Quality Payment Program – EHR vendors’ view

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Quality Payment Program

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Disparate programs such as EHR incentive program, PQRS and VBM tied together to yield ONE score

Advanced APMs MIPS

ACI Quality IA Cost

EHR incentive program

PQRS Value-ModifierNEW

Report for at least 90 days

Jan 1’17 Mar 31’18Dec 31’17

Submit

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How about the future

Options for Clinicians

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Don’t report Submit something Submit for 90 days Full-year

-4% 0 or +ve Small +ve Modest +ve

20194%

20205%

20217%

20229%

2017 2018

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What needs to be done?

Capabilities that EHRs need to have for ACI

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What do EHR vendors need to do

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2017 8 Objectives including 11 Measures for Clinicians using a 2014 edition CEHRT

2018 6 Objectives including 15 measures for Clinicians using a 2015 edition CEHRT

Patient information

Demographics

Problem list

Medication list

Medication allergy list

Smoking status

Implantable device list

Interoperability

CPOE

Transitions of care

Data portability

API access – capture & query

Intelligence

CDS

2015 edition CEHRT

Base score Performance score Bonus score ACI score

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Interoperability

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Send Summary of Care

Support for C-CDA 1.1 and 2.1 across document templates

Date based search on CCDS: real-time automatic creation as per user’s preference

DIRECT implementation using Edge protocol

Information Reconciliation

Receipt of C-CDA; support both passive and active communication

Support to incorporate both versions of C-CDA; validate and display errors

B P

P

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Coordination of care

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Patient Generated Health Data

Import documents shared by patient through reference or links

Label, record and access the documents; support external site

Enable Patient Access

Support new C-CDA version

Real-time access to data for VDT through APIs (ONC recommends FHIR)

P

B

P

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Public Health Agencies

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Immunization registries (bidirectional)

Updated IG, Support for NDC code system for administered vaccines; CVX for historical vaccines

Syndromic surveillance (Optional)

No changes for Ambulatory, Updated SNOMED CT, LOINC codes and HL7 IG (only for Inpatient settings)

Electronic Case Reporting (Optional)

Implement trigger codes, match patient list, send a constrained ToC

Cancer Registry Reporting (Optional)

Specialized registry; updated IG along with updated versions of coding systems

P

+

+

+

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eRx & Security

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eRx

Expand eRx transactions and Codify e-Rx instructions in structured Sig format

eRx all meds in metric unit standard

Security Risk Analysis

Use of SHA-2 hashing algorithm

Audit user privileges and patient information access; include emergency access events

B

B

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Highlights

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CQMs API accessCCDA

• Structural changes (expect this

in future too)

• Need to support backward

compatibility

• New templates introduced

• Future-proof yourself, through

an extensible and flexible design

• Over 271 distinct criteria under

‘Quality’

• For max. scoring, providers will

need ability to report on those

where they score the most

• Likely to change annually

• EHRs need to eliminate

programming from this part

• Open your EHR data to

authorized third-parties

• Respond to requests for partial

or complete data

• FHIR recommended

• Design to minimize changes

keeping future considerations in

mind

The above are likely to be the focus areas of QPP for EHR vendors

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How do numbers work out?

Sample calculation for composite score…

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Base score

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2017 2018

eRx

Send Summary of care

Request Summary of care

Security risk analysis

Provide patient access

All or Nothing

Options for reporting

Report on ALL criteria

For the entire ACI category

50%

Complete base score

0%

Fail to report on ALL

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Performance score

13

2017

Provide patient access

VDT

Patient specific education

Secure messaging

Send Summary of care

Sample data

45/100

Weightage (%)

15/100

51/100

91/100

Accept Summary of care

Clinical Info. Reconciliation

Immunization Reporting

Patient generated health data

20

10

10

20

10

10

10

12/100

Yes

90

62/100

Score (%)

10

2

6

20

2

10

7

57

2018

Sample data

45/100

Weightage (%)

23/100

27/100

29/100

10

10

10

10

10

10

10

22/100

No

90

18/100

Score (%)

5

3

3

3

3

0

2

23

10

10

2/10

16/100

2

2

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Bonus score

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2017 2018

Syndromic Surveillance

e Case reporting

PHR reporting

CDR reporting

CEHRT usage for IA

Report on ANY ONE to get 5%

To get 10%

Sample data Sample data

Yes Yes

Yes

5 1515 15

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Total score

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2017

Base score

Performance score

Bonus score

155 112

2018

155 88

Score (%) Score (%)Weightage (%) Weightage (%)

50 50 50 50

90 57 90 23

15 5 15 15

Total ACI score

(out of 25)

Gets capped at 100% Remains at 88%

25 22

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The golden question – What’s in my future?

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ACI development Certification

Quality measures

Provider training

(6-7 months) (1 month)

(3 months)*

(1 month)

* Assuming an EHR caters to multiple specialties and needs to cover multiple criteria

** Assuming these changes turn out to be simple enough. 90 activities have been specified for which exact impact isn’t known yet.

Note: The timelines mentioned above are indicative and may vary across solution providers

Aug2017

Upgrade

(1 month)

IA

(2 months)**

Oct2017

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CertifyPlan Develop

Where we come in

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• Sign an NDA

• Analyse gaps w.r.t

MU3 & QPP

• Chalk out a delivery

plan that’s mutually

agreeable

• Agile development in

collaboration with you

• Preparation for

certification

• Simulate certification

process

• Demonstrate compliance

during certification

We can help you identify & close the gaps and finally get your solution certified.

Assess

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For more information, contact amit.m@Nalashaa.com

Nalashaa Solutions llc.

555, US Highway One South, Ste 170, Iselin, NJ 08830

+1-732-602-2560 Ext: 200

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Thank You