1. Thank you to our Chapter Sponsors! Elite Sponsors Premier Sponsors Partner Sponsors

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

3. Session Agenda  Announcements  Introduction to Patient Engagement Playbook  Overview of MACRA MIPS/Advancing Care Information  Group discussions / comments (if time available)

4. Let Us Hear From You  Meet Bi-Monthly, third Wednesday at 12:00  Issues and barriers – MU, HIE, Interoperability, MACRA  Topics for future CoP calls  Topics for Chapter Lunch ‘n Learns or webcasts sessions  ga.comm@himsschapter.org ga.comm@himsschapter.org

5. 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/

6. 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

7. 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

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

9. 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

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

11. 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

12. 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

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14. 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?

15. 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

16. 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

17. 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? Repeals the Sustainable Growth Rate (SGR) Formula Changes the way that Medicare rewards clinicians for value over volume Streamlines multiple programs under the new Merit-Based Incentive Payments System (MIPS) 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

18. 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

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

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

21. 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

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

23. 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

24. Who will NOT Participate in MIPS? There are 3 groups of clinicians who will NOT be subject to MIPS https://www.cms.gov/Medicare/Quality-Initiatives-Patient-Assessment-Instruments/Value-Based- Programs/MACRA-MIPS-and-APMs/MACRA-LAN-PPT.pdf 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

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

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

27. MIPS Advancing Care Information Performance Category  Who can participate?

28. MIPS Advancing Care Information Performance Category

29. 29 25% of total MIPS score May be reduced if >75% of clinicians are successful 12-month physician reporting period MIPS weight 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 Base measures and scoring 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 Performance measures and scoring MIPS Advancing Care Information Performance Category

30. MIPS Advancing Care Information Performance Category

31. MIPS Advancing Care Information Performance Category

32. 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 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 Quality Component of MIPS

34. MIPS Advancing Care Information Performance Category

35. Sample Performance Score

36. 36 Sample Total Score

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

38. MIPS Advancing Care Information Performance Category

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

40. . Calculating the Composite Performance Score for MIPS

41. . MACRA Proposed Rule – Performance Scoring

42. . Calculating the Composite Performance Score for MIPS

43. . Calculating the Composite Performance Score for MIPS

44. 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 Payment Structure

45. . MACRA Proposed Rule MIPS Timeline

46. . 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.

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48. . 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!

49. Centers for Medicare and Medicaid Services www.cms.gov/ehrincentiveprograms http://go.cms.gov/QualityPaymentProgram 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. Resources

50. GA-HIMSS Community of Practice Meaningful Use, MACRA, HIE and Interoperability Recording of session available http://ga.himsschapter.org/cop-interoperability 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 CoPs beginning soon! Thank you for your participation and input!