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2017 Quality Payment Program & MicroMD EMR 101

CLIENT GUIDE:

table of contents

1. QPP Program Overview . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2

2. MIPS Eligibility . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3

3. MIPS Performance Categories & Scoring . . . . . . . . . . . . . . . . . . . . . . 4

4. MIPS Payment Adjustments Based on 2017 “Pick Your Pace” Model . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5

5. Reporting/Data Submission Methods . . . . . . . . . . . . . . . . . . . . . . . . . 6

6. What should MicroMD EMR ECs be doing? . . . . . . . . . . . . . . . . . . . . . 7

7. Using MicroMD EMR to Meet MIPS Requirements . . . . . . . . . . . . . . . 8

8. Quality Performance Category Scoring and MicroMD EMR . . . . . . . 9

9. Improvement Activities (IAs) Performance Category Scoring and MicroMD EMR . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 10

10. Advancing Care Information (ACI) Performance Category and MicroMD EMR . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 11

11. MicroMD QPP Resources . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 14

2017 QPP & MICROMD EMR 101

CLIENT GUIDE

QPP PROGRAM OVERVIEW

A t a high level, the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA) replaces the Medicare Part B Sustainable

Growth Rate (SGR) and creates a new method regarding how Medicare reimburses physicians. CMS made new changes to the Physician Fee Schedule (PFS) and replaced the fee-for-service method with value-based payments under the Quality Payment Program (QPP). The QPP is made up of two major sections: the Merit-based Incentive Payment System (MIPS) and Advanced Alternative Payment Models (Advanced APMs). CMS estimates that around 600,000 Part B physicians will fall under MIPS. MIPS will now be the “new norm” for Part B physicians who will only be exempt if they meet certain conditions.

The Quality Payment Program (QPP), put simply, has the goal to improve Medicare by allowing physicians to concentrate on the quality of care they are providing their patients, as well as other benefits the QPP intends to achieve. Some of those benefits include:

1. Reducing the burden on providers

2. Maintaining independent clinical practices

3. Promoting existing efforts of Delivery System Reform

The QPP will replace and streamline the existing independent programs of Meaningful Use, PQRS, and value-based programs. To have long-term

success, the QPP must take into consideration diversity in care delivery and provide options that work for both physicians and their patients. Clinicians can choose how they want to participate in the Quality Payment Program based on practice size, specialty, location, or patient population and features two tracks:

1. Advanced Alternative Payment Models (APMs)

2. The Merit-based Incentive Payment System (MIPS)

The majority of providers will participate in the QPP through the MIPS track. Let’s explore more details of the MIPS program, as well as guidance on how to work with MicroMD to maximize Eligible Clinician (EC) participation. We also urge you to visit the CMS QPP website for specific program guidance and resources.

2017 QPP & MICROMD EMR 101 CLIENT GUIDE

https://qpp.cms.gov/

For the 2017 MIPS performance periods, the following Eligible Clinician (EC) types can participate in MIPS:


MIPS ELIGIBILITY

• Physicians, which includes doctors of medicine, doctors of osteopathy (including osteopathic practitioners), doctors of dental surgery, doctors of dental medicine, doctors of podiatric medicine, doctors of optometry, and chiropractors

• Physician assistants (PAs)

• Nurse practitioners (NPs)

• Clinical nurse specialists

• Certified registered nurse anesthetists

• Any clinician group that includes one of the professionals listed here

ECs must bill more than $30,000 to Medicare AND provide care to more than 100 Medicare patients per year. Both elements of this criteria must be met to participate.

In late April through May you should have received a “MIPS Participation Status” letter from your Medicare Administrative Contractor that processes Medicare Part B claims that confirmed the MIPS eligibility status of each clinician associated with your practice Taxpayer Identification Number (TIN).

You may also check your status on the CMS QPP website.

https://qpp.cms.gov/

MIPS PERFORMANCE CATEGORIES & SCORING

M ACRA replaced three Medicare reporting programs with MIPS (Medicare Meaningful Use, the Physician Quality Reporting System, and the Value-Based Payment Modifier). Under the combination of

the previous programs, ECs would have faced a negative payment adjustment as high as 9% total in 2019, but MACRA ended those programs, reduced the potential negative payment adjustments in the early years, and streamlined the overall requirements. While these three programs will end in 2018, if an EC has participated in these programs in the past, they will have an advantage in MIPS because many of the requirements should be familiar. MACRA defined four performance categories for QPP, linked by their connection to quality and value of patient care:

1. Quality: Replaces PQRS – Makes up 60% of the MIPS Composite Performance Score (CPS). Each EC/practice will select 6 measures to report on. 1 of the 6 measures must be an outcome measure or other high priority measure if no outcome measure is available.

2. Improvement Activities (IAs): New (Doesn’t replace an existing pro-gram) – Makes up 15% of the MIPS CPS. ECs/practices choose activities from the CPIA inventory, which lists over 90 proposed activities. Full credit will be rewarded under this category for all patient-centered medical homes. APM participants can also receive IA category credit based on their Alternative Payment Model (APM) participation. Partici-pation must be in a short list of qualifying APMs.

3. Advancing Care Information (ACI): Replaces Meaningful Use – Makes up 25% of the MIPS CPS. Scoring the ACI category will be comprised of a score for participation and reporting, which is the “base score”, a score for performance, called the “performance score” and offer an opportunity for a payment bonus called the “bonus score”

4. Not Scored in 2017: Cost: Replaces cost from the Value-Based Pay-ment Modifier (VM) – This category has been weighted to zero for the 2017 transition year and will be calculated by CMS. It will be based solely on claims to calculate total per capital cost for all attributed beneficiaries, Medicare spending per beneficiary (MSPB), and several episode-based measures will be used to calculate Resource Use. 2019 payment adjustments and bonuses based on 2017 QPP reporting will not be based on this category, although ECs will have the opportunity to review their performance to assist in planning for when the category is weighted and activated.


Eligible Clinicians to Earn Performance-Based Reimbursement

four categories for

15%

25% 60%

Improvement Activity

Quality(replacesPQRS)

AdvancingCare Info

*Cost (0% for 2017, but will be weighted from 2018 forward)

D epending on the QPP track chosen (APM or MIPS) and the data submitted by March 31, 2018, 2019 Medicare payments

will be adjusted up, down, or not at all. The information provided below is only relevant for the 2019 payment year. CMS will provide additional information on payment adjustments for 2020 and beyond beginning next year. The options for 2017 “pick your pace” participate include:

• Do not participate: If an EC doesn’t send in any 2017 data, they’ll receive a negative 4% payment adjustment

• Submit something: If an EC submits a minimum amount of 2017 “test” data to Medicare (for example, one quality measure or one improvement activity), they can avoid a downward payment adjustment

• Submit a partial year: If an EC submits 90 days of 2017 data to Medicare, they may earn a neutral or small positive payment adjustment

• Submit a full year: If an EC submits a full year of 2017 data to Medicare, they may earn a moderate positive payment adjust-ment

The size of an EC’s payment adjustment will depend both on how much data the EC submits and their quality results. Note for ECs participating in the Advanced APM track: If an EC receives 25% of Medicare covered professional services or sees 20% of Medicare patients through an Advanced APM in 2017, then they will earn a 5% Medicare incentive payment in 2019.


MIPS PAYMENT ADJUSTMENTS BASED ON 2017 “PICK

YOUR PACE” MODEL

important notes

Not sending in any 2017 data, will incur a negative 4% payment adjustment

Submiting a minimum amount of 2017 “test” data to Medicare, can help avoid a downward payment adjustment

Submitting 90 days of 2017 data to Medicare, may earn a neutral or small positive payment adjustment

Submitting a full year of 2017 data to Medicare, may earn a moderate positive payment adjustment

REPORTING PERIODAs of January 1, 2017, Eligible Clinicians (ECs) can start meeting the category requirements with MicroMD EMR. ECs who have already been participating in PQRS and/or the EHR Incentive Program may have a leg up as they’ve already been successfully meeting many of the requirements with MicroMD EMR. If choosing to wait, any time before October 2, 2017, is an acceptable date to begin. Regardless of start date, performance data must be submitted by March 31, 2018. The first performance-based payment adjustments will begin the first of the year in 2019.


REPORTING AND DATA SUBMISSION METHODS

Report as an individualIf an EC will report as an individual, their payment adjustment will be based on their performance. An individual is defined as a single clinician, identified by a single National Provider Identifier (NPI) number tied to a single Tax Identification Number (TIN). For 2017, ECs submitting as an individual using MicroMD EMR will be able to submit their data through MicroMD EMR direct QRDA submission, a qualified registry, or attestation for some items depending on the performance category. ECs may also opt to submit quality data through routine Medicare claims submission although the list of claims-based quality measures is limited.

Report with a groupEach EC participating in MIPS via a group will receive a payment adjustment based on the group’s performance. Under MIPS, a group is defined as a single Taxpayer Identification Number (TIN) with 2 or more eligible clinicians (including at least one MIPS eligible clinician), as identified by their National Provider Identifiers (NPI), who have reassigned their Medicare billing rights to the TIN. For 2017, groups using MicroMD EMR are able to submit their data through MicroMD EMR direct QRDA III submission, a qualified registry, or via attestation for some items depending on the performance category.

Determine your 2017 “Pick Your Pace” performance target and identify what’s

required to get thereIf you’re new to reporting quality measures and or EHR Meaningful Use (MU) consider submitting a minimum test amount to avoid the

negative payment adjustment

If you’ve reported PQRS and MU in the past consider submitting 90 days or a full year of data to boost change of positive payment adjustment

Choose your reporting period

Maximize your reporting outcomes – strive to be a high performer to earn a higher payment adjustment and/or bonuses

Pick, stick, and don’t switch your measures – Stick with what’s working; work to improve what’s not versus scrapping and starting with a new

measure

Select performance measures you’ve already been successful at for PQRS and/or Meaningful Use

Determine additional performance measures to target to meet your goals

Ensure you have the portal and secure messaging

tools you need to meet ACI measure requirements including:

Secure Messaging (MicroMD Portal and Secure Messaging)

Provide Patient Access (MicroMD Portal)

View, Download, and Transmit (MicroMD Portal and Secure Messaging)

Send a Summary of Care (Secure Messaging)

Request/Access Summary of Care (MicroMD Portal and Secure Messaging)

Patient Generated Health Data (MicroMD Portal)

Health Information Exchange (Secure Messaging)

Review reports and goals

monthlyStay on track with performance in

each MIPS category and be proactive, not reactive

Compare scores to benchmarks to determine where you can improve

Empower staff to get involved

Post signs in break room and offices and at front desk – change of mind set for

everyone

QPP is about VALUE NOT VOLUME

Sign up to receive MicroMD Client Alert Emails to ensure you’re receiving notifications of MicroMD educational resources, QPP notifications, upgrade requirements, and training opportunities. To add contacts to receive Client Alert emails, visit https://www.micromd.com/sign-up-for-communications/

Participate in scheduled MicroMD EMR training webinars to learn how to use MicroMD EMR features and tools to meet each of the reporting category requirements. Watch for invitations via MicroMD Client Alert Emails.

Reach out to the MicroMD Training Team to discuss practice-specific training opportunities to maximize QPP participation. Contact [email protected] to discuss.

If you have an interest in maximizing your ACI Bonus score by attesting to submitting to a registry, connect with us to review your selected registry specifications and purchase an interface. Contact [email protected] to discuss registry interface options.

Get to know the MIPS

requirements for each category

Weigh the pros and cons of submitting individually or as a group

Understand and select your submission methods available for

each category

Learn how to earn bonus points

Remember that patient-

centered, quality, cost effective care

is the goal

The more care delivered

outside the hospital setting, the more you

will lower cost, improve patient satisfaction,

and get more value

Determine your chosen

pathway (MIPS or APM)

Conduct/update your

HIPAA Security Risk Assessment

WHAT SHOULD MICROMD EMR ECS BE DOING?

Expand your continuity-of-care network

for optimal patient care and reimbursement

GET STARTED TODAY

Prepare for next year while

earning this yearOrder your QRUR report to better

understand the quality of care you delivered during the performance period

and compare it to your peers

Provide input in open forums and on draft rules when CMS requests feedback

Focus on quality of care, not on the quantity of services

Upgrade to MicroMD EMR

2015 CEHRT Edition Version 13.5 or Higher

Confirm which data you EHR can report and how, as well as confirm

certification status (MicroMD clients will use 2015 Edition

CEHRT MicroMD EMR Version 13.5 or Higher)


USING MICROMD EMR TO MEET MIPS REQUIREMENTS

C lients participating in the Medicare QPP or the EHR Incentive program will need to upgrade to Version 13.5.2 or higher to access new 2015 Edition CEHRT functionality. Updated reporting dashboards will be available in Version 13.5.2 to better help ECs monitor success to maximize

payment adjustments and incentives. We will be announcing when the version is available for upgrade and Client Support will be working with individual practices to schedule upgrades with ample time to meet the October 2 reporting period deadline.

MicroMD is offering FREE training webinars for users to understand how to use 2015 Edition CEHRT MicroMD EMR Version 13.5 and higher to achieve both QPP and EHR Incentive Program Meaningful Use requirements. Additionally, users will be able to access step-by-step guidance through traditional reference materials, and will be able to review new functionality detailed in the MicroMD EMR Update Guide plus confirm how MicroMD EMR captures data and calculates 2017 Quality measures outlined in the “Clinical Quality Measure Calculations 2017” document.

When Version 13.5 and higher are released, updated reference materials can be accessed in the Help Menu of your software, as well as via the MicroMD Lounge: http://www.micromd.net/index.php?topic=193.0.

Clients that want a practice-specific training experience can contact [email protected] to discuss options and scheduling.


Quality

PERFORMANCE CATEGORY SCORING & MICROMD EMR

MicroMD EMR offers a Host of Clinical Quality Measures (CQMs) and Submission OptionsECs using MicroMD EMR Version 13.5 or Higher who seek to maximize their MIPS Quality performance category score have multiple measures and data submission options. They can chose to monitor and submit their own data or they can let an integrated qualified registry automate and submit the data for them. ECs that opt to submit their own measures for 2017 reporting via EHR direct submission can chose from 45 quality measures with 2015 Edition CEHRT. MicroMD also has full integration with ReportingMD’s Total Outcomes Management (TOM) qualified registry to receive data for 87 2017 MIPS Quality measures directly from MicroMD EMR, calculate the measures, monitor achievement, and submit the Quality measure data to CMS. ECs that also use MicroMD PM may choose to submit their measures via claims-only.

Selecting Your CQMsAs you get started in selecting your quality measures, consult the MicroMD EMR Quality Measures Matrix to help select your measures. Use the matrix to identify which measures are available via which submission method (EHR direct, ReportingMD qualified registry, or claims-only) as well as to see measures grouped by our top specialties. Also consider the following when selecting measures:

• What measures did you report under PQRS that are most meaningful to your practice?

• Identify those PQRS measures above related to the new quality measures

• What quality measures are you already submitting to private payers that you could align with MIPS?

• Would a specialty measure set be more appropriate for your practice?

• Does your staff ACCURATELY and CONSISTENTLY enter patient data so the measurements reflect true to your practice? (If not…fix processes and re-train staff!)

CQM ResourcesA great reference is the MicroMD “Clinical Quality Measure Calculations 2017” document that provides guidance on how MicroMD gathers the data used to calculate the Clinical Quality Measures (CQMs) that MicroMD EMR supports and helps you troubleshoot how or why a patient does or does not appear in the denominator, numerator, or exclusion. And both MicroMD EMR and ReportingMD TOM qualified registry have dashboard tools to monitor Quality measure success. If you have any questions on how to use the MicroMD EMR administrative reporting dashboard tools, please contact Client Support.

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https://www.micromd.com/docs/MicroMD-EMR-2017-Quality-Measures-Matrix.xlsx

http://www.micromd.net/documentation/Incentive%20Programs/MicroMD-CQMs-Guide-2017.pdf

mailto:[email protected]


Improvement Activities (IAs)

PERFORMANCE CATEGORY SCORING & MICROMD EMR

Multiple MicroMD EMR Enabled IAsWhile many Improvement Activities take place outside of your PM or EMR software, MicroMD EMR offers functionality to help you meet the requirements for 26 Improvement Activities. And, ECs who report “Yes” to the completion of at least 1 of the 18 specified IAs, that are eligible for the Advancing Care Information (ACI) bonus score, can earn 10% of the available 15% bonus for the ACI category. MicroMD EMR includes functionality to help meet the requirements for 11 of those 18 ACI IAs!

Selecting Your IAsAs you get started in selecting your IAs, consult the MicroMD EMR Improvement Activities (IAs) Matrix to identify which IA MicroMD can help you complete, as well as to view activity descriptions, weighting, and/or if the measure can be used for the ACI bonus score. Also consider the following when selecting IAs:

• Are you currently involved in care coordination and documenting/billing as allowed under Medicare?

• Improving beneficiary engagement? Improving utilization of patient portal, education of disease-specific groups, and addressing satisfaction scores?

• Involved in your Community Needs Assessment under the ADA with your hospital and address equity issues?

• Integrating behavior and mental health?

• Addressing patient safety issues?

• Identify from the IA list any “High” vs. “Low” activities you currently perform. (Get your bonus points!)

• Which IAs can you also complete to count towards the ACI IA bonus?

MicroMD EMR includes functionality to help meet the requirements for 11 of those 18 ACI IAs!

https://www.micromd.com/docs/MicroMD-EMR-2017-Improvement-Activites-Matrix.xlsx


Advancing Care Information (ACI)

PERFORMANCE CATEGORY AND MICROMD EMR

Use Either Measure Set, Fulfill Base Score Requirements, Increase Score for Potential Positive Payment Adjustment, and Meet Bonus Score RequirementsIf the ACI measures apply to the EC, select which Measure Set under which to report – either the 2017 ACI Transition Measures Objectives and Measures (4 Measures) or ACI Measures Objectives and Measures (5 Measures). Then fulfill the required Base Score measures for a minimum of 90 days depending on the selected Measure Set:

1. Security Risk Analysis (Y/N Attestation)

2. e-Prescribing

3. Provide Patient Access

4. Send Summary of Care

5. Request/Accept Summary of Care

ECs can choose to submit up to 9 measures within their selected Measure Set for a minimum of 90 days for additional credit.

For bonus credit, ECs can:

• Report Public Health and Clinical Data Registry Reporting measures (5%)

• Use certified EHR technology to complete certain Improvement Activities (10%)

MicroMD EMR CEHRT Functionality to Help You Meet ACI RequirementsMicroMD EMR Version 13.5 and Higher will feature 2015 Edition CEHRT to meet almost all of BOTH ACI Measure Set requirements, as well as offer interface options and functionality to support the potential to earn additional credit for measures above the Base Score, as well as Bonus Scores.


continue reading on the next page

Advancing Care Information (ACI)Performance Category and MicroMD EMR continued

MicroMD CEHRT Integrated Add-ons Help You Meet ACI RequirementsSome of the ACI requirements are often met using tools that are typically separate from the EMR software, including patient portal for View, Download, and Transmit and direct secure email for securely sharing summaries of care or messaging ECs and patients. Other vendors may or may not integrate these tools with their EMR software under their CEHRT certification. MicroMD does. Both the Henry Schein Secure Chart Patient Portal and Surescripts CIN Direct Secure Email Addresses are integrated and certified under our 2015 Edition CEHRT to help ECs meet multiple requirements across both ACI Measure Sets, including:

• Secure Messaging (MicroMD Portal and Secure Messaging)

• Provide Patient Access (MicroMD Portal)

• View, Download, and Transmit (MicroMD Portal and Secure Messaging)

• Send a Summary of Care (Secure Messaging)

• Request/Access Summary of Care (MicroMD Portal and Secure Messaging)

• Patient Generated Health Data (MicroMD Portal)

• Health Information Exchange (Secure Messaging)

If you’re not using MicroMD EMR and integrated tools to meet requirements for the QPP performance categories or EHR Incentive Program Meaningful Use measures, be sure to confirm with your vendor(s) the continued CEHRT status for each product(s), what measures it captures and calculates data for, and how to locate each CHPL ID on the CHPL website for attestation.

Selecting Your ACI Measure SetAll MicroMD EMR clients participating in the QPP program will need to upgrade to MicroMD EMR Version 13.5 or Higher which will have 2015 Edition CEHRT. Because it will have 2015 Edition CEHRT, ECs will be able to also choose to meet the requirements for either measure set.


Advancing Care Information (ACI)Performance Category and MicroMD EMR continued

As you get started in selecting your ACI measure set, consult the MicroMD Advancing Care Information (ACI) Measures Matrix to identify the requirements for each measure set, as well as the add-on tools that can help you meet not only base requirements, but also to help increase your potential for performance category and bonus scoring. The matrix also features a tab that highlights the 18 Improvement Activities (IAs) that are applicable for Bonus Scoring and which of those can be completed with the help of MicroMD EMR. Also consider the following when selecting your ACI Measure Set:

• Which measures have the ECs already been successfully meeting or exceeding under the former EHR Incentive Program Meaningful Use requirements?

• Which IAs can MicroMD EMR help you achieve?

• Do the ECs want to report on 4 or 5 Base Score measures?

• What additional measures could ECs do for additional credit?

For the Security Risk Analysis, ECs should work with their IT professional to conduct a security risk analysis in accordance with the requirements in 45 CFR 164.308(a)(1). MicroMD EMR includes a host of security features that can assist ECs in reducing their security risk; contact MicroMD Client Support to receive a “MicroMD Security Features Overview” or access it in the MicroMD Lounge – QPP Information Center – Resources, Tools and Communications.

https://www.micromd.com/docs/MicroMD-EMR-2017-ACI-Objective-Measure-Sets-Matrix.xlsx

mailto:[email protected]


MICROMD QPP RESOURCESMicroMDClient Support Help Center: https://hsms.zendesk.com/hc/en-us MicroMD QPP FAQs: http://www.micromd.net/index.php?topic=980.0 MicroMD EMR QPP Training Contact: [email protected] Sign up for MicroMD QPP Client Alert Emails: https://www.micromd.com/sign-up-for-communications/ eBook – Demystifying MACRA, QPP and MIPs: https://www.micromd.com/docs/MicroMD-MIPS-Impact-eBook.pdf

eBook – Guide to Interpreting HIPAA Security: https://www.micromd.com/docs/MicroMD-Interpreting-HIPAA.pdf

Blogs: https://www.micromd.com/blogmd/

Educational webinar – MIPS 101 – What Practices Need to Know:http://www.micromd.net/index.php?topic=952.0

Educational webinar – Cybersecurity Basics for Providers: http://www.micromd.net/index.php?topic=957.0

MicroMD EMR Reference – Clinical Quality Measure Calculations 2017: http://www.micromd.net/documentation/Incentive%20Programs/MicroMD-CQMs-Guide-2017.pdf

MicroMD Lounge QPP Info Center Resources: http://www.micromd.net/index.php?board=93.0

MicroMD EMR Quality Measures Matrix: https://www.micromd.com/docs/MicroMD-EMR-2017-Quality-Measures-Matrix.xlsx

MicroMD EMR Improvement Activities (IAs) Matrix: https://www.micromd.com/docs/MicroMD-EMR-2017-Improvement-Activites-Matrix.xlsx

MicroMD EMR Advancing Care Information (ACI) Measures Matrix: https://www.micromd.com/docs/MicroMD-EMR-2017-ACI-Objective-Measure-Sets-Matrix.xlsx

MicroMD Security Features Overview: https://www.micromd.com/docs/MicroMD-Security-Features.pdf

MicroMD EMR Registry Interfaces Contact: [email protected]

Access MicroMD 2015 CEHRT Edition Tools Contact: [email protected]

CMS References/ResourcesQPP site: https://qpp.cms.gov/

Technical Assistance Resources for ECs: https://qpp.cms.gov/docs/QPP_Technical_Assistance_Resource_Guide.pdf

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