Quirk Healthcare: 2014 HIT Road Map
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Transcript of Quirk Healthcare: 2014 HIT Road Map
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2014 HIT Road Map Wednesday, February 12, 2014
Disclaimer: Nothing that we are sharing is intended as legally binding or prescrip7ve advice. This presenta7on is a synthesis of publically available informa7on and best prac7ces.
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2014 – An Overview
• NextGen 5.8 and KBM 8.3 upgrades • ICD-‐10 • Meaningful Use Stage 1 (MU1)
• Meaningful Use Stage 2 (MU2)
• Physician Quality ReporQng System (PQRS)
• PaQent-‐Centered Medical Home (PCMH)
• Accountable Care OrganizaQons (ACOs)
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OpQmal 2014 HIT Road Map
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NextGen 5.8 Upgrade
• Prerequisite for KBM 8.3 upgrade • ICD-‐10, SNOMED, and MU2-‐ready • Log-‐in • Advanced Audit • Race, ethnicity, and language • PaQent status designaQon • Syndromic surveillance measure • Diagnosis module • PaQent educaQon • ePrescribing • PaQent informaQon bar
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KBM 8.3Upgrade
• Non-‐KBM/KBM 8.1 or earlier • ICD-‐10 and MU-‐compliant • Upgrade cost and effort predicated on current KBM version
• Scope of conversion based on customizaQon, data mapping, and workflow changes
• Upgrade opQons – In-‐house – Outsource
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Do You Have The Right Hardware?
• Windows OperaQng System • Windows workstaQons
• Server size • Development environment
• SQL Server • Separate SQL server for reports, HQM, and Advanced Audit
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ICD-‐10
• October 1, 2014 • All enQQes covered by HIPAA affected • 14,000 ICD-‐9 codes grow to 68,000 ICD-‐10 codes • No impact on CPT codes • Version 5010 standards • Significant changes to clinical and revenue cycle systems
• Complex conversion to updated codes • System upgrades to expand data fields for longer codes • Staff retraining on new versions and codes
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What Are ICD-‐10 Codes?
• Granular code set developed by WHO for: – Increased clinical accuracy – Improved disease tracking – Disease trending
• More ICD-‐10 codes compared to ICD-‐9
ICD-‐9 14,000 diagnosis codes 4,000 procedure codes 5 digit numeric codes
ICD-‐10 68,000 diagnosis codes 87,000 procedure codes
7 digit alphanumeric codes
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Anatomy of ICD-‐10 Diagnosis Codes
• 3–7 digits • Digit 1 is alpha, including O and I but no U • Digit 2 is numeric • Digits 3–7 are alpha (not case sensiQve) or numeric • Decimal is aher third digit • Examples:
– A78 – Q fever – A69.21 – MeningiQs due to Lyme disease; and – S52.131a – Displaced fracture of neck of right radius, iniQal encounter for closed fracture
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Anatomy of ICD-‐10 Procedure Codes
• 7 digits • Alpha (not case sensiQve) or numeric digits – O and I not used to avoid confusion with 0 and 1
• No decimal • Examples: – 0FB03ZX – Excision of liver percutaneous approach, diagnosQc; and
– 0DQ10ZZ – Repair upper esophagus, open approach
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What is SNOMED?
• SystemaQzed Nomenclature of Medicine – Clinical Terminology
• InternaQonal standard for clinical terminology • Available through the NaQonal Library of Medicine • Enables communicaQon in common language
– Increased quality of paQent care across specialQes – Improved accuracy of paQent data analysis
• 19 “hierarchies” define the clinical concept • Increasing granularity • Very specific clinical concepts to define paQent condiQon • More complex than ICD-‐10 hierarchy
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The ICD-‐10-‐SNOMED RelaQonship
• SNOMED CT has beoer clinical coverage than ICD • Number of codes:
– SNOMED CT (Clinical findings): 100,000 – ICD-‐9-‐CM: 14,000 – ICD-‐10-‐CM: 68,000
• ICD focus is staQsQcal – Less common diseases subsumed under general categories – Aher-‐the-‐fact codes
• SNOMED CT is clinically-‐oriented – Used during care – Clinical relevance and user-‐friendliness
• Clinically coded data generates ICD-‐10 code for billing
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EffecQve ImplementaQon Strategy
Impact Analysis • IdenQfy current systems and work processes that use ICD-‐9 codes • Talk with payers about effect of ICD-‐10 implementaQon on provider contracts
Needs Assessment • Workflow and business process changes • Staff training • PracQce management vendor accommodaQons
Project Plan • ImplementaQon plan with clearing houses, billing services, and payers • Inventory systems and workflows • ConQngency plan for failed go-‐live
Budget • Time and costs related to implementaQon • Training • IT/IS upgrade • Assistance from outside vendor/consultant • PotenQal producQvity loss
Conversion • TransacQon tesQng using ICD-‐10 codes • Historic data conversion • Review coded data for claims reimbursement consistent with ICD-‐9 rates
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Training
• AHIMA recommendaQon: no more than six months before compliance deadline
• Approximately 16 hours for ambulatory coders and 50 hours for hospital coders – Physician pracQce coders learn ICD-‐10 diagnosis coding only – Hospital coders learn both ICD-‐10 diagnosis and ICD-‐10
inpaQent procedure coding • Specialty-‐specific ICD-‐10 training • ICD-‐10 coding training integrated into credenQal
maintaining CEUs • ICD-‐10 resources and training materials available through
CMS, professional associaQons and socieQes
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Meaningful Use
• Set of standards defined by the Centers for Medicare & Medicaid Services (CMS)
• Financial incenQves for using cerQfied EHR technology (CEHRT): – In a meaningful manner – For electronic exchange of health informaQon – Submit Clinical Quality Measures (CQM)
• Three stages – CreaQng informaQon – Exchanging informaQon – Focusing on improved outcomes
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MU Stages
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MU1
• InformaQon gathering • Two years – 90 days (Year 1) – Full year (Year 2)
• Different schedules for hospitals/CAHs and Eligible Providers (EPs) – Federal fiscal calendar (Hospitals/CAHs) – Calendar year (EPs)
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MU2
• All EPs must meet MU1 – Two or three years
• Focus on advanced clinical procedures – Rigorous health informaQon exchange – Enhanced ePrescribing and lab results requirements
– ConQnuity of care across mulQple sesngs – Increased paQent and family engagement
• Improved paQent care
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MU Structure
MU1
• 13 Core • 5/10 Menu • Total: 18
MU2
• 17 Core • 3/6 Menu • Total: 20
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MU Requirements
• Adopt or upgrade newly cerQfied EHR • ReporQng – Medicare
• First year: Any 90 day reporQng period • Beyond first year: Calendar quarter
– Medicaid • Any 90 day reporQng period
• PaQent Portal
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MU CalculaQons
• Denominator – All unique paQents – Subset of unique paQents
• Numerator – Number of unique paQents for whom required informaQon was recorded
Threshold = Numerator
Denominator
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MU ReporQng
• ReporQng through aoestaQon – ObjecQves – Clinical Quality Measures
• ReporQng may be: – yes/no answers – numerator/denominator aoestaQon
• Exclusions – Menu objecQves not applicable to every pracQce
• Certain objecQves/measures require 80% of paQents with records in CEHRT
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AoestaQon Checklist
• Ensure all EPs are properly registered • Run reports • Validate data • Complete aoestaQon worksheet
• Collect all supporQng documents
• Aoest before 3/31/2014 (MAO – 3/1/2014)
• Be prepared for audit
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What is PQRS?
• Voluntary, individual reporQng program – Quality measures for services provided to Medicare beneficiaries
• Started in 2007 – Tax Relief and Health Care Act
• IncenQve payments for parQcipaQon through 2014
• Financial penalty for non-‐parQcipaQon aher 2014 • Measures based on combinaQons of CPT, ICD and paQent age at the Qme of the encounter
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Provider ReporQng Methods
• Individual – EHR Direct Product that is CerQfied EHR Technology (CEHRT) – EHR data submission vendor that is CEHRT – Qualified PQRS Registry – ParQcipaQon through a Qualified Clinical Data Registry (QCDR) – Medicare Part B claims submioed to CMS
• Group PracQce ReporQng – GPRO Web Interface – Qualified PQRS Registry – EHR Direct Product that is CEHRT – EHR data submission vendor that is CERT – CMS-‐cerQfied survey vendor
*Group prac*ces repor*ng via GPRO must register for their selected repor*ng method by September 30, 2014.
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Measure SelecQon
• Individual Measures – 110 Claims Based Measures
– 201 Registry Based Measures
– 64 EHR Measures
• Group Measures – 25 Measures Groups
• Domains – Clinical Process / EffecQveness
– PaQent Safety
– PopulaQon / Public Health
– Efficient Use of Healthcare Resources
– Care CoordinaQon
– PaQent and Family Engagement
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Measure SelecQon
• Which measures should you choose? – Difficulty
– Relevance • Clinical condiQons usually treated – Cardiac, HTN, Diabetes, etc. • Types of care typically provided – e.g., prevenQve, chronic, acute
– Best performance
• 200 standardized quality measures
• Meet 50% threshold requirement – Choose a PQRS quality measure for services that are performed frequently. (This is the
minimum required to prevent penalty)
• IncenQve Payment or Avoid Penalty
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• TransformaQve model for delivery of care • Espouses team-‐based approach – Comprehensive and conQnuous paQent-‐driven care
– Evidence based healthcare and best pracQces – Consistent high quality care
• RelaQonship-‐based • Whole person • Team-‐based
PCMH -‐ Overview
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What TransformaQon Looks Like
• Constant innovaQon • Key data measurement and improvement targets
• Capitalizing the benefits of EHRs • Regular paQent communicaQon • ProacQvely scheduled paQent follow up • Expanded access to care • PaQent care plan coordinaQon
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NCQA RecogniQon Process
• Complete self-‐assessment to idenQfy gaps • Ensure all P&Ps were in effect for at least 90 days
• Run reports • Collate all supporQng documents
• Submit applicaQon
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• Builds off PaQent-‐Centered Medical Home – Coordinated care to ensure seamless transiQon between services and levels of care
• Formalizes PaQent-‐Centered Medical Neighborhoods – Brings together primary care physicians, specialists, and hospitals
• Reimbursement amount linked to quality • Launched in 2012
Accountable Care OrganizaQons (ACOs)
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ACO Technology Infrastructure
Enterprise Revenue
Cycle Management
Electronic Health
Record
Health InformaQon Exchange InformaQcs
PaQent Engagement
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Technology ConsideraQons
PaQent Engagement
Data AggregaQon
PopulaQon Health
Management
Privacy and Security
Clinical and AdministraQve Date Exchange
Performance Management
ReporQng Infrastructure Finances
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Startup Costs by Beneficiaries
0
500,000
1,000,000
1,500,000
2,000,000
2,500,000
3,000,000
5,000 -‐ 15,000 16,000 -‐ 25,000 26,000+
Es:mated
Start Up Co
sts
Aligned Beneficiaries
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IT Costs
0 100,000 200,000 300,000 400,000 500,000 600,000 700,000 800,000 900,000
1,000,000
5,000 -‐ 10,000
10,000 -‐ 15,000
15,000 -‐ 25,000
26,000+
Costs
Aligned Beneficiaries
Internal IT
External Vendor