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This event is live as of XYZ
Thriving Through Change: Meaningful Use and PQRS
Catherine ChuterSr. Associate, athenahealth
2
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;
3
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
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
ACO
PCMHPQRSMIPS
MSSP
MUEHR
HCCICD-10
ANSIAPM
s
MACRA
ACA
IRM
PQRSMU
2007PQRI starts
2016PQRS VM applies to all HCPs
2011Meaningf
ul Use Stage 1
2014Meaningf
ul Use Stage 2
2017Start
MIPS or APM
2015Meaningf
ul Use penalties
hit
2015ICD-10
2015PQRS
penalties hit
SGR Repeal bill
SGR repeal bill (MARCA) represents continuation of the shift toward value
Source: The Medicare Access and CHIP Reauthorization Act of 2015; Advisory Board analysis.
2. APM participants who are close to but fall short of APM bonus requirements will not qualify for bonus but can report MIPS measures and receive incentives or can decline to participate in MIPS.
Merit-Based Incentive Payment System1
2020: -5% to +15%
2019: -4% to +12%
2022 and on: -9% to +27%
2021: -7% to +21%
2018: Last year of separate MU, PQRS, and VBM penalties
2019 - 2024: 5% participation bonus
2019 - 2020: 25% Medicare revenue requirement
2021 and on: Ramped up Medicare or all-payer revenue requirements
1. Positive adjustments may be scaled by a factor of up to 3 times the negative adjustment to ensure budget neutrality. Actual positive adjustments may be lower than numbers shown here. In addition, top performers may earn additional adjustments of up to 10 percent.
Advanced Alternative Payment Models2
PQRS Overview
10
The Evolution of PQRS
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
2014 participation affects penalty in
2016.
QU
ALIT
Y
COST
HIG
HLO
W
HIGH LOW
0.0%
-2.0%
-4.0% -2.0%
0.0%
Bonus paymen
t
Bonus paymen
t
Bonus paymen
t
0.0%
PQRS Value-based Modifier Quadrants
Meaningful Use Overview
13
Meaningful Use is designed to create infrastructure that supports reform
Stage 1:Data capture and sharing
Stage 2:
Advanced processes
Stage 3:
Improved outcomes
14
Stage 2 has more core measures, fewer menu measures, and higher thresholds
Stage 1 Stage 2
5 of 9
Menu
13
Core
Higher thresholds
3 of 6 Menu
17 Core
A comparison…
MU versus PQRS Eligible providers
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
• Federally Qualified Health Centers (FQHCs)
• Hospitals
• Independent Labs
• Rural Health Clinics
• Ambulance providers
• Ambulatory Surgical Centers (ASCs)
Who is not “eligible” for PQRS?
PQRS versus MU Number of measures
9 out of
287 measures
PQRS Meaningful Use
20 out of
23 measures
PQRS versus MU Measurement style
Report first.
Then, performance against your
peers.
PQRS Meaningful Use
Measure thresholds.
PQRS versus MU Penalties
Upcoming Medicare Penalties
Program 2015 2016 2017 2018 2019 2020
Physician Quality Reporting System (PQRS)
-1.5% -2% -2% -2% TBD TBD
Value Based Modifier Program (VM)
-1% -2%** -2% or -4%*** TBD TBD TBD
Meaningful Use/EHR Incentive Program
-1% or -2%* -2% -3% -4% TBD TBD
Penalty -3.5% or -4.5% -6% -7% or
-9% TBD TBD TBD
*-2% in 2015 only applies to providers who failed Meaningful Use and eRx thresholds
PQRS versus MU National success on the programs
Approximately
37% of eligible providers face a payment reduction for not reporting in 2013.
PQRS Meaningful Use
More than 30% of providers will be penalized for not meeting requirements in 2013 and 2014.
22
2013 VM Results from CMS
Of
1,010
participating groups …
Only
106provided enough data for CMS to calculate both
quality and cost.
Of those, only
13%
earned an incentive payment for 2015.
23
athenahealth’s award-winning services can help you thrive through
change
23“2013 Best in KLAS Awards: Software & Services,” January, 2014. © 2014 KLAS Enterprises, LLC. All rights reserved. www.KLASresearch.com
#1 Overall
Software Vendor
#1 Overall
Physician Practice Vendor
#1 PatientPortal
#1 Practice
Management System(1-10, 11-75 physicians)
#2 EHR
(1-10, 11-75 physicians)
2013 Best in KLAS
• 64,000+ providers on athenaNet®
• Clients ranging from 1 to 5,000+ providers
• 50 states and 104 medical specialties
• $11.7 billion in client collections per year
• Acquired Epocrates March, 2013
We navigate regulatory change so you don’t have to
Meaningful Use Stage 1 attestation
Meaningful Use Stage 2 attestation
NATIONAL AVERAGE
70%
ATHENAHEALTHCLIENTS
95.8%
NATIONAL AVERAGE
33%
ATHENAHEALTHCLIENTS
98.2%
25
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:
If provider is failing MU Patient Engagement measures, auto-launch registration upon check-in
Three new workflows to register the patient when in-office
27
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 Messaging
99%
100%
Providers who satisfied required 3 of 6 menu measures:
100%
100%
100%
100%
100%
100%
100%
28
PQRS success with athenahealth
1For enrollment, we look at our network data to determine the best 9 measures for each specialty.
2Once enrolled, we track the performance of each HCP and adjust enrollment based on performance.
3Our software provides real-time visibility into performance to ensure you are on track.
We navigate regulatory change so you don’t have to
% of HCPs expecting PQRS penalties in 2015
NATIONAL AVERAGE
37%
ATHENAHEALTHCLIENTS
6.4%
30
Ask a few key questions ofyour EHR vendor
Is your vendor able to deploy the 2014 Certified Edition to all clients at once?1
How is your vendor monitoring your PQRS and MU performance?2
Does 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
How can I switch if
2015 requires full-year reporting?
Meaningful Use Guarantee
ICD-10 Guarantee
PQRS Guarantee
MSSP ACO Guarantee
This event is live as of XYZ
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This event is live as of XYZ
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