How to Maximize Your EHR Use to Succeed in MIPS: Advice ......2018/08/08 · HOW TO MAXIMIZE YOUR EHR USE TO SUCCEED IN MIPS 18 2014 VS 2015 EDITION CEHRT 2014, 2015, or a combination

QUALITY PAYMENT PROGRAM SMALL UNDERSERVED RURAL SUPPORT (QPP SURS) WEBINARAUGUST 14, 3:30 PM ET AND AUGUST 16, 11:00 AM ET

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HOW TO MAXIMIZE YOUR EHR USE TO SUCCEED IN MIPS: ADVICE FOR SOLO AND SMALL GROUP PRACTICES

HOW TO MAXIMIZE YOUR EHR USE TO SUCCEED IN MIPS

HOUSEKEEPING ANNOUNCEMENTS

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To ask a question, enter your inquiry in the chat box.

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POLLING QUESTIONWhat is your role?▸

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A clinician working in a practice with 15 or fewer clinicians

Non clinical staff from a practice with 15 or fewer clinicians

A clinician working in a practice with more than 15 clinicians

Non clinical staff in a practice with more than 15 clinicians

Quality Payment Program (QPP) contractor

Other person helping practices prepare for MIPS

Other

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POLLING QUESTIONWhich of these best describes your practice’s EHR use?▸

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We have a certified EHR and want to maximize its use to meet MIPS requirements

We are considering an EHR but do not have one at this time

We have a certified EHR but are frustrated and are thinking about getting a different one

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CMS WELCOME5

Brenda Gentles, RN, BS, MS

Division of ESRD, Population & Community Health

Centers for Medicare & Medicaid Services

QPP SURS Central Support Contractor COR


Jim Rice, RN MBA, Quality Improvement Consultant, AFMC

Bruce Spurlock, MDPresident & CEO,Cynosure Health

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Gordon Wright, Medical Informatics Specialist, Health

Services Advisory Group

Chris Hopwood, Senior Program Administrator, Healthcentric Advisors


SETTING THE STAGE▸

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Focus: Using your Electronic Health Records (EHR) system to streamline your processes, maximize time and resources, and assist in achieving a better MIPS score.

Strategy: Discussion with panelists that understand MIPS and how to leverage your EHR to achieve the highest possible MIPS score.

Topic Overview: Benefits of using an EHR Types of EHRs including Certified Electronic Health Record Technology (CEHRT) What to consider when selecting an EHR Leveraging your EHR to enhance you MIPS score in all four performance categories Practical advice

▸ Using the Chat Box

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RESOURCES FOR FREE SUPPORT8

Technical Assistance Organizations

Free technical assistance and advice available for small practices from CMS-funded organizations. Contact information for each organization at: https://qpp.cms.gov/docs/QPP_Support_for_Small_Practices.pdf

• General information about QPP for eligible clinicians participating in MIPS or Advanced APMs: https://qpp.cms.gov/

• Questions to CMS about Quality Payment Program:[email protected]

• Sources of support for larger practices and APM participants described in: https://qpp.cms.gov/docs/QPP_Technical_Assistance_Resource_Guide.pdf

https://qpp.cms.gov/docs/QPP_Support_for_Small_Practices.pdf

https://qpp.cms.gov/

mailto:[email protected]

https://qpp.cms.gov/docs/QPP_Technical_Assistance_Resource_Guide.pdf

QUESTION:

Why do some small practices use an EHR?

9HOW TO MAXIMIZE YOUR EHR USE TO SUCCEED IN MIPS


BENEFITS OF USING AN EHR ▸▸

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Reduce workloadReduce costs through decreased paperwork and duplication of testing

Benefit your patients

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Quick, simultaneous access to patient records

Identify gaps in care

Appropriate coding

Coordination of health services

Patient portal

Reduce medical errors

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BENEFITS OF USING AN EHR ▸

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Streamline reporting across programs

Secure sharing of information with patients and other clinicians

Reduce workload

Reduce costs through decreased paperwork and duplication of testing

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QUESTION:

But…do I need an EHR to participate in MIPS?



AVOIDING A PENALTY FOR SMALL PRACTICES

*assumes PI isn’t reweighted

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▸Only need 15 points to avoid a negative penalty

Reporting data on at least one performance category 5 points added to your final MIPS score

Completing two medium-weighted improvement activities or one high-weighted improvement activity

15 points

Meeting base score requirements in the Promoting Interoperability* category over a 90-day period

12.5 points

Submitting valid data for at least some patients for a quality measure

2.5 points

Earn up to 5 points for treating complex patients 1-5 points

Earn up to 10 points for each of the 2 cost measures 1-10 Points


AVOIDING A PENALTY FOR SMALL PRACTICES 14

▸ Improvement ActivitiesActivities Total Points

Tobacco Use Screening and Counseling (medium-weighted)

7.5

Alcohol Use Screening and Brief Counseling (medium-weighted)

7.5

24/7 Access (high-weighted) 15Consultation of thePrescription Drug

Monitoring program (high-weighted)

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▸Promoting Interoperability▸

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Just for meeting the base score requirements, you can receive 12.5 pointsIf you qualify for the 10% bonus you can earn another 2.5 points for a total of 15


AVOIDING A PENALTY FOR SMALL PRACTICES 15

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Quality MeasuresMeasures Total Points

Tobacco Use 2.5DM Poor Control (A1c>9%) 2.5

BMI 2.5Fall Risk 2.5

Pneumonia Vaccination 2.5Influenza Immunization 2.5

If approved for the PI hardship exemption, 25% of PI weight is applied to quality— making quality 75% or 3.75 points per measure


MIPS SPECIFIC BENEFITS OF EHR USE▸▸▸▸

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Required to meet the Promoting Interoperability (PI) categoryEarn bonus points in multiple performance categoriesPrepare for the futureProvides additional options for submitting data to the QPP portal in the required format (EHR vendor)You can still submit via Qualified Registry (QR), or Qualified Clinical Data Registries (QCDR) Can still use administrative claims to submit quality dataCan streamline data submission for group reporting

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QUESTION:

There are many types of EHRs…certified, uncertified, 2014 and 2015 editions. What is the difference between these and what kind should I use?


CERTIFIED EHR TECHNOLOGY (CEHRT)▸CMS and the Office of the National Coordinator for Health Information

Technology (ONC) have established standard certification criteria for EHRs

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Promotes CMS’s focus on improving patients’ access to health information and interoperability

Data storage format requirements

Provides benchmarks to improve care

Fully functional and secure software

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Must be used to earn points in the PI category criteria

Promotes consistency across the industry


https://www.healthit.gov/

2014 VS 2015 EDITION CEHRT

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2014, 2015, or a combination is required to meet PI criteria

2015 edition builds on previous editions to facilitate interoperable health information infrastructure

Clinicians and groups who exclusively report the PI Measures using 2015 Edition CEHRT will earn a 10% bonus

Relevance of these editions in future years


2014 VS 2015 EDITION CEHRT ▸ Comparison of the 2014 and 2015 Edition and Edition Certification Criteria


https://www.healthit.gov/sites/default/files/playbook/pdf/2014-and-2015-edition-comparision.pdf

WHAT TO CONSIDER FOR YOUR PRACTICE ▸

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Initial and maintenance costs

Ease of use

Relevant measures for your practice that can be reported

Peer use of an EHR (practices like yours)

Additional costs if aggregated across multiple EHRs

Enhancing interoperability

Reporting capabilities


WHAT TO CONSIDER– VENDOR SUPPORT ▸▸

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Fees when upgrading to 2015 CEHRTFees associated with support or functionality from qualified registries or Qualified Clinical Data Registries (QCDR)

Support provided for submitting data to CMS

Resources and available trainings

CMS EHR Vendor Fact Sheet


https://www.cms.gov/Medicare/Quality-Payment-Program/Resource-Library/Advancing-Care-Information-for-Vendors.pdf

PRACTICAL ADVICE FOR SELECTING AN EHR23HOW TO MAXIMIZE YOUR EHR USE TO SUCCEED IN MIPS

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Consider features and options that work best for your practice

List of top 10 things you want your practice to do better

Perform a cost analysis based on your needs and what the EHR can do

Endorsement by your specialty society

Don’t make a decision in isolation

QUESTION:

How can I leverage my EHR to benefit my practice and MIPS score?


QUALITY MEASURES▸

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Eligible for MIPS bonus points▸ Bonus for end-to-end electronic reporting up to 10% of denominator Many automatically capture quality measure data as you enter information into each patient’s recordElectronically Calculate Clinical Quality Measures▸ May include a number of electronic clinical quality measures that can be

calculatedSubmit Quality Measure Reports Electronically▸ You may use an electronic submission file or use the assistance of a third

party, like a specialty society registry or QCDR, to submit an electronic file on your behalf to CMS


QUALITY MEASURES— HELPFUL TIPS

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Set up and customize health maintenance reminders ▸ Identify gaps in careSet up dashboardsReview your data on a regular basisBenchmark across providers in your practice


IMPROVEMENT ACTIVITIES▸

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Supports all improvement activity sub-categories Using a CEHRT and patient portals may help you perform better and benefit your patientsYou may submit your IAs by attestation via the CMS portal, your CEHRT vendor, QR, or QCDRAdditional improvement activities are eligible for a 10% PI bonus


IMPROVEMENT ACTIVITIES—HELPFUL TIPS▸

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24/7 hour accessSend next day appointment remindersUse of patient portalConfigure for specific activities▸

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Glycemic Screening ServicesTobacco useMental health screenings



PROMOTING INTEROPERABILITY▸

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Requires the use of CEHRT to capture data

Clinicians and groups who exclusively report the PI measures using 2015 Edition CEHRT will earn a 10% bonus.

Two Promoting Interoperability measure sets available for clinicians in 2018:

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Promoting Interoperability Objectives and Measures

Promoting Interoperability Transition Objectives and Measures

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PROMOTING INTEROPERABILITY▸The measure set a clinician or group selects will depend on the

CEHRT edition.

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PROMOTING INTEROPERABILITY—REWEIGHTING▸▸

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Your PI score may be reweighted to 0% if: You’re one of the MIPS eligible clinicians who qualify for automatic reweighting. To see if you are one of these clinicians, go to the Promoting Interoperability Fact SheetYou’re a MIPS eligible clinician who has applied for reweighting, using one of these reasons:

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You’re in a small practice

You’re using decertified EHR technology

You have insufficient internet connectivity

You have extreme and uncontrollable circumstances

You don’t have any control over whether CEHRT is available ▸ Reweighting application is due December 31, 2018. Apply here for the hardship application :

https://cmsqualitysupport.service-now.com/exception_application.do

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https://www.cms.gov/Medicare/Quality-Payment-Program/Resource-Library/2018-Promoting-Interoperability-Fact-Sheet.pdf

https://cmsqualitysupport.service-now.com/exception_application.do


COST CATEGORY▸

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Ability to regularly review data

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Documents activity

Provides accurate account of care provided

Appropriate coding

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Reflects patient acuity

HCC Coding (comorbidities)

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COST CATEGORY▸

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Helps provide justification with costs

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Enables utilization review (such as relative drug costs)

Accurate documentation of patient care provided

Review of high cost/high risk patients more easily

EHR allows you to track patients for

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APMs/Value-Based Care

Integrated care for all payors

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QUESTION:

What advice do you have for small practices who are struggling with EHR issues?


PRACTICAL ADVICE▸

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Reach out to your Specialty SocietyTalk with other colleagues in your areaReach out and ask questions of your TA contractorsKeep in contact with your vendorPhysician championVisit the ONC website for resources on how to select an EHR and the Certified Health IT Product List



https://chpl.healthit.gov/#/search

PRACTICAL ADVICE

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Develop relationships with your vendor▸

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Communication is keyAwareness of vendor trainings and materials

Don’t need all the bells and whistles to provide good care


QUESTION:

If I need more help, where can I go?


FREE RESOURCES FOR ASSISTANCE FROM CMS▸

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QPP website: https://qpp.cms.gov/--includes information tailored for the needs of small practices https://www.cms.gov/Medicare/Quality-Initiatives-Patient-Assessment-Instruments/Value-Based-Programs/MACRA-MIPS-and-APMs/Quality-Payment-Program-Events.html

Contact the Quality Payment Program at: [email protected] or call 1-866-288-8292

Support and Available resources for Small, Underserved, and Rural Practices: https://qualitypaymentprogram.cms.gov/about/small-underserved-rural-practices

Small Underserved Rural Support Technical Assistance Organizations (see list on slide 8)

Contact information is available at: https://qpp.cms.gov/docs/QPP_Support_for_Small_Practices.pdf

Available websites of each Technical Assistance Organization

Types of help: needs assessments, webinars, technical support, links to peers you can talk with, assistance getting signed up to report through an approved channel that meets your practice’s needs

▸ FREE Technical Assistance funded by CMS is also available for larger group practices and for clinicians interested in participating in an Alternative Payment Model. More information on those programs is available at: https://www.cms.gov/Medicare/Quality-Payment-Program/Resource-Library/Technical-Assistance-Resource-Guide.pdf


https://qpp.cms.gov/

https://www.cms.gov/Medicare/Quality-Initiatives-Patient-Assessment-Instruments/Value-Based-Programs/MACRA-MIPS-and-APMs/Quality-Payment-Program-Events.html

mailto:[email protected]

https://qualitypaymentprogram.cms.gov/about/small-underserved-rural-practices

https://qpp.cms.gov/docs/QPP_Support_for_Small_Practices.pdf

https://www.cms.gov/Medicare/Quality-Payment-Program/Resource-Library/Technical-Assistance-Resource-Guide.pdf

FREE RESOURCES FOR ASSISTANCE FROM CMS

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Year 2 Overview Fact SheetImprovement Activities Fact SheetCost Performance Fact sheetPromoting Interoperability Fact SheetOffice of the National Coordinator for Health Information Technology (ONC)Data Submission fact sheetOther national webinars focused on small practicesOther national events about Quality Payment Program


https://www.cms.gov/Medicare/Quality-Payment-Program/Resource-Library/QPP-Year-2-Final-Rule-Fact-Sheet.pdf

https://www.cms.gov/Medicare/Quality-Payment-Program/Resource-Library/Improvement-Activities-Performance-Category-fact-sheet.pdf

https://www.cms.gov/Medicare/Quality-Payment-Program/Resource-Library/2018-Cost-Performance-Category-Fact-Sheet.pdf

https://www.cms.gov/Medicare/Quality-Payment-Program/Resource-Library/2018-Promoting-Interoperability-Fact-Sheet.pdf


https://www.cms.gov/Medicare/Quality-Payment-Program/Resource-Library/QPP-2017-Data-Submission-Factsheet.pdf


POLLING QUESTIONWhat are the largest challenges you are experiencing related to using an EHR in your practice?

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WRAP-UP ACTIVITIES▸

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Links to Q&A documents, transcripts, and recordings of the event are available here: https://qppsurs.wordpress.com/resources/September: Understanding Advanced Alternative Payment Models (APMs): Advice for Solo and Small Group Specialty Practices September 11, 2018 at 11:00 AM ET Register September 13, 2018 at 3:30 PM ET Register

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REFERENCESSlide decks created by event panelists also provided information reflected in this presentation. The input from project panelists is gratefully acknowledged.Other documents on the https://qpp.cms.gov/ and https://www.cms.gov/Medicare/Quality-Payment-Program/Resource-Library/Resource-library.html website provide additional detail about the MIPS program.Disclaimer: This presentation was current at the time it was published or uploaded onto the web. Medicare policy changes periodically so links to the source documents have been provided within the document for your reference. This presentation was prepared as a service to the public and is not intended to grant rights or impose obligations. This presentation may contain references or links to statutes, regulations, or other policy materials. The information provided is only intended to be a general summary. It is not intended to take the place of either the written law or regulations. We encourage readers to review the specific statutes, regulations, and other interpretive materials for a full and accurate statement of their contents.


https://www.cms.gov/Medicare/Quality-Payment-Program/Resource-Library/Resource-library.html

ACRONYMSAPM – Alternative Payment ModelACO – Accountable Care Organization ACI – Advancing Care InformationCMS – Centers for Medicare & Medicaid ServicesER— Emergency RoomEOB— Explanation of BenefitsEIDM— Enterprise Identity Data Management MIPS – Merit-based Incentives Payment SystemPCHM— Patient Centered Medical HomePCP— Primary Care ProviderPI— Promoting Interoperability

PQRS— Physician Quality Reporting SystemIA – Improvement ActivitiesEHR – Electronic Health Records QCDR—Qualified Clinical Data Registry

QPP – Quality Payment ProgramQRUR— Quality and Resource Use Reports

SURS - Small Underserved Rural Support TIN—Tax Identification Number
