Post on 09-Aug-2020
MedicaidMeaningfulUseandAlternativePaymentModels:ConnectingtheDots
LaceyVericker,RHIA,CPHIMSOutreachSupervisor
5/23/17 Copyright©2017AFMC,Inc.AllRightsReserved. 2
Objectives
§ MedicaidMeaningfulUse(MU)• ModifiedStage2andStage3
§ Briefoverviewofalternativepaymentmodelsandadvancedpaymentmodels
§ ExamplesofAPMsandadvancedAPMs§ HowdoAPMsandadvancedAPMsimpacttheMedicaidprovider?§ HowcanparticipationintheMedicaidMUprogramhelpqualifiedclinicianssuccessfullyparticipateinAPMs,advancedAPMs,MedicaidPCMHandMIPS?
§ Overviewofprogramyear2017MedicaidMUandupcomingchangesforStage3andprogramyear2018
§ WhatisAFMCdoingtohelpproviders?
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FrequentlyUsedAcronyms
§ MU:MeaningfulUse§ MIPS:Merit-BasedIncentivePaymentSystem§ APM:Alternativepaymentmodels§ A-APM:Advancedalternativepaymentmodels§ HIE:Healthinformationexchange§ ACI:Advancingcareinformation§ CDS:Clinicaldecisionsupport§ SRA:Securityriskanalysis§ CPOE:Computerizedproviderorderentry§ EHR:Electronichealthrecord§ CCD:Continuityofcaredocument§ TOC:Transitionofcare§ SOC:Summaryofcare§ VDT:View,downloadortransmit§ EP:Eligibleprovider§ API:Applicationprograminterface
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MedicaidMUHasNotGoneAway
• TheMerit-BasedIncentivePaymentSystem(MIPS)appliestocliniciansprovidingservicesunderMedicarePartB
• MIPSdoesnotreplacetheMedicaidEHRincentiveprogram,whichwillcontinuethroughprogramyear2021
• ClinicianswhoareeligiblefortheMedicaidEHRincentiveprogramwillcontinuetoattesttotheirrespectivestateMedicaidagenciestoreceivetheirincentivepayments
• EligiblecliniciansmustattestseparatelytoMIPSinadditiontoMedicaidMU
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Don’tMissOut
• TheMedicaidMUincentiveprogramwillcontinueuntil2021• 2016wasthelastyeartobegintheMedicaidMUprogram• Returningproviderswhomeet>30%patientvolumeandrequired
objectivescanstillattestuntil2021oruntiltheyhavereceivedsixincentivepaymentstotaling$63,750
• ReturningprovidersparticipatinginMedicaidMUprogramcanskipyearsandpickbackup
• ThelastyeartoattesttoMedicaidMUisprogramyear2021• AFMCcanhelpqualifiedproviderswithMedicaidMU,whichwillhelp
providerswiththeACIcategoryofMIPS(requiredforbothMIPSeligiblecliniciansandAPMparticipatingclinicians)
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MedicaidMUProgramYear2017
Reportingrequirements:• Minimum90-DayreportingperiodforMUobjectives• Minimum90-Dayreportingperiodforclinicalqualitymeasures
(CQM)
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MedicaidMUObjectives
§ ModifiedStage2§ Stage3§ Advancingcareinformation
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Objective1:ProtectPatientHealthInformation
§ Securityriskanalysismustbecompletedduringtheperformanceyear§ SRAhastobedoneforStage2andStage3
• RequirementforACIcategoryofMIPS• Noexclusions
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Objective2:ClinicalDecisionSupport(CDS)
• ImplementfiveclinicaldecisionsupportinterventionsrelatedtofourormoreCQMsatarelevantpointinpatientcarefortheentireEHRreportingperiod• Example:Creatingarulethatwillnotifytheproviderthatapatient
hasnothadainfluenzaimmunizationinoverayear• Implementthefunctionalityfordrug-druganddrugallergyinteraction
checksfortheentireEHRreportingperiod• Thisobjectiveisthesameforbothstages2and3• ThereisnotanequivalentmeasureforMIPS
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ModifiedStage2ComputerizedProviderOrderEntry(CPOE)
Measure1:MedicationOrdersMorethan60%ofmedicationorderscreatedbytheEPduringtheEHRreportingperiodarerecordedusingCPOE
Measure2:LaboratoryOrdersMorethan30% oflaboratoryorderscreatedbytheEPduringtheEHRreportingperiodarerecordedusingCPOE
Measure3:RadiologyOrdersMorethan30% ofradiologyorderscreatedbytheEPduringtheEHRreportingperiodarerecordedusingCPOE
• Exclusion:AnyEPwhowritesfewerthan100ordersduringtheEHRreportingperiod
• NotrequiredforACIinMIPS
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Stage3CPOE
Measure1:MedicationOrdersMorethan 60%ofmedicationorderscreatedbytheEPduringtheEHRreportingperiodarerecordedusingCPOE
Measure2:LaboratoryOrdersMorethan60%oflaboratoryorderscreatedbytheEPduringtheEHRreportingperiodarerecordedusingCPOE
Measure3:RadiologyOrdersMorethan60%ofradiologyorderscreatedbytheEPduringtheEHRreportingperiodarerecordedusingCPOE
• Exclusion:AnyEPwhowritesfewerthan100ordersduringtheEHRreportingperiod
• NotrequiredforACIinMIPS
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Objective4:ElectronicPrescribing
§ ModifiedStage2:50percentofallpermissibleprescriptionswrittenbytheEParequeriedforadrugformularyandtransmittedelectronicallyusingCEHRT
§ Stage3:60percentofallpermissibleprescriptionswrittenbytheEParequeriedforadrugformularyandtransmittedelectronicallyusingCEHRT
§ Exclusion:Iftheproviderwritesfewerthan100prescriptionsduringthereportingperiod
§ RequiredforACIcategoryinMIPS
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Objective5:HealthInformationExchange(HIE)
§ Formerlynamedtransitionsofcare(TOC)§ Incomingandoutgoingtransitions§ Whatisatransition?
• Atransitionisthemovementofapatientfromonesettingofcare(hospital,ambulatoryprimarycarepractice,ambulatory,specialtycarepractice,long-termcare,homehealth,rehabilitationfacility)toanother.AtaminimumthisincludesalltransitionsofcareandreferralsthatareorderedbytheEP.
§ WithcertainEHRs,youhavetomarkthepatientasatransitiontocapturethedenominatorbeforeyousendtheCCDdocumenttogetthenumerator
§ RequirementforACIcategoryofMIPS
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Objective5:HealthInformationExchange(HIE)
ModifiedStage2§ EPwhoreferstheirpatienttoanothersettingofcaremustuseCEHRTtocreateasummaryofcare(SOC)andelectronicallytransmitsuchSOCtoareceivingProviderfor10percent ofalloutgoingTOC
Exclusion:AnyEPwhotransfersapatienttoanothersettingofcareorrefersapatienttoanotherproviderfewerthat100timesduringtheEHRreportingperiod
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Objective5:HealthInformationExchange(HIE)
Stage3:Three-partmeasurethatincorporatesclinicalinformationreconciliation§ Sendmorethan50percentofoutgoingtransitionselectronically§ Incorporatemorethan40percentofincomingtransitionsintoyourEHRelectronically
§ Formorethan80percentoftransitionsornewpatients,aproviderhastoperformclinicalinformationreconciliation.Theprovidermustimplementclinicalinformationreconciliationforthefollowingthreeclinicalinformationsets:1. Medication2. Medicationallergy3. Currentproblemlist
Exclusions:§ AnyEPwhotransfersapatienttoanothersettingorrefersapatienttoanotherproviderfewerthan100timesduringtheEHRreportingperiod
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Objective6:PatientSpecificEducation
ModifiedStage2:Nochanges§ Patient-specificeducationresourcesidentifiedbyCEHRTareprovidedtopatientsformorethan10percent ofalluniquepatientswithofficevisitsseenduringtheEHRreportingperiod
Stage3§ Measureisincludedinthepatientelectronicaccesstohealthinformationobjective;rategoesupto35percent andtheEPmustprovideelectronicaccess tothesepatient-specificeducationresources
§ Exclusion:AnEPmayexcludefromthemeasureiftheyhavenoofficevisitsduringtheEHRreportingperiod.
§ ThismeasureisabonuspointforACIcategoryforMIPS
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Objective7:MedicationReconciliation– IncomingTransitions
§ Transitionofcare:Themovementofapatientfromonesettingofcare(hospital,ambulatoryprimarycarepractice,ambulatoryspecialtycarepractice,long-termcare,homehealthorrehabilitationfacility)toanotherExamples:• NewpatientneverbeforeseenbytheEP• PatienttransitioningbacktotheEPfromED,hospitalinpatientdischarge,SNF
• Provider’sdiscretion:EncounterwarrantsTOCvisit(notseeninthreeyears)
§ Demoninator:PatientencountermustbeidentifiedinEHRasanincomingTOCvisit
§ Numerator:EPmustreconcilepatient’smedicationsinencounter
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Objective7:MedicationReconciliation
Stage2:Nochanges§ EPperformsmedicationreconciliationformorethan50percentoftransitionsofcareinwhichthepatientistransitionedintothecareoftheEP.
§ Exclusion:AnyEPwhowasnottherecipientofanyTOCduringtheEHRreportingperiod
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Objective7:MedicationReconciliation
§ Stage3:ThismeasureisincludedintheHIEobjective,Measure3clinicalinformationreconciliation
§ BonuscreditforACIforMIPSCategory
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Dr.ChadRodgersHealthChat– PatientPortals
§ Dr.ChadRogers-AFMCChiefMedicalOfficer
§ https://www.youtube.com/watch?v=2xlHXBNt-yM
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Objective8:PatientElectronicAccess
Stage2:§ Measure1:>50%ofalluniquepatientsseenbytheEP
duringtheEHRreportingperiodwereprovidedtimelyaccesstoview,downloadortransmit(VDT)toathirdpartytheirhealthinformationwithinfourbusinessdaysofitbeingavailabletotheEPforeveryencounterwherethepatientisseenbytheEP
§ Measure2:>5%ofuniquepatients(ortheirauthorizedrepresentative)seenbytheEPduringtheEHRreportingperiodVDTtheirhealthinformationtoathirdparty
§ EPmustsatisfyandmeetthethresholdforbothmeasurestosatisfythisobjective.
§ RequirementforACICategoryofMIPS
PatientportalpostersandhandoutsareavailableontheAFMCwebsite
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CoordinationofCarethroughPatientEngagement
Stage3:ObjectivechangestitletoCoordinationofCarethroughPatientEngagement§ Measure1:Morethan5percent ofalluniquepatientsseenbytheEP(ortheirauthorizedrepresentatives)activelyengagewiththeelectronichealthrecordmadeaccessiblebytheproviderandVDTtoathirdpartytheirhealthinformation
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CoordinationofCarethroughPatientEngagement
§ Measure2:Morethan5percent ofalluniquepatientsseenbytheEP,asecuremessagewassentusingtheelectronicmessagingfunctionofCEHRTtothepatient(orthepatient’sauthorizedrepresentative)orinresponsetoasecuremessagesentbythepatientortheirauthorizedrepresentative
§ Measure3:Patient-generatedhealthdataordatafromanonclinicalsettingisincorporatedintotheCEHRTformorethan5percent ofalluniquepatientsseenbytheEPduringtheEHRreportingperiod
Patient-generatedhealthdataorhealthmonitoringtechnologyexamples:• Fitnesswatches• Wireless-connectedscales• Heartratemonitors• Bloodpressuremonitors
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Objective9:SecureMessaging
§ Stage2:5percenthavetosendorreceiveasecuremessagethroughthepatientportalto/fromapatientorpatientrepresentative
§ Stage3- Thismeasureistransitionedtocoordinationofcareobjective§ RequirementforACIcategoryinMIPS
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Objective10:PublicHealthReporting
§ ModifiedStage2§ Mustattesttotwomeasures§ Optionsare:
• Immunizationregistryreporting• Syndromicsurveillancereporting• Specializedregistry
§ Exclusions:Thereareexclusionsbuttheywillbeona-caseby-casebasis
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Objective10:PublicHealthReporting
§ Stage3• Mustattestto2measures• Optionsare
o Immunizationregistryreportingo Syndromicsurveillancereportingo Electroniccasereportingo Publichealthregistryreportingo Clinicaldataregistryreporting
• Exclusions:Thereareexclusionsbuttheywillbeona-caseby-casebasis
ClinicalQualityMeasures
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§ Stillhavetoreportonnineclinicalqualitymeasures• Ninemeasuresoverthreedifferentdomains
§ SinceclinicalqualitymeasureswillbeapartofMIPS,youwillwanttoalignthesetwoprograms
§ CQMnumeratoranddenominatorswillcount,soyouwillwanttoreportyourbestnumbers
AlternativePaymentModelsandAdvancedAPM
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AlternatePaymentModels(APM)
APMisagenerictermdescribingapaymentmodelinwhichproviderstakeresponsibilityforcostandqualityperformanceandreceivepaymentstosupporttheservicesandactivitiesdesignedtoachievehighvalue
Source:CMS
OnlysomeoftheseAPMswillbe“eligible”or“AdvancedAPMs”
CurrentAPMsInclude:• MSSPACOs,Track1• CompESRDCare(Non-
LDO)• OncologyCare(1-sided
risk)
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AdvancedAPMs
Source:CMS
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AdvancedAPMs
In2017,thefollowingareadvancedAPMs• ComprehensiveESRDcare(CEC)– Two-sidedrisk• ComprehensivePrimaryCarePlus(CPC+)• NextgenerationACOmodel• Sharedsavingsprogram– Track2• Sharedsavingsprogram– Track3• Oncologycaremodel(OCM)– Two-sidedrisk• Comprehensivecareforjointreplacement(CJR)paymentmodel–
Track1CEHRT
MedicalHomeModels
Source:CMS
WhatAboutArkansasMedicaidPCMH?
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§ ArkansasMedicaidPCMH– isitaneligible/advancedAPM?• ThegoalhasbeenforArkansasMedicaidPCMHtobecomeanadvanced APM by2019
• Plansarecurrentlyunderdevelopment
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ConnectingtheDots:HowDoesEverythingTieTogether?
PaymentModel
VBM
MUPQRS
AdvancedAlternativePaymentModel
ACIvs.MedicaidMU
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ACI2017TransitionObjectivesandMeasures
1. Protectpatienthealthinformation2. e-Prescribing3. Healthinformationexchange4. Providepatientaccess5. Patient-specificeducation6. VDT(Portal)7. Securemessaging8. Medicationreconciliation9. Immunizationregistryreporting
Bonus:Syndromicsurveillance,specializedregistryreporting,andreportingIAsviaEHR
MedicaidMU2017ObjectivesandMeasures
1. Protectpatienthealthinformation2. Clinicaldecisionsupport3. CPOE(medications,labs,radiology)4. e-Prescribing5. Healthinformationexchange6. Patient-specificeducation7. Medicationreconciliation8. PatientportalaccessandVDT9. Securemessaging
PublichealthrReporting (tworequired)1. Immunizationregistryreporting2. Syndromicsurveillance3. Specializedregistry
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WhatisAFMCDoing?
§ Preparingtodelivertechnicalassistance§ EncouragingproviderstomakeprogresswithMUofCEHRTandelectronicexchangeofhealthinformation(interoperability)
§ Assistingpracticesstatewidewithqualityinitatives• MedicaidMU• HIPAAsecurityandprivacypolicies/securityriskanalysis• ArkansasMedicaidPCMHpracticetransformation• MSSPACOpracticetransformation• MIPStechnicalassistanceforeligiblecliniciansthroughtheTMFQIN-QIO
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Questions
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Resources
§ CMSqualitypaymentprogramslidesandresources• https://qpp.cms.gov
§ CMSspecsheets• https://www.cms.gov/regulations-and-guidance/legislation/ehrincentiveprograms/2016programrequirements.html
§ AFMCpatientportalhandouts• https://afmc.org/product/patient-engagement-patient-portal-poster/
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ContactInformation
§ Forfurtherassistance:• Pleaseemailhealthit@afmc.org• Call501-212-8616