Table of Contents - Practice Director Director MIPS 2017... · Table of Contents MIPS 2017 Overview...

2017MIPSGUIDE|12/29/2017

PracticeDirectorSupport844.574.2020|1

TableofContents

MIPS2017Overview.................................................................................................3-5MIPSComponents:.....................................................................................................3

DeterminingEligibilityorExclusion….……………………………………………………………..….3-4GrouporIndividualParticipation…………………………………………………………………………..4PickYourPace……………………………………………………………………………………………………….4StartingDate…………………………………………………………………………………………………………5

Quality...................................................................................................................6-26Overview:...................................................................................................................6QualityAOAMORERegistrySubmission...............................................................6-19

AOAMOREenrollment……………………………………………………………………………………6-7 AOAManagementSetup………………………………………………………………………………..8-9 AOAMoreQualityMeasuresTable……………………………………………….……………10-11 GuidelinesforEnteringQualitydatainPracticeDirectorforRegistrySubmission ……………………………………………………………………………………………………………………11-14 AOASubmissionTrialandProductionSubmissionRun……………………………….15-20 UseAOAMORERegistryDashboardtotrackprogress…………………………………….20 OR(YouwillfollowdirectionsforRegistryORClaimsSubmission)QualityClaimsSubmission………………………………………………………………………………21-26 ClaimsQualityMeasuresTable……………………………………………………………………21-22 GuidelinesforEnteringQualitydatainPracticeforClaimsSubmission……….23-26 TrackingProgresswithCQMVerficationReport…………………………………………..…..26 ExampleQualityComponentScore…………………………………………………………………..26

ClinicalPracticeImprovementActivities(CPIA)....................................................27-28Overview…………………………………………………………………………………………………………..27

CPIAMeasures……………………………….………………………………………………………………..27ReportingCPIA………………………………………………………………………………………………….27 ExampleCPIAComponenetScore…………………………………………………………………….28

AdvancingCareInformation(ACI)........................................................................29-72Overview..................................................................................................................29

PerformanceScoreTable…………………………....……………………………………………………29 2017ACIObjectivesandMeasuresTable………….…………………………………………30-31

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BaseandPerformanceMeasureInstructions…………….…………………………………32-72SecurityRiskAnalysis……..…………………………………………………………………………….32 ElectronicPrescribing………………………………………………………………………………33-34HealthInformationExchange……………………………………………………..………35-41 ProvidePatientAccess…………………………………………………………………………….42-50 MedicationReconciliation……………..……………………………………………………....51-55 PatientSpecificEducation……………………………..………………………………………..56-59 SecureMessaging………………………………..………………………………………………….59-63 ViewDownloadTransmit(VDT)…………………………….…………………………………64-66 TrackingACIprogress…………………………………………………………………………………..66-72 2017ACITransitionReport………………………………………………………………………66-70 2017ACITransitionVerificationReport……………………………………………….....70-72 ExampleScoringforACI……………………………………………………………………………………72

ResourceUse/Costin2017……………………………………………………………………………………….73CalculatingYourFinalScorein2017………………………………………………………………….…73-75PublicReporting……………………………………………………………………………………………………….75

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MIPSOverviewIn2017theCentersforMedicareandMedicaidServices(CMS)ischangingthewayitpaysdoctors.ThenewsystemiscalledtheMerit-BasedIncentiveProgram(MIPS).MIPScombines4programsintoone.PQRS,MeaningfulUse,ValueBasedModifier,andanewcategoryClinicalPracticeImprovement.CMSismakingthischangeto:

• StreamlineReporting• StandardizeMeasures• EliminateDuplicateReporting• Incentivizecarethatfocusesonimprovedqualityoutcomes

CMSwillgradeprovidersonascaleof1-100todetermineyourpaymentforprovidingservices;thisisknownasyourMIPSFinalScoreandisbasedon4components:

• Quality–ThisisbasicallyPQRS/CQM/eCQM,asyoucurrentlyknowit.Thisareaholdsa60%weightonyourfinalscore

• ClinicalPracticeImprovementActivities(CPIA)–Thisisnewin2017.Thisareaholdsa

15%weightonyourfinalscore

• AdvancingCareInformation(ACI)–ThisisbasicallyMeaningfulUse,asyouknowitwithmoreflexibility.Thisareaholdsa25%weightonyourfinalscore

• ResourceUse–Thisareaholdsa0%weightin2017

DetermineEligibility:YouareeligibletoparticipateinMIPSif:

• YouareaPhysician,PhysicianAssistant,NursePractitioner,ClinicalNurseSpecialist,orCertifiedRegisteredNurseAnesthetist

• Youbillmorethan$30,000,inMedicarePartBallowedchargesORmorethan100

Medicarepatients. *Ifyoubilllessthanorequalto$30,000inMedicarePartBallowedchargesOR lessthanorequalto100Medicarepatientsyouareexempt.Thismeansyou willnotgetpositiveornegativereimbursements

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*CMSisgoingtobelookingattwobillingperiodstodetermineifyouareeligible fortheexclusion.Ifyouareunder$30,000or100patientsinEITHERperiod youwillbeeligibleforMIPSexclusion9/1/2015–8/31/2016or9/1/2016- 8/31/2017

*IfyouhavenotreceivedaneligibilityletterfromCMS,youcancheckyoureligibilityonlinehttps://qpp.cms.gov/participation-lookup

• If2017isyourfirstyearsubmittingclaimstoMedicare,youarenoteligibleto

participateOnceyoudetermineEligibilitythendecideifyouwillparticipateasaGrouporIndividually.GrouporIndividualParticipationYoudecidewhetheryouwanttoparticipateasanIndividualorasaGroup.OnceyouselecthowyouaregoingtoparticipateeveryonemustfollowthatrouteIndividual–Paymentadjustmentisbasedonyourperformance.AnindividualisdefinedasasingleNPItiedtoasingleTaxIdentificationNumberGroup–Paymentadjustmentsarebasedonthegroupperformance.Agroupisdefinedas2ormoreclinicians(NPI’s)whoshareacommonTaxIdentificationNumber.Whencalculatingthethresholdforparticipationthetotalofallproviders’allowablechargesmustbemorethan$30,000or100MedicarePatientsThereisNOregistrationorenrollmentyousimplybeginparticipatingThenextstepistoselectyourPacefor2017.PickyourPacePickYourPacein2017providesflexibilityandoptions.WerecommendchoosingtheFullParticipationOptiontomaximizeyourreimbursements

• FullParticipation-Reportforafull90-dayperiodormore.Youmayearnuptoa4%paymentincreaseonallMedicarePartBclaimsin2019

• PartialParticipation–Reportforafull90-dayperiodormoreandreportmorethanone

qualitymeasure,ormorethanoneimprovementactivity,ormorethantherequiredmeasuresinadvancingcareinformationperformancecategory.Successful“partialparticipation”youmayearnasmallpaymentincreaseonallMedicarePartBclaimsin2019

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• TestParticipation–Reportonemeasureinqualityperformancecategory;oroneactivityintheclinicalpracticeimprovementscategory;orreporttherequiredbasemeasuresoftheadvancingcarecategory.YouwillavoidapaymentdecreaseonallMedicarePartBclaimsin2019

• Don’tparticipate–Ifyouchoosenottoparticipateyouwillreceivea4%negative

adjustmentonallMedicarePartBclaimsin2019Thefinalstepistobeginparticipatingaccordingtothepaceyouhaveselected.StartingDateIfyouarereadyyoucanbeginJanuary1,2017.Ifyouaren’treadytobeginJanuary1,youcanchoosetostartanytimebetweenJanuary1andOctober2,2017.WheneveryoustartyouwillneedtosendinyourperformancedatabyMarch31,2019

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QualityProviderswillreporton6qualitymeasuresincludinganoutcomemeasure.Ifyoucannotreportanoutcomesmeasure,youmustreportonhighprioritymeasure.Eachmeasurecountsfor0-10points.YoucanearnBonuspointsonsomemeasuresandalsoforreportingmorethanoneoutcomesorhighprioritymeasure.Formaximumreimbursementsyoumustreporton50%ofyourpatientsacrossallpayersforatleast90days.Qualitymeasuresarerepresentedinmanyways…CQM,eCQM,PQRS,CMS.Qualityisworth60%weightonyourcompositescoreThequalitycategorywithinPracticeDirectorcanbereportedonviaAOAMORERegistryorClaims(Youcannotmixclaimsandregistryyoumustselectoneortheother).WerecommendusingtheRegistryforreportingandsubmission.RegistrySubmission:

• FreeforAOAMembers• ElectronicPQRSSubmission• HelpsyoutomaximizereimbursementsunderMIPSin2017andon

Youwillreceivepointsforeachmeasurethatyouperform:0Pointsifyoudonothing3PointsforsubmittingANYdatapermeasure(youget3pointsjustfortrying)4-10Pointsifyousubmitgreaterthanorequalto20eligiblepatientsandrecordproperfindingsBonusPoints:2pointsforeachadditionaloutcomemeasure1pointforeachadditionalhighprioritymeasureThepointsarenotcalculatedona1to1ratio,i.e.ifyoudo90%youmaynotget9points,youmaygetmoreorlesssincebenchmarkingisused.Benchmarkingcomparesyourresultsversusotherprovidersandthetechnologyyouareusing(iesubmissionthroughRegistrymaybeworthmorethanclaims)ThefirststepinQualityistodecidewhetheryouaregoingtouseRegistry(p.6-19)orClaims(p.20-25)reporting.OnceyouhavedeterminedthemethodusethedirectionsbelowtorecordyourdatainPracticeDirector

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QualityAOAMORERegistrySubmissionCompleteenrollmentwithAOAMOREifyouhavenotalreadydonesobygoingtotheAOAMOREwebsitewww.aoa.org/moreWhenthewebsitelaunchesselecttheENROLLbuttonlocatedontherightsideofthescreenFollowthepromptstocompleteregistrationIfyouhavequestionsonwhetherornotyouhaveregisteredoronhowtoregisteryoucanclicktheHELPDESKbuttonandamemberoftheAOAMOREteamwillfollowupwithyou

PracticeDirectorVersions5.1.63andaftercontainaccesstoAOAMORE.ToverifyyourversionfromPracticeDirector:SelectHelpSelectAboutPracticeDirectorTheAboutdialogwillopenVerifythatBuild#isequalorgreaterthan5.1.63

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• Ifthebuild#isequalorgreaterthan5.1.63youcancompletetheAOAManagementsetupwithinPracticeDirector

• Ifthebuild#islessthan5.1.63youcanruntheCDUtoupdatePracticeDirectortothemostrecentversion

AOAManagementSetupAOAManagementSetupisaone-timestep.Onceyouareonversion5.1.63orgreateryoucansetupPracticeDirectortocommunicatewithAOAMORERegistry.TheinformationbelowisalsocoveredinTrainingVideo28.1AOARegistryMenuItems,locatedattraining.practicedirector.com.YoucancontactPracticeDirectorSupportifyouareunsureofyouronlinetrainingUsernameandPassword.LogintoPracticeDirector

SelectEHROptionsSelectAOARegistrySelectAOAManagement

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TheAOAManagementdialogwillopen(Allfieldsarerequiredforsubmission)

1. PracticeDirectorwillkeepthefirstfourdatesupdatedforyou.2. ClickonthelookuptoselectanyAOAprovidertobetheLegalAuthenticator.The

authenticatorassumeslegalresponsibilityofthegeneratedQRDACategoryIfilesbeingsubmittedtotheAOARegistry.Selectthedatethattheselectedprovidertookresponsibility.

3. ClickonthelookuptoselectanyAOAprovidertobetheCustodian.ThecustodianrepresentstheorganizationthatisinchargeofmaintainingthegeneratedQRDACategoryIfilesbeingsubmittedtotheAOARegistry

4. SubmissionDate&Time-FortheDayyoucanselectbetweenWednesdayorThursdayforsubmission.AOArequirestheAOARegistryEndDatetobepriortotheweeklysubmissiondeadline.AOAreleasestheweeklyproviderwhitelistonWednesdayatnoonandtheAOAweeklysubmissiondeadlineisFridayat5:00pm.ThedefaultselectionisWednesday.Youmayspecifyanytimeforsubmissionafter6:00pmonWednesdayorThursday.

5. SelectEnable6. SelectSave

OncesavedyourinformationwilltransfertoAOAMORERegistryperyoursetupspecifiedinAOAManagement

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PracticeDirectorandAOAMOREarestructuredtoreportonthefollowingmeasures:

MeasureName MeasureDescription eMeasureID NQF Additional

InfoClosingthe

ReferralLoop:Receiptof

SpecialistReport

Percentageofpatientswithreferrals,regardlessofage,forwhichthereferringproviderreceivesareportfromtheprovidertowhomthepatientwasreferred

CMS50v5

N/A

BonusPointsHighPriority

ControllingHighBloodPressure

Percentageofpatients18-85yearsofagewhohadadiagnosisofhypertensionandwhosebloodpressurewasadequatelycontrolled(<140/90mmHg)duringthemeasurementperiod

CMS165v5

18

BonusPointsOutcome&HighPriority

PreventiveCareandScreening:TobaccoUse:ScreeningandCessation

Intervention

Percentageofpatients18-85yearsofagewhohadadiagnosisofhypertensionandwhosebloodpressurewasadequatelycontrolled(<140/90mmHg)duringthemeasurementperiodPercentageofpatientsaged18yearsandolderwhowerescreenedfortobaccouseoneormoretimeswithin24monthsANDwhoreceivedcessationcounselinginterventionifidentifiedasatobaccouser

CMS138v5

28

Diabetes:EyeExam

Percentageofpatients18-75yearsofagewithdiabeteswhohadaretinalordilatedeyeexambyaneyecareprofessionalduringthemeasurementperiodoranegativeretinalexam(noevidenceofretinopathy)inthe12monthspriortothemeasurementperiod

CMS131v5

55

Diabetes:HemoglobinA1c(HbA1c)PoorControl(>9%)

Percentageofpatients18-75yearsofagewithdiabeteswhohadhemoglobinA1c>9.0%duringthemeasurementperiod

CMS122v5

59

BonusPoints,Outcome&HighPriority

PrimaryOpen-AngleGlaucoma(POAG):Optic

NerveEvaluation

Percentageofpatientsaged18yearsandolderwithadiagnosisofprimaryopen-angleglaucoma(POAG)whohaveanopticnerveheadevaluationduringoneormoreofficevisitsw/in12months

CMS143v5

86

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MeasureName MeasureDescription eMeasureID NQF Additional

InfoDiabetic

Retinopathy:Documentationof

PresenceorAbsenceof

MacularEdemaandLevelofSeverityofRetinopathy

Percentageofpatientsaged18yearsandolderwithadiagnosisofdiabeticretinopathywhohadadilatedmacularorfundusexamperformedwhichincludeddocumentationofthelevelofseverityofretinopathyandthepresenceorabsenceofmacularedemaduringoneormoreofficevisitswithin12months

CMS167v5

88

DiabeticRetinopathy:

CommunicationwiththePhysician

ManagingOngoingDiabetes

Care

Percentageofpatientsaged18yearsandolderwithadiagnosisofdiabeticretinopathywhohadadilatedmacularorfundusexamperformedwithdocumentedcommunicationtothephysicianwhomanagestheongoingcareofthepatientwithdiabetesmellitusregardingthefindingsofthemacularorfundusexamatleastoncewithin12months

CMS142v5

89


DocumentationofCurrent

MedicationsintheMedicalRecord

Percentageofvisitsforpatientsaged18yearsandolderforwhichtheeligibleprofessionalatteststodocumentingalistofcurrentmedicationsusingallimmediateresourcesavailableonthedateoftheencounter.ThislistmustincludeALLknownprescriptions,over-the-counters,herbals,andvitamin/mineral/dietary(nutritional)supplementsANDmustcontainthemedications'name,dosage,frequencyandrouteofadministration.

CMS68v6

419


GuidelinesforenteringQualitydatawithinPracticeDirectorforComplianceUserswillnoticethatyounolongerhavetoenterPQRScodesincoding/final.Byfollowingthedocumentationguidelinesbelow,youwillsatisfytherequirementfordatacalculation.Werecommendcompletingasmanymeasuresasyoucan,CMSwilltakeyourtop6scoringmeasures.Theguidelinesbelowwillnotshowallcodingpossibilities.Toseethefulllistingofcodesets,pleaseseetheMeasuresHelptabwithinEHROptions>AOARegistry>AOAeCQMHelp.Eachofthesemeasuresisalsoreviewedinourtrainingvideoslocatedat:http://training.practicedirector.com

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NQF0050ClosingofReferralLoop:receiptofspecialistreportVideo28.5

• Anypatientwhohasbeenreferredout,regardlessofage• Medicalor92002,92004,92012,and92014coding• Referralsavedtoexam

o SelectPatientExamandselectEdito Scantheletterfromthespecialistwereferredo UndertheDocuments/ReferralsclickAddo Importthescannedlettero UnderreferraltypechoosetheClinicalConsultationReport

UnderReferralDocumentsyouthenMUSTchoosetheoutgoingreferralNQF0018Hypertension:BPMeasurement(onlyifBPcontrolledthenumeratorwillbepopulated)Video28.6

• Patientage18–85duringmeasureperiod• Hasancompletedofficevisitsrecorded(Medical99xxx)duringmeasurementperiodin

Coding/Final• Musthave2visitswithintheyear• HypertensiondiagnosisrecordedinICD-10inCoding/Final<=6monthsstartafterstart

ofmeasurementperiodinCoding/Final• OrDiagnosisofEssentialHypertensionendsbeforethestartofthemeasurementperiod• RecordcontrolledrangeofSystolic<140andDiastolic<90BPinVitalssectionofthe

EHR

NQF0028PreventiveCareandScreening:TobaccoUse:ScreeningandCessationInterventionVideo28.7

• Patientage18yearsandolder• Atleast2officevisitsrecorded(Medical99xxxor92xxx)inCoding/Finalwithin24

months• SmokingstatusselectedinRespiratorysectionofROS

o Ifanon-smoker,thisisallthatisneededo Ifacurrentsmoker,willneedaCessationCounselingcoderecorded(99406or

99407)o DenominatorException,ifyouselecttheTobaccoUseStatusasUnknown,then

youwillbeabletoselectaMedicalReasonforNotDone

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NQF0055DiabetesEyeExam

Video28.2

• Patients18-75• PatienthasadiabetesdiagnosisinCoding/Final• Hashadaretinalordilatedeyeexamduringthereportingperiod,oranegativeretinal

examwithnoevidenceofretinopathy12monthsprior• 92xxxor99xxxcodes• PDFundoscopysectionofexamcompleted(dilatedmethod,etc.)

NQF0059Diabetes:HemoglobinA1CPoorControl

Video28.3

• Patients18-75yearsold• CPTMustbe99xxx• PatienthasdiabetesdiagnosisinCoding/Final(E10.xxx,E11.xxx,E13.xxx)• HashadhemoglobinA1C>9%duringthereportingperiod• ResultsfromhemoglobintestenteredasLabResultinPracticeDirectorEHR

Options>Optometry>LabTestReports.OneofthefollowingLOINCcodes4549-2,17856-6,4548-4willimportwiththelabresult

• LabResultsshowthatA1Cisstillnotcontrolledandisstill>9%• Youwantthismeasuretohavesmallpercentage

NQF0086POAG:OpticNerveEvaluationVideo28.8

• Patients18andolder• Atleast2officevisitsrecorded(99xxxor92xxx)inreportingperiodinCoding/Final• POAGdxcoderecordedinCoding/Final(H40.xxx)• CuptoDiscRatioresultsrecordedinDiscAssessmentsection• AppearancerecordedinDiscAssessmentsection• DenominatorException,ifnotdonerecordinDiscAssessmentbyselectingcheckbox

andMedicalReasondropdown

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NQF0088DiabeticRetinopathyExaminationVideo28.9

• Patient18yearsandolder• Atleast2officevisitsrecorded(99xxxor92xxx)withinreportingperiodinCoding/Final• DiabeticRetinopathydxrecordedinCoding/Final(E08.3xx,E09.3xx,E10.3xx,E11.3xx,

E13.3xx)• PDEHRMacularEdemaandRetinopathySeverity(Severitycannotbenormal)fields

completedinthePosteriorSegmentsection.• DenominatorExceptionlocatedinPosteriorSegmentselect“EvaluationnotPerformed”

andthenselectMedicalorPatientReason

NQF0089DiabeticRetinopathyCommunicationVideo28.10

• Patients18yearsandolder• CPT92xxxor99xxx• NQF0088ismet• CreateReferralletterandsavetoEHR,includingthePosteriorSegmentsectioninreport• DenominatorExceptionlocatedinPosteriorSegmentselectoneoftheFindingsnot

communicated,andthentheMedicalorPatientReason

NQF0419DocumentationofCurrentMedicationintheMedicalRecordVideo28.11

• Patients18yearsandolder• Atleast1officevisitrecorded(92xxxor99xxx)inCoding/Final• AddallcurrentmedicationstotheeRXportal• Checkthe“Documentedallcurrentmedications”boxinCurrentMedicationsectionof

EHR• DenominatorException,CurrentMedications,ifnotdone,select“Documentingall

CurrentMedicationswasnotdone”andthenSelecttheMedicalReasonfromthedropdown.

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AOASubmissionTrialandProductionSubmissionRunPracticeDirectorhasgiventheusertwooptionsforverifyinginformationthathasbeenorwillbetransmittedtotheAOA.AOATrialSubmissionRunwillallowyoutoviewandorsavetheresultsofthedatathatwouldbesentintheSubmissionRun.ThiswillallowyoutoverifythatallanticipatedpatientsaregoingtobetransmittedtoAOA.IfanyproblemsaredetectedyoucanresolvethembeforetheProductionrunoccurs.TrialSubmissionRunSelectEHROptionsSelectAOARegistrySelectAOATrialSubmissionRun

1. Provider–selectthedesiredproviderfromthedropdown2. Thedatefieldsarepre-populatedwiththedatessetupinAOAManagement,youcan

overrideanydatebyclickingonthecalendar3. Destination–Leaveempty(thisisforthePracticeDirectorsupportteamto

troubleshootfileproblemsifneeded).4. SelectOKtosave

YouwillseetheAOATrialSubmissionRundialogshowingtheprogress.YoucanwaitorselectRuninBackgroundsothatyoucancontinuetowork

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Oncetheruniscompletetheresultswilldisplayonthescreenorinthetray(ifyouselectedRuninBackground)

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1. TheProvider,eCQMReportingPeriod,andAOARegistryReportingPeriodwilldisplay2. EachNQFwilldisplaywiththenumeratoranddenominatorcountsthatwillbesentto

AOAMOREintheProductionRun ToseethepatientsthatmakeupthecountsyoucangotoEHROptions>AOA Registry>AOAeCQMVerificationReport

3. Ifthereareanypatientsthatwillnotpushuptheirnamesandtheissuewillbelisted,ifnoproblemsyouwillsee“NoproblematicpatientQRDAIdatawasdetected”

4. Youwillseealistofpatientsthathavebeenseenbytheprovidersincethelastsubmission.

5. YoucanselectSavetoSavethereportlocallyandthenyoucanprintfromthesavedlocationifdesired

ProductionSubmissionRunReport TheProductionSubmissionRunReportisusedtoviewwhatwassenttotheAOAduringtheweeklyrun.TheReportwillshowyouifthereareanypatientsthatwerenottransmittedandwilllistthereasonwhy.Youcanusethisreporttofixthedatabeforethenextscheduledupload.ToruntheProductionSubmissionRunReportSelectEHROptions

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SelectAOARegistrySelectAOAProductionSubmissionRunReportsTheAOAProductionSubmissionRunReportdialogwillopen

IntheupperlefthandsideofthescreenyouwillseealistofProviderNamesandtheSubmittedDate.TheuserisabletosortbytheProviderandortheSubmittedDatebyclickingontheheader.*NoteRunInformationisonlyretainedfor90daysToviewdetailsaboutaspecificProviderandSubmittedDate,selectthedesiredinformation.Onceselecteddataabouttherunwilldisplayontherightsideofthescreen

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1. TheProvider,eCQMReportingPeriod,andAOARegistryReportingPeriodwilldisplay2. AlistofeachNQFwilldisplayalongwiththesubmittedNumeratorandDenominator

counts ToseethepatientsthatmakeupthecountsyoucangotoEHROptions>AOA Registry>AOAeCQMVerificationReport

3. Thisarealistsanypatientsthathaderrorsandcouldnotbesubmitted.BeforethenextAOAsubmissionyouwillwanttoresolvetheerrors

4. SelectSavetosavethereportlocally.Oncesavedlocally,theinformationcanbeprinted

UsetheAOAMORERegistrydashboardtotrackyourprogressTheAOAwillprovideyouwillaccesstoanonlinedashboardthatwillallowyoutotrackyourprogressforeachmeasure

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QualityClaimsSubmissionPracticeDirectorisstructuredtoreportonthefollowingmeasuresforclaimsbasedreporting:

MeasureName MeasureDescription eMeasureID NQF PQRS Additional

Info

ClosingtheReferralLoop:Receiptof

SpecialistReport

Percentageofpatientswithreferrals,regardlessofage,forwhichthereferringproviderreceivesareportfromtheprovidertowhomthepatientwasreferred

CMS50v5

N/A

None


ControllingHighBloodPressure

Percentageofpatients18-85yearsofagewhohadadiagnosisofhypertensionandwhosebloodpressurewasadequatelycontrolled(<140/90mmHg)duringthemeasurementperiod

CMS165v5

18

G8752orG8753

BonusPoints

Outcome&High

Priority

PreventiveCareandScreening:TobaccoUse:ScreeningandCessation

Intervention

Percentageofpatientsaged18yearsandolderwhowerescreenedfortobaccouseoneormoretimeswithin24monthsANDwhoreceivedcessationcounselinginterventionifidentifiedasatobaccouser

CMS138v5

28

4004For1036F

Diabetes:EyeExam

Percentageofpatients18-75yearsofagewithdiabeteswhohadaretinalordilatedeyeexambyaneyecareprofessionalduringthemeasurementperiodoranegativeretinalexam(noevidenceofretinopathy)inthe12monthspriortothemeasurementperiod

CMS131v5

55

Diabetes:HemoglobinA1c(HbA1c)PoorControl(>9%)

Percentageofpatients18-75yearsofagewithdiabeteswhohadhemoglobinA1c>9.0%duringthemeasurementperiod

CMS122v5

59

BonusPoints,

Outcome&High

Priority

2017MIPSGUIDE|12/29/2017


MeasureName MeasureDescription eMeasureID NQF PQRS Additional

Info

PrimaryOpen-AngleGlaucoma(POAG):Optic

NerveEvaluation

Percentageofpatientsaged18yearsandolderwithadiagnosisofprimaryopen-angleglaucoma(POAG)whohaveanopticnerveheadevaluationduringoneormoreofficevisitsw/in12months

CMS143v5

86

2027F


DocumentationofPresenceorAbsenceof

MacularEdemaandLevelofSeverityofRetinopathy

Percentageofpatientsaged18yearsandolderwithadiagnosisofdiabeticretinopathywhohadadilatedmacularorfundusexamperformedwhichincludeddocumentationofthelevelofseverityofretinopathyandthepresenceorabsenceofmacularedemaduringoneormoreofficevisitswithin12months

CMS167v5

88

None


CommunicationwiththePhysicianManaging

OngoingDiabetesCare

Percentageofpatientsaged18yearsandolderwithadiagnosisofdiabeticretinopathywhohadadilatedmacularorfundusexamperformedwithdocumentedcommunicationtothephysicianwhomanagestheongoingcareofthepatientwithdiabetesmellitusregardingthefindingsofthemacularorfundusexamatleastoncewithin12months

CMS142v5

89

5010F+G8397orG8398


DocumentationofCurrent

MedicationsintheMedicalRecord

Percentageofvisitsforpatientsaged18yearsandolderforwhichtheeligibleprofessionalatteststodocumentingalistofcurrentmedicationsusingallimmediateresourcesavailableonthedateoftheencounter.ThislistmustincludeALLknownprescriptions,over-the-counters,herbals,andvitamin/mineral/dietary(nutritional)supplementsANDmustcontainthemedications'name,dosage,frequencyandrouteofadministration.

CMS68v6

419

G8427orG8430orG8428


2017MIPSGUIDE|12/29/2017


GuidelinesforenteringQualitydatawithinPracticeDirectorforComplianceUserswillcontinuetodocumentthesemeasuresastheyalwayshaveinthePracticeDirectorEHRFinal/CodingSection.InsuranceBillerswillcontinuetoselectthePQRScodesforclaimssubmissionontheInvoiceScreen.

Werecommendcompletingasmanymeasuresasyoucan,CMSwilltakeyourtop6scoringmeasures.Theguidelinesbelowwillnotshowallcodingpossibilities.Toseethefulllistingofcodesets,pleaseseetheMeasuresHelptabwithinEHROptions>ClinicalQualityMeasures>CQMHelpEachofthesemeasuresisalsoreviewedinourtrainingvideoslocatedat:training.practicedirector.comNQF0018Hypertension:BPMeasurement(onlyifBPcontrolledthenumeratorwillbepopulated)Video11.2

• Patientage19–85duringmeasureperiod• Hasancompletedofficevisitsrecorded(Medical99xxx)duringmeasurementperiodin

Coding/Final• HypertensiondiagnosisrecordedinCoding/Final<=6monthsstartafterstartof

measurementperiodinCoding/Final• OrDiagnosisofEssentialHypertensionendsbeforethestartofthemeasurementperiod• RecordcontrolledrangeofSystolic<140andDiastolic<90BPinVitalssectionofthe

EHR

NQF0028PreventiveCareandScreening:TobaccoUse:ScreeningandCessationInterventionVideo11.4

• Patientage18yearsandolder• Atleast2officevisitsrecorded(Medical99xxxor92xxx)inCoding/Final

2017MIPSGUIDE|12/29/2017


• SmokingstatusselectedinRespiratorysectionofROSo Ifanon-smoker,thisisallthatisneededo Ifacurrentsmoker,willneedaCessationCounselingcoderecorded(99406or

99407)

NQF0050ClosingofReferralLoop:receiptofspecialistreportVideo11.5

• Anypatientwhohasbeenreferredout,regardlessofage• 92xxxcodesdoNOTcount• Referralsavedtoexam

CompletethereferralloopbyimportingthereferralreportbackintotheEHR.NQF0419DocumentationofCurrentMedicationintheMedicalRecordVideo11.9

• Patients18yearsandolder• Atleast1officevisitrecorded(92xxxor99xxx)inCoding/Final• AddallcurrentmedicationstotheERxportal• ChecktheDocumentedallcurrentmedicationsboxinCurrentMedicationsectionof

EHR

NQF0086POAG:OpticNerveEvaluationVideo11.6

• Patients18andolder• Atleast2officevisitsrecorded(99xxxor92xxx)inreportingperiodinCoding/Final• POAGdxcoderecordedinCoding/Final• OpticNerveHeadEvaluationrecorded(2027F)inCoding/Final• CuptoDiscRatioresultsrecordedinDiscAssessmentsection• AppearancerecordedinDiscAssessmentsection

NQF0088DiabeticRetinopathyExaminationVideo11.7

• Patient18yearsandolder• Atleast2officevisitsrecorded(99xxxor92xxx)withinreportingperiodinCoding/Final• DiabeticRetinopathydxrecordedinCoding/Final• MacularorFundusExamrecorded(2021F)inCoding/Final• PDEHRMacularEdemaandRetinopathySeverity(Severitycannotbenormal)fields

populatedinthePosteriorSegmentsection.

NQF0089DiabeticRetinopathyCommunicationVideo11.8

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• Patients18yearsandolder• NQF0088ismet• CreateReferralletterandsavetoEHR,includingPosteriorSegmentsectioninreport• Findingcommunicatedtophysicianrecorded(5010F)inCoding/Final

NQF0024WeightAssessmentandCounselingforChildrenandAdolescents

Video11.3

• Patients3-17yearsold• Officevisitrecorded(Medical99xxx)

Numerator1• Height/Weight/BMIdocumented• CodeforBMI

Numerator2• CounselingforNutritionindicated,codesrecordedinCoding/Final(97802,97803,

97804)

Numerator3• ActivityCounselingenteredinVitalSignssection

NQF0421PreventiveCareandScreening:BMIScreeningandFollow-up(Adult)Video11.10N1>=65(normalBMIrange>23<30)

• Atleast1officevisitrecorded(99xxx)• WeightandheightrecordedinEHRVitalssection• IfabnormalBMI,Follow-upManagementPlanrecorded(97804,98961,G8417for>

normalorG8418for<normal)OR• CreateReferralLetterincludingVitalssection

N2age18-64(normalrange18.5<25)

• Atleast1officevisitrecorded(99xxx)• WeightandheightrecordedinEHRVitalssection• IfabnormalBMI,Follow-upManagementPlanrecorded(97804,98961,G8417>normal

orG8418<normal)OR• CreateReferralLetterincludingtheVitalssection

ImportantInformationaboutCQMNumeratorCountsAsofOctober1,2016,theICD10listwasupdatedfordiagnosingpatients.However,thevaluesetsusedtodetermine/calculatetheClinicalDecisionSupportinterventionsandtheClinical

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QualityMeasureshaveNOTbeenupdatedtoincludethenewlyreleasedICD10codes.Becauseofthis,bothyoursysteminterventionsmaytriggerandyourCQMcountsmayhavelowernumerators.Wehavecontactedthegoverningbodiesaskingforthenewvaluesets.Wehavenotyetreceivedresponses.Oncethenewvaluesetsarereleasedandimplemented,thesystemwillaccuratelyincludeallentereddata/patientsinthesecounts/interventions.Pleasecontinuetoenteryourexamdataasneeded.UnderstandingthatifyouenteredanewPOAGorDiabetesICD10,thosewillgetcountedcorrectlyassoonaswereceivetheupdatedvaluesets.TrackingReportingViaClaimsTrackingofsuccessisnotasthoroughwiththismethod.YouarenotabletoseeyourpercentagesasyoucanwiththeAOAMORERegistrymethodTheClinicalQualityMeasuresVerificationReportlocatedinEHROptions.OnceyourunthereportselecttheMeasureResultsTabtoseeeachmeasure,andthepatientsthatmakeupthatmeasure.TrainingVideo11.1ExampleCompositeScoreQualityRegardlessoftheSubmission/ReportingMethodthatyouselectattheendoftheyearyouwillreceiveascoreasoutlinedonpage6ofthisdocumentforeachCQMcompletedandsubmitted

Measure Score PointsDiabeticEyeExam 90 9POAG 90 9DiabeticRetinopathyCommunication 80 7

ControllingBP(outcome) 75 9ClosingReferralLoop 95 10DocumentationofcurrentMeds 90 7

DiabeticRetinopathy+/-andLevel 90 9

TotalPoints 60

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CLINICALPRACTICEIMPROVEMENTSACTIVITIES(CPIA)CPIAareanewcomponenttoMedicarein2017.CPIAareactivitiesinyourpracticethathelpthepublic.ParticipationwithAOAMORERegistryisencouraged,asitwillhelpyoutomeetthismeasureCPIAaccountsfor15%weightonyourtotalMIPSPerformanceScoreThereare40totalpointsavailableinthisarea.

• Ifyourpracticehas15orfewerProvidersyoucanreporton1HighweightedCPIAfor40points,or2MediumweightedCPIAeachfor20pointsforaminimumof90days

• Ifyouhavemorethan15Providersyoucanreporton2high-weightedCPIAfor20

pointseachorfor4medium-weightedCPIAfor10pointseachforaminimumof90daysReportingonCPIAReportingwillbecompletedattheendoftheyearviaattestationportalprovidedbytheCMS.AttestationwillbeintheformofYesorNo.Youshouldkeepdocumentationofwhatactionsyoutook.IfyouuseAOAMORERegistry,attestationisaseasyassayingYesanddocumentationisthatyouusedAOAMORERegistryCPIAMeasuresThereareatotalof92differentactivitiesprovidedbytheCMS.ThecompletelistofmeasurescanbelocatedontheCMSwebsitehttps://qpp.cms.gov/measures/iaPracticeDirectorrecommendsusingAOAMORERegistrytomeettheCPIArequirement.Inthefuture,theywilladdmoremeasures.HighWeightCPIA:

• UseAOAMOREtoreportlocalpracticepatterns -Useyourdatatolearnhowyoutreatandmanagepatients

• Allow24/7accesstocliniciansMediumWeightCPIA

• UseAOAMOREtoshowoutcomecomparisonsacrossspecificpopulation -CompareyourdatavsaggregateofalldatainAOAMOREforglaucomaand more

• UseAOAMOREtopromotestandardpracticeuses -CompareyourdatavsaggregateofalldatainAOAMOREdashboard

• UseAOAMOREtotrackpatientsafety• CollectPatientexperienceandsatisfactiondata• Closereferralloop:providereportstoreferredfromphysicians• Timelycommunicationoftestresults

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• EngagepatientsandfamiliesindecisionmakingCMSandAOAarestillworkingondetailsforhowAOAMOREwillhelpyouwiththemeasuresExampleCompositeScoreCPIAOfficewithfewerthan15providerscompletestwomediumweightactivities:UseAOAMOREtoshowoutcomecomparisonsacrossspecificpopulation20ptsUseAOAMOREtopromotestandardpracticeuses20ptsPointtotal40pts

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ADVANCINGCAREINFORMATION(ACI)ACIiswhatyouusedtoknowasMeaningfulUse.Thisareaisworth25%ofyouroverallMIPSPerformanceScore.ScoringisbasedonBaseScore+PerformanceScore+BonusScore=TotalACIScore.Earna100ormorepercentandreceivethefull25%.ThisiswhereflexibilitycomesintheBase,Performance,andBonusscorewillcomeouttomorethan100%ifyoufullyparticipateandgetmaximumscores.TheBaseScoreisallornothingandisworth50points.Thereare4basemeasures.WitheachBaseMeasurethereisnominimumpercentagetoachieve,youmustanswerYesorhaveatleasta1inthenumeratorinordertomeetthebasescoreforallfourmeasures.ThePerformanceScoreisbasedonhowoftenyouperformthemeasureandisworthupto90points.Thereare7Performancemeasures.Thehigheryourperformanceratesthebetteryourperformancescoreis.MeasureswithHigherPerformanceRatePercentageareworthmorepoints(seethirdcolumnbelow)

PerformanceRate PerformanceScore PerformanceScoreMeasuresupto20%

1-10 1 1111-20 2 1221-30 3 1331-40 4 1441-50 5 1551-60 6 1661-70 7 1771-80 8 1881-90 9 1991-100 10 20

BonusScore–Receiveuptoa15%bonus Receive5%bonusforsubmittingtoaClinicalDataRegistry(AOAMORE) Receiveupto10%bonusforCPIAMeasures24/7ClinicianAccessandCloseReferral LoopPracticeDirectoris2014CEHRTthereforeyouwillusethe2017ACIObjectivesandMeasures.Thereare4BaseMeasuresand7totalPerformanceMeasures

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MEASURENAME

MEASUREDESCRIPTION

OBJECTIVENAME

REQUIREDFORBASESCORE

PERFORMANCESCOREWEIGHT

SecurityRiskAnalysis

Conductorreviewasecurityriskanalysisinaccordancewiththerequirementsin45CFR164.308(a)(1),includingaddressingthesecurity(toincludeencryption)ofePHIdatacreatedormaintainedbycertifiedEHRtechnologyinaccordancewithrequirementsin45CFR164.312(a)(2)(iv)and45CFR164.306(d)(3),andimplementsecurityupdatesasnecessaryandcorrectidentifiedsecuritydeficienciesaspartoftheMIPSeligibleclinician'sriskmanagementprocess.

ProtectPatientHealth

Information

Yes

0

e-Prescribing

AtleastonepermissibleprescriptionwrittenbytheMIPSeligibleclinicianisqueriedforadrugformularyandtransmittedelectronicallyusingcertifiedEHRtechnology.

ElectronicPrescribing

Yes 0

HealthInformationExchange

TheMIPSeligibleclinicianthattransitionsorreferstheirpatienttoanothersettingofcareorhealthcareclinician(1)usesCEHRTtocreateasummaryofcarerecord;and(2)electronicallytransmitssuchsummarytoareceivinghealthcareclinicianforatleastonetransitionofcareorreferral.

HealthInformationExchange

Yes

Upto20%

ProvidePatientAccess

AtleastonepatientseenbytheMIPSeligibleclinicianduringtheperformanceperiodisprovidedtimelyaccesstoviewonline,download,andtransmittoathirdpartytheirhealthinformationsubjecttotheMIPSeligibleclinician'sdiscretiontowithholdcertaininformation.

PatientElectronicAccess

Yes

Upto20%

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MEASURENAME

MEASUREDESCRIPTION

OBJECTIVENAME

REQUIREDFORBASESCORE

PERFORMANCESCOREWEIGHT

MedicationReconciliation

TheMIPSeligibleclinicianperformsmedicationreconciliationforatleastonetransitionofcareinwhichthepatientistransitionedintothecareoftheMIPSeligibleclinician.

MedicationReconciliation

No

Upto10%

Patient-SpecificEducation

TheMIPSeligibleclinicianmustuseclinicallyrelevantinformationfromCEHRTtoidentifypatient-specificeducationalresourcesandprovideelectronicaccesstothosematerialstoatleastoneuniquepatientseenbytheMIPSeligibleclinician.

PatientSpecificEducation

No

Upto10%

SecureMessaging

ForatleastoneuniquepatientseenbytheMIPSeligibleclinicianduringtheperformanceperiod,asecuremessagewassentusingtheelectronicmessagingfunctionofCEHRTtothepatient(orthepatient-authorizedrepresentative),orinresponsetoasecuremessagesentbythepatient(orthepatient-authorizedrepresentative)duringtheperformanceperiod.

SecureMessaging

No

Upto10%

View,Download,orTransmit(VDT)

AtleastonepatientseenbytheMIPSeligibleclinicianduringtheperformanceperiod(orpatient-authorizedrepresentative)views,downloadsortransmitstheirhealthinformationtoathirdpartyduringtheperformanceperiod.

PatientElectronicAccess

No

Upto10%

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BASEANDPERFORMANCEMEASUREINSTRUCTIONSTheinstructionsbelowarethesameinstructionsyouhavebeenusingforthepast3years.Theonlychangeisthatthereisnominimumthresholdamounttomeet.SecurityRiskAnalysisBaseRequired:Yes(MustAttestYes)PerformanceScoreWeight:0Measure:Conductorreviewasecurityriskanalysisinaccordancewiththerequirementsin45CFR164.308(a)(1),includingaddressingthesecurity(toincludeencryption)ofePHIdatacreatedormaintainedbycertifiedEHRtechnologyinaccordancewithrequirementsin45CFR164.312(a)(2)(iv)and45CFR164.306(d)(3),andimplementsecurityupdatesasnecessaryandcorrectidentifiedsecuritydeficienciesaspartoftheMIPSeligibleclinician'sriskmanagementprocess.

Attestation Format:Yes/NoEligibleprofessionals(EPs)mustattestYEStoconductingorreviewingasecurityriskanalysisand implementingsecurityupdatesasneeded tomeet thismeasure.Instructions:

• Printoff theSecurityRiskAnalysisworksheetavailableon theClientDocumentation website.http://www.practicedirector.com/pdf/Meaningful_Use_Security_Risk_Analysis_Worksh eet.pdf

• Filloutandkeeponfile.• IfyouhaddonethisinapreviousStageofMU,youmustreviewyour

savedSecurityRiskAnalysis worksheetyearlyandupdateifnecessary.Signanddatethedateofreview

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ElectronicPrescribingeRXBaseRequired:Yes(Mustattestwithatleast1intheNumerator)PerformanceScoreWeight:NoMeasure:AtleastonepermissibleprescriptionwrittenbytheMIPSeligibleclinicianisqueriedforadrugformularyandtransmittedelectronicallyusingcertifiedEHRtechnology.NoExclusionsAttestationFormat:Numerator/DenominatorNumerator:Numberofprescriptions inthedenominatorgenerated,queriedforadrugformularyand transmittedelectronicallyusingCertifiedEHRTechnologyPD:EntryofprescriptionswithinDrFirstthataresignedandsentwillcountinthismeasure.Eachprescriptionentered,signed,andsent,not justthefirstoneperpatient. Pendingprescriptionsorprescriptionsthatareonlysignedwillnotcount inthenumerator. Seeinstructionsbelow

Note:Prescriptions for scheduleddrugs (controlled substances)doNOTcount ineithernumeratorordenominatorof thismeasuresincetheycannotbesentelectronicallyDenominator:Numberofprescriptionswrittenfordrugsrequiringaprescriptionin ordertobedispensedotherthancontrolledsubstancesduringtheEHRreporting period;orNumberofprescriptionswritten fordrugs requiringaprescription in ordertobedispensedduring theEHRreportingperiodPD:EntryofprescriptionswithinDrFirstthataresigned,orsigned/sentwillcount forthismeasure. PendingprescriptionswillnotaffectcountInstructions:ToenteradrugprescriptionintoPracticeDirector’se---Prescribingportal:

1. Beloggedinasaprovider2. IfyouarenotintheEHRmodulealreadygototheEHROptions>E---Prescribing3. Verifythepatientthatisdisplayedisthepatientyouareintendingtocreateandsend

a drug prescription for4. Ifnotclickthespyglasstosearchforthecorrectpatient.5. Clickthe“LaunchE---Prescribing”button6. IfyouarealreadyintheEHRmoduleandhaveapatientselectedyoucanjustclickthe

“LaunchE-Prescribing”button

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Createandtransmitthedrugprescription(fordetailedinstructionsonceinPracticeDirector’se--- PrescribingportalpleasereadthePracticeDirectore---Prescribingportaldocumentation)http://www.practicedirector.com/pdf/PD---ePrescribing---Portal---Training---Guide.pdf*Note:Anyprescriptiontransmittedelectronicallythroughadifferente---prescribingsystemwillnotbeautomaticallycalculatedortracked.Theywillneedtobemanuallytrackedforattestation.

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HealthInformationExchangeBaseRequired:Yes(Mustattestwithatleast1intheNumerator)PerformanceScoreWeight:Upto20%Measure:TheMIPSeligibleclinicianthattransitionsorreferstheirpatienttoanothersettingofcareorhealthcareclinician(1)usesCEHRTtocreateasummaryofcarerecord;and(2)electronicallytransmitssuchsummarytoareceivinghealthcareclinicianforatleastonetransitionofcareorreferral.SummaryofCareRecord–Asummaryofcarerecordmust includethefollowingelements:

1. Patient name1. Referringor transitioningprovider'snameandoffice

contact information (EP only)2. Procedures3. Encounterdiagnosis4. Immunizations5. Laboratory test results6. Vital signs (height,weight,bloodpressure,BMI)7. Smoking status8. Functionalstatus, includingactivitiesofdaily living,

cognitive anddisability status9. Demographic information (preferred language, sex,

race, ethnicity,dateofbirth)10. Careplan field, includinggoalsand instructions11. Careteam includingtheprimarycareproviderof

recordand anyadditionalknowncare teammembersbeyond thereferringor transitioningprovider and the receivingprovider

12. Reason for referral13. Currentproblem list (EPsmayalso includehistorical

problems at their discretion)14. Currentmedication list*15. Currentmedication allergy list*

*Note:AnEPmustverifythatthefieldsforcurrentproblemlist,currentmedicationlist,andcurrentmedicationallergylistarenotblankandincludethemostrecentinformationknownbytheEPasofthetimeofgeneratingthesummaryofcaredocument.NoExclusionsAttestationFormat:Numerator/Denominator

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Numerator:ThenumberoftransitionsofcareandreferralsinthedenominatorwhereasummaryofrecordwascreatedusingCEHRTandexchangedelectronicallyPD:Patientswhowerereferredthroughatransitionofcareoutoftheprovider’scaretoanotherproviderwhoalsohadaSummaryofCarereportgeneratedandsentelectronically.NOTE:onlyvalidCCDAscanbesentelectronically. (SendelectronicallyusingPortalandthenEHROptions>TOC>SaveCCDA>CareDocument check sent electronically).See instructionsbelow

Denominator:Numberof transitionsofcareandreferralsduring theEHRreportingperiod forwhichtheEPwasthetransferringorreferringprovider.PD:Patientswhowerereferredthroughatransitionofcareoutoftheprovider’scaretoanotherprovider.Instructions

ToProvideaSummaryofCare:GotoEHROptionsselectTransitionofCare

TheTransitionofCaredialogwillopen1. Usethespyglasstoselectyourdesiredpatientiftheyarenot

already displaying

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2.ClickonthearrownexttoSave,SelectSaveasC-CDA

Youwillreceivethefollowingmessage“TocreateavalidCCDA,the ProblemsListmustbecodedwithSNOMED---CT.WouldyouliketoconverttheProblems ListtoSNOMED---CTbeforesavingtheCCDA?”SelectYes

AnewdialogwillopenandshowyoutheICD-10codeandthecorrespondingSNOMED-CTcode.YoucanchecktheRememberthis associationboxtohaveitrememberthisgrouping.SelectOK. Thesystem willrepeatthisprocessuntilallICD-10havebeenmatchedtoSNOMED-CT

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TheSaveC-CDAdialogwillopen;selectthedestinationforwhereyouwanttosaveyourC-CDA.SelectSave

TheViewscreenwillopen

To transmit electronically:

1. SelectCareDocumentTab

2. Selectthepatientyouwishtotransfer(onlypatientswithSentstatuscanbetransferred)(Optional)WhentheTabopensClickonthefilenameheadertoput thepatient’s inalphabeticalordertomakeiteasiertofinddesiredpatient.

3. SelectTransfer TOCbutton

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TheTransferTransitionofCareusingDirectTransferdialogwillopen1.ClickontheSpyglassintheFromfieldtoselecttheproviderthatissending. AdialogwillopenshowingyouProviderswiththeirDirectEmailAddress. Selecttheprovider andthenclickOK

2.ClickontheSpyglassintheTofieldtoselecttheprovideryouaresendingto. AProviderDirectorydialogwillopenyoucanuseanycriteriaoranycombinationof criteriatolocateaProvidersDirectemailaddress. InthisexampleIsearchedbyPortal IDand3resultswerereturned. SelectthedesiredproviderandthenclickOK

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3.EnteraSubject for themessage. IMPORTANTProtectedHealth Information (PHI)underHIPAAmustnotbe included inamessage’ssubject line4.Youcanaddamessagetoyouremail5.TheCCDAwillalreadybeattachedselectAddAttachmentifyouwanttosendanythingelsesuchasEHRReportorImages6.SelectSendMessagetoSend

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Youwillreceiveamessagenotifyingyouthatthemessagehasbeensuccessfullysent

WhenyouviewtheCareDocumentstabtheElectronicCopywillnowhavea checkmark in itsoshowElectronicallySent

Completing theabovestepswill increaseyournumerator

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ProvidePatientAccessBaseRequired:Yes(Mustattestwithatleast1intheNumerator)PerformanceScoreWeight:Upto20%Measure:AtleastonepatientseenbytheMIPSeligibleclinicianduringtheperformanceperiodisprovidedtimelyaccesstoviewonline,download,andtransmittoathirdpartytheirhealthinformationsubjecttotheMIPSeligibleclinician'sdiscretiontowithholdcertaininformation.NoExclusionsAttestationFormat:Numerator/DenominatorPatient Electronic Access:Numerator:Thenumberofpatients inthedenominatorwhohavetimely(within4businessdaysafterthe information isavailabletotheEP)onlineaccesstotheirhealth informationtoViewdownload,andtransmittoathirdpartyPD:Patientswillcountinthisnumeratorif,withinfourdaysofavisit(savedEHR),theyhaveregisteredwithinthepatientportalandtheirregistrationhasbeen linkedtotheirfilewithinPD (Patientmenu>PatientPortalMgmt.). TheydoNOThavetoactuallyviewtheirinformation withintheportal…they justhavetohaveaccess. See instructionsbelowDenominator:Numberofuniquepatientsseenby theEPduringtheEHRReportingperiodPD:Uniquepatientsseenintheperiod. Patienthasanexamsavedascompleted,completednon---billable,orinvoicedinsystemduringreportingperiod

ContactPracticeDirectorSupport torequestPatientPortalActivation. Supportwillsendyoua provider linkandapatient linkonceenabledOnetimeSetupforeachProviderinyourPractice Create yourProviderPortal accountSelect PatientMenu Select PatientPortal SelectUserAdministration

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When thePatientPortalUserManagementScreenopens select thePreferencesTab1. Select Enable Portal Communications2. ChecktheshowinthePatientPortalcheckboxfortheProvider/syouwanttodisplayon

Portal. IntheNPIcolumnmakesureyourProviderhasauniqueNPI,iftheydonotenterone inProviderManagementbefore saving

3. Select Save4. Select Close

Youwill receiveconfirmationwhen thedatahassuccessfully saved

YouwillthenneedtoregisteryourProvider.FromPDSelect Patient Portal S e l e c t Reg i s t e r P ro v ide r

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WhentheRegisterNewAccountpageopensadd the following information:

UserNamePassword (mustcontainupperand lowercase lettersandanumberorsymbol) ConfirmPasswordNPI numberEmailAddress(Ifyoudonotenteranemailaddresstheofficewillhavetoverify youraccount inPracticeDirectorConfirm EmailD i re c t Email AddressConfirm EmailSelectyournamefromtheprovider list Select Register once completed

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Instructions

Atsomepointduringthepatientvisityoumayregisterthepatientorhavethemregisterthemselves for Patient PortalAccess.Werecommenddoingthiswiththemintheofficetoensurethattheycompletethesteps.Oncetheexamissaved,asCompletedorCompletedNon-BillabletheinformationwillbeavailabletoPatientontheportalGotoyourPatientPortalLink: Examplehttps://test.only.com:8181/PatientPortal/?practiceName= &userTypeHavethePatientSelectRegisterintherightcorner

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TheRegisterNewAccountpagewillopenHavethepatientfill intherequiredFields:

UserNamePassword (Mustcontainupper, lowercase,andnumericvalue) ConfirmPasswordFirstName LastName Birthdate Gender ZipHomeorCellPhoneEmailisoptional(Ifyouareover18yearsofageyouremailmustbeunique). Ifyouuseemailthepatientwillreceiveanemailwithalinkthattheymustselecttoactivate. Ifyoudonotuse emailtheofficewillneedtoverifythepatient.Select your Provider

Select Register

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Theuserwillreceiveaconfirmationthattheaccounthasbeencreated. Ifemailwasnotspecifiedtheywillseethisconfirmation

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Ifuserusedemailaddresstheywillseethisconfirmation

Andtheywillreceiveanactivationemail

Theuserdoesnothavetoclickonthelinktoactivatetheaccountinordertosatisfythismeasure,however theymustactivatebefore theycanaccess their information.InorderfortheMUnumeratorcounttoincrease,thestaffmustimportthenewlyregistered patientintoPDinorderto linkthePortalAccountandPracticeDirectorAccount.Thismustbe donewithin4daysofthepatientDOSTo linktheaccounts:Select PatientMenu

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Select PatientPortal SelectUserAdministration

When thePatientPortalUserManagement screenopens

1. Select theUserManagementTab2. Selectthedesiredpatientfromtheleftsideofthescreen3. Ifthereisamatchingpatientinthesystemthepatientwill

displaytotherightofthe screen4. Select Link

The ImportNewPatientdialogwillopen

1. The left sidewilldisplayportal information2. TherightsidewilldisplayPDinformation. Youarealsoabletoeditanyinformation

on therightbyselectingthefieldandthentyping.Notethiswillupdatetheportalalso

3. YoucanselectSynconthePDinformationsidetooverridethecurrentDemographic informationwithwhatthepatiententeredontheportal

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4.IfyoudonotwishtoSyncyoucanselectOKtolinkthePortalandPDaccount.Oronce youhaveselectedtoSyncthePortalinformationtothePDyoucanselectOK

Youwillreceiveamessagethatthepatienthasbeensuccessfully imported

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MedicationReconciliationBaseRequired:NoPerformanceScoreWeight:Upto10%Measure:TheMIPSeligibleclinicianperformsmedicationreconciliationforatleastonetransitionofcareinwhichthepatientistransitionedintothecareoftheMIPSeligibleclinician.AttestationFormat:Numerator/DenominatorNumerator:Numberoftransitionsofcare inthedenominatorwheremedicationreconciliation was performedPD:Patientswithinthedenominator(hadaTransitionofCare intotheprovider’scare)whohad amedication reconciliationperformedduring the transition. (EHROptions>TOC>Import>Medication Reconciliation performed formanual and on screenreconciliationperformedwhenanelectronic summaryofcarewas received). See instructionsbelowDenominator:NumberoftransitionsofcareduringtheEHRreportingperiodforwhichtheEPwasthereceivingpartyofthetransitionPD:AllpatientsthathadeitheramanualoranelectronicsummaryofcareimportedintoPDduring the reporting period. (EHR Options>TOC>import).Instructions:Toindicatethepatientwasreceivedfromanothersettingofcareorprovider:

SelectEHROptionsMenu>TransitionofCare

WhentheTransitionofCaredialogopensusethespyglasstoselectthedesiredpatient ifthey arenotdisplayingSelect Import

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TheTransitionofCareTypedialogwillopen

YoucanselecttoImporttheTransitionofCarefromaCCDAortomanuallyenterareceivedTransitionofCare1ImportingTransitionofCare2.SelectImportTransitionofCarebuttonandSelectOK3.TheimportC---CDAdialogwillopenselectthesavedC---CDAFileSelect Open

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4.TheImportCCDAReconciliationdialogwillopen. Gothrougheachofthetabs,Problems,

Medications,andAllergiesandreconcile thedata ineach5. TheleftsideofthescreenforeachTabdisplaystheActiveList(what

isinyoursystem currently)and ImportedList (information that isbeing imported)6. SelectAutoMatchatthebottomofthescreentoletthesystemfind

matches7. HighlightanitemfromImportedListandifthereisamatchinActive

Listitwillhighlight italso8. SelectMergetomergetheitemstotheReconciledList

9. Adialogwillpopupwithbothmedicationssidebyside;iftheyaretheexactsameand youwanttocontinueselectOK. Iftheydon’tmatchselectCancelandmovethemeach independently

10. OncecompleteselectOK

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11.Themedicationswilldisplayontherightsideasmerged

12.RepeatforallTabs(Youwillnotbeabletofinishuntilallarereconciled) AddtheselectedActiveand/or Importedfromthepatient’sreconciled list(located attopandbottomofscreen)

ExcludetheselectedActiveand/or imported fromthepatient’s reconciled list(locatedatthetopandbottomofscreen)

Mergeentriesfromboth liststothepatient’sreconciled list

13.TheReconciliationReviewdialoguewillopen14.SelectSubmitwhenyouarereadytofinish

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YouwillbereturnedtoTOCscreenSelecttheredXinupperleftcornertoclose

ManuallyReceiveTransitionofCare

1. SelectManuallyenterareceivedTransitionofCare2. TheCareReceivedDatewilldefaulttotoday,usethecalendarto

selectanother date ifdesired.3. ChecktheMedicationReconciliationPerformedBox ifyouhavedone this4. SelectOK

Toperformthemedicationreconciliation:Youcanperformthemedicationreconciliationbycomparingmedicationsthatarereportedby patientorotherphysicianwithyourlistifyouarenotusingPracticeDirector’se-Prescribingportal.

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PatientSpecificEducationBaseRequired:NoPerformanceScoreWeight:Upto10%Measure:TheMIPSeligibleclinicianmustuseclinicallyrelevantinformationfromCEHRTtoidentifypatient-specificeducationalresourcesandprovideelectronicaccesstothosematerialstoatleastoneuniquepatientseenbytheMIPSeligibleclinician.AttestationFormat:Numerator/DenominatorNumerator:Numberofpatientsinthedenominatorwhowereprovidedpatient-specificeducation resources identifiedby theCertified EHRTechnologyPD:Thisnumeratorwillpopulatewhenapatienthasbeengivensomepieceofeducationwithin the system (EHROptions>PatientEducation>either infobuttonorotherentered education…with thedateprovidedwithin the reportingperiod). See instructionsbelow

Denominator:NumberofuniquepatientswithofficevisitsseenbytheEPduringtheEHRreporting periodPD:Uniquepatientseenintheperiod. Patienthasanexamsavedascompleted,completednon-billable,orinvoicedinthesystemduringthereportingperiod.Instructions:Toidentifyandprovidepatient-specificeducationresources: GototheEHRmenu>PatientEducation

ORClickonthe“PatientEducation”buttoninthe“Final”sectionoftheEHRafteryouhavesavedtheEHR

WhenthePatientEducationwindowopensifthedesiredpatient isnotdisplayingclickonthe

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spyglasstoselectthedesiredpatient

1. Youwillseealistofalldiagnoses,medication,andlabresultsthatthepatientis associatedwithinthePatientConditioncolumnlocatedtothe

leftside.Youwillalso seethis image for InfoButtonthis indicatesthatadditional information is availablefromMedlinePlus. ClickontheInfoButtontoseethedetailsavailable

2. ConditionTypeshowswhetherthecondition isaLabResult,Diagnostic,orMedication

3. EducationResource–thisfieldstaysblankuntilyouclickontheInfo

Button . OncetheInfobuttonhasbeenselectedthewordingInfoButtonwillpopulateinthe field

4. Provided–Allowsyoutocheckto indicatethatyousharedthisinformationwithyour patient,by showingonscreen,printing,oremailing.

5. DateProvided–Onceprovidedbox ischeckedthisfieldwillpopulatewithtoday’sdate. Youcandoubleclickonthedatetoadjustittothecorrectdate

Viewing Info Button 1.ClickontheInfoButton

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2.MedlinePluswindowwillopen,fromhereyoucan:

A.Clickonthelinkandshowyourpatienttheinformationandprintitforthemfromthelinked website

B. ClickLaunchSystemViewertoprintthecontentofthisscreen. Itwillopeninyourbrowser andyoucanprintasyounormallywouldfromthe Internet

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OnceyouhavesharedthedatawiththepatientyoucanclosethewindowyouwillbereturnedtothePatientEducationWindow

TheEducationResourcefieldwillnowbefilled inwithInfobutton

ChecktheProvidedfieldandthenadjustthedateifneededbydoubleclickinginthedatefield

SelectSaveinthelowerrightcornertofinishSecureMessagingBaseRequired:NoPerformanceScoreWeight:Upto10%Measure:ForatleastoneuniquepatientseenbytheMIPSeligibleclinicianduringtheperformanceperiod,asecuremessagewassentusingtheelectronicmessagingfunctionofCEHRTtothepatient(orthepatient-authorizedrepresentative),orinresponsetoasecuremessagesentbythepatient(orthepatient-authorizedrepresentative)duringtheperformanceperiod.AttestationFormat:Numerator/DenominatorNumerator:Thenumberofpatientsinthedenominatorforwhomasecureelectronicmessageissenttothepatient(orpatient-authorizedrepresentative),orinresponsetoasecuremessagesentbythepatient(orpatient-authorizedrepresentative)Denominator:NumberofuniquepatientseenbytheEPduringtheEHRreportingperiodIfyouhavenotsetupyourproviderportalyet,seepages40-42ProviderPortalActivation

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InstructionsforLoggingintoProviderPortal1. LaunchyourProviderPortalbygoingtoyourbrowserandenteringyourportaladdress

Or FromPD SelectPatientPortal SelectLaunchPortal

2. SelectLogin,fromtheupperrightcorner3. EnteryourUserNameandPassword

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InstructionsforSendingandReceivingMessages

1. OnceloggedinyouwillbeontheSecureMessagingscreen

2. PatientNamesthatareavailabletomessagewilldisplaytotheleftsideofthescreen.Selectthepatientthatyouwishtomessage

3. Inthefieldatthebottomofthescreenenteryourmessagetothepatient

4. SelectSendoncecompleted

1. Thesentmessagewilldisplayonthescreenwiththedateandtimesent,theproviderthatsentthemessage,andthemessage

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2. Whenthepatientresponds,themessagewilldisplayatthetopofthelistSelectingaPatientdisplaysallcommunicationwiththatpatientandallowsyoutosendnewmessages

DirectionsforPatienttosendmessage:Haveyourpatientlogonwiththeirusernameandpassword

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1. OnceloggedinthepatientwillbeontheSecureMessagingscreen

2. Providersthatareavailabletomessagewilldisplaytotheleftsideofthescreen

3. Messagesthathavebeenreceivedandsentwilldisplayonrightsideofthescreenwiththemostrecentmessageontop

4. Entermessagethatyouwanttosend

5. SelectSend

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View,Download,orTransmit(VDT)BaseRequired:NoPerformanceScoreWeight:Upto10%Measure:AtleastonepatientseenbytheMIPSeligibleclinicianduringtheperformanceperiod(orpatient-authorizedrepresentative)views,downloadsortransmitstheirhealthinformationtoathirdpartyduringtheperformanceperiod.AttestationFormat:Numerator/DenominatorNumerator: Thenumberofuniquepatients (or theirauthorized representatives) in thedenominatorthathaveviewedonline,downloaded,or transmitted toa thirdparty thepatient’s healthinformationPD:Patientswillcount inthisnumerator iftheyhaveactuallyviewedtheirhealth information(CCDA)throughthepatientportal. So,ifapatienthasregisteredasauserfortheportal,their accounthasbeenlinkedtotheirPDaccountandtheyhaveactuallyviewedtheCCDAinformation intheportal,theywillcount. See instructionsbelow

Denominator:NumberofuniquepatientseenbytheEPduring theEHRreportingperiodPD:Uniquepatientsseeintheperiod. Patienthasanexamsavedascompleted,completednon---billable,orinvoicedinsystemduringreportingperiodThreshold:Theresultingpercentagemustbemorethan1(one)patientinorderforanEPtomeet thismeasureInstructions Atsomepointduringthepatientvisityoumayregisterthepatientorhavethemregisterthemselves for Patient PortalAccess.Werecommenddoingthiswiththemintheofficetoensurethattheycompletethesteps.Oncetheexamissaved,asCompletedorCompletedNon---BillabletheinformationwillbeavailabletoPatientontheportalUsethedirectionsonpages43-47ifyouhavenotalreadyregisteredandlinkedyourpatient.If youhavealreadydonethisforProvidePatientAccessyoudonotneedtohavethemregisterandlinkedagain.

PatientAccess toPortalThepatientcannowaccesstheir informationfromtheportalandmustView,Download,orTransmit the information

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HaveyourpatientgotothePatientPortalLink:Examplehttps://test.only.com:8181/PatientPortal/?practiceName= &userTypeHavetheuserlogonwiththeirusernameandpassword

Once logged intheywillselectPatientHealth Information

ThepatientConsolidatedCCDAwilldisplayonthescreen. Allthepatienthastodoisviewthis pageinorderforitto increasethenumeratorThepatientmayalsochoosetoDownloadorTransfertheCCDA

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TrackingACIinPracticeDirectorAnewreporthasbeenaddedunderEHROptions>MeaningfulUse,the2017AdvancingCareInformation(ACI)TransitionReportcanbeusedtoseehowyouaredoingatmeetingthebaseandperformancescores.TheVerificationReporthasalsobeenupdatedtoshowthepatientsthatmakeupeachmeasure.2017AdvancingCareInformation(ACI)TransitionsReportThisreportwillrunthesamewaythattheMeaningfulUseReportsrun,andisinthesamedialogToRuntheACIReport:SelectEHROptions>MeaningfulUse>MeaningfulUseReport

TheMeaningfulUserReportingPeriodsdialogwillopenFromthisdialogyoucandothefollowing:1.SelectAddtocreateanewreportforadesireddaterange,provider,andstage

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2.SelectaSavedReporttoView,Edit,orDelete

1.Add:TheSelectReportingPerioddialogwillopenThecurrentyearwillbedefaultedasthedaterange.Youcanchangethedaterangetoanydesiredrangebyclickingonthecalendaricons

1.Provider–Selectthedesiredproviderfromthedropdown2.Start–Clickonthecalendaricontoselectastartdateforthedesiredreportingperiod3.End–Clickonthecalendaricontoselectanenddateforthedesiredreportingperiod4.Stage–Thedefaultis2017AdvancingCareInformation(ACI)Transition(EveryoneparticipatinginMIPSwilluse2017AdvancingCareInformation(ACI)Transitionforattestationin2017).ThepreviousStage1,Stage2,2015and2016ModifiedStage2Reportsarestillavailabletoview.5.SelectOKtoviewtheReportThereportwillopen:1.Theheaderwilldisplaythenameofthereportthatyouareviewing2.Periodwilldisplaytheperiodyouarerunningthereportfor

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3.Providerwilldisplaytheprovideryouarerunningthereportfor4.Ontheleftsideofthereport,themeasures/objectivesarenamedwithinthegreyheaders.Adescriptiondisplaysunderneath.5.Ontherightsideofthescreen,System,Calculated,andRequireddisplay.

• Systemdisplays the system calculatednumerator anddenominator.KeepinmindthatforMIPSyouneedatleast1inthenumeratorforeachBaseMeasure

• Calculated displays the system calculated percentage.ForPerformancemeasuresthehigherthepercentage,themorepointsyouwillearn

• Required indicatesYesorNo.YesindicatesthatitisrequiredforyourBasescore6.SelectingSavewillsaveyourdaterangeontheMeaningfulUsedialog.OnceSaveisselectedyouwillbereturnedtotheMeaningfulUsedialog7.ViewReportwilllaunchtheprintableversioninanotherdialog.

IfyouselectViewReportyourcanthenselecttheprintericontoprintorthediscicon(intheupperleftcorner)tosavetoyourcomputer

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***Werecommendsavingthereportthatyouattestwithtoyourcomputer***PrintableView

Youcanusetheamountsinthecalculatedfieldtoestimateyourpoints.ForthefourrequiredBasemeasuresyouneedtohaveaYesora1indicatedinthenumerator.ForthePerformancemeasuresyoucanusethetableonpage28toestimateyourpoints.2.SelectaSavedReportYoucanselectasavedReporttoviewandorprintFromtheMeaningfulUseReportingPeriodsdialog:

• Doubleclickonthedesiredreport,thesavedMUreportwillopenor• SelectthedesiredreportandthenselectViewReport,thesavedMUreportwillopen

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Eachtimeyouviewthereportortheprintablereportthevaluesareautomaticallyrecalculated,sotheAdvancingCareReportisalwaysuptodate.2017AdvancingCareInformation(ACI)TransitionVerificationReportYoucanusetheverificationreporttofindthepatientname,dateofbirth(Age)andwhethertheyareincludedinthenumeratorandordenominatorsothatyouknowthepatientsthatarecountingforeachobjectiveIfapatientisonlydisplayinginthenumeratorordenominatoryoucanthendeterminewhytheydonotfallintobothToRuntheVerificationReport:SelectEHROptions>MeaningfulUse>VerificationReport

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TheMeaningfulUseMeasuresdialogwillopenYoucanrunthereportforasavedproviderandperiod,orrunanewreportforproviderandperiod.Youmayalsoselectifyouwanttorunforallmeasuresorjustspecificmeasures.OnceyourunyoumaysavethesearchforquickerlocationRunningNewReport1.LeavethePresetfieldblank2.SelectthedesiredProviderfromthedropdown3.Thestageisdefaultedto2017AdvancingCareInformation(ACI)Transition,youcanselectanotherreportfromthedropdownifdesired4.SelectdesiredStartandEnddatebyclickingonthecalendarsorusethecurrentyeardefaultdates5.Youcanselectspecificmeasurebycontrolorcommandclick,ifyoudonotselectmeasure(s)thereportwillcalculateforALL6.SelectSearchReportResultswilldisplayatthebottomofthedialog7.Selectanobjectivetoviewthedetails.8.Onceselectedtheupperrightsideofthescreenwilldisplaywhatmakesupthenumeratoranddenominator.Thesystemcalculatednumeratoranddenominator,thepercent,andwhetheritisrequiredfortheBasemeasure9.ThelowerrightsidewilldisplayPatientName,DateofBirth(Age),checkmarkindicateinNumeratorand/orDenominatortoindicatethattheycountforthemeasure.10.YoucanSelectSavetosavethereportsothiscriteriawillappearinthePresetforselectionnexttime.

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ExampleScoringforAdvancingCareInformation(ACI)asoutlinedonpages27-28Youhavecompletedall4ofthebaserequirements=50ptsYouselectthefollowing6measuresandhavethefollowingperformance:Measure/Objective Performance PointsHealthInformationExchange 10% 11ProvidePatientAccess 51% 16MedicationReconciliation 50% 5PatientSpecificEducation 10% 1SecureMessaging 5% 1VDT 5% 1 TotalPerformance 35YousubmitdatatoAOAMORERegistry=5YoucompleteCPIACloseReferralLoop=5Base50+Performance35+Bonus10=95ACIScore95%of25maxpoints=23.75totalPoints

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RESOURCEUSEORCOSTIN2017CostreplacesValue-BasedModifier.Thisareaisworth0%ofyouroverallMIPSPerformanceScorein2017.Itwillstartcountingin2018CostmeasurerepresentstheMedicarepayments(forexample,paymentsunderthePhysicianFeeSchedule,IPPS,etc.)fortheitemsandservicesfurnishedtoabeneficiaryduringanepisodeofcareNodatasubmissionisrequired;thisamountisderivedfromadjudicatedclaimsIn2017CMSwillbetrackingthisamountforeachproviderandwillprovidefeedbacktoproviderssotheycanseehowtheywillbeimpactedinfutureyears.InformationaboutyourcostisavailabletoyouviaCMSQualityandResourceUseReport(QRUR)onaCMSportalhttps://www.cms.gov/Medicare/Medicare-Fee-For-Service-Payment/PhysicianFeedbackProgram/Obtain-2013-QRUR.htmlCALCULATINGYOURFINALSCOREIN2017Quality+Cost+CPIA+ACI=MIPSCompositeScoreThresholdscoretodeterminepaymentandpenaltyisdeterminedbyCMSeachyear -IfCompositeScoreisabovetheCMSthresholdproviderwillgetabonus -IftheCompositeScoreisbelowtheCMSthresholdproviderwillgetapenalty(pay reduction)Thethresholdsfor2017arebelow:FinalScore PaymentAdjustment≥70points • Positiveadjustment

• Eligibleforexceptionalperformancebonus–minimumofadditional0.5%4-69points • Positiveadjustment

• Noteligibleforexceptionalperformancebonus3points • Neutralpaymentadjustment(NOincreaseordecrease)0points • Negativepaymentadjustmentof-4%

• 0points=doesnotparticipate

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ExampleScoringforQualityfrompage25

Measure Score PointsDiabeticEyeExam 90 9POAG 90 9DiabeticRetinopathyCommunication 80 7

ControllingBP(outcome) 75 9ClosingReferralLoop 95 10DocumentationofcurrentMeds 90 7

DiabeticRetinopathy+/-andLevel 90 9

TotalPoints 60ExampleScoringforCPIAfrompage27Officewithfewerthan15providerscompletestwomediumweightactivities:UseAOAMOREtoshowoutcomecomparisonsacrossspecificpopulation20ptsUseAOAMOREtopromotestandardpracticeuses20ptsPointtotal40ptsExampleScoringforAdvancingCareInformation(ACI)frompage68Youhavecompletedall4ofthebaserequirements=50ptsYouselectthefollowing6measuresandhavethefollowingperformance:Measure/Objective Performance PointsHealthInformationExchange 10% 11ProvidePatientAccess 51% 16MedicationReconciliation 50% 5PatientSpecificEducation 10% 1SecureMessaging 5% 1VDT 5% 1 TotalPerformance 35YousubmitdatatoAOAMORERegistry=5YoucompleteCPIACloseReferralLoop=5Base50+Performance35+Bonus10=95ACIScore95%of25maxpoints=23.75totalPoints

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ThistotalwillbecomparedagainsttheThresholdScoretodetermineifyougetapositiveornegativepaymentadjustment.Withthethresholdsfor2017andtheexamplesusedthroughoutthedocument,thisproviderwouldreceiveapositivepaymentadjustmentandbeeligibleforperformancebonus.PUBLICREPORTING MIPSdataandthefinalscorewillbeavailableforpublicreportingonPhysicianComparewebsitetoallowpatientstomakeinformeddecisionsabouttheproviderthattheyselect.https://www.medicare.gov/PhysicianCompare/search.html

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