the latest regulations, simplified: mu, pqrs & mips
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The Latest Regulations, Simplified:
MU, PQRS & MIPSCatherine Chuter
Product Marketing
Source: CMS, “2013 Annual Report of the Boards of Trustees of the Federal Hospital Insuranceand Federal Supplementary Medical Insurance Trust Funds,” May 31, 2013, available at:http://downloads.cms.gov/files/TR2013.pdf;
Projected Medicare Fee-for-service Payment Cuts per the ACA
2014 2015 2016 2017 2018 2019 2020
Projected number of Medicare beneficiaries
54M 56M 57M 59M 61M 63M 64M
-14B -21B -25B -32B -42B -53B -64B
Source: CMS, “2013 Annual Report of the Boards of Trustees of the Federal Hospital Insuranceand Federal Supplementary Medical Insurance Trust Funds,” May 31, 2013, available at: http://downloads.cms.gov/files/TR2013.pdf
Shift Toward Quality
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2018: 90% of Medicare
payments tied to quality.
2020: 75% of commercial plans will be value-based.
Jan 2015. http://www.hhs.gov/news/press/2015pres/01/20150126a.html
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ACO
PCMHPQRSMIPS
MSSP
MUEHR
HCCICD-10
ANSIAPMs
MACRA
ACA
IRMVM
5
April 16th
MACRA, H.R. 2, made law• Medicare Access and CHIP
Reauthorization Act
• Replaced SGR formula
• EHR Incentive Programs to be streamlined into one new payment system
• Incentivizes the shift to alternative, value-based payment models
News from Washington:
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MACRA represents a continuation in the
shift toward value.
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MIPS2019
2022
Fully implemented with a much
greater range of adjustments
-4% penalty+12%
incentive
MIPS takes over and replaces
penalties from current programs
-9% penalty+27%
incentive
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2007PQRI starts
2011Meaningf
ul Use Stage 1
2014Meaningf
ul Use Stage 2
2017Start
MIPS or APM
2015Meaningf
ul Use penalties
hit
2015ICD-10
2015PQRS
penalties hit
2016PQRS VM applies to all HCPs
PQRS and MU Overview
PQRS Meaningful UseMEDICARE PHYSICIANSDoctor of Medicine X XDoctor of Osteopathy X XDoctor of Podiatric Medicine X XDoctor of Optometry X XDoctor of Oral Surgery X XDoctor of Dental Medicine X XDoctor of Chiropractic X XPRACTITIONERSPhysician Assistant XNurse Practitioner XClinical Nurse Specialist XCertified Registered Nurse Anesthetist XCertified Nurse Midwife XClinical Social Worker XClinical Psychologist XRegistered Dietician XNutrition Professional XAudiologists XTHERAPISTSPhysical Therapist XOccupational Therapist XQualified Speech-Language Therapist X
PQRS and MU eligible providers
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• Federally Qualified Health Centers (FQHCs)• Patient Centered Medical Homes (PCMH)• Hospitals• Independent Labs• Rural Health Clinics• Ambulance providers• Ambulatory Surgical Centers (ASCs)
Who is not eligible for PQRS?
Program Backgrounds
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The Evolution of PQRS and Beyond
2007 2008 2009 2010 2011 2012 2013 2014 2015 2016
• 74M • Claims
• 119 M • 4 MG• Claims• Registry
• 119 M• 4 MG• Claims• Registry
• 175 M• 13 MG• Claims• Registry• EHR• GPRO
• 198 M• 14 MG• Claims• Registry• EHR• GPRO
• 225 M• 22 MG• Claims• Registry• EHR• GPRO
• 260 M• 22 MG• Claims• Registry• DSV• HER• GPRO
• 287 M• 25 MG• Claims• Registry• EHR• GRPO• CSV• CDR
+2.0% +1.0
% +0.5%
+0.5%
+0.5%
-1.5%-2.0%
BONUS PENALTY
2017 MIPS participation affects penalty beginning in
2019.
2017
• MIPS
-9.0%M – MeasuresMG – Measure Groups
Stage 1:Data capture and sharing
Stage 2:
Advanced processes
Stage 3:
Improved outcomes
2015
The Evolution of MU and Beyond
Meaningful Use is designed to create infrastructure that supports reform.
Program Comparison
PQRS versus MU Upcoming Medicare Penalties
Program 2015 2016 2017 2018
Physician Quality Reporting System (PQRS)
-1.5% -2% -2% -2%
Value Based Modifier Program (VM) -1% -2%** -2%*** or
-4%**** -4%
Meaningful Use/EHR Incentive Program
-1% or -2%* -2% -3% -4%
Penalty -3.5% or -4.5% -6% -7% or
-9%At least -
10%
* -2% in 2015 only applies to providers who failed Meaningful Use and eRx thresholds** -2% applies to practices with 100+ EPs only*** -2% is only for practices with 1-9 EPs**** -4% only applies to practices with 10+ EPs
20out of23
measures
MUPQRS
9out of287
measures
PQRS versus MU Reporting Measures
Report on patient-specific
data.
Then, measure against peers.
PQRS Meaningful Use
Fully demonstrate
success within three types of measurement.
PQRS versus MU Measurement Style
PQRSPeer Measured Performance
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PQRS40%
MU30%
Nearly 40% of eligible providers face a payment reduction for not reporting in 2013.
More than 30% will be penalized for not meeting requirements in 2013 and 2014.
National Penalty ResultsPQRS versus MU
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Success with athenahealth
Ask a few key questions ofyour EHR vendor
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Is your vendor able to deploy the 2014 Certified Edition to all clients at once?1How is your vendor monitoring your PQRS and MU performance?2Does the vendor provide MU/PQRS support and training as part of the regular pricing without additional fees?3Do they provide the required interfaces for free and without interruption? How many connections? When will they be available? 4
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PQRS Success with athenahealth
1For enrollment, we look at our network data to determine the best 9 measures for each specialty.
2 Once enrolled, our rules engine tracks the performance of each HCP and adjusts enrollment based on performance.
3Our software provides real-time visibility into performance to ensure you are on track.
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Performance on Meaningful Use Stage 2 Behavioral measures
Covering period: Q1 2014
100% 89%
99%
99%
99%
100%
99%
95%
80%
1. CPOE for Medication, Laboratory, and Radiology Orders
2. E-prescribing (eRx)
3. Record Demographics
4. Record Vital Signs
5. Record Smoking Status
6. Clinical Decision Support Rule
7. Patient Electronic Access
8. Clinical Summaries
9. Protect Electronic Health Information (N/A)
10. Clinical Lab Test Results
11. Patient Lists (N/A)
12. Preventive Care Reminders
13. Patient-Specific Education Resources
14. Medication Reconciliation
15. Summary of Care
16. Immunization Registry Data Submission
17. Use Secure Electronic Messaging
75%
92%
99%
89%
90%
33%
98%Providers who satisfied required 3 of 6 menu measures:
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Performance on Meaningful Use Stage 2 Behavioral measures
As of 12/31/2014
100%
100%
100%
100%
100%
99%
99%
1. CPOE for Medication, Laboratory, and Radiology Orders
2. E-prescribing (eRx)
3. Record Demographics
4. Record Vital Signs
5. Record Smoking Status
6. Clinical Decision Support Rule
7. Patient Electronic Access
8. Clinical Summaries
9. Protect Electronic Health Information (N/A)
10. Clinical Lab Test Results
11. Patient Lists (N/A)
12. Preventive Care Reminders
13. Patient-Specific Education Resources
14. Medication Reconciliation
15. Summary of Care
16. Immunization Registry Data Submission
17. Use Secure Electronic Messaging99%
100%
Providers who satisfied required 3 of 6 menu measures:
100%
100%
100%
100%
100%
100%
100%
We navigate regulatory change so practices don’t have to
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Meaningful Use Stage 2 attestationNational average:
33% 98.2%
athenahealth clients:
% of HCPs expecting PQRS penalties in 2015National average:
40% 6.4%athenahealth clients:
2014 Best in KLAS
#1 Practice
Management System
(1-10, 11-75 physicians)
#2 Practice
Management System
(Over 75 physicians)
#2 EHR
(1-10, 11-75 physicians)
#2 PatientPortal
#2Overall
PhysicianPractice Vendor
“2014 Best in KLAS Awards: Software & Services,” January, 2015. © 2015 KLAS Enterprises, LLC. All rights reserved. www.KLASresearch.com
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