2017 ACI Transition Measure: Health Information Exchange

Under the Merit-based Incentive Payment System (MIPS) pathway of the MACRA Quality Payment Program, the Advancing Care Information (ACI) category replaces the Medicare EHR Incentive Program (Meaningful Use). ACI is one of the three performance categories that will be considered and weighted for scoring a clinician’s performance under MIPS (four categories will be included starting in 2018). An eligible clinician’s score for the Health Information Exchange measure is dependent on the clinician meeting the measure’s base score requirements. This measure may also be selected to earn additional performance score credit. For more information on ACI scoring methodology, please click here.

Objective:

Health Information Exchange

Measure:

Health Information Exchange                   
The MIPS eligible clinician that transitions or refers their patient to another setting of care or health care clinician (1) uses certified EHR technology (CEHRT) to create a summary of care record; and (2) electronically transmits such summary to a receiving health care clinician for at least one transition of care or referral.

Scoring Information:

  • Required for Base Score (50%): Yes
  • Percentage of Performance Score (up to 90%): Up to 20%
  • No bonus points available

Reporting Requirements

  • Numerator: The number of outgoing transitions of care and referrals in the denominator where a summary of care record was created using CEHRT and exchanged electronically.
  • Denominator: The number of outgoing transitions of care and referrals during the performance period for which the MIPS eligible clinician was the transferring or referring health care clinician.
  • Measure Exclusion: Any MIPS eligible clinician who transfers a patient to another setting or refers a patient fewer than 100 times during the performance period. A MIPS eligible clinician may claim this exclusion if the exclusion criteria are met, but is not required to do so and may report on the measure if he or she chooses.

Scoring Requirements
To earn base score credit for this measure, a MIPS eligible clinician must meet the numerator requirements for at least one denominator eligible patient during the 2017 calendar year. To meet numerator requirements for this measure, a MIPS eligible clinician who transitions or refers his or her patient to another setting of care or health care clinician must 1) use CEHRT to create a summary of care record, 2) electronically transmit such summary to a receiving health care clinician, and 3) must have reasonable certainty of receipt by the receiving clinician to count the action toward the measure.

To earn further credit for the performance score component of this measure, the clinician may complete the numerator requirements for as many additional denominator eligible patients as the clinician deems appropriate during the 2017 calendar year.

Practice Fusion Suggested Workflow
Practice Fusion suggests the following workflow to help ensure that you gain numerator credit for this measure within the Practice Fusion EHR. For information on how to meet this measure for historical referrals in 2017, please see Step 5.

  1. Ensure that your recipient is a contact in your Directory: Ensure that the referral recipient is added as a contact in your Directory and, if the recipient is not a verified Practice Fusion provider (i.e. the provider uses a different EHR system), that a Direct address has been entered into the recipient’s contact information.

  2. Create an electronic summary of care record: Create an electronic summary of care record for the patient being referred: Generate either a clinical or referral summary by selecting Create clinical document from the Actions dropdown menu in the patient chart. A referral summary is recommended for more completeness. Note: Per the CMS measure specifications, the MIPS eligible clinician must verify that the fields for current problem list, current medication list, and current medication allergy list are not blank and include the most recent information known by the MIPS eligible clinician at the time of generating the summary of care document, or include a notation of no current problem, no medication and/or no medication allergies.

  3. Initiate the referral: Once the summary of care record has been created, initiate an electronic referral by selecting Add referral from the Actions dropdown menu in the patient chart and completing the appropriate fields. Ensure that the electronic summary of care is attached in the Attachments field (the attachments list will display an indicator icon next to each eligible attachment to quickly distinguish it for selection) and send the referral once you have confirmed that the referral details are complete.

  4. After the referral is sent: Obtain reasonable certainty that the receiving clinician has received the referral and the attached summary of care, and once you have done so, indicate this confirmation by checking the Receipt checkbox in the Referrals section of the patient Timeline.

  5. Confirm historical referrals: In order to count any historical referrals from the 2017 calendar year towards the numerator of this measure within the Practice Fusion EHR, Step 4 must also be completed with respect to those referrals. From the patient Timeline, indicate referral receipt confirmation using the Receipt checkbox associated with any referrals from the 2017 calendar year for which you have reasonable certainty that the receiving clinician received the referral and attached summary of care.

1. Ensure that your recipient is a contact in your Directory
Practice Fusion Recipient
Before sending a referral to another verified Practice Fusion provider, you will need to ensure that they are added as a contact in your Practice Fusion EHR Directory. To access your Directory, select the Home button from your left-hand navigation bar and click the Directory tab at the top of the page. If the recipient is not listed as an existing contact in your Directory, you can add a new contact using the workflow outlined here.

Non-Practice Fusion Recipient
If you are sending a referral via Direct message to a provider outside the Practice Fusion network (i.e. a provider using a different EHR system), you and the receiving provider must each have a Direct address. If you do not have a Direct address, you can request one using the steps detailed here. Once you have obtained your Direct address, you can manually add your referral recipient as a new contact to your Directory, making sure to add their Direct address in the appropriate field. Please note that you will need to contact the recipient to obtain their Direct address. Furthermore, only Practice Fusion providers who have been verified for a Direct address will see the Direct Address field when adding a new contact to their Directory.

2. Create an electronic summary of care document (clinical or referral summary)
From the Actions dropdown menu in the patient’s chart, select Create clinical document. You may generate either a clinical or referral summary, though a referral summary is recommended for more completeness. Per the CMS measure specifications, the MIPS eligible clinician must verify that the fields for current problem list, current medication list, and current medication allergy list are not blank and include the most recent information known by the MIPS eligible clinician at the time of generating the summary of care document or include a notation of no current problem, no medication and/or no medication allergies. For a complete list of information that should be included in the summary of care record if known by the referring provider, please review FAQ #3 at the end of this article.

  

3. Initiate an electronic referral
Once you have generated your electronic summary of care record, select Add referral from the Actions dropdown menu in the patient’s chart.

Select the recipient from the My Connections flyout pane. In order to earn numerator credit for this measure, you must send the referral electronically to a verified referral recipient. (Please see FAQ #1 at the end of this article for more information about verified referral recipients.)

If you are sending the referral on behalf of another member of your practice, select the MIPS eligible clinician’s name from the On Behalf Of menu. Please note: to successfully send a referral via Direct Message on behalf of the clinician, you will also need to request a Direct Address within your own account. For details on how to do so, please click here.

Click into the Attachments field to attach the clinical/referral summary you previously generated; you may also attach other relevant documentation as necessary. The attachments list will display an indicator icon next to each eligible summary of care attachment to quickly distinguish it for selection. If you do not wish to send a paper copy of the referral in addition to the electronic copy, you may un-check the Send by fax checkbox.

4. Confirm referral receipt
Obtain reasonable certainty that the receiving clinician has received the referral and the attached summary of care, and once you have done so, navigate to the patient Timeline and select Referrals from the dropdown menu. Use the “Confirmed” checkbox in the Receipt column to indicate receipt confirmation.

Receipt confirmation may also be indicated in the Referrals section of Messages.

5. Confirm Historical Referrals. In order to count any historical referrals from the 2017 calendar year towards the numerator of this measure within the Practice Fusion EHR, Step 4 must also be completed with respect to those referrals. From the patient Timeline, indicate referral receipt confirmation using the Receipt checkbox associated with any referrals from the 2017 calendar year for which you have reasonable certainty that the receiving clinician received the referral and attached summary of care.

FAQs

1. Who are verified referral recipients?
In order to gain numerator credit for this measure using Practice Fusion, you will need to send referrals to verified recipients. Verified referral recipients who use Practice Fusion are providers who have completed e-Prescribing verification within the Practice Fusion EHR. These providers will appear as searchable contacts in the Practice Fusion Directory. Practice Fusion providers who have not completed e-Prescribing verification will not appear in the Practice Fusion Directory, but will count as verified referral recipients if they have obtained a Direct address as part of the Direct Trust network. Please note that you will need to contact them to obtain their Direct address before sending a referral.

Verified referral recipients who use other certified EHR systems are those who have obtained a Direct address as part of the Direct Trust network. Before sending a referral to a non-Practice Fusion provider, you will need to contact them to obtain their Direct address. To see a list of other EHR systems that are part of the Direct Trust network, click here for those in the Direct Trust network and here for those who are partnered with Updox, a member of the Direct Trust network. You can also visit our blog post for suggested guidance on obtaining Direct addresses from providers to whom you wish to send referrals.

2. What is considered a transition of care for the purposes of this measure?
CMS defines a transition of care as the movement of a patient from one setting of care (hospital, ambulatory primary care practice, ambulatory, specialty care practice, long-term care, home health, rehabilitation facility) to another. Within Practice Fusion, a transition of care for the purposes of this measure is recorded upon the transition of a patient from your care to an outside setting of care, e.g. another provider, specialist, a long term care facility, or hospital.

3. What is the minimum amount of information that is required in the summary of care?
CMS indicates that all summary of care documents used to meet this measure must include the following information if known by the MIPS eligible clinician:

  • Patient name
  • Referring or transitioning healthcare provider’s name and office contact information (MIPS eligible clinician only)
  • Procedures
  • Encounter diagnosis
  • Immunizations
  • Lab test results
  • Vital signs (height, weight, blood pressure, BMI)
  • Smoking status
  • Functional status, including activities of daily living, cognitive and disability status
  • Demographic information (preferred language, sex, race, ethnicity, date of birth)
  • Care plan field, including goals and instructions
  • Care team including the primary care provider of record and any additional known care team members beyond the referring or transitioning provider and the receiving provider
  • Reason for referral (MIPS eligible clinician only)
  • Current problem list (Providers may also include historical problems at their discretion)
  • Current medication list
  • Current medication allergy list

Note: Per the CMS measure specifications, the MIPS eligible clinician must verify that the fields for current problem list, current medication list, and current medication allergy list are not blank and include the most recent information known by the MIPS eligible clinician as of the time of generating the summary of care document or include a notation of no current problem, medication and/or medication allergies.

4. How do I sign up for Direct Messaging?
Visit our article on Direct messaging to get started.

5. When does the referral need to be sent or documented in order to gain credit?
Electronic referrals may occur before, during, or after the selected MIPS performance period. However, the referral must occur within the 2017 calendar year to count in the measure numerator.

6. Should I send a referral summary or clinical summary as part of the referral?
You may generate either a clinical or referral summary, but a referral summary will offer more completeness and will automatically include all of the required fields indicated in response to FAQ #3 above.

Data Validation
CMS has published guidance to help providers better understand the documentation they should retain around meeting MIPS requirements. CMS calls this guidance "MIPS Data Validation Criteria" because it describes the types of documentation that would validate the data the provider submits to CMS at the end of the performance period. You can learn more about this by reviewing CMS’ MIPS Data Validation Fact Sheet and you can see the specific documentation guidelines applicable to the ACI Transition Measures in CMS’ MIPS Data Validation Criteria for ACI Transition Measures.  

More information

Quality Payment Program

  1. 2018 Quality Payment Program: What is the Merit-Based Incentive Payment System (MIPS)
  2. What is the MIPS Dashboard watch list and how do I use it?
  3. How does the MIPS Dashboard work?
  4. What is the Promoting Interoperability (formerly Advancing Care Information) performance category in MIPS?
  5. 2018 What is the Quality performance category in MIPS?
  6. 2018 What are Improvement Activities in MIPS?
  7. Which Improvement Activities qualify for the Promoting Interoperability performance category bonus in 2018?
  8. What is the Cost performance category of MIPS and how is it scored in 2018?
  9. How is the MIPS Final Score Calculated in 2018?
  10. What is a MIPS eligible clinician in 2018?
  11. MIPS for Small, Rural and Underserved Practices
  12. 2018 PI Transition Measure: Medication Reconciliation
  13. 2018 PI Transition Measure: Electronic Prescribing (eRx)
  14. 2018 PI Transition Measure: Secure Messaging
  15. 2018 PI Transition Measure: Security Risk Analysis
  16. 2018 PI Transition Measure: Health Information Exchange
  17. 2018 PI Transition Measure: Immunization Registry Reporting
  18. 2018 PI Transition Measure: Specialized Registry Reporting
  19. 2018 PI Transition Measure: Syndromic Surveillance Reporting
  20. 2018 PI Transitional Measure: View, Download, or Transmit (VDT)
  21. 2018 PI Transition Measure: Provide Patient Access
  22. 2018 PI Transition Measure: Patient-Specific Education
  23. What is the Practice Fusion QCDR?
  24. 2017 Quality Payment Program: What is the Merit-Based Incentive Payment System (MIPS)
  25. How do I report my 2017 MIPS data to CMS using the Practice Fusion QCDR?
  26. What is the Advancing Care Information (ACI) Performance Category for MIPS and how is it scored?
  27. 2017 ACI Transition Measure: Security Risk Analysis
  28. 2017 ACI Transition Measure: Electronic Prescribing (eRx)
  29. 2017 ACI Transition Measure: Provide Patient Access
  30. 2017 ACI Transition Measure: Health Information Exchange
  31. 2017 ACI Transition Measure: View, Download, or Transmit (VDT)
  32. 2017 ACI Transition Measure: Patient-Specific Education
  33. 2017 ACI Transition Measure: Secure Messaging
  34. 2017 ACI Transition Measure: Medication Reconciliation
  35. 2017 ACI Transition Measure: Immunization Registry Reporting
  36. 2017 ACI Bonus Measure: Syndromic Surveillance Reporting
  37. 2017 ACI Bonus Measure: Specialized Registry Reporting
  38. What is the Improvement Activities Performance Category for MIPS?
  39. What are the Quality performance category reporting requirements for MIPS?
  40. What is the difference between the two Advancing Care Information measure sets available in 2017?
  41. What are Alternative Payment Models (APMs) and Advanced APMs?
  42. What is Comprehensive Primary Care Plus (CPC+)?
  43. Which Improvement Activities Qualify for the Advancing Care Information (ACI) Bonus Score in 2017?
  44. How do I contact CMS about the Quality Payment Program?
  45. How do I indicate interest in the Practice Fusion QCDR and get my MIPS estimated scores?
  46. Chronic Care Management FAQs
  47. How do I export a JSON file for 2017 MIPS reporting?
  48. How is the MIPS Final Score Calculated in 2017?

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