Quirk Healthcare: 2014 HIT Road Map

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Information about Quirk Healthcare: 2014 HIT Road Map
Health & Medicine

Published on February 25, 2014

Author: BenQuirk2

Source: slideshare.net

Description

This webinar covers Health Information Technology (HIT) topics that are very much on everyone's mind today. From ICD-10 and SNOMED coding to MU and PQRS regs, this webinar will fill you in on the background and details you need to know. And if you're currently using an older version of NextGen/KBM, you'll find the upgrade info on those systems especially useful. Take advantage of this free information from Quirk Healthcare Solutions.

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.  

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)  

OpQmal  2014  HIT  Road  Map  

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  

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  

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  

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   •  •  •  •  •  • 

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  

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  

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  

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  

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  

EffecQve  ImplementaQon  Strategy   Impact  Analysis   Needs  Assessment   Project  Plan   Budget   Conversion     • IdenQfy  current  systems   and  work  processes  that   use  ICD-­‐9  codes   • Talk  with  payers  about   effect  of  ICD-­‐10   implementaQon  on   provider  contracts     • Workflow  and  business   process  changes   • Staff  training   • PracQce  management   vendor   accommodaQons   • ImplementaQon  plan   with  clearing  houses,   billing  services,  and   payers   • Inventory  systems  and   workflows   • ConQngency  plan  for   failed  go-­‐live   • Time  and  costs  related   to    implementaQon   • Training   • IT/IS  upgrade   • Assistance  from  outside   vendor/consultant   • PotenQal  producQvity   loss   • TransacQon  tesQng     using  ICD-­‐10  codes   • Historic  data  conversion   • Review  coded  data  for   claims  reimbursement   consistent  with  ICD-­‐9   rates  

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  

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  

MU  Stages  

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)  

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  

MU  Structure   MU1   • 13  Core   • 5/10  Menu   • Total:  18   MU2   • 17  Core   • 3/6  Menu   • Total:  20  

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  

MU  CalculaQons   •  Denominator   –  All  unique  paQents   –  Subset  of  unique  paQents     •  Numerator   –  Number  of  unique  paQents  for  whom  required   informaQon  was  recorded   Threshold  =  Numerator                                                                Denominator  

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  

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  

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  

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.  

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  

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  

PCMH  -­‐  Overview   •  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  

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  

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  

Accountable  Care  OrganizaQons   (ACOs)   •  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  

ACO  Technology  Infrastructure   Enterprise  Revenue     Cycle  Management   Electronic  Health     Record         PaQent Engagement InformaQcs   Health  InformaQon   Exchange  

Technology  ConsideraQons   PaQent   Engagement   Data   AggregaQon   PopulaQon   Health   Management   Privacy  and   Security   Clinical  and   AdministraQve   Date  Exchange   Performance   Management   ReporQng   Infrastructure   Finances  

Startup  Costs  by  Beneficiaries   Es:mated  Start  Up  Costs   3,000,000   2,500,000   2,000,000   1,500,000   1,000,000   500,000   0   5,000  -­‐  15,000   16,000  -­‐  25,000   Aligned  Beneficiaries   26,000+  

Costs   IT  Costs   1,000,000   900,000   800,000   700,000   600,000   500,000   400,000   300,000   200,000   100,000   0   Internal  IT   External  Vendor   5,000  -­‐   10,000   10,000  -­‐   15,000   15,000  -­‐   25,000   Aligned  Beneficiaries   26,000+  

Q&A   dan.holleran@quirkhealthcare.com   tamina.vahidy@quirkhealthcare.com  

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