure the ability of the EHR to perform a function while the performance category measures the ability of the practice to use the technology
Deadline for reporting is 3/31/2018

19. appendix

20. Advancing Care Information (ACI) (max 100 points)
BASE SCORE: 50 points, 6 measures
Max reportable score = 100
Clinicians must use certified EHR technology
No longer all-or-nothing reporting
If the measures are not applicable for a clinician, CMS may reweight the whole category to zero and adjust the weighting of the remaining categories
PERFORMANCE SCORE: up to 80 points

21. 2017 ACI Transition Objectives and Measures (11 Measures)
Health Information Exchange (similar to Send Summary of Care)
IT risk analysis
E-Rx
Patient Access to Data
View, Download, Transfer Patient Info
Secure Messaging
Immunization Registry
Medication Reconciliation
Patient Specific Education
Specialized Registry Reporting
5% Bonus if submitting
Syndromic Surveillance
Not supported in AZ

22. ACI Objectives and Measures (15 Measures)
Request/Accept Summary of Care
IT risk analysis
Send a Summary of Care
E-Rx
Patient Access to Data
Immunization Registry
Patient Generated Data
Patient Specific Education
Public Health Reporting
Secure Messaging
Syndromic Surveillance*
View, Download, Transfer Patient Info
Clinical Data Registry Reporting
Clinical Information Reconciliation
Rx | Problem List | Allergy
Electronic Case Reporting

23. Arizona Immunization Registry: https://asiis.azdhs.gov/main.jsp