CMS is transitioning to what the they call "a new and more responsive regulatory framework" for quality reporting and reimbursement. CMS goals are "…electronic health records helping physicians, clinicians, and hospitals to deliver better care, smarter spending, and healthier people". Over the next couple years, we will see a transformation of fee for service into value-based care models driven by the VBP, Quality Payment Program, MACRA, Merit-based Incentive Payment System (MIPS) and Alternative Payment Models (APM). Healthcare organizations will no longer be motivated by implementing and meeting Meaningful Use, but instead will be driven by value-based care and risk-based payment models that focus on quality outcomes for reimbursements.
In this Education Session we will review:
• How CMS is aligning clinical quality measures (CQMs) to reduce the reporting burden for healthcare organizations and providers. We will cover the vision and goals for achieving quality alignment for CMS.
• We will dive into the following CMS reporting programs and how they interact with each other: Value-Based Purchasing (VBP), Medicare Access and CHIP Reauthorization Act (MACRA), Merit-based Incentive Payments (MIPS), Hospital Inpatient Quality Reporting (IQR), The Joint Commission (ORYX), Outpatient Quality Reporting (OQR), and Alternative Payment Models (APM).
Revenue at Risk: Understanding Financial Impacts of Quality ReportingBill Presley
Jodi Frei, Northwestern Medical Center Vermont, and I co-presented at the MUSE Executive Institute on Revenue at Risk: Understanding Financial Impacts of Quality Reporting. The Executive Institute featured many amazing CXO's discussing the changing landscape of revenue cycle management and how finance, quality, and IT departments are converging on revenue cycle.
Though pay for performance is the common theme, the logistics of programs including Value Based Purchasing (VBP), Inpatient Quality Reporting (IQR), Hospital Acquired Condition (HAC) Reduction Program, Readmission Reduction, MACRA, MIPS and APMs, are very different. In this session, the specifics of each Quality Program including reporting requirements, scoring methodologies, and associated incentives and penalties will be covered. In addition, tools to track performance and quantify financial risk will be shared.
Reimbursement in this era of health care reform is challenging. We all seek success under this new normal in health care. Optimizing revenue capture in a quality reimbursement model requires acquisition of new knowledge and the use of new tools and strategies. Join us in the conversation; share your strategies; learn from others.
Riding the Rapids of Payment Reform: Downstream Effects of Quality Reporting ...Bill Presley
In this presentation, we highlighted how quality measurement programs impact reimbursement affecting your revenue. The revenue at risk in your organization. We focused on quality programs like Value-Based Purchasing (VBP), Merit-Based Incentive Program (MIPS) and Alternative Payment Models (APM) and their impact on Part A and Part B reimbursements.
It’s no surprise that reimbursement tied to quality performance is quickly becoming a reality for hospitals and physicians. CMS’ aggressive goals aimed at increasing the percentage of Medicare payments associated with quality versus quantity can be achieved through such programs as Value-based Purchasing and MACRA. This session will cover scoring methodologies, reporting requirements, reimbursement impact, infrastructure (and other resource needs), EMR tools and tactics, and workflow modifications.
The Medicare Aaccess and CHIP Reauthorization Act of 2015 establishes two Quality Payment Programs to transition the U.S. Healthcare System from a Fee-For-Service reimbursement methodology to a Fee-For-Value model. MACRA fundamentally adjusts the Medicare Fee Schedule, forcing healthcare providers to utilize HIT, population health management, and care coordination to receive financial rewards.
In order to best prepare our clients for CMS' transition from Fee-For-Service to Fee-For-Value physician reimbursement, we have prepared a summary of the Merit Incentive-Based Payment System (MIPS). The MIPS program will consolidate PQRS, Meaningful Use, and the Value-Based Modifier into a single reporting program in which CMS affecting ≈95% of physicians beginning in 2017.
An actionable summary of the MIPS Merit-Incentive Based Payment System, MACRA (or the Quality Payment Program), and how to approach value-based healthcare.
Quality and Outcome Framework (QOF) is a voluntary annual incentive programme for GPs in England, detailing practice achievement results. The primary objective of QOF is to drive the quality of primary care and reduce variations in the quality of care amongst GPs
MIPS APM for ACOs: A Hybrid Reimbursement ModelCitiusTech
CMS announced the Quality Payment Program (QPP) final rule in October 2017, stating how it plans to implement the clinician payment changes to QPP, mandated under the Medicare Access and CHIP Reauthorization (MACRA) act. The implementation of the MACRA act impacts different type of organizations, one such being the Accountable Care Organizations (ACOs). ACOs are evaluated for payments on the basis of quality care and the cost factors associated in achieving their quality goals. Post MACRA implementation, all clinicians will receive payments as per the MIPS (Merit based incentive payments) and Advanced APMs (Advanced alternative payment models). ACO’s can register as APM entities and are eligible to receive payments under Advanced APMs. There is a third category of APM entities which participate in Advanced APMs models but do not meet the threshold of payments and patients set by CMS. Such entities fall into a category that is straddling the line between APM and the MIPS track, called MIPS APM (partially qualifying APM participants). This document discusses about the reporting, scoring and payments for the MIPS APM entities
Revenue at Risk: Understanding Financial Impacts of Quality ReportingBill Presley
Jodi Frei, Northwestern Medical Center Vermont, and I co-presented at the MUSE Executive Institute on Revenue at Risk: Understanding Financial Impacts of Quality Reporting. The Executive Institute featured many amazing CXO's discussing the changing landscape of revenue cycle management and how finance, quality, and IT departments are converging on revenue cycle.
Though pay for performance is the common theme, the logistics of programs including Value Based Purchasing (VBP), Inpatient Quality Reporting (IQR), Hospital Acquired Condition (HAC) Reduction Program, Readmission Reduction, MACRA, MIPS and APMs, are very different. In this session, the specifics of each Quality Program including reporting requirements, scoring methodologies, and associated incentives and penalties will be covered. In addition, tools to track performance and quantify financial risk will be shared.
Reimbursement in this era of health care reform is challenging. We all seek success under this new normal in health care. Optimizing revenue capture in a quality reimbursement model requires acquisition of new knowledge and the use of new tools and strategies. Join us in the conversation; share your strategies; learn from others.
Riding the Rapids of Payment Reform: Downstream Effects of Quality Reporting ...Bill Presley
In this presentation, we highlighted how quality measurement programs impact reimbursement affecting your revenue. The revenue at risk in your organization. We focused on quality programs like Value-Based Purchasing (VBP), Merit-Based Incentive Program (MIPS) and Alternative Payment Models (APM) and their impact on Part A and Part B reimbursements.
It’s no surprise that reimbursement tied to quality performance is quickly becoming a reality for hospitals and physicians. CMS’ aggressive goals aimed at increasing the percentage of Medicare payments associated with quality versus quantity can be achieved through such programs as Value-based Purchasing and MACRA. This session will cover scoring methodologies, reporting requirements, reimbursement impact, infrastructure (and other resource needs), EMR tools and tactics, and workflow modifications.
The Medicare Aaccess and CHIP Reauthorization Act of 2015 establishes two Quality Payment Programs to transition the U.S. Healthcare System from a Fee-For-Service reimbursement methodology to a Fee-For-Value model. MACRA fundamentally adjusts the Medicare Fee Schedule, forcing healthcare providers to utilize HIT, population health management, and care coordination to receive financial rewards.
In order to best prepare our clients for CMS' transition from Fee-For-Service to Fee-For-Value physician reimbursement, we have prepared a summary of the Merit Incentive-Based Payment System (MIPS). The MIPS program will consolidate PQRS, Meaningful Use, and the Value-Based Modifier into a single reporting program in which CMS affecting ≈95% of physicians beginning in 2017.
An actionable summary of the MIPS Merit-Incentive Based Payment System, MACRA (or the Quality Payment Program), and how to approach value-based healthcare.
Quality and Outcome Framework (QOF) is a voluntary annual incentive programme for GPs in England, detailing practice achievement results. The primary objective of QOF is to drive the quality of primary care and reduce variations in the quality of care amongst GPs
MIPS APM for ACOs: A Hybrid Reimbursement ModelCitiusTech
CMS announced the Quality Payment Program (QPP) final rule in October 2017, stating how it plans to implement the clinician payment changes to QPP, mandated under the Medicare Access and CHIP Reauthorization (MACRA) act. The implementation of the MACRA act impacts different type of organizations, one such being the Accountable Care Organizations (ACOs). ACOs are evaluated for payments on the basis of quality care and the cost factors associated in achieving their quality goals. Post MACRA implementation, all clinicians will receive payments as per the MIPS (Merit based incentive payments) and Advanced APMs (Advanced alternative payment models). ACO’s can register as APM entities and are eligible to receive payments under Advanced APMs. There is a third category of APM entities which participate in Advanced APMs models but do not meet the threshold of payments and patients set by CMS. Such entities fall into a category that is straddling the line between APM and the MIPS track, called MIPS APM (partially qualifying APM participants). This document discusses about the reporting, scoring and payments for the MIPS APM entities
The Latest Regulations, Simplified: MU, PQRS & MIPSathenahealth
Changing governmental regulations for the advancement of healthcare is more than difficult and we have simplified these changes to keep you up to date.
Guide to CMS Comprehensive Care for Joint Replacement modelQ-Centrix
On April 1, the CMS Comprehensive Care for Joint Replacement (CCJR) model went into effect for nearly 800 hospitals in 67 markets nationwide. Essentially, CMS converted its voluntary payment model—Bundled Payment for Care Improvement (BPCI)—into a regulatory mandate that will hold hospitals accountable for spending by all healthcare providers for 90 days following the initial episode of care.
OpenNotes: Transparent Clinicians' Notes for Health & IllnessOpenNotes
Sharing clinicians’ notes with patients is a simple idea for health. This presentation can be used to introduce your institution to the benefits of open notes and how to adopt this practice with your patients. It guides you through the OpenNotes study, which sparked a movement towards more transparent notes across the nation.
Physician Payment Reforms: The Future of MIPS and APMs – Value-Based Payments...Epstein Becker Green
Epstein Becker Green Webinar with Attorney Lesley Yeung - Value-Based Payments Crash Course Webinar Series - May 16, 2016.
Topics include:
* An overview of the physician payment reforms included in the Medicare Access and CHIP Reauthorization Act of 2015 (“MACRA”)
* A summary of the Merit-Based Incentive Payment System (“MIPS”) and Alternative Payment Models (“APMs”) Proposed Rule (publication is expected in the spring of 2016)
* Opportunities for provider engagement with the Centers for Medicare & Medicaid Services to shape physician payment reform efforts
http://www.ebglaw.com/events/physician-payment-reforms-the-future-of-mips-and-apms-value-based-payments-crash-course-webinar-series/
These materials have been provided for informational purposes only and are not intended and should not be construed to constitute legal advice. The content of these materials is copyrighted to Epstein Becker & Green, P.C. ATTORNEY ADVERTISING.
Enhancing Competitive Advantage through Improved HEDIS Reporting and NCQA Rat...CitiusTech
The objective of this document is to provide a high level understanding of the Healthcare Effectiveness Data and Information Set (HEDIS), which is a tool used by more than 90 percent of America's health plans to measure performance on important dimensions of care and service. This document helps in understanding different components of the HEDIS in terms of the measure sets (what it is meant for health plans, changes to the previous year), different methods of collecting data for HEDIS and key requirements for reporting HEDIS
Patient Registries: A New Pillar of Modern CareQ-Centrix
www.q-centrix.com
A vital resource for patient data are registries. This white paper examines the rise of patient registries, how hospitals are taking advantage of the data, the challenges hospitals face in submitting quality information, and the benefits of real-time registry reporting.
White Paper - eCQMs: It's Time to Make Data Quality the No. 1 Priority Q-Centrix
This white paper will examine eCQM data quality issues and their implications. It will raise questions hospitals should consider when developing strategies to improve their eCQM capabilities. Lastly, it will outline how they can benefit from implementing better data quality control practices and present new developments in eCQM data collection and reporting.
Making CJR Work for You: A Roadmap for Successful Implementation of Medicare ...Wellbe
This presentation will describe a structured approach to successfully launching a program for the Comprehensive Care for Joint Replacement (CJR) Model. Based on years of experience with bundled programs, this roadmap provides the basis for developing a targeted plan for your organization as the April 1, 2016 deadline for CJR rapidly approaches.
Key topics to be addressed include:
• Overview of CJR rules and program requirements
• CJR implications for your organization
• Bundle evaluation – financial and clinical issues
• Gainsharing considerations with program collaborators
• Designing an effective post-acute care network
• Using analytics to develop and monitor your program
• Key “must-dos” for an April 1, 2016 launch
Learning Objectives:
1. Describe the rules and requirements of CJR
2. Assess the key success drivers in bundle performance
3. Evaluate where and why organizations fail in bundles
4. Develop strategies and tactics to create a post-acute partnership
5. Illustrate risk stratification factors in bundle design
About the Speaker:
Sheldon Hamburger is an Alternative Payment Model advisor for hospitals and healthcare firms nationally. With a focus on program implementation, he brings extensive knowledge and experience gained from more than 25 years of healthcare financial consulting, technology design and development, and sales & marketing strategy for Fortune 1000 clients. He is a frequently sought-after speaker and writer on regulatory and technology trends affecting hospital operations, provider reimbursement issues, BPCI / CJR, programs and regulations, medical expense strategies and payer-provider dynamics. Residing in Raleigh, he is an active member of HIMSS, HFMA, & ACHE. He earned his B.S.E. in Computer Engineering from the University of Michigan.
White Paper - Infection Preventionists: Healthcare’s Guardians at the Gate Ne...Q-Centrix
This white paper examines a key player at the front lines of hospitals’ never-ending battles against HAIs –Infection Preventionists (IPs). It briefly explains their varied roles, responsibilities and new challenges, the difficulty in recruiting these highly sought-after experts, and why and how hospitals should be doing more to help overworked and understaffed IPs be successful. Lastly, it covers new technologies and IP support services that can be integrated into hospitals’ infection control practices.
Prepping for CCJR: Lessons Learned in Physician Alignment and Bundled PaymentsWellbe
With CMS’ recent announcement of its Comprehensive Care for Joint Replacement (CCJR) payment model and its plan to implement in seventy-five geographic areas, hospitals must be prepared to manage the entire episode of care from the time of surgery through ninety days after discharge. CCJR presents both opportunities and challenges for hospitals. In order to achieve success, organizations must manage their system of care delivery, ensure they are aligned with their physicians and post acute providers, and master the analytics necessary for driving high quality, low cost care.
MedAssets has worked with numerous providers to implement alignment models that bring hospitals and their physicians together, evaluate, identify, and implement changes to the care delivery system to improve quality and decrease cost across the continuum, and employ meaningful analytics for managing an episode of care.
Kevin Lieb, Senior Director for MedAssets’ Physician Alignment Solutions division, will share examples demonstrating how organizations have successfully implemented Episodes of Care. Mr. Lieb will also share examples from both hospital led and specialist led programs and provide lessons learned from these experiences.
This webinar will enable attendees to do the following:
• Identify alignment models within bundled payments and understand their applicability to your organization
• Understand the analytic capabilities necessary for success in a bundled payment environment
• Identify opportunities and strategies for cost reduction and quality improvement
About the Speaker:
Mr. Lieb has more than 20 years of healthcare-related experience focusing on quality improvement, market development and cost reduction initiatives for the hospital provider market. Mr. Lieb has worked for a number of well-known healthcare companies including GE Medical Systems, HCIA and LBA in Denver, Colorado. His responsibilities included healthcare consulting with a focus on process improvement and quality initiatives.
The alphabet soup of clinical quality measures reporting and reimbursement 2...Bill Presley
CMS is transitioning to what the they call "a new and more responsive regulatory framework" for quality reporting and reimbursement. CMS goals are "…electronic health records helping physicians, clinicians, and hospitals to deliver better care, smarter spending, and healthier people". Over the next couple years, we will see a transformation of fee for service into value-based care models driven by the VBP, Quality Payment Program, MACRA, Merit-based Incentive Payment System (MIPS) and Alternative Payment Models (APM). Healthcare organizations will no longer be motivated by implementing and meeting Meaningful Use, but instead will be driven by value-based care and risk-based payment models that focus on quality outcomes for reimbursements.
In this Education Session we will review:
• How CMS is aligning clinical quality measures (CQMs) to reduce the reporting burden for healthcare organizations and providers. We will cover the vision and goals for achieving quality alignment for CMS.
• We will dive into the following CMS reporting programs and how they interact with each other: Value-Based Purchasing (VBP), Medicare Access and CHIP Reauthorization Act (MACRA), Merit-based Incentive Payments (MIPS), Hospital Inpatient Quality Reporting (IQR), The Joint Commission (ORYX), Outpatient Quality Reporting (OQR), and Alternative Payment Models (APM).
• How the Eligible Hospital and Eligible Professional reimbursement models will change in 2017 and going forward.
• Compare and contrast the requirements for quality measure reporting and identify strategies to ensure compliance.
• The potential impact to hospital reimbursement of current and proposed programs that will affect quality reporting for hospitals and providers.
• How to improve efficiency and quality by aligning measures across initiatives.
• Where to find current information (and breaking news) on each of these Quality Initiatives.
In the past, organizations participating in quality reporting initiatives involved abstractors sifting through a small sample set of unstructured data in paper charts to then manually convert their findings to discrete reportable data. This approach is time consuming and requires extensive amount of resources from both IT and Quality staff. Aligning quality initiatives can improve efficiencies and processes, and contribute to population health management efforts, both locally and nationally.
At the conclusion of this presentation, attendees will be able to apply what they’ve learned about aligning Clinical Quality Measures across initiatives specific to their organization to improve reimbursements, reduce their reporting burden, increase efficiencies, and realize the benefits of Population Health Management.
If you are responsible for hospital quality, IT, clinical quality measure initiatives or have a vested interest in making sure your organization is aligning quality measures reporting, this informational session is a must.
This presentation walks through the transition from chart abstracted quality reporting to electronic quality reporting for the CMS and The Joint Commission
The Latest Regulations, Simplified: MU, PQRS & MIPSathenahealth
Changing governmental regulations for the advancement of healthcare is more than difficult and we have simplified these changes to keep you up to date.
Guide to CMS Comprehensive Care for Joint Replacement modelQ-Centrix
On April 1, the CMS Comprehensive Care for Joint Replacement (CCJR) model went into effect for nearly 800 hospitals in 67 markets nationwide. Essentially, CMS converted its voluntary payment model—Bundled Payment for Care Improvement (BPCI)—into a regulatory mandate that will hold hospitals accountable for spending by all healthcare providers for 90 days following the initial episode of care.
OpenNotes: Transparent Clinicians' Notes for Health & IllnessOpenNotes
Sharing clinicians’ notes with patients is a simple idea for health. This presentation can be used to introduce your institution to the benefits of open notes and how to adopt this practice with your patients. It guides you through the OpenNotes study, which sparked a movement towards more transparent notes across the nation.
Physician Payment Reforms: The Future of MIPS and APMs – Value-Based Payments...Epstein Becker Green
Epstein Becker Green Webinar with Attorney Lesley Yeung - Value-Based Payments Crash Course Webinar Series - May 16, 2016.
Topics include:
* An overview of the physician payment reforms included in the Medicare Access and CHIP Reauthorization Act of 2015 (“MACRA”)
* A summary of the Merit-Based Incentive Payment System (“MIPS”) and Alternative Payment Models (“APMs”) Proposed Rule (publication is expected in the spring of 2016)
* Opportunities for provider engagement with the Centers for Medicare & Medicaid Services to shape physician payment reform efforts
http://www.ebglaw.com/events/physician-payment-reforms-the-future-of-mips-and-apms-value-based-payments-crash-course-webinar-series/
These materials have been provided for informational purposes only and are not intended and should not be construed to constitute legal advice. The content of these materials is copyrighted to Epstein Becker & Green, P.C. ATTORNEY ADVERTISING.
Enhancing Competitive Advantage through Improved HEDIS Reporting and NCQA Rat...CitiusTech
The objective of this document is to provide a high level understanding of the Healthcare Effectiveness Data and Information Set (HEDIS), which is a tool used by more than 90 percent of America's health plans to measure performance on important dimensions of care and service. This document helps in understanding different components of the HEDIS in terms of the measure sets (what it is meant for health plans, changes to the previous year), different methods of collecting data for HEDIS and key requirements for reporting HEDIS
Patient Registries: A New Pillar of Modern CareQ-Centrix
www.q-centrix.com
A vital resource for patient data are registries. This white paper examines the rise of patient registries, how hospitals are taking advantage of the data, the challenges hospitals face in submitting quality information, and the benefits of real-time registry reporting.
White Paper - eCQMs: It's Time to Make Data Quality the No. 1 Priority Q-Centrix
This white paper will examine eCQM data quality issues and their implications. It will raise questions hospitals should consider when developing strategies to improve their eCQM capabilities. Lastly, it will outline how they can benefit from implementing better data quality control practices and present new developments in eCQM data collection and reporting.
Making CJR Work for You: A Roadmap for Successful Implementation of Medicare ...Wellbe
This presentation will describe a structured approach to successfully launching a program for the Comprehensive Care for Joint Replacement (CJR) Model. Based on years of experience with bundled programs, this roadmap provides the basis for developing a targeted plan for your organization as the April 1, 2016 deadline for CJR rapidly approaches.
Key topics to be addressed include:
• Overview of CJR rules and program requirements
• CJR implications for your organization
• Bundle evaluation – financial and clinical issues
• Gainsharing considerations with program collaborators
• Designing an effective post-acute care network
• Using analytics to develop and monitor your program
• Key “must-dos” for an April 1, 2016 launch
Learning Objectives:
1. Describe the rules and requirements of CJR
2. Assess the key success drivers in bundle performance
3. Evaluate where and why organizations fail in bundles
4. Develop strategies and tactics to create a post-acute partnership
5. Illustrate risk stratification factors in bundle design
About the Speaker:
Sheldon Hamburger is an Alternative Payment Model advisor for hospitals and healthcare firms nationally. With a focus on program implementation, he brings extensive knowledge and experience gained from more than 25 years of healthcare financial consulting, technology design and development, and sales & marketing strategy for Fortune 1000 clients. He is a frequently sought-after speaker and writer on regulatory and technology trends affecting hospital operations, provider reimbursement issues, BPCI / CJR, programs and regulations, medical expense strategies and payer-provider dynamics. Residing in Raleigh, he is an active member of HIMSS, HFMA, & ACHE. He earned his B.S.E. in Computer Engineering from the University of Michigan.
White Paper - Infection Preventionists: Healthcare’s Guardians at the Gate Ne...Q-Centrix
This white paper examines a key player at the front lines of hospitals’ never-ending battles against HAIs –Infection Preventionists (IPs). It briefly explains their varied roles, responsibilities and new challenges, the difficulty in recruiting these highly sought-after experts, and why and how hospitals should be doing more to help overworked and understaffed IPs be successful. Lastly, it covers new technologies and IP support services that can be integrated into hospitals’ infection control practices.
Prepping for CCJR: Lessons Learned in Physician Alignment and Bundled PaymentsWellbe
With CMS’ recent announcement of its Comprehensive Care for Joint Replacement (CCJR) payment model and its plan to implement in seventy-five geographic areas, hospitals must be prepared to manage the entire episode of care from the time of surgery through ninety days after discharge. CCJR presents both opportunities and challenges for hospitals. In order to achieve success, organizations must manage their system of care delivery, ensure they are aligned with their physicians and post acute providers, and master the analytics necessary for driving high quality, low cost care.
MedAssets has worked with numerous providers to implement alignment models that bring hospitals and their physicians together, evaluate, identify, and implement changes to the care delivery system to improve quality and decrease cost across the continuum, and employ meaningful analytics for managing an episode of care.
Kevin Lieb, Senior Director for MedAssets’ Physician Alignment Solutions division, will share examples demonstrating how organizations have successfully implemented Episodes of Care. Mr. Lieb will also share examples from both hospital led and specialist led programs and provide lessons learned from these experiences.
This webinar will enable attendees to do the following:
• Identify alignment models within bundled payments and understand their applicability to your organization
• Understand the analytic capabilities necessary for success in a bundled payment environment
• Identify opportunities and strategies for cost reduction and quality improvement
About the Speaker:
Mr. Lieb has more than 20 years of healthcare-related experience focusing on quality improvement, market development and cost reduction initiatives for the hospital provider market. Mr. Lieb has worked for a number of well-known healthcare companies including GE Medical Systems, HCIA and LBA in Denver, Colorado. His responsibilities included healthcare consulting with a focus on process improvement and quality initiatives.
The alphabet soup of clinical quality measures reporting and reimbursement 2...Bill Presley
CMS is transitioning to what the they call "a new and more responsive regulatory framework" for quality reporting and reimbursement. CMS goals are "…electronic health records helping physicians, clinicians, and hospitals to deliver better care, smarter spending, and healthier people". Over the next couple years, we will see a transformation of fee for service into value-based care models driven by the VBP, Quality Payment Program, MACRA, Merit-based Incentive Payment System (MIPS) and Alternative Payment Models (APM). Healthcare organizations will no longer be motivated by implementing and meeting Meaningful Use, but instead will be driven by value-based care and risk-based payment models that focus on quality outcomes for reimbursements.
In this Education Session we will review:
• How CMS is aligning clinical quality measures (CQMs) to reduce the reporting burden for healthcare organizations and providers. We will cover the vision and goals for achieving quality alignment for CMS.
• We will dive into the following CMS reporting programs and how they interact with each other: Value-Based Purchasing (VBP), Medicare Access and CHIP Reauthorization Act (MACRA), Merit-based Incentive Payments (MIPS), Hospital Inpatient Quality Reporting (IQR), The Joint Commission (ORYX), Outpatient Quality Reporting (OQR), and Alternative Payment Models (APM).
• How the Eligible Hospital and Eligible Professional reimbursement models will change in 2017 and going forward.
• Compare and contrast the requirements for quality measure reporting and identify strategies to ensure compliance.
• The potential impact to hospital reimbursement of current and proposed programs that will affect quality reporting for hospitals and providers.
• How to improve efficiency and quality by aligning measures across initiatives.
• Where to find current information (and breaking news) on each of these Quality Initiatives.
In the past, organizations participating in quality reporting initiatives involved abstractors sifting through a small sample set of unstructured data in paper charts to then manually convert their findings to discrete reportable data. This approach is time consuming and requires extensive amount of resources from both IT and Quality staff. Aligning quality initiatives can improve efficiencies and processes, and contribute to population health management efforts, both locally and nationally.
At the conclusion of this presentation, attendees will be able to apply what they’ve learned about aligning Clinical Quality Measures across initiatives specific to their organization to improve reimbursements, reduce their reporting burden, increase efficiencies, and realize the benefits of Population Health Management.
If you are responsible for hospital quality, IT, clinical quality measure initiatives or have a vested interest in making sure your organization is aligning quality measures reporting, this informational session is a must.
This presentation walks through the transition from chart abstracted quality reporting to electronic quality reporting for the CMS and The Joint Commission
PYA Highlights Next Steps of Meaningful UsePYA, P.C.
At the 2013 AICPA Healthcare Industry Conference, PYA Principal David McMillan and Senior Manager Chris Wilson recently explored the “new normal” of meaningful use as compliance and strategic standards in new care/reimbursement-model development.
Health IT Summit Houston 2014 - Case Study "EHR Optimization for Organizational Value in a Changing Healthcare Environment"
Luis Saldana, MD, MBA, FACEP
CMIO
Texas Health Resources
iHT2 case studies and presentations illustrate challenges, successes and various factors in the outcomes of numerous types of health IT implementations. They are interactive and dynamic sessions providing opportunity for dialogue, debate and exchanging ideas and best practices. This session will be presented by a thought leader in the provider, payer or government space.
The CMS Innovation Center hosted a special webinar featuring Dr. Patrick Conway, CMS Deputy Administrator for Innovation and Quality and CMS Chief Medical Officer, on Monday, November 10, 2014 from 10:30am – 11:30 am ET. Dr. Conway will provided an update about the work of the CMS Innovation Center and the models being tested to improve better care for patients, better health for our communities, and lower costs through improvement for our health care system. Opportunities for questions were provided.
- - -
CMS Innovation Center
http://innovation.cms.gov
We accept comments in the spirit of our comment policy:
http://newmedia.hhs.gov/standards/comment_policy.html
CMS Privacy Policy
http://cms.gov/About-CMS/Agency-Information/Aboutwebsite/Privacy-Policy.html
Our Insights webinar this week tackles a little-known program that will have a big impact on fee-for-service Medicare providers. The Value-Based Payment Modifier (or Value Modifier for short) is something every Medicare provider should know about as soon as possible. One way or another, providers will wind up on either the incentive or penalty side of this legislation. Take advantage of our webinar for in-depth information on this complex and far-reaching topic.
Industry Perspectives and Future Trends in Population HealthRohan DSouza
Presentation on industry perspectives on the future of population health management. This is a talk I gave at the eClinicalWorks National Users Conference in Nashville, TN (2015). With a lot of buzz surrounding pop health programs, I wanted to provide a roadmap on making the switch and succeeding.
The Accountable Care Organization Final Rule may be a 700-page mammoth, but fear not! This presentation will provide you with the highlights you need to know about the Final Rule, including details on the ACO contract with CMS; information on ACOs and FQHCs, Rural Health Centers and Hospitals; required processes and patient-centered criteria; quality and reporting highlights; application details; and more!
Netta Hollings (Programme Manager - Mental Health and Community Care) discusses how you can get the most out of the Maternity Services Data Set (MSDS) and the Child Health Data Sets.
The data sets provide comparative, mother and child-centric data that will be used to improve clinical quality and service efficiency; and to commission services in a way that improves health and reduce inequalities.
mHealth Israel_Hospitals and Healthcare Data_Carol Gomes_Stony Brook Universi...Levi Shapiro
Presentation by Carol Gomes, CEO / COO, Stony Brook University Hospital: Hospitals + Healthcare Data. Key Sections:
- Overview of Stony Brook Medicine Health System
- IT capital planning process
- Transition from Fee-for-Service
- Clinically Integrated Network
- Population Health Analytics Platform
- REGISTRIES – Benchmarking Quality
- Digital Transformation- Business & Clinical Capacity
- Transformation Projects: Analytics; Real-Time Health System Capabilities; Telehealth Services; Command Center Capabilities
- Command Center: Centralized Throughput Office (CTO)
- Command Throughput Office Dashboard
- Real-Time Dashboards
- Early Progress of Command Throughput Office (Boarders, Cases)
- Mobile STROKE Unit Program
- Telemedicine / TeleHealth
- Stony Brook University Hospital awarded $966,026
- Data Strategy in Decentralized Environment
- Call to Action for Startups
Advisor Live: Hospital Outpatient Prospective Payment System and Physician Fe...Premier Inc.
The Centers for Medicare & Medicaid Services (CMS) published the proposed payment rules on the outpatient prospective payment system (OPPS) and the Medicare physician fee schedule (PFS) on July 14 and 15, 2016. If finalized, the changes generally would be effective Jan. 1, 2017.
This webinar provides an overview of the final rules, with more specific coverage of outpatient PPS and Telehealth services.
Similar to The Alphabet Soup of Clinical Quality Measures Reporting (20)
Couples presenting to the infertility clinic- Do they really have infertility...Sujoy Dasgupta
Dr Sujoy Dasgupta presented the study on "Couples presenting to the infertility clinic- Do they really have infertility? – The unexplored stories of non-consummation" in the 13th Congress of the Asia Pacific Initiative on Reproduction (ASPIRE 2024) at Manila on 24 May, 2024.
New Directions in Targeted Therapeutic Approaches for Older Adults With Mantl...i3 Health
i3 Health is pleased to make the speaker slides from this activity available for use as a non-accredited self-study or teaching resource.
This slide deck presented by Dr. Kami Maddocks, Professor-Clinical in the Division of Hematology and
Associate Division Director for Ambulatory Operations
The Ohio State University Comprehensive Cancer Center, will provide insight into new directions in targeted therapeutic approaches for older adults with mantle cell lymphoma.
STATEMENT OF NEED
Mantle cell lymphoma (MCL) is a rare, aggressive B-cell non-Hodgkin lymphoma (NHL) accounting for 5% to 7% of all lymphomas. Its prognosis ranges from indolent disease that does not require treatment for years to very aggressive disease, which is associated with poor survival (Silkenstedt et al, 2021). Typically, MCL is diagnosed at advanced stage and in older patients who cannot tolerate intensive therapy (NCCN, 2022). Although recent advances have slightly increased remission rates, recurrence and relapse remain very common, leading to a median overall survival between 3 and 6 years (LLS, 2021). Though there are several effective options, progress is still needed towards establishing an accepted frontline approach for MCL (Castellino et al, 2022). Treatment selection and management of MCL are complicated by the heterogeneity of prognosis, advanced age and comorbidities of patients, and lack of an established standard approach for treatment, making it vital that clinicians be familiar with the latest research and advances in this area. In this activity chaired by Michael Wang, MD, Professor in the Department of Lymphoma & Myeloma at MD Anderson Cancer Center, expert faculty will discuss prognostic factors informing treatment, the promising results of recent trials in new therapeutic approaches, and the implications of treatment resistance in therapeutic selection for MCL.
Target Audience
Hematology/oncology fellows, attending faculty, and other health care professionals involved in the treatment of patients with mantle cell lymphoma (MCL).
Learning Objectives
1.) Identify clinical and biological prognostic factors that can guide treatment decision making for older adults with MCL
2.) Evaluate emerging data on targeted therapeutic approaches for treatment-naive and relapsed/refractory MCL and their applicability to older adults
3.) Assess mechanisms of resistance to targeted therapies for MCL and their implications for treatment selection
Title: Sense of Taste
Presenter: Dr. Faiza, Assistant Professor of Physiology
Qualifications:
MBBS (Best Graduate, AIMC Lahore)
FCPS Physiology
ICMT, CHPE, DHPE (STMU)
MPH (GC University, Faisalabad)
MBA (Virtual University of Pakistan)
Learning Objectives:
Describe the structure and function of taste buds.
Describe the relationship between the taste threshold and taste index of common substances.
Explain the chemical basis and signal transduction of taste perception for each type of primary taste sensation.
Recognize different abnormalities of taste perception and their causes.
Key Topics:
Significance of Taste Sensation:
Differentiation between pleasant and harmful food
Influence on behavior
Selection of food based on metabolic needs
Receptors of Taste:
Taste buds on the tongue
Influence of sense of smell, texture of food, and pain stimulation (e.g., by pepper)
Primary and Secondary Taste Sensations:
Primary taste sensations: Sweet, Sour, Salty, Bitter, Umami
Chemical basis and signal transduction mechanisms for each taste
Taste Threshold and Index:
Taste threshold values for Sweet (sucrose), Salty (NaCl), Sour (HCl), and Bitter (Quinine)
Taste index relationship: Inversely proportional to taste threshold
Taste Blindness:
Inability to taste certain substances, particularly thiourea compounds
Example: Phenylthiocarbamide
Structure and Function of Taste Buds:
Composition: Epithelial cells, Sustentacular/Supporting cells, Taste cells, Basal cells
Features: Taste pores, Taste hairs/microvilli, and Taste nerve fibers
Location of Taste Buds:
Found in papillae of the tongue (Fungiform, Circumvallate, Foliate)
Also present on the palate, tonsillar pillars, epiglottis, and proximal esophagus
Mechanism of Taste Stimulation:
Interaction of taste substances with receptors on microvilli
Signal transduction pathways for Umami, Sweet, Bitter, Sour, and Salty tastes
Taste Sensitivity and Adaptation:
Decrease in sensitivity with age
Rapid adaptation of taste sensation
Role of Saliva in Taste:
Dissolution of tastants to reach receptors
Washing away the stimulus
Taste Preferences and Aversions:
Mechanisms behind taste preference and aversion
Influence of receptors and neural pathways
Impact of Sensory Nerve Damage:
Degeneration of taste buds if the sensory nerve fiber is cut
Abnormalities of Taste Detection:
Conditions: Ageusia, Hypogeusia, Dysgeusia (parageusia)
Causes: Nerve damage, neurological disorders, infections, poor oral hygiene, adverse drug effects, deficiencies, aging, tobacco use, altered neurotransmitter levels
Neurotransmitters and Taste Threshold:
Effects of serotonin (5-HT) and norepinephrine (NE) on taste sensitivity
Supertasters:
25% of the population with heightened sensitivity to taste, especially bitterness
Increased number of fungiform papillae
MANAGEMENT OF ATRIOVENTRICULAR CONDUCTION BLOCK.pdfJim Jacob Roy
Cardiac conduction defects can occur due to various causes.
Atrioventricular conduction blocks ( AV blocks ) are classified into 3 types.
This document describes the acute management of AV block.
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Report Back from SGO 2024: What’s the Latest in Cervical Cancer?bkling
Are you curious about what’s new in cervical cancer research or unsure what the findings mean? Join Dr. Emily Ko, a gynecologic oncologist at Penn Medicine, to learn about the latest updates from the Society of Gynecologic Oncology (SGO) 2024 Annual Meeting on Women’s Cancer. Dr. Ko will discuss what the research presented at the conference means for you and answer your questions about the new developments.
Prix Galien International 2024 Forum ProgramLevi Shapiro
June 20, 2024, Prix Galien International and Jerusalem Ethics Forum in ROME. Detailed agenda including panels:
- ADVANCES IN CARDIOLOGY: A NEW PARADIGM IS COMING
- WOMEN’S HEALTH: FERTILITY PRESERVATION
- WHAT’S NEW IN THE TREATMENT OF INFECTIOUS,
ONCOLOGICAL AND INFLAMMATORY SKIN DISEASES?
- ARTIFICIAL INTELLIGENCE AND ETHICS
- GENE THERAPY
- BEYOND BORDERS: GLOBAL INITIATIVES FOR DEMOCRATIZING LIFE SCIENCE TECHNOLOGIES AND PROMOTING ACCESS TO HEALTHCARE
- ETHICAL CHALLENGES IN LIFE SCIENCES
- Prix Galien International Awards Ceremony
These lecture slides, by Dr Sidra Arshad, offer a quick overview of physiological basis of a normal electrocardiogram.
Learning objectives:
1. Define an electrocardiogram (ECG) and electrocardiography
2. Describe how dipoles generated by the heart produce the waveforms of the ECG
3. Describe the components of a normal electrocardiogram of a typical bipolar leads (limb II)
4. Differentiate between intervals and segments
5. Enlist some common indications for obtaining an ECG
Study Resources:
1. Chapter 11, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 9, Human Physiology - From Cells to Systems, Lauralee Sherwood, 9th edition
3. Chapter 29, Ganong’s Review of Medical Physiology, 26th edition
4. Electrocardiogram, StatPearls - https://www.ncbi.nlm.nih.gov/books/NBK549803/
5. ECG in Medical Practice by ABM Abdullah, 4th edition
6. ECG Basics, http://www.nataliescasebook.com/tag/e-c-g-basics
ARTIFICIAL INTELLIGENCE IN HEALTHCARE.pdfAnujkumaranit
Artificial intelligence (AI) refers to the simulation of human intelligence processes by machines, especially computer systems. It encompasses tasks such as learning, reasoning, problem-solving, perception, and language understanding. AI technologies are revolutionizing various fields, from healthcare to finance, by enabling machines to perform tasks that typically require human intelligence.
The Alphabet Soup of Clinical Quality Measures Reporting
1. Data Repository Experts Since 1998
The Alphabet Soup of Clinical
Quality Measures Reporting
and Reimbursement
2. Introductions
• Jodi Frei, PT, MSMIIT, Northwestern Medical Center
• William Presley, Vice President , Acmeware
3. Acronyms in this Presentation
ACA - Affordable Care Act
ASCQR - Ambulatory Surgical Center Quality Reporting
ARRA - American Recovery and Reinvestment Act
CEHRT - Certified Electronic Health Record Technology
eCQM - Electronic Clinical Quality Measures
HAI - Healthcare-Associated Infection
HCAHPS - Hospital Consumer Assessment of Healthcare Providers
and Systems
IACS - Individuals Authorized Access to the CMS Computer
Services
IPFQR - Inpatient Psychiatric Facilities Quality Reporting
IPPS - Inpatient Payment Prospective System
IQR - Inpatient Quality Reporting
NHSN - National Healthcare Safety Network
MU – Meaningful Use EHR Incentive Program
OPPS - Outpatient Prospective Payment System
OQR - Outpatient Quality Reporting
PCCEC - Patient and Caregiver-Centered Experience of care/Care
Coordination
PCHQR - PPS-Exempt Cancer Hospital Quality Reporting
VBP – Value-Based Purchasing
7. Vision for Quality Reporting
One Spec to rule them all, One Spec to find them,
One Spec to bring them all and in the darkness bind them
8. Vision for Quality Reporting
Unified and aligned set of clinical quality measures and
reporting requirements to synchronize and integrate CMS
quality programs which will reduce reporting burden and
improve on patient outcomes.
9. Quality Reporting Direction
The Future - One Specification
Core Measures
(Chart Abstraction)
•Manual Chart Abstracted
•Paper-based
specifications
•Translated to CMS
Specification Manual
Clinical Quality
Measure (eCQM)
•Electronically Captured
•Measure Concepts
•Electronic Codification
•Electronic Specification
•eCQM Library (One Spec)
10. Human vs Machine
Patient Care
documented
Capture
Manual
chart review
by
abstraction
and coding
Interpret
Manual
interpreted
results
calculated
Calculate
Manual Abstraction Process
11. Human vs Machine
Patient Care
documented
Capture
Data codified
and coding
reviewed
Codify
Electronically
calculate and
report
Calculate
Electronic Measure Process
12. Electronic Measures vs Manual Abstraction
Specifications Manual
o The Specifications Manual for National Hospital
Inpatient Quality Measures
o Uniform set of national hospital quality measures
o Paper tools for use in abstracting data for each
collection (discharge) period are provided with the
Specifications Manual
eCQM Library
Electronically specified versions of traditionally
chart-abstracted Clinical Quality Measures
Developed specifically so Certified Electronic Health
Record Technology (CEHRT) can capture, calculate,
export, and transmit the measure data
For eReporting of eCQMs to demonstrate
meaningful use or for Quality Reporting Programs
Data Collection Period Specifications Manual
10/01/15 - 06/30/16 Version 5.0
01/01/15 - 09/30/15 Version 4.4a
01/01/14 - 12/31/14 Version 4.3b
Reporting Year eCQM Specifications
2016 May 2015 Update
2015 April 2014 Update
2014 April 2013 Update
13. Hospital Quality Reporting Reductions
Year IQR EHR MU VBP HAC HRRP
2013 2.0% MBU N/A 1.0% DRG N/A 1.0% DRG
2014 2.0% MBU N/A 1.25% DRG N/A 2.00% DRG
2015 0.25% MBU 0.25% MBU 1.50% DRG 1.0% DRG 3.00% DRG
2016 0.25% MBU 0.50% MBU 1.75% DRG 1.0% DRG 3.00% DRG
2017 0.25% MBU 0.75% MBU 2.00% DRG 1.0% DRG 3.00% DRG
MBU = Market Basket Update
DRG = Diagnosis-related group
17. IQR Purpose
o Provide hospital transparency about quality and safety
o Provide consumers (us) with quality of care information to
make better decisions
o Publish on CMS Hospital Compare website
o Resulting in improved quality of inpatient care to all
patients
o Provides incentives to report quality of care measures
18. IQR Background
o Medicare Modernization Prescription Drug, Improvement
and Modernization Act (MMA) of 2003
◦ Non-submission would result in a 0.4 % reduction in APU
o Deficit Reduction Act of 2005
◦ Non-submission would result in a 2.0 % reduction in APU
o CMS issued the 2014 Inpatient Prospective Payment
System (IPPS) final rules to align IQR with eCQM.
o CMS issued the 2016 Inpatient Prospective Payment
System (IPPS) mandating eCQM for IQR program.
19. IQR Penalties
o Social Security Act, starting in FY 2015, penalized hospitals that fail to submit
quality information.
Year IQR EHR MU VBP HAC HRRP
2016 25% MBU 50% MBU 1.75% DRG 1.0% DRG 3.00% DRG
2017 25% MBU 75% MBU 2.00% DRG 1.0% DRG 3.00% DRG
2018 25% MBU 75% MBU 2.00% DRG 1.0% DRG 3.00% DRG
2019 25% MBU 75% MBU 2.00% DRG 1.0% DRG 3.00% DRG
20. IQR Requirements
o Create CMS Portal and QualityNet Administrator Accounts
o Complete the Hospital IQR Program Notice of Participation
o Collect and report data:
◦ Clinical data
◦ HCAHPS data
◦ HAI measures reported through NHSN
◦ Structural measures
◦ Data Accuracy and Completeness Acknowledgement
o Meet validation requirements
o Quality data published to Hospital Compare (not eCQMs)
23. EHR Incentive Program Purpose
o Known as “Meaningful Use”, provides Medicare and
Medicaid incentive payments to qualifying physicians and
hospitals, when they adopt and use Certified Electronic
Health Record Technology (CEHRT)
o CEHRT adoption promotes:
◦ Improve quality, safety, efficiency, and reduce health disparities
◦ Engage patients and their families
◦ Improve care coordination
◦ Ensure adequate privacy and security protections for personal
health information
◦ Improve population and public health
24. EHR Incentive Program Background
o The American Recovery and Reinvestment Act (ARRA)
established in 2009, a framework of financial incentives to
stimulate growth and improve the health care system.
o CMS published Meaningful Use CEHRT regulations in:
◦ Stage 1 Final Rule published July 2010
◦ http://www.gpo.gov/fdsys/pkg/FR-2010-07-28/pdf/2010-17207.pdf
◦ Stage 2 Final Rule published September 2012
◦ http://www.cms.gov/Regulations-and-
Guidance/Legislation/EHRIncentivePrograms/Stage_2.html
◦ Stage 3 Final Rule published October 2015
◦ https://www.federalregister.gov/articles/2015/10/16/2015-25595/medicare-and-
medicaid-programs-electronic-health-record-incentive-program-stage-3-and-
modifications
25. EHR Incentive Program Penalties
o Payment adjustment amounts are tied to the year
hospitals do not demonstrate meaningful use.
o Payment adjustment is tied to the percentage increase for
the Inpatient Prospective Payment System (IPPS) rate.
o Hospitals that do not meet meaningful use in 2018 will
receive a 75% reduced update.
26. EHR Incentive Program Requirements
o Utilization of certified EHR technology (CEHRT)
o Value Set Nomenclature Mapping
o Submission of objective measures and electronic clinical
quality measures (eCQM)
o Submission of clinical quality measure data:
◦ Option 1: Aggregate reporting of numerators and denominators in
the CMS Registration and Attestation system
◦ Option 2: Submission of QRDA files to QualityNet
27. EHR Incentive Program Penalties
Year IQR EHR MU VBP HAC HRRP
2016 25% MBU 50% MBU 1.75% DRG 1.0% DRG 3.00% DRG
2017 25% MBU 75% MBU 2.00% DRG 1.0% DRG 3.00% DRG
2018 25% MBU 75% MBU 2.00% DRG 1.0% DRG 3.00% DRG
2019 25% MBU 75% MBU 2.00% DRG 1.0% DRG 3.00% DRG
28. EHR Incentive Program Resources
National Library of Medicine
http://www.nlm.nih.gov/healthit/meaningful_use.html
eCQM Library
http://www.cms.gov/Regulations-and-
Guidance/Legislation/EHRIncentivePrograms/eCQM_Library.html
eCQI Resource Center
https://ecqi.healthit.gov
30. ORYX Program Purpose
o The Joint Commission’s ORYX® initiative integrates
outcomes and other performance measurement data into
the accreditation process.
o ORYX measurement requirements are intended to support
Joint Commission accredited organizations in their quality
improvement efforts.
o ORYX measures are publicly reported on The Joint
Commission website at www.qualitycheck.org.
31. ORYX Program Background
o Hospitals began reporting core measures nearly 15 years ago as
part of hospital accreditation by the Joint Commission.
o In 1999, the first ORYX data transmitted to the Joint Commission
from hospitals and long term care organizations.
o In 2007, added seven hospital outpatient measures to core
measure sets to satisfy ORYX performance measurement
requirements.
o New in 2015, offered Hospitals greater flexibility in meeting
ORYX performance measures with eCQM reporting.
32. ORYX Program Requirements
o As of 2015, Core measures have been aligned with CMS
eCQM Specifications.
o Perinatal care will remain mandatory in 2016 for hospitals
with at least 300 live births per year.
o Approved ORYX Vendor for Chart Abstraction or eCQM.
34. ORYX Program Resources
The Joint Commission
http://www.jointcommission.org
ORYX Program
http://www.jointcommission.org/facts_about_oryx_for_hospitals/
default.aspx
Pioneers in Quality
https://www.jointcommission.org/topics/pioneers_in_quality.aspx
36. VBP Program Purpose
o Required by the Affordable Care Act for IPPS hospitals;
quality payment program
o Moving toward rewarding better value, outcomes, and
innovations, instead of volume
o Promote better clinical outcomes for hospital patients
o Improve patient experience of care during hospital stays
37. VBP Program Background
o Funded by reductions from Diagnosis-Related Group (DRG)
payments; Budget Neutral
o Built on the Hospital Inpatient Quality Reporting (IQR)
measure reporting infrastructure
o Measures collected through the Hospital IQR Program
infrastructure
o Reimbursements based on either national benchmarks or
internal improvements
39. VBP Program Domains and Measures
MORT-30-AMI:
Acute Myocardial Infarction (AMI)
30-Day Mortality Rate
MORT-30-HF:
Heart Failure (HF)
30-Day Mortality Rate
MORT-30-PN:
Pneumonia (PN)
30-Day Mortality Rate
THA/TKA:
Elective Primary Total Hip
Arthroplasty (THA) and/or Total
Knee Arthroplasty (TKA)
Complication Rate
40. VBP Program Domains and Measures
HCAHPS Dimensions:
• Communication with Nurses
• Communication with Doctors
• Responsiveness of Hospital Staff
• Communication about
Medicines
• Cleanliness and Quietness of
Hospital Environment
• Discharge Information
• Overall Rating of Hospital
• Care Transition
41. VBP Program Domains and Measures
PSI-90: Complication/patient safety
for selected indicators (composite)
CLABSI: Central line-associated blood
stream infections
CAUTI: Catheter-associated urinary
tract
infections
SSI: Surgical site infections specific to
abdominal hysterectomy and colon
surgery
MRSA: Methicillin-Resistant
Staphylococcus
aureus Bacteremia
CDI: Clostridium difficile Infection
PC-01: Elective Delivery prior to 39
Completed Weeks of Gestation
42. MSPB: Medicare
Spending by Beneficiary:
• Claims-Based Measure
• Includes risk-adjusted and
price-standardized
payments for Part A and
Part B services provided
three days prior to hospital
admission through 30 days
after hospital discharge
VBP Program Domains and Measures
43. Value Based Purchasing Scoring
• Scores for all measures generate total performance score
• Types of points awarded
• Achievement points
• 0-10 based on comparison to all hospitals’ baseline period
rates
• Improvement points
• 0-9 based on comparison to same hospital’s baseline period
rates
• Consistency points
• 0-20 based on hospital’s HCAHPS scores compared to all
hospitals’ baseline period rates
44. Financial Impact
o Total amount of value-based incentive payments must
equal the total amount withheld across all hospitals in the
program.
o For FY19 payment (2017 performance): 2% withhold
o Value-based incentive payments = Sum of all hospital’s
base-operating DRG*0.02 (withhold)
45. VBP Program Penalties
Reimbursement = Achievement + Improvement
Year IQR EHR MU VBP HAC HRRP
2016 25% MBU 50% MBU 1.75% DRG 1.0% DRG 3.00% DRG
2017 25% MBU 75% MBU 2.00% DRG 1.0% DRG 3.00% DRG
2018 25% MBU 75% MBU 2.00% DRG 1.0% DRG 3.00% DRG
2019 25% MBU 75% MBU 2.00% DRG 1.0% DRG 3.00% DRG
46. VBP Program Resources
Quality Reporting Center
http://www.qualityreportingcenter.com/inpatient/vbp-archived-
events
CMS VBP
https://www.cms.gov/Medicare/Quality-Initiatives-Patient-
Assessment-Instruments/hospital-value-based-
purchasing/index.html
QualityNet
https://www.qualitynet.org/dcs/ContentServer?c=Page&pagenam
e=QnetPublic%2FPage%2FQnetTier2&cid=1228772039937
48. HRRP Program Purpose
o The Affordable Care Act (ACA) established the Hospital
Readmissions Reduction Program (HRRP).
o Requires the CMS to adjust payments to hospitals with
excess unplanned readmissions for certain conditions.
o Aims to improve the quality of care by improving
communication and care coordination, while reducing the
costs.
49. HRRP Program Background
o According to CMS, historically about one in five Medicare
patients discharged from a hospital are readmitted within
30 days.
o In 2005, the Medicare Payment Advisory Commission
(MedPAC) concluded that about three-quarters of
readmissions within 30 days were preventable.
◦ Estimated at $12 billion in Medicare spending.
50. HRRP Program Requirements
Readmission Measures 2013 2014 2015 2016 2017
Acute myocardial
Infarction
Heart failure
Pneumonia
Chronic obstructive
pulmonary disease
Total hip arthroplasty/
Total knee arthroplasty
Coronary artery bypass
graft surgery
51. HRRP Program Penalties
o Hospitals below national average for any one of the conditions
are subject to a payment adjustment.
o Payment adjustment applies to all Medicare discharges for that
year, not just a hospital’s readmissions.
Year IQR EHR MU VBP HAC HRRP
2016 25% MBU 50% MBU 1.75% DRG 1.0% DRG 3.00% DRG
2017 25% MBU 75% MBU 2.00% DRG 1.0% DRG 3.00% DRG
2018 25% MBU 75% MBU 2.00% DRG 1.0% DRG 3.00% DRG
2019 25% MBU 75% MBU 2.00% DRG 1.0% DRG 3.00% DRG
52. HRRP Program Resources
QualityNet Program
https://www.qualitynet.org/dcs/ContentServer?c=Page&pagenam
e=QnetPublic%2FPage%2FQnetTier2&cid=1228772412458
CMS Acute IPPS
https://www.cms.gov/medicare/medicare-fee-for-service-
payment/acuteinpatientpps/readmissions-reduction-
program.html
Quality Reporting Programs
https://www.cms.gov/Medicare/Quality-Initiatives-Patient-
Assessment-Instruments/Value-Based-Programs/HRRP/Hospital-
Readmission-Reduction-Program.html
54. HAC Program Purpose
o The Affordable Care Act (ACA) established the HAC
Reduction Program to incentivize hospitals to reduce
hospital-acquired conditions (HACs)
o Payment adjustments to discharges started in FY 2015
o Payment adjustments for lowest performing quartile
o Improve patient outcomes with quality measurements
55. HAC Program Background
o Applies to hospitals paid under the Medicare Inpatient
Prospective Payment System (IPPS)
o Program does not affect:
◦ Long-term acute care hospitals
◦ Cancer hospitals
◦ Children’s hospitals
◦ Inpatient rehab facilities
◦ Inpatient psychiatric facilities
◦ Critical access hospitals
56. HAC Program Requirements
HAC Measures 2015 2016 2017
Patient Safety Indicator (PSI) 90 Composite
Central line-associated bloodstream infection
(CLABSI)
Catheter associated urinary tract infection
(CAUTI)
Surgical site infection (SSI) (colon and
hysterectomy)
Methicillin-resistant Staphylococcus (MRSA)
Clostridium difficile (C.diff)
57. HAC Program Penalties
o Reduce hospital payments by 1 percent for hospitals that
rank among the lowest-performing 25 percent.
o All hospitals receive between 1 and 10 points per measure
- Higher Score = Worse Performance
o 1% penalty to any hospital that falls into the bottom 25%
Year IQR EHR MU VBP HAC HRRP
2016 25% MBU 50% MBU 1.75% DRG 1.0% DRG 3.00% DRG
2017 25% MBU 75% MBU 2.00% DRG 1.0% DRG 3.00% DRG
2018 25% MBU 75% MBU 2.00% DRG 1.0% DRG 3.00% DRG
2019 25% MBU 75% MBU 2.00% DRG 1.0% DRG 3.00% DRG
58. HAC Program Resources
Quality Reporting Programs
https://www.cms.gov/Medicare/Quality-Initiatives-Patient-
Assessment-Instruments/Value-Based-
Programs/HAC/Hospital-Acquired-Conditions.html
Hospital Compare
www.medicare.gov/hospitalcompare/HAC-reduction-
program.html
QualityNet HAC Reduction Program
www.qualitynet.org/dcs/ContentServer?c=Page&pagename
=QnetPublic%2FPage%2FQnetTier2&cid=1228774189166
60. OQR Program Purpose
o The Hospital Outpatient Quality Reporting (OQR) Program
is a quality measure reporting program implemented by
the CMS for outpatient hospital services
o Starting CY 2009, Hospitals report data using standardized
measures of care to receive the full annual update to their
Outpatient Prospective Payment System (OPPS) rate
o Pay for quality data reporting program
61. OQR Program Background
o CMS publicly reports Hospital OQR data
o OQR Program is modeled after the IQR Program
o OQR Program is a voluntary for outpatient hospital services
o OQR focuses on quality measures that have a high impact
and improved quality and efficiency.
◦ process of care, imaging efficiency patterns, care transitions, ED
throughput efficiency, use of Health Information Technology (HIT)
care coordination, patient safety and volume.
62. OQR Program Requirements
o Measures submitted on QualityNet
o Clinical data submission is accomplished in one of two
ways:
◦ CMS Abstraction & Reporting Tool (CART)
◦ Third party vendor
o Hospitals measurements published to Hospital Compare
o CMS is considering a proposal for eCQM submissions
64. OQR Program Penalties
o Hospitals that meet measure reporting requirements
during a calendar year to receive their full OPPS
reimbursements
o Fail to meet these requirements receive a 2% reduction of
their APU
65. OQR Program Resources
Hospital OQR Program
www.qualityreportingcenter.com
Quality Reporting Center
http://www.qualityreportingcenter.com/hospitaloqr
OQR Measures
https://www.qualitynet.org/dcs/ContentServer?c=Page&pagenam
e=QnetPublic%2FPage%2FQnetTier3&cid=1192804531207
Hospital OQR ListServe
www.qualitynet.org/dcs/ContentServer?pagename=QnetPublic/Li
stServe/Register
67. MACRA Background
• Bipartisan legislation signed into law on April 16, 2015
• Repealed Sustainable Growth Rate Formula
• Rewards providers for quality versus quantity
• Combines existing quality programs into one
• Participants: Part B Eligible Professionals
68. MIPS Background
• Combines components of PQRS, Value Modifier, and MU
into one program
• One composite performance score, 0-100 points,
determined through 3 weighted categories
• Budget neutral program rewarding quality performance
• 2017 performance impacts 2019 payment
69. MIPS Categories: 2017 Weights
Quality
Replaces the Physician Quality
Reporting System (PQRS).
Advancing Care
Information
Replaces the Medicare
EHR Incentive Program
also known as
Meaningful Use.
Improvement
Activities
New category.
70. MIPS Eligibility
EC EC EC EC EC
Hospitalist ED Provider Ortho Practice Family Practice
EC
Private Practice
Acute Ambulatory
71. MIPS Participation Options
Pick Your Pace
Option 1 (Crawl)
Test the System by submitting partial data
(1 Quality Measure OR 1 IA OR Base ACI Measures)
Avoid negative payment adjustment in
2019
Option 2 (Walk)
Participate for Part of the Year (minimum 90 days)
Neutral or small positive payment
adjustment in 2019
Option 3 (Run)
Participate Full Calendar Year
Modest payment adjustment
in 2019
72. Meaningful Use vs Advancing Care
Meaningful Use
• Strict Reporting
Requirement
• Labor Intensive
• Misaligned with Other
Quality programs
Advancing Care
• Flexible Reporting
• Streamlined
• Aligned with Other Quality
Programs
73. Advancing Care Information Objective Measures
Required Objective Measures:
o Security Risk Analysis
o e-Prescribing
o Provide Patient Access
◦ Timely access, access via application of choice - API
o Send Summary of Care
o Request/Accept Summary of Care
74. Advancing Care Information Transition Objective Measures
Required Objective Measures:
o Security Risk Analysis
o e-Prescribing
o Provide Patient Access
◦ Timely access only
o Send Summary of Care
75. Improvement Activities
15% of Total MIPS Score
Minimum of 1 must be selected
Maximum Score of 40 points
Credit for involvement in Medical Home and APMs
90 available to accommodate specialists
76. Description of Improvement Activities
90 available aligned with:
• Care Coordination
• Beneficiary Engagement
• Patient Safety
• Expanded Practice Access
• Population Management
• Emergency Preparedness
• Achieving Health Equity
• Participation in APM
77. Improvement Activities: Scoring
Scoring based on weighting
• Up to 20 points for highly weighted activities
• Medical Home, transformation of the clinic, public health
priorities
• Examples: Patient experience ratings, timely access for
Medicaid patients
• Up to 10 points for all other activities, considered medium
weight. Most options are of medium weight
Total high weight points + total medium points/total
possible points (40) = % of Improvement Activities Score
78. Improvement Activities: Reporting
Individual clinicians, groups or designated 3rd party
vendors must designate Yes/No to each chosen activity
Reporting Options:
• Attestation
• QCDR
• Qualified Registry Reporting
• EHR
• Claims (If feasible, no other reporting necessary)
• Groups of 25 or greater also have option of reporting
via CMS Web Interface
79. Cost Catagory
0% of total MIPS score
Replaces Value Modifier
Claims based reporting
*No additional reporting requirements
Scoring is based on comparison to others
*Those that provide the most efficient, effective care
will receive greater scores
83. The Future of Quality Reporting
o 2016 Inpatient Prospective Payment System (IPPS) Rule
mandates eCQM
o 2016 IPPS eCQM Submission Requirements for IQR
◦ 4 eCQMs reflecting Q3 or Q4 CY 2016
▪ In 2015 Joint Commission issued guidance that they were
transitioning from Core Measures to CMS eCQM
Specifications
▪ Outpatient Quality Reporting Program (OQR) has a
proposed 2017 eCQM requirement
▪ Comprehensive Primary Care Initiatives have embedded
eCQM submission into their reporting options
We Hates It!
84. Prepare Now for eCQM
What are eCQMs?
o Electronically specified versions of traditionally chart-
abstracted Clinical Quality Measures
o Developed specifically so Certified Electronic Health
Record Technology (CEHRT) can capture, calculate, export,
and transmit the measure data
o Electronic Codification of Patient Health Record
No, no…We Loves It!
85. 2017 IPPS Proposal - eCQMs Removed
• Mean in g fu l Use ( MU)
• Inpatient Quality Reporting ( IQR)
* Excluded from IQR and ORYX
86. Finalized List of eCQMs for 2017
▪ AMI-8a - Primary PCI Received Within 90 Minutes of Hospital Arrival
▪ CAC-3 - Home Management Plan of Care Document Given to Patient/Caregiver
▪ ED-1 - Median Time from ED Arrival to ED Departure for Admitted ED Patients
▪ ED-2 - Admit Decision Time to ED Departure Time for Admitted Patients
▪ EHDI-1a - Hearing Screening Prior to Hospital Discharge 1354
▪ PC-01 - Elective Delivery
▪ PC-05 - Exclusive Breast Milk Feeding
▪ STK-02 - Discharged on Antithrombotic Therapy
▪ STK-03 - Anticoagulation Therapy for Atrial Fibrillation/Flutter
▪ STK-05 - Antithrombotic Therapy by the End of Hospital Day Two
▪ STK-06 - Discharged on Statin Medication
▪ STK-08 - Stroke Education
▪ STK-10 - Assessed for Rehabilitation
▪ VTE-1 - Venous Thromboembolism Prophylaxis
▪ VTE-2 - Intensive Care Unit Venous Thromboembolism Prophylaxis
88. Enhanced Oversight and Accountability
➢ONC expands role of oversight
➢Clinicians required to give access to their EHR for “field
inspection”
➢Clinicians must attest to cooperating with ONC surveillance
and oversight activities
➢No restriction of data sharing and interoperability
90. Hospital Quality Measures
• Mean in g fu l Use ( MU)
• Inpatient Quality Reporting ( IQR)
• Joint Commission ( O RYX )
* Excluded from IQR and ORYX
91.
92. eCQM Reporting Submission
Meaningful
Use EP
Meaningful
Use EH
Electronic Clinical Quality Measures (eCQM)
PQRS IQR
Joint
Commission
QualityNet PQRS QualityNet IQR TJC
QRDA I or III
94. eCQM Reporting Standards
o Introduction of universal identifier
• Example: Venous Thromboembolism Patients with Anticoagulation
Overlap Therapy
• NQF# = 0373 (VTE-3)
• eMeasure ID = CMS-73
o How do standardized nomenclature based code system work?
• Using Quality Data Model (QDM) with HL7 QRDA (Quality
Reporting Document Architecture)
o eCQM Library Specifications Published Annually
◦ VTE-3 Example
95.
96. Description:
This measure assesses the number of patients diagnosed with confirmed VTE who received an overlap of parenteral
(intravenous [IV] or subcutaneous [subcu]) anticoagulation and warfarin therapy. For patients who received less than five
days of overlap therapy, they should be discharged on both medications or have a reason for discontinuation of overlap
therapy. Overlap therapy should be administered for at least five days with an international normalized ratio (INR) greater
than or equal to 2 prior to discontinuation of the parenteral anticoagulation therapy, discharged on both medications or
have a reason for discontinuation of overlap therapy.
Data criteria (QDM Data Elements):
"Medication, Administered: Warfarin" using "Warfarin RXNORM Value Set (2.16.840.1.113883.3.117.1.7.1.232)"
"Medication, Discharge not done: Medical Reason" using "Medical Reason SNOMEDCT Value Set
(2.16.840.1.113883.3.117.1.7.1.473)"
"Medication, Discharge not done: Patient Refusal" using "Patient Refusal SNOMEDCT Value Set
(2.16.840.1.113883.3.117.1.7.1.93)"
"Medication, Discharge: Parenteral Anticoagulant" using "Parenteral Anticoagulant RXNORM Value Set
(2.16.840.1.113883.3.117.1.7.1.266)"
"Medication, Discharge: Parenteral anticoagulant ingredient specific" using "Parenteral anticoagulant ingredient specific
RXNORM Value Set (2.16.840.1.113762.1.4.1021.4)"
"Medication, Order not done: Medical Reason" using "Medical Reason SNOMEDCT Value Set
(2.16.840.1.113883.3.117.1.7.1.473)"
"Medication, Order not done: Patient Refusal" using "Patient Refusal SNOMEDCT Value Set
(2.16.840.1.113883.3.117.1.7.1.93)"
eMeasure Identifier: CMS-73
Reconcile and Validate eCQMs
VTE-3 Reporting Example
97. This shows a value set for a class of medications (Warfarin)
VTE-3 Reporting Example
Data criteria (QDM Data Elements):
"Medication, Administered: Warfarin" using "Warfarin RxNorm Value Set (2.16.840.1.113883.3.117.1.7.1.232)“
Value Set Table:
eMeasure Identifier: CMS108
98. VTE-3 Reporting Example
Data criteria (QDM Data Elements):
"Medication, Administered: Warfarin" using "Warfarin RxNorm Value Set (2.16.840.1.113883.3.117.1.7.1.232)“
Value Set Table:
eMeasure Identifier: CMS108
99. Data criteria (QDM Data Elements):
"Medication, Administered: Warfarin" using "Warfarin RXNORM Value Set (2.16.840.1.113883.3.117.1.7.1.232)"
"Medication, Discharge not done: Medical Reason" using "Medical Reason SNOMEDCT Value Set
(2.16.840.1.113883.3.117.1.7.1.473)"
"Medication, Discharge not done: Patient Refusal" using "Patient Refusal SNOMEDCT Value Set
(2.16.840.1.113883.3.117.1.7.1.93)"
"Medication, Discharge: Parenteral Anticoagulant" using "Parenteral Anticoagulant RXNORM Value Set
(2.16.840.1.113883.3.117.1.7.1.266)"
"Medication, Discharge: Parenteral anticoagulant ingredient specific" using "Parenteral anticoagulant ingredient specific
RXNORM Value Set (2.16.840.1.113762.1.4.1021.4)"
"Medication, Order not done: Medical Reason" using "Medical Reason SNOMEDCT Value Set
(2.16.840.1.113883.3.117.1.7.1.473)"
"Medication, Order not done: Patient Refusal" using "Patient Refusal SNOMEDCT Value Set
(2.16.840.1.113883.3.117.1.7.1.93)"
VTE-3 Reporting Example
eMeasure Identifier: CMS108
103. HL7 QRDA (XML File) Snippet for Patient Visit that meets NQF#: 0371
VTE-3 Reporting Example
104. Challenges
o Disparate Systems
o Difficult to assess performance across settings
o Creation of Clinical Alerts
o Coding occurs post discharge
o Understanding workflow required by eCQMs
o Transition from free text and customized reporting