Electronic Health Records: An Integral Part of Value-Based Care

The fourth in a series of articles on value-based payment focuses on electronic health records.

The American health care system is moving from paying physicians for the volume of services they perform to paying for the value of the care they provide. This movement toward “value-based payment” has greatly accelerated in recent years to address the high level of Medicare spending and is furthered by advances in technology—especially the proliferation of electronic health records (EHRs) and payer-incentive programs to encourage more EHR adoption. The goal of this evolution is summed up in the so-called Triple Aim: improved patient care, better population health, and lower per capita cost of health care.

In the fourth of a series of articles in “Changing Practice/Changing Payment,” Psychiatric News focuses on electronic health records (EHRs). The use of EHRs in clinical practice has increased in recent years. Much of this adoption has been propelled by the Health Information Technology for Economic and Clinical Health (HITECH) Act of 2009—legislation designed to provide incentives toward EHR adoption. According to the Office of the National Coordinator for Health Information Technology, CMS’s EHR Incentive Program (that is, Meaningful Use) has resulted in about 56 percent of office-based physicians adopting an EHR in their practice.

With the passage of the Medicare Access and CHIP Reauthorization Act (MACRA), many features of the Meaningful Use Program are being rolled into the new Merit-Based Incentive Payment System (MIPS), which focuses heavily on the use of EHRs in quality reporting and reimbursement. Specifically related to the use of EHRs in the total MIPS score a physician receives is a portion called Advancing Care Information (ACI).

Q: What is ACI?

A: The main goal of ACI is to encourage patients’ electronic access to records, to facilitate coordination of care through patient engagement, and to promote health information exchange.

Q: How is ACI used in MIPS?

A: Initially, ACI will account for 25 percent of the total MIPS composite score—although the proposed rule suggests that the weighting for ACI within MIPS may decrease as more physicians adopt EHRs, thus allowing physicians to focus on quality outcomes.

Q: How is ACI related to Meaningful Use?

A: ACI carries over many of the objectives and measures that were used in Stage 2 and Stage 3 of Meaningful Use, but no longer with an emphasis on a “one-size-fits-all” approach to quality measures. Rather than all physicians having to report on every measure within ACI, physicians will mostly be able to choose which measures best fit their practice, thus providing multiple paths to successful reporting.

Q: How will ACI be scored?

A: ACI will be composed of a base score and a performance score. In general, the base score accounts for 50 points of ACI. The performance score accounts for up to 80 points of the total ACI score. Although this seemingly adds up to over 100 (ACI = base score + performance score), any value over 100 counts the same as a score of 100 itself. A score of 100 results in receiving the full 25 percent of ACI counting toward MIPS.

Q: What is measured in the base score?

A: To receive the base score of 50 points, clinicians must provide the numerator/denominator or yes/no for each objective and measure. The proposed rule identifies the following objectives (with corresponding measures) for the base score: Protect Patient Health Information, Electronic Prescribing, Patient Electronic Access, Coordination of Care Through Patient Engagement, Health Information Exchange, and Public Health and Clinical Data Registry Reporting.

Q: What is measured in the performance score?

A: For the performance score (up to 80 points), clinicians select measures from the following three objectives: Patient Electronic Access, Coordination of Care Through Patient Engagement, and Health Information Exchange. Additionally, clinicians who choose to report to a public health registry will receive one additional bonus point.

Q: When is this expected to happen?

A: Although this is just a proposed rule—and comments were due to CMS by June 27—the first performance period for reporting through MIPS and the ACI category is proposed to be from January 1, 2017, through December 31, 2017. If a physician has data only from a portion of the year (rather than for the entire reporting year), the proposed rule still allows the clinician to participate in reporting.

Q: How do I get an EHR?

A: While APA is working on compiling resources to help members select an EHR, some information can be accessed here. The Office of the National Coordinator for Health Information Technology has a searchable product list of EHRs that meet its certification requirements at http://oncchpl.force.com/ehrcert. Capterra, a national clearinghouse for EHRs, has a searchable database that includes EHRs specifically tailored to mental health. ■