16 th Controversies & Advances In The Treatment Of Cardiovascular Disease Piecing Together the MACRA Puzzle: How the ACCand NCDRwill Help Members Navigate Radical Changes Ahea Ralph Brindis, MD, MPH, MACC, FSCAI, FAHA Clinical Professor of Medicine, UCSF Dept. of Medicine &the Philip R. Lee Institute for Health Policy Studies Senior Medical Officer, External Affairs, ACC National Cardiovascular Data Registry November 17, 2016
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16th Controversies& AdvancesIn The Treatment Of Cardiovascular Disease
Piecing Together the MACRA Puzzle:How the ACCand NCDRwill Help
MembersNavigate RadicalChangesAhea
Ralph Brindis , MD, MPH, MACC, FSCAI, FAHAClinical Professor of Medicine, UCSF
Dept. of Medicine & the Philip R. Lee Institute for Health Policy Studies
Senior Medical Officer, External Affairs,
ACC National Cardiovascular Data Registry
November 17, 2016
Disclosures
Senior Medica l Office r, NCDR
Message to Clinicians:Prepare for the Future
The Bridge to NowhereCholuteca Bridge, Honduras
What isYour Value & Worth?
The answer isnot monetary, but what isyour value andworth to...
1. Your Patients
2. Your Peers
3. Your Hospital System
4. The Payer(s)
5. The Government
We will be graded by them all.
Your data will be critical to your success—
real and perceived.
Clin ic ian Se lf-Awarenes s5 Rea lities over next 5 Years
1. Know your Personal Data!!!!
2. Certainty of Transparency & PublicReporting
3. Accountability for Patient & Peer Satisfaction
4. Accountability for Efficiency and Cost-Savings
5. Accountability for Demonstration of Value
- EHRs; meaningful use - ICD-10
- Value Based Purchas ing
- Efficiency metrics (= cut cos ts )
- Payment cuts
- Accountable Care Organiza tions- DOJ Fraud inves tiga tions
- Bundled payments (capita tion)
- Preauthoriza tion
- Phys ician Quality Reporting Sys tem (PQRS)
- Public Reporting
- Payer Programs
- Utiliza tion review
- Cla ims da ta profiling
- Episode groupers
- MOC / MOL- Certifica tion exams
- Coverage de te rmina tions
- Appropria teness auditing
- Hospita l employment
Health Care Environment 2016-2020
Merit Incentive Based Payment(MIPS)
Alternative Payment Models (APMs )Bundled Payments
MIPS APM participants will report the quality measurerequirements of their program
High Priority Measures collected in NCDRRegistries:Outcomesand AUC
GAPS: PROMS-SAQ, Cost data
Can use MIPSand also non-MIPSmeasuresfrom NCDRQCDR(CMS) certified
and non-certified registries
Advancing Care Information (25%)
Full Credit
• Report 5 required measures for atleast 90 days
BonusPoints
• Submit up to 9 additionalmeasures for at least 90 days
– Clinical Data Registry Reporting
RequiredMeasures
Security Risk Analysis
E-Prescribing
Provide Patient Access
Send Summary of Care
Request/ AcceptSummary of Care
BonusPoints for QCDRreportingPINNACLE, Diabetes, next year CathPCI
Gaps: ICD, ACTION, PVI
Clinical Practice Improvement ActivitiesA KeyComponent of MIPS
Quality60%
Resource Use (0%) will be incorporated into MIPS score(10%) in 2018 performance period
Advancing Care Information• Security Risk Analysis• E-Prescribing• Provide Patient Access• Send Summary of Care• Request/ Accept Summary of
Care• Bonus: Registry Reporting
Clinical PracticeImprovement
• Expanded Practice Access• Population Management• Care Coordination• Beneficiary Engagement• Patient Safety• Practice Assessment (ex. MOC)• Patient-Centered Medical Home or
Access data and participate inclinical practice improvementactivities in a mobileenvironment
Flexible coaching format thatallows participant to constructan improvement activity toalign with local goals andobjectives rather than overlydirective
Guided self-assessment of goalachievement and personalengagement allow participantto reflect on skills andknowledge gained, andsustaining clinical practicegains for patient care
MobileAppOfferingOverview
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• See My Data 1: Clinicians can access their dashboard to track andcompare their performance to national benchmarks and identify caregaps and areas of strength.
• Choose My Improvement: Convenient access to the ACC’s qualityinterventions as well as self-guided programs that allow clinicians toleverage insights and NCDR data in a self-guided clinical practiceimprovement activity. Provides access to a survey question instrument toprovide reflection on QI activities.
• Know MyProgress: See a summary of current quality improvementactivities, data review history, and status on all MOC activity: licensure,lifelong learning/ self-assessment, board certification and practice self-assessment.
• Submit My Activities2: Choose to have the ACC automatically submitclinical practice improvement activities based on NCDR data to multipleaccrediting boards and receive email confirming participation.
• Get My Alerts: Provides new data notifications, MOC reminders, whenthere is an opportunity for an MOC activity, when a practice has claimedyou as a physician as well as other helpful reminders.
• Learn More : Provides helpful resources for clinicians including MOC,reimbursement, quality improvement and PQRS reporting information.
Program components via a convenient, streamlined app as well as online within acc.org
ClinicalPractice
ImprovementApp
• Performance based on ACC registry participation (e.g. PINNACLE,CathPCI, ICD).
• Dashboard provide all metrics as well as recommended metric sets.
Data Driven“SeeMyData”
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Save Metrics to Review and Track
Select Group of Metrics to ReviewCompare Performanceto Na tional Benchmarks
“Although this sounds onerous, is it not better for us to imposethese controls on ourselves than what is done currently by
payers to control costs and procedures.”
SMARTCare:Smarter Management And Resource Use
for Today’s Complex Care Delivery
Center for Medicare Medicaid InnovationProject Grant
Florida ChapterWisconsin Chapter
American College of Cardiology
• SMARTCare:Smarter Management And Resource Use for Today’s Complex Care Delivery
Appropriate Access to CareImproving QualityReducing Cost and Enhancing Value
Evidence-based GuidelinesTechnology at the point-of-careState-of-the-Art Data Analytics
By Improving the Science of Medicine
Improving the Outcomes of Medicine
A collaborative effort sponsored by theAmerican College of Cardiology to:
Reduce variation and cost while•Improving the quality of care in patients with established or potential CAD•Employing proven clinical software tools at the point of care
• Decrease imagingnot meeting AUCfor 12-15%to <8%• Decrease PCI not meeting AUCfrom 9-20%to <6%• Reduce the average rate of bleeding andcomplications to lessthan 2%
• Improve patient quality of life (based on the patientsurveys)
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CMSBundled PaymentsProposed Model
• Mandated bundled payments for 3 episodesofcare announced August 2, 2016
• Acute MI
• CABG
• Hip or Femoral Fractures
• 5-year Demonstration Project for increasingparticipation/retention in cardiac rehab postCABG& MI– Beginning July 2017 in 98 randomly selected areas
MACRA andPopulation Health Management
JACCOctober 2016
Discussesthe need to focusonPopulation Health Management
and upcomingCV Bundled Payments
ACCMACRA WebsiteEducation and Communication to Members
ACCMACRA Website
Quality Payment Program Information– Merit-Based Incentive Payment System
– MIPS: Clinical Practice Improvement
– MIPS: Resource Use
– Advanced Alternative Payment Models
– Advanced APM Overview
Articles
ACCAction
Education and Meetings– 2017 Cardiovascular Summit
Resources
Videos
Message to Physicians
• Be aware of the changinglands cape– “You can run, but you can ’t hide ”
– Sticking your head in the sandwill not work
• Unders tand tha t th is will a ffec t yourprac tice and how you are pa id in the future
• Now is the time to ge t involved with your da ta– If you’re not a t the table , you’re on the menu