WOMEN IN OPHTHALMOLOGY

WIO 2015 Summer Symposium 08/07/2015

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AMERICAN ACADEMY OF OPHTHALMOLOGY AMERICAN ACADEMY OF OPHTHALMIC EXECUTIVES

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Women in Ophthalmology 2015 Summer Symposium

August 7, 2015

Rebecca Hancock

Manager, Quality & HIT Policy

American Academy of Ophthalmology

Update on Medicare Quality Reporting Programs and the

IRIS® Registry


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Agenda

Medicare Quality Reporting Programs

IRIS Registry

What’s Next: Future Quality Reporting


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Medicare Quality Reporting Programs

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AMERICAN ACADEMY OF OPHTHALMOLOGY

EHR Meaningful Use

Created by the Health Information Technology for Economic and Clinical Health (HITECH) Act

Intended to stimulate adoption of EHRs by providing financial incentives to physicians who demonstrate “meaningful use” of an EHR


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EHR Meaningful Use Goals

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EHR Meaningful Use

Physicians not using electronic medical records and failing to meet the Federal government’s “meaningful use” regulations will see their Medicare physician payments cut

These penalties are substantial: • 1 percent in 2015

• 2 percent in 2016

• 3 percent in 2017


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EHR Meaningful Use

Over half of ophthalmologists are receiving the 1 percent penalty this year

Ophthalmology has received over $210 million in Meaningful Use incentive payments since start of program

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Meaningful Use: Recent Policy Developments CMS Proposed Rules:

• Proposed Modifications to Stages 1 and 2

• Meaningful Use Stage 3

Congressional Action:

• Senate HELP Committee EHR Workgroup

• Flex IT Act 2

• 21st Century Cures Act


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Ophthalmology & PQRS

2013 PQRS: • 70% of ophthalmologists participated

• Of those, 75% earned bonus

• Average bonus to ophthalmologists, $1690

• Ophthalmology earned $17.9 M in PQRS bonuses

• 28% ophthalmologists receiving 1.5% penalty this year

2014 PQRS: • 75% of respondents to Academy survey indicated they

were participating or planned to participate in 2014 PQRS

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2015 PQRS

No more incentive. To avoid 2% penalty in 2017:

• Report 9 measures across 3 domains for 50% of patients,

Including 2 “cross cutting” measures (cross cutting measures required for claims and traditional registry reporting)

• QCDR Reporting requires reporting 9 measures on all patients, all payers, including 2 outcome measures

Claims reporting not feasible for most ophthalmologists

Cataract Measures Group still an option


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Proposed: 2016 PQRS

Penalty remains at 2 percent

Reporting requirements remain the same

Cataract Measures Group still an option

New Diabetic Retinopathy Measures Group • Diabetes: Hemoglobin A1c Poor Control

• Diabetic Retinopathy: Documentation of Presence or Absence of Macular Edema and Level of Severity of Retinopathy

• Diabetic Retinopathy: Communication with the Physician Managing Ongoing Diabetes Care

• Diabetes: Eye Exam

• Documentation of Current Medications in the Medical Record

• Preventive Care and Screening: Tobacco Use: Screening and Cessation Intervention

• Preventive Care and Screening: Screening for High Blood Pressure and Follow-Up Documented


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Value-Based Modifier

CMS is required to phase in VBM from

2015-2017 to adjust physician payments

based on cost and quality

VBM adjustments are based on PQRS

participation 2 years prior to the VBM year

2015

Groups of 100+

2016

Groups of 10+

2017

All Physicians


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Value-Based Modifier 2015

If at least 50% of eligible professionals (EPs) in a practice do NOT successfully participate in PQRS, and depending on your cost and quality score, penalties in 2017 can reach up to:

• -2 percent for groups < 10 EPs* and solo practitioners

• -4 percent for groups > 10 EPs*

* Calculation of practice size includes ODs, PAs, NPs


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Value-Based Modifier 2015

Practices with 1-9 MDs / ODs that

participate in PQRS in 2015 will not

have negative adjustments in 2017

Practices with 10+ MDs / ODs that

participate in PQRS in 2015 may

have negative adjustments in 2017


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Proposed: 2016 VBM

Penalty and bonus amounts remain

the same

Small groups and solo practitioners

would be subject to penalty for high

costs and low quality


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2015 Quality Reporting Programs: Bonuses

Value-Based Modifier

• Incentives available to high quality / low

cost practices

EHR Incentive Program

• $4,000-$8,000 per physician if started in

the program prior to 2014


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2015 Quality Reporting Programs: Penalties

PQRS • -2 percent in 2017

Value-Based Modifier *based on 2015 PQRS reporting and cost of care

• -2 percent in 2017 (groups of <10 and solos)

• -4 percent in 2017 (groups of >10 or more)

EHR Incentive Program • -3 percent in 2017

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Value Based Purchasing VBP ’09 ’10 ’11 ’12 ’13 ’14 ’15 ’16 ‘17 ‘18

PQRS (Successful Participation)

2 2 1 .5 .5 .5

(Not Participating)

-1.5

-2

-2

-2

EHR (Achieve MU)

*Beginning in 2011, physicians can earn up to $44,000 for adoption of EHR/MU (Qualifying for

EHR MU precludes e-prescribing bonus)

(Not Achieving)

-1 -2 -3 -3 to -5

VBM (based on PQRS participation)

-1 to +2x (groups of

100+)

-2 to +2x

(groups of 10 or more)

-4 to +4x

(groups of 10 or more)

-2 to +2x (groups of 1 -

9)

TBD Potentially

-4 (or more)

Total Exposure

4% 4% 2.5%

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+2% to -1%

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+1.5% to -1.5%

*

+1% to -2%

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-3.5% to +2x

Potentially

-6%

Potentially

-9%

Potentially

-9 to 11%


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IRIS® Registry

WWW.AAO.ORG AMERICAN ACADEMY OF OPHTHALMOLOGY

IRIS Registry (Intelligent Research In Sight) is the nation’s first comprehensive eye disease clinical database

• Enables ophthalmologists to use clinical data to improve care delivery and patient outcomes

• Helps practices meet requirements of the federal quality reporting programs

• Uses HIPAA-compliant methods to collect data from patient records directly from electronic health record (EHR) systems

Introduction to IRIS Registry


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Contracted

• 8,846 physicians from 3,393 practices

Total for EHR Integration

• 6,805 physicians from 1,912 practices

Number of patient visits

• 31+ million, representing 10.3 million unique patients

Current Stats (July 1, 2015)


The impact big data will have on medicine

• The power of aggregated data can’t be underestimated. There will be a rapid evolution of new types of scientific inquiry to include elements of correlation in addition to causation – the power of big data!

• Aggregated data allows researchers to identify correlations related to outcomes and develop predictive risk assessment models and questions for further inquiry

The Big Idea


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What is unique about the IRIS Registry • It is an outpatient registry with the ability to follow patients longitudinally

using probabilistic matching (94%)

o Other surgical registries record the short term evaluation of drugs, devices and procedures, but are unable to measure their impact on the natural course of the disease – the IRIS Registry will!

• Big data will facilitate ophthalmic drug and device surveillance and the IRIS Registry can serve as the backbone for mandated FDA post-market studies

The Big Idea


Evaluate your own data • Benchmark your outcomes against your

practice colleagues or national averages

Manage your patients at a population level • Look at a specific group of patients based on

conditions, risk factors, demographics or outcomes

• Identify trends and track interventions

• Answer specific clinical questions

Value of IRIS Registry


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Regulatory compliance benefits • The IRIS Registry can report on your behalf to satisfy requirements

o for PQRS o to report meaningful use clinical quality measures o to report on quality measures for the value-based

modifier

• Reduces the reporting burden

o The IRIS Registry is updated as needed and submits the data required to meet new criteria, with no extra work on your part

o The Academy keeps you informed of any necessary clinical changes



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Your data extracted from

your EHR system

IRIS Registry

Your individual performance improvement

dashboard

Physician Quality

Reporting System

Meaningful use quality measure

reporting

Meaningful use stage 2 menu:

report to registry

Quality measures for value-based

modifier


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IRIS Registry and Quality Reporting

IRIS Registry supports several options to help practices succeed in quality reporting programs this year and avoid 2017 penalties:

• IRIS Registry EHR System Integration

• Cataracts Measures Group

• Individual Measure Reporting via IRIS Registry – Qualified Registry (no EHR)

• Individual Measure Reporting via IRIS Registry – Qualified Clinical Data Registry (QCDR) (no EHR)

• Group Reporting Option


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Data entry methods

There are two ways to enter your data

• EHR integration with automatic uploads

• Web portal with manual entry

EHR integration with automatic uploads

• FIGMD’s System Integration (SI) Solution is designed to integrate with your EHR and enables you to seamlessly participate in the IRIS Registry without any workflow modification or interference

• The system integration solution is compatible with nearly any EHR system – all versions, no matter how much customization you’ve done

How IRIS Registry Works


Data entry methods How it works with your EHR

• The EHR system integration for the IRIS Registry involves the installation of a piece of interface software known as the Light Weight Connector

• This software is installed on a server in your practice and helps us interface with your EHR system in order to extract IRIS Registry data fields for reporting



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Currently integrated with 34 EHR systems


• ChartLogic

• Compulink

• DoctorSoft

• eClinicalWorks

• EyeDoc EMR

• Eyefinity ExamWRITER

• EyeMD EMR

• First Insight

• GE Centricity

• HCIT

• ifa systems

• iMedicWare

• Integrity

• IO Practiceware

• KeyChart EMR

• ManagementPlus

• MDIntelleSys

• MDoffice

• Medflow

• Medinformatix EHR

• NexTech

• NextGen

• SRS

• VersaSuite

• Vitera Intergy EHR

• WebChart by MIE


Data entry methods Web portal

• Documentation in a medical practice is often done on paper at the point-of-care; not all practices currently use EHR systems

• You can still participate in the IRIS Registry by manually entering your data in the online portal

• However, this method is much more time consuming than the EHR integration option



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What’s Next: Future Quality Reporting

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HR 2, Medicare Access and CHIP Reauthorization Act

Repeals the problematic sustainable growth rate (SGR) methodology and

Fundamentally changes the way Medicare determines and updates payments to physicians

Incentivizes development and participation in Alternative Payment Models (APMs) – 5% bonus 2019-2024

Establishes Merit Based Incentive Program (MIPS)


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MIPS

Effective January 1, 2019 (2017 performance year)

Consolidates and replaces several existing incentive programs (PQRS, MU, VBM)

Incentives would be based on composite score for each professional

4 Performance Categories • Quality

• Resource Use

• Clinical Practice Improvement Activities

• MU of an EHR


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MIPS Weighting

Performance based on:

• Quality measures 30% (50% - 2019, 45% - 2020)

• Resource use 30% (10% - 2019, 15% - 2020)

• Clinical practice 15%

• MU – EHR 25% (15% if 75% qualify)

Weights can change over time. When 75% of eligible achieve MU – EHR, weight for that could be reduced to 15% to emphasize other categories.


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MIPS Incentives

Professionals with composite scores at the established

threshold (mean/median) would receive no adjustment, higher

scores receive higher adjustment, performance scores below

the threshold would lead to a negative adjustment

Adjustment factor plus or minus:

• 2019 4%

• 2020 5%

• 2021 7%

• 2022 9%

An additional MIPS adjustment (up to 10%) could be earned

for exceptional performance from 2019-2024


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MIPS

IRIS Registry will continue to support quality reporting

“The Secretary shall encourage the use of qualified clinical data registries in carrying out this subsection”

Academy is exploring and advocating to further align MIPS with IRIS participation

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WOMEN IN OPHTHALMOLOGY