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The Latest Regulations, Simplified:

MU, PQRS & MIPSCatherine Chuter

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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

3

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

4

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:

7

MACRA represents a continuation in the

shift toward value.

8

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

9

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

14

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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