Why Don’t We Have Coordinated Healthcare Networks?

Guest post by Abhinav Shashank, CEO and co-founder, Innovaccer.

Abhinav Shashank

The story of Geraldine Alshamy explains how a minor complication in healthcare network can be catastrophic! The patient started experiencing severe headaches, and she was rushed to an emergency room. Since she didn’t have a primary care physician, she had a previous condition of hypothyroidism. But because of a lack of proper communication channel, her care process wasn’t the best that she could have gotten and, unfortunately, she had a heart attack!

This story might seem unusual but enough to understand that the consequences of uncoordinated health care could be grave. Health care is too critical and margin of error doesn’t exist here, it is imperative that we realize the importance of coordinating the healthcare sector and bridge the gaps in care.

Why Coordinated Healthcare?

When patients are brought in to be treated, the thing that physicians, nurses, assistants and other professionals require are the relevant medical information about them. For such a scenario, healthcare providers need to be well connected to provide coordinated care through smooth information flow.

According to a survey, some 40 percent of physicians believe that their patients undergo problems because of lack of coordination and information exchange between providers. The possibility of repetitive tests, unnecessary visits to the emergency rooms and preventable readmissions increases, giving way to poor health outcomes. Inadequate care coordination is estimated to cost as much as $45 billion to the healthcare industry, tagged as wasteful spending — $8.3 billion are lost every year because of inefficient technology.

What is the aim?

With everything around us changing and healthcare picking up pace, it’s high time we start thinking accordingly. The future of healthcare is smart teams aiding the one-on-one patient-physician interaction for better outcomes. These teams have physicians, nurses, financial advisors, health coaches and even family members and watch over patient’s health, follow-ups, and the insurance matters as well.

We have to move beyond the paradigm of isolated partial care towards integrated teams performing comprehensive patient care by encouraging the development of technology and providing care at hand with the center of our focus being:

1.) Accessible Care Anywhere

There used to be a time where people were not as well-connected to each other, and the only way of staying informed was telephones, letters, and postcards. With the evolution of information technology, we can safely share every ounce of information.

We need to put the rapid evolution of information technology to use and have patients connected with their physicians. Real-time alerts, genome sequencing, and data analytics will help us establish a world where patients won’t necessarily have to travel to a particular building and wait for hours to get treated.

2.) Connected Care Networks

Coordinated healthcare will hardly be possible without interoperable technology: teams connecting providers and specialists everywhere with the aim to deliver quality care. And the primary requirement for creating this team would be health information exchange, followed by notifying the PCPs.

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Interoperability: A Necessity of Modern Healthcare

Guest post by Abhinav Shashank, CEO and co-founder, Innovaccer.

Abhinav Shashank
Abhinav Shashank

P.J. Carter in a blog explained how the lack of interoperability resulted in extreme physical pain to his father who had to go into an eye surgery for the repair of a detached retina. His father was told by his eye specialist that and an urgent operation had to carried out. The operation began, but doctors could not access the past medical record of his father. Since doctors were unaware of the medical history, they had to carry out a painful operation of the eye without anesthesia! His father was awake the whole time and had to endure the pain.

Healthcare industry is lagging the most when it comes to advancements. There have been innovations, but equal implementation has been lacking. The cost of care has risen to over $10,000 per person in the US because there is huge expenditure on various digital infrastructures, but not for the meaningful use of them.

Interoperability and Its Types

Interoperability is a term that has no single definition. In broad terms, interoperability is the ability of systems and devices to exchange vital information and interpret it. For healthcare, interoperability is the ability of computer systems in hospitals to communicate, share critical information and put it to use to achieve quality health services delivery.

There are three levels of health information technology interoperability:

1) Foundational: This is the most basic level of interoperability. In this tier, the health information systems are equipped to transmit and receive data, but the HIT system on the receiving end may not be decked up to interpret that information.

2) Structural: The middle level, structural interoperability defines how the data exchange will take place. Structural interoperability is all about how data should be presented in pre-described message standards. This tier is critical to interoperability as it allows a uniform movement of health information from one system to another, avoiding the alteration and promoting the security of data.

3) Semantic: Semantic interoperability is the third tier, and at the top of the communications pyramid. The highest level of interoperability, it provides the systems the ability to exchange data and make use of the information. The message is received in an encoded format and which is later normalized. This normalization of data pushes health IT systems to close in on the technology gaps and create a common platform for secure, uninterrupted machine-to-machine communication.

Scope of Interoperability

There has been a dramatic increase in population, and with that came the need to manage population health. The amount of information increased exponentially with the use of EMRs. They helped in storing the increasing information, but sharing was still doubtful.

In 2005, only about 30 percent of the entire group of office-based physicians and hospitals used basic EHRs which increased to 75 percent for hospitals by the end of 2011. The state of Indiana now connects more than 10 million patients across 80 hospitals, and about 18,000 physicians use this data.

How long until 100 percent interoperability?

It has been accepted that health care, as a single entity, faces challenges in the exchange of information. Even the pioneer EHR vendors admit that although they have some complex connections established, not all of them were successful. According to a report, less than half the providers were satisfied with the way their information exchange was taking place. Stakeholders involved have always been concerned that EHRs, even the ones for Meaningful Use 2, are unable to share data effectively.

In the latest ONC report, it was mentioned that if all the providers were to come down to a common consensus, there happen to be two barriers on the road to complete interoperability. One, discord on how data should be transmitted. Second, a lack of proper infrastructure which is equipped enough to transmit data nationwide. It is very critical that the technology being used is updated and standardized to ease the flow of patients’ vital information to avoid any probable mishap.

Persisting Problems in the Path of Interoperability

1) Inadequate Standards

More often than not even after collecting patients’ data, it cannot be passed on to the members of the healthcare community because of lack of the appropriate standards. Most of the times it happens that two systems trying to exchange data are using a different version of standards. This is because there are varying standards and numerous version for which providers aren’t equipped.

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Care Coordination 101: Evolving to Patient-Centric Care

Guest post by Abhinav Shashank, CEO and co-founder, Innovaccer.

Abhinav Shashank
Abhinav Shashank

The US healthcare is getting costlier every day, and it is without a doubt true that most of the US citizens live in fear that they won’t get access to the care when the illness strikes. The sad truth is that every year more than 100,000 deaths occur because of medical errors. All this when we see horrifying figures even after adjusting the America’s higher per capita GDP; US spends roughly $500 billion more than other developed countries.

The Problems with Coordination

13 years ago, way back in 2003, the Institute of Medicine had identified the most persistent problem in the healthcare industry, and it was coordination. The idea behind implementing EHRs was to create digital data that is easy to share, but that did not happen. According to a study, 63 percent of primary care physicians and 35 percent specialist are not satisfied with the information they receive from other physicians within the adult referral system.

The above graph shows how poorly coordinated care has affected the adults. The US stands second when it comes to high-need patients. This is when US spends more than $10,000 on one person’s health.

According to a research article, the biggest challenges Primary Care Physicians and Hospitalists faced were:

Besides these, a lot of problems arise when patients miss out on medications, follow-up visits or any other requirements. Thus, there is a need to create a process where neither do PCPs miss out on critical information nor does the patient stay unaware of the care plans. For this PCPs had identified the most successful care coordination components:

The most important aspect of healthcare is that when a care process is nearing its end, the patient should be in a better state. A patient-centric approach is must to make sure a patient gets the best treatment. Health Coaches ensure that the patients get what they need. They make sure that the

The Three Pieces of Care Coordination

More often than not care coordinators miss out on the essential information about the patients. In worst cases, they have no discharge information of patients creating gaps in care and indirectly increases the cost of care. Ideally, the three pieces of care coordination together can bring dramatic improvements in patient-centric care. The three pieces are:

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How Does the Future of Health IT Look Under the New Administration?

Guest post by Abhinav Shashank, CEO and co-founder, Innovaccer.

Abhinav Shashank
Abhinav Shashank

The picture of healthcare industry is changing rapidly and still continues to evolve, with technology playing a huge role and the other factor being the government. With a new administration in the White House, the Senate and the House of Representatives, there ought to be numerous changes in healthcare, modifying ACA being one of them. Come January, what will be the effect of the new policies of the GOP have on health IT?

Healthcare Today

In his victory speech, President-elect Donald Trump emphasized on restoring and improving infrastructure and calling healthcare and hospitals an integral part of that plan. The Trump administration even after a session is less likely to remove its focus from IT investments and developments in healthcare; the Republicans believe in leveraging technology and healthcare experts are confident that healthcare-related initiatives like Cancer Moonshot and Precision Medicine Initiative will continue to speed up.

According to a recent ONC report, 96 percent of hospitals and 78 percent of physician offices were using certified EHRs to maintain patient data.

With digital initiatives developing, the hassle in prescribing medicines, scheduling appointments and access to vital records have reduced.

Making the consumer the center of the healthcare system and empowering them has been favorable. According to a survey conducted on 13,000 users, it was revealed that 28% changed their providers based on data made available online – implying that patients wish to be a part of the decision making.
A substantial number of digital health startups have emerged, and their revenue in 2015 was over $4.5 billion – and continues to grow.

Health IT developments to look ahead

Although Donald Trump has his healthcare plan for the country under the covers, some significant advancements are coming our way and following is a slice of what’s coming:

Value-Based Care: One of the most important thing Trump has asserted on in his plan is that he wants to ensure that “no one slips through the cracks simply because they cannot afford insurance.” With U.S. healthcare accounting for 17.1% of the entire nation’s GDP, it’s important to back this transition towards value-based care.

Advancements in Interoperability: In ONC’s latest report to Congress, interoperability was tagged as an essential priority. There are still a lot of factors getting in the way of free flow of data between providers, topped with the inability on patients’ part to access their medical information freely. There are many initiatives on the block: the Sequoia Project’s Care Quality programs, the development of FHIR standards that will be backed by Trump and will pan out impressively.

Banking on Digitization: In sustaining the momentum of this transformation, digitization would be the cornerstone. The use of data analytics, machine learning, patient-centered technology developments and the Internet of Things will unleash their forces under Trump administration and fuel further developments and investments.

Changing the Dynamics of the Marketplace: Donald Trump plans to allow insurance companies to sell their plans across the state lines which may result in an increase in competition and making their plans value-focused. Allowing a free market for drug import could also prove critical in reducing the cost of healthcare: he said in one of his speeches that Medicare could save as much as $300 billion every year, if drug prices were negotiated.

Future Implications

Health IT will stay because the need is to continue to work on making healthcare industry interoperable. Major value-focused programs on healthcare by federal government, such as MACRA won’t see significant changes. However, there is a possibility that the Quality Payment Program could be “enhanced.”

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The Rise of Trump Care: 7 Ways Trump Could Impact Healthcare Reform

Guest post by Abhinav Shashank, CEO & co-founder, Innovaccer.

Abhinav Shashank
Abhinav Shashank

On Nov. 9, 2016 the United States of America witnessed a major turnaround in the administration. Republican candidate Donald Trump is the 45th president-elect of the United States. Donald Trump plans to bring about numerous changes to “Make America Great Again,” and true to his Republican roots, Trump’s plans for the healthcare focus on some key facets which have always been a concern for the GOP.

Trump has outlined his healthcare plan for America that is centered around mainly the following key facets. A study conducted by the Commonwealth Fund with RAND Corporation using simulation analyzed his plans and came up with probable impacts.

1.) Repeal Affordable Care Act

Donald Trump and the GOP want to fully repeal the ACA and replace it with something new, dubbed “Healthcare Reform to Make America Great Again.” However, the intention is to achieve a better law with some parts of ACA.

Planned changes: Pre-existing condition clause will remain. As the Republican plan “the better way” dated June 22, 2016, Trump plans to continue with it as no American should be denied on the basis of pre-existing medical conditions or demographics. Remove the individual and employer mandate, as no one should be forced to buy health insurance. Reduce the growth rate of Medicare spending and implementation of new taxes and fees.

2.) Use of Health Savings Accounts (HSA)

A Health savings account is a tax-advantaged medical saving account available to the people of US, which allows people to contribute or draw money from for paying off medical expenses, tax-free.

Planned changes: Under Obamacare, HSAs were available to only individuals who were enrolled in “High Deductible Health Plans.” Keeping the basics same, Trump proposes to expand HSAs, allowing all individuals to use HSAs where the contributions would not only be tax-free but will also accumulate over time. Moreover, he would allow HSAs to become a part of a person’s estate and would be passed on to heirs without any penalty.

3.) Making premiums tax deductible

Before ACA came along, there were substantial tax advantages available to people who had their employer cover for them, but that privilege did not extend to people who took up private, individual-market policies not provided by the employer. To solve this disparity, ACA had the provision of means-tested advance premium tax credits, known as APTCs – where the government reduces the cost of insurance by providing APTCs to bridge the gap between the cost of premium and payment limit.

Planned changes: Trump’s plan will allow individuals to fully deduct their premiums from their tax returns under the current tax system, facilitating a free market to provide insurance coverage to companies and individuals. The scheme Trump has will abolish APTCs and let individuals use pre-tax money to purchase individual market insurance.

The aim is to provide people with an incentive to pay for coverage when they are healthy, and not make it mandatory.

4.) Funding Medicaid through block-grants

Under the current law, Medicaid gets join funds by the federal and state government and the federal government contributes 50 percent to 75 percent of the total costs and the rest is borne by the states.

Planned changes: Trump proposes to fund Medicaid all over the country through block grants. Under this, the federal government would give a fixed amount of money to states and let them fund their programs.
The rationale behind this is that state governments know best about their population and should have the sole authority on how the money should be spent and will fare better without federal administration overhead.

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Shifting From Volume to Value with Technology

Guest post by Abhinav Shashank, CEO and co-founder, Innovaccer.

Abhinav Shashank
Abhinav Shashank

Since 1966, Americans have received more Nobel Prizes in Medicine than rest of the world combined with astonishing advancement in medical treatments, but how much of it reflected on ground level is still a troublesome figure. The soaring costs of healthcare; the amount spent on healthcare is approximately 20 percent of the country’s GDP and the amount spent on one person per year is going to be roughly $10,000 in 2017; much higher than any other country. Despite ACA, more than 30 million people in the U.S. are still uninsured. With so many concerns, the healthcare industry needs innovation to change this bleak picture.

Innovative solutions have emerged in these aspects – the delivery of treatments to patients, the technology as well as the business aspects. A few innovations in healthcare are here to stay, resulting in a more convenient and effective treatment for patients today, where time is of the essence and providing patients a better future is a priority.

Big Data. Big Use. Big Outcomes

Data-driven innovations are poised to do wonders in healthcare industry. Big data has been used to predict diseases, find their cure, improve the quality of care and avoid preventable deaths. From increasing awareness in patients to transforming data into information, big data offers healthcare a paradigm shift. Instead of analyzing a single patient’s data, we can now explore entire patient population and predict patients’ health trend.

Some healthcare leaders have already extracted value from big data and are already putting them to good use. Many value-focused healthcare organizations are working to improve healthcare delivery and healthcare delivery and patient outcomes by making an integrated technology system that will allow practices to deliver evidence-based care that is more coordinated and personalized.

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Breakdown of the Final MACRA Rule

Guest post by Abhinav Shashank, CEO and co-founder, Innovaccer.

Abhinav Shashank
Abhinav Shashank

A new complex rule is about to change the entire US healthcare industry. It will replace the Sustainable Growth Rate (SGR) and streamline the three programs. The NPRM for MACRA was passed in 2015 and after the comments and feedbacks from numerous healthcare experts, the final rule with comment period has been released by CMS.

In the final rule, CMS has responded to more than 4,000 comments in a document which is more than 2,300 pages long. Some of these comments have been implemented in the law. As a result of this feedback friendly approach, substantial changes have been made.

The New MACRA after changes

The law aims to bring in unified policies that will add greater value to the healthcare system through the new Quality Payment Program (QPP). The program rewards for value in two ways:

Chance to adapt

To help the physicians get used to the program CMS has declared the first year — 2017 — as “transition” year. There will be four options available to physicians in the transition year:

Merit-based Incentive Payment System

Under this program, eligible clinicians will get payment adjustments based on the quality, cost and other measures related to care. This program will see the “sunset” of three existing programs namely:

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MIPS: All You Need to Know About It

Guest post by Abhinav Shashank, CEO and co-founder, Innovaccer.

Abhinav Shashank
Abhinav Shashank

According to a survey almost 50 percent of the physicians do not understand MACRA. With less than five months to full implementation of MACRA, are we ready to embrace one of the most elaborate laws of US? And, most importantly, will it produce the needed positive outcomes? The program is expected to improve the current standards, sort the most persistent problems and create opportunities to rework and revise Medicare. How will all this happen?

With MACRA in place, there won’t be two digit payment cuts like in the current Sustainable Growth Rate (SGR) formula. Besides enhancing the use of electronic health records, MACRA is expected to increase the relevance of Medicare to the real world and reduce the administrative burden from physicians’ shoulders.

Decoding MIPS

MIPS stands for Merit-Based Incentive Payment System. It will streamline the three independent programs Physician Quality Reporting System (PQRS), meaningful use, and value-based modifier to ease the burden on the clinicians. The three components in MIPS will replace these programs. Besides this, one more component will be there to bring improvements in practice. Namely following components will be there in MIPS:

1.) Quality: This component will replace the Physician Quality Reporting System (PQRS). Under MIPS the methods of reporting and the various quality measures have been adopted from the old programs PQRS and VBM. There are some changes in the reporting methods and for the registry, EHR, and Qualified Clinical Data Registry (QCDR) reporting methods, a clinician can select minimum six measures which could be a combination of any quality domain. If the clinician faces patients, then he has to select in such a way that one of these measures is cross-cutting measure (cross-domain-cutting), and one is outcome-based measure. If there is no outcome-based measure, then a high priority measure has to be selected.

Besides these six measures, CMS will calculate two or three more measures depending on the size of the group of physicians. For instance, if there is an individual physician or a group less than 10 then two measures and if more than that then three measures. Additionally, for QCDR and registry reporting methods, the “data completeness” standard has been changed. The number of patients to be reported within a measure denominator has been raised from 50 percent to 90 percent.

2.) Advancing Care Information: According to MIPS the meaningful use program will see a lot of changes. Currently, the meaningful use program is everything-or-nothing; i.e., if one clinician achieves a performance rate of 20 percent on meaningful use measures and another achieves 90 percent then they both get rewards in a similar fashion. However, under ACI the latter one gets 10 out of 10 points, and the former gets three points.

More than 100 ACI performance points have been defined out of which base 50 are base points given for reporting either “yes” or a non-zero numerator. The performance scores are up to 80 points based on the performance on eight measures. Rest bonus points are awarded for reporting any other public health registry.

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The Dream of Learning Healthcare Systems: How We Think It’s Doable

Guest post by Abhinav Shashank, CEO and co-founder, Innovaccer.

Abhinav Shashank
Abhinav Shashank

The digitization of healthcare was a much-needed change brought after years of hard work and effort. One might wonder how could one justify the expenditure of $10 billion in a span of five years just on digitization. The problem intensifies when after several studies we find out that EHRs only reciprocate around 30 to 35 cents on a dollar and sometimes the figure dips to 15 cents.

Why have we digitized healthcare when the efforts required to get the desired result is still too much? I think we haven’t used the available technological aids appropriately. It is like driving a car at midnight and not knowing that you have headlights. You can have a clear view of your path, you can get to your destination fairly fast but can’t because you don’t know what is going to help you and in what way, your performance is reduced to a great extent to be able to achieve what you desire

Justified use of EHR could create the needed ecosystem

According to a report, 10 percent to 20 percent of savings are possible if a value-focused healthcare organizations capitalize on EHRs and interact with their patients better through technology. The amount that could be saved annually per bed is in between $10,000 and $20,000.

Meaningful Use

There are incentives for meaningful use of EHRs, but the truth is that the return through meaningful use incentives is somewhere around 15 or 20 cents on a dollars. There have been implementation, stabilization and optimization problems that have made it hard for healthcare organizations to extract the best out of EHRs. Practices will have to start using data as a source of innovation and come up with solutions that’ll not provide them better incentives but assist them in providing even better patient-centric care.

There are certain key points one can work on to make their healthcare ecosystem more efficient and patient-centric. Only judicious data usage from data disparate sources can help in so many ways, imagine what else is possible with advanced solutions. The integration of EHR with different disparate sources could be really beneficial in understanding the factors that drive value-based care. For instance, with the help of various data one can perform:

Population Health Management: With the help of data collected from different sources, impact at a population could be created and analyzed. Once you have the data of millions of patients, imagine all the things that are possible. Identification of at-risk patients, stratification of patients on the basis of various disease registries, better decision making, and a lot more. According to a study, due to disease management programs the cost of care were reduced by $136 per member per month because of reduction in admission rates by 29 percent.

Variations in Care Delivery: Efficient analytics and data management can help answer many questions. The medication process could be streamlined on the basis of past cases, and identified opportunities could be capitalized. Also, a thorough data-driven analytics could provide substantial insights on the performance of various facilities and how they differ when it comes to care delivery process.

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The ABC of MACRA

Guest post by Abhinav Shashank, CEO and co-founder, Innovaccer.

Abhinav Shashank
Abhinav Shashank

Currently, one of the most discussed topics in the healthcare industry is MACRA; a complex 962-page document that is supposed to redesign the entire healthcare industry. Know all about MACRA in six questions.

What is MACRA?

MACRA stands for Medicare Access and CHIP Reauthorization Act. It’ll repeal the current Sustainable Growth Rate (SGR) Formula and extend CHIP for two more years. Extending CHIP for two more years (in total four years now) will help tens of millions of kids in retaining their insurance.

SGR was introduced in 1997, as a method to curb the Medicare expenditures. Under SGR the physician payments were cut if the overall expenditure was above the benchmark. This payment cut system turned out to be a major reason for significant losses incurred by physicians. Fearing payment cuts, many physicians started denying services to Medicare beneficiaries.

In 2015, “Doc Fix” or MACRA was proposed, which as the name suggests fixed the unprecedented payment cuts. If it weren’t for “Doc Fix,” physicians would have faced 21 percent payment cuts in 2015.

The Notice for Proposed Rulemaking (NPRM) was issued on Apr. 27, 2016, and the final rule will come in November. MACRA’s full implementation will begin from 1st January 2017.

What will MACRA change/replace?

The idea behind implementing MACRA is to create something that works and is enduring. MACRA would bring changes through its unified framework called “Quality Payment Program,” which has been further divided into Merit-Based Incentive Payment System (MIPS) and Advanced Alternative Payment Model (APMs).

All those who will be eligible for MIPS are called Eligible Clinicians. The term has expanded from “Eligible Provider” to “Eligible Clinicians.” It will include physicians, physician assistants, nurse practitioners, clinical nurse specialists, certified registered nurse anesthetists and groups of such clinicians. This expansion has increased the number of people who will receive payments from Medicare. CMS might expand to Medicare part B after two years, which will include therapists, clinical social workers, clinical psychologists.

To keep health information flexible and user-centric, and bring all these changes with better care opportunities, MIPS will evaluate eligible clinicians on four measures namely: Quality Category to replace PQRS; resource use category to replace value-based modifier; Advanced Care Information (ACI) to replace meaningful use; Clinical Practice Improvement Activities (CPIA).

How will the four categories measure the performance?

Quality Category: Instead of reporting on nine measures, Clinicians will have the choice to pick speciality-specific measures. They can choose six measures to report to CMS that suits them the best reflecting their practice. But one of these measures must be an outcome measure or a high-priority measure and one must be a cross-cutting measure. Clinicians can also choose to report a specialty measure. Clinicians can report through Claims, Electronic Health Record (EHR), Clinical Registry, Qualified, Clinical Data Registry (QCDR) or Group practice reporting web portal.

For the year one, quality category will have 50 percent weight in the performance scoring procedure.

Resource Use: Clinicians are not required to report for this, CMS will calculate these measures based on claims and “availability of sufficient volume.” To account for the differences among specialties, CMS has proposed to add 41 episode-based measures. These episode groups have potential to provide more actionable insights on measure resource use than the various cost measures.

For the year one, resource use category will have 10 percent weight in the performance scoring procedure.

Advancing Care Information: Clinicians can report on the measures that suit their practices the best and reflect how the EHR technology is being used for daily needs, with particular emphasis on the interoperability and information exchange. The performance score does not use threshold and allows physicians to receive partial credits on measures.

For the year one, advancing care information category will have 25 percent weight in the performance scoring procedure.

Clinical Practice Improvement Activities: In this category, clinicians would be rewarded for activities that improves overall care delivery such as care coordination, beneficiary engagement, and patient safety. Clinicians can choose practices’ goal from a list of 90 plus activities. This category does not require a full year reporting. CPIA activities need to be performed for at least 90 days during the performance period.

For the year one, CPIA Category will have 15 percent weight in the performance scoring procedure.

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