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GA-HIMSS Community of Practice Meaningful Use, HIE and Interoperability July 27, 2016

Session Agenda Ø Announcements Ø Introduction to Patient Engagement Playbook Ø Overview of MACRA üMIPS/Advancing Care Information Ø Group discussions / comments (if time available)

Let Us Hear From You ØMeet Bi-Monthly, third Wednesday at 12: 00 ØIssues and barriers – MU, HIE, Interoperability, MACRA ØTopics for future Co. P calls ØTopics for Chapter Lunch ‘n Learns or webcasts sessions Øga. comm@himsschapter. org

Additional Announcements • GA-HIMSS 2016 Annual Conference http: //gahimss. com/ • September 7, 2016 • Cobb Galleria • Sessions on MACRA, HIE, Meaningful Use Stage 3, Patient Engagement, Quality Initiatives, and more! • Register Today! Providers attend for free! http: //gahimss. com/registration-2/

Patient Engagement Playbook • Increasing requirements and needs around Patient Engagement • Rewards are real: more effective delivery of care; reduced burden on office staff; and informed, engaged patients • Potential barriers: cumbersome enrollment; clunky interfaces; reluctant patients, doctors, and office staff; not to mention questions of privacy and security

Patient Engagement Playbook • ONC introduces the Patient Engagement Playbook https: //www. healthit. gov/playbook/pe/ • Evolving resource • Compilation of tips and best practices ONC collected from providers and health systems • Introduced June, 2016 • Tool for health care providers, practice staff, hospital administrators • Leverage Health IT through a Patient Portal to engage patients in their health and care

Patient Engagement Playbook https: //www. healthit. gov/playbook/pe/

MACRA: MIPS – Advancing Care Information Session Objective The objective of this session is to provide some basic understanding and direction for practices in preparation for the 2017 requirements as it relates to the Advancing Care Information performance category

MACRA: MIPS – Advancing Care Information Agenda • Why MACRA? • What is MACRA? • How does MACRA relate to Meaningful Use? • How can a practice prepare?

MACRA: MIPS – Advancing Care Information Proposed Rules • This session looks at proposed rules • Information provided only intended to be a general summary • It is not intended to take the place of either the written law or regulations • Public commentary until June 27, 2016 • Final regulations published in November 2016

What is MACRA? • Medicare Access and CHIP Reauthorization Act of 2015 – MACRA • Quality Payment Program • Establishes new ways to pay physicians for caring for Medicare beneficiaries • Path to value

Why MACRA? • MACRA is part of a broader push towards value and quality • In January 2015, the Department of Health and Human Services announced new goals for value-based payments and advanced payment models (APMs) in Medicare https: //www. cms. gov/Medicare/Quality-Initiatives-Patient-Assessment-Instruments/Value-Based. Programs/MACRA-MIPS-and-APMs/MACRA-LAN-PPT. pdf

Why MACRA? • MACRA moves us closer to meeting these goals https: //www. cms. gov/Medicare/Quality-Initiatives-Patient-Assessment-Instruments/Value-Based. Programs/MACRA-MIPS-and-APMs/MACRA-LAN-PPT. pdf

Why MACRA? ……and toward transforming our healthcare system https: //www. cms. gov/Medicare/Quality-Initiatives-Patient-Assessment-Instruments/Value-Based. Programs/MACRA-MIPS-and-APMs/MACRA-LAN-PPT. pdf

What is MACRA? The Medicare Access and CHIP Reauthorization Act of 2015 is a bipartisan legislation signed into law on April 16, 2015. What does Title 1 of MACRA do? ü Repeals the Sustainable Growth Rate (SGR) Formula ü Changes the way that Medicare rewards clinicians for value over volume ü Streamlines multiple programs under the new Merit-Based Incentive Payments System (MIPS) ü Provides bonus payments for participation in eligible alternative payment modes (APMS) https: //www. cms. gov/Medicare/Quality-Initiatives-Patient-Assessment-Instruments/Value-Based. Programs/MACRA-MIPS-and-APMs/MACRA-LAN-PPT. pdf

MACRA – Advancing Care Information What is MACRA? Significant changes in Medicare payments are coming in 2019 based on 2017 performance https: //www. cms. gov/Medicare/Quality-Initiatives-Patient-Assessment-Instruments/Value-Based. Programs/MACRA-MIPS-and-APMs/MACRA-LAN-PPT. pdf

MACRA – Advancing Care Information What is MACRA? Two Tracks of MACRA The Meritbased Incentive Payment System (MIPS) or Advanced Alternative Payment Models (APMs) • Today, we will focus on MIPS https: //www. cms. gov/Medicare/Quality-Initiatives-Patient-Assessment-Instruments/Value-Based. Programs/MACRA-MIPS-and-APMs/MACRA-LAN-PPT. pdf

What is MIPS? https: //www. cms. gov/Medicare/Quality-Initiatives-Patient-Assessment. Instruments/Value-Based-Programs/MACRA-MIPS-and-APMs/MACRA-LAN-PPT. pdf

MIPS – First Step to a Fresh Start https: //www. cms. gov/Medicare/Quality-Initiatives-Patient-Assessment-Instruments/Value-Based. Programs/MACRA-MIPS-and-APMs/MACRA-LAN-PPT. pdf

MIPS: Major Provisions https: //www. cms. gov/Medicare/Quality-Initiatives-Patient-Assessment-Instruments/Value-Based. Programs/MACRA-MIPS-and-APMs/MACRA-LAN-PPT. pdf

Who will Participate in MIPS? • Affected clinicians are called “MIPS eligible clinicians” • This is different from the MU “eligible professional” • Types of Medicare Part B eligible clinicians may expand https: //www. cms. gov/Medicare/Quality-Initiatives-Patient-Assessment-Instruments/Value-Based. Programs/MACRA-MIPS-and-APMs/MACRA-LAN-PPT. pdf

Who will NOT Participate in MIPS? • There are 3 groups of clinicians who will NOT be subject to MIPS Medicare billing charges less than or equal to $10, 000 and provides care for 100 or fewer Medicare patients in one year Note: MIPS does not apply to hospitals or facilities https: //www. cms. gov/Medicare/Quality-Initiatives-Patient-Assessment-Instruments/Value-Based. Programs/MACRA-MIPS-and-APMs/MACRA-LAN-PPT. pdf

What will Determine the MIPS Score? (PQRS, CQMs) X (TCPI, PCMH) * (Meaningful Use) Based on 2017 data *% weight of this may decrease as more users adopt EHR technology

MIPS: Four Categories The MIPS composite performance score will factor in performance in 4 weighted performance categories on a 1 -100 point scale Ø Advancing Care Information replaces MU for participants in MIPS

MIPS Advancing Care Information Performance Category Ø Who can participate?

MIPS Advancing Care Information Performance Category

MIPS Advancing Care Information Performance Category MIPS weight Base measures and scoring Performance measures and scoring • 25% of total MIPS score • May be reduced if >75% of clinicians are successful • 12 -month physician reporting period • 50 points for achieving 6 objectives (pass/fail) • Immunization registry reporting required; reporting to more than one public health registry earns bonus point • CPOE and clinical decision support no longer required • Provide numerator/denominator or yes/no attestation for each • Failure to attest to “protecting patient health information” results in zero total ACI score • 80 points available; total combined score exceeding 100 gets full credit • Clinicians select from measures across 3 objective areas: patient electronic access, patient engagement, HI exchange • ACI performance category will be reweighted to zero and other MIPS categories increased if objectives don’t apply (e. g. , for hospital-based clinicians) • Clinical quality measures from Meaningful Use no longer required 29

MIPS Advancing Care Information Performance Category

MIPS Advancing Care Information Performance Category

MACRA: MIPS - ACI vs Meaningful Use Proposed Rule MIPS: Advancing Care Information Performance Category Advancing Care Information 1. Protect Patient Health Information 2. Electronic Prescribing 3. Patient Electronic Access 4. Coordination of Care through Patient Engagement 5. Health Information Exchange 6. Public Health and Clinical Data Registry Reporting Quality Component of MIPS Meaningful Use Stage 3 1. Protect Patient Health Information 2. Coordination of Care 3. Patient Electronic Access to Health Information 4. Quality of Care 5. Health Information Exchange 6. Interoperability 7. Public Health and Clinical Data Registry Reporting

MIPS Advancing Care Information Performance Category

Sample Performance Score

Sample Total Score 3

MACRA: MIPS - ACI vs Meaningful Use MU 100% score required on all measures to avoid 5% penalty NPRM Concerns Pass-fail program replaced with base and performance scoring 50 point base score threshold still 100%; security attestation required Measures reduced Included redundant measures and problematic CPOE, CDS and clinical quality measures Performance score thresholds eliminated Public health registry reporting reduced Remaining MU measures unchanged; simply reorganized MU exclusions eliminated Full-year reporting 37

MIPS Advancing Care Information Performance Category

MACRA: MIPS – Quality Performance vs Meaningful Use and PQRS Quality Performance Category

Calculating the Composite Performance Score for MIPS .

MACRA Proposed Rule – Performance Scoring .

Calculating the Composite Performance Score for MIPS .

Calculating the Composite Performance Score for MIPS .

MACRA Proposed Rule MIPS Payment Structure The potential maximum adjustment % will increase each year from 2019 to 2022 MIPs payment adjustments are required to be budget neutral. This means that rather than additional spending, higher reimbursement for those who score well will come from reduced payments to those with poorer performance.

MACRA Proposed Rule MIPS Timeline .

MACRA Proposed Rule Key Take-Away Points 1. The Quality Payment Program changes the way Medicare pays clinicians and offers financial incentives for providing high value care. 2. Medicare Part B clinicians will participate in the MIPS, unless • they are in their 1 st year of Part B participation, • become QPs through participation in Advanced APMs, or • have a low volume of patients 3. Contains components consistent with MU Stage 3 4. Payment adjustments and bonuses will begin in 2019 5. Begin preparation now!. Focus on lessening the burden of keeping score and increase the focus on providing increased patient care.

MACRA Proposed Rule How Can You Prepare? 1. Participate in available webinars (National, local, HIMSS, RECs, HIEs, etc. ) 2. Initiate Community of Care / Community of Practice meetings 3. Use professional society resources 4. Review and analyze MU and Quality reports 5. Patient Engagement Playbook 6. Participate in TCPI and/or PCMH 7. Determine which track is best for your practice 8. Determine risk 9. GA-HITEC supporting Technical Assistance for ACI 10. Allocation of $20 million/year from 2016 -2020 to small practices to provide technical assistance regarding MIPS performance criteria. or transitioning to an APM 11. Begin preparation now!

Resources • Centers for Medicare and Medicaid Services • www. cms. gov/ehrincentiveprograms • http: //go. cms. gov/Quality. Payment. Program • Office of the National Coordinator • www. health. gov • State’s Department of Community/Public Health • State’s Health Information Exchange • State’s QIOs The information provided in this presentation is only intended to be a general summary. It is not intended to take the place of either the written law or regulations.

GA-HIMSS Community of Practice Meaningful Use, MACRA, HIE and Interoperability • Recording of session available http: //ga. himsschapter. org/cop-interoperability • Next Meeting: September 21, 2016, 12: 00 • Topic 1: MACRA, the Adventure Continues • Let us know what you want to hear or if you would like to contribute • Additional Co. Ps beginning soon! Thank you for your participation and input!