Council Rural Quality Improvement Technical Assistance (RQITA) - - PowerPoint PPT Presentation
Rural Quality Advisory Council Rural Quality Improvement Technical Assistance (RQITA) Program January 4, 2018 Agenda Welcome 2018 Final MIPS Rule: Implications for Rural NQF MAP Rural Health Workgroup Update From the Field
Rural Quality Improvement Technical Assistance (RQITA) Program
January 4, 2018
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FORHP
– Offer advice and counsel on development of rural-relevant quality improvement goals and metrics, and integration into new and existing FORHP funded programs. – Provide feedback, guidance, and insight on the development, implementation, and evaluation of the Rural QI TA strategies, tools, and resources.
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RQITA and FORHP staff
– Representation across FORHP programs, different types of rural providers, geography
– Key Partners (ongoing) – Rural In-the-Field Leaders (2-year terms) – Subject Matter Experts (2-year terms)
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purpose
round robin with each Council member introducing themselves and responding briefly to the question,
– “What is the most pressing rural health quality issue or opportunity in 2018 from your perspective?”
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including measure changes and virtual group reporting.
https://www.cms.gov/Medicare/Quality- Payment-Program/Resource- Library/Resource-library.html
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Rural Quality Advisory Council Meeting January 4, 2018 6
QUALITY PAYMENT PROGRAM BACKGROUND
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QPP: WHERE ARE WE GOING IN 2018?
Final rule with comment for QPP participation in CY18
published November 2017, comments due January 2
Considerations for Latest QPP Updates
Improve beneficiary outcomes Reduce burden on clinicians Increase adoption of Advanced APMs Maximize participation Improve data and information sharing Ensure operational excellence in program implementation Deliver IT systems capabilities that meet the needs of users
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MIPS YEAR 2 PARTICIPATION ESTIMATES
>600,000 clinicians are estimated to
be MIPS-eligible in year 2
These clinicians represent 40% of
TIN/NPIs and 66% of Medicare Part B allowed charges
Approx. 540,000 clinicians excluded
due to low-volume threshold
185,000-250,000 clinicians expected
to be qualifying participants (QPs) in APMs
19%
MIPS Eligibility by Practice Size
(2018 Estimate)
1-15 Clinicians 25-99 Clinicians 16-24 Clinicians 100 or More Clinicians
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QUALITY PAYMENT PROGRAM FINAL RULE FOR CY 2018
MIPS Policies of Interest to Rural Providers:
payment adjustment
MIPS score
choice to form Virtual Groups
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LOW VOLUME THRESHOLD IN YEAR 2
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PERFORMANCE THRESHOLD AND PAYMENT ADJUSTMENT IN YEAR 2
Year 2: Performance in 2018 that applies to payments in 2020 Performance Threshold: 15 point MIPS Performance Score for
neutral or positive payment adjustment in year 2
Increases from 3 point threshold in year 1 Exceptional performance remains set at 70 points
Payment Adjustment: Maximum payment adjustment of ±5%
in year 2
Increasing from ±4% in year 1
Fee Schedule Adjustment: 0% for 2020 payments
Decreases from +0.5% for 2019 payments Remains at 0 until 2026
0.75% qualifying APM conversion factor 0.25% non-qualifying APM conversion factor
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MIPS YEAR 2 SCORING
Performance Period in Year 2
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Change: 10% Counted toward Final Score in 2018
Medicare Spending per Beneficiary (MSPB) and
total per capita cost measures are included in calculating Cost performance category score for the 2018 MIPS performance period.
These measures were used in the Value Modifier
and in the MIPS transition year
CMS is developing new episode-based measures
with significant clinician input to propose in future rulemaking
COST YEAR 2 SCORING
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QUALITY YEAR 2 SCORING
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QUALITY: TOPPED OUT MEASURES
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QUALITY: TOPPED OUT MEASURES
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QUALITY: NEW MEASURES FOR 2018
1.
Q459: Average Change in Back Pain following Lumbar Discectomy / Laminotomy
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Q460: Average Change in Back Pain following Lumbar Fusion
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Q461: Average Change in Leg Pain following Lumbar Discectomy / Laminotomy
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Q462: Bone Density Evaluation for Patients with Prostate Cancer and Receiving Androgen Deprivation Therapy
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Q463: Prevention of Post-Operative Vomiting (POV) - Combination Therapy (Pediatrics)
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Q464: Otitis Media with Effusion (OME): Systemic Antimicrobials - Avoidance of Inappropriate Use
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Q465: Uterine Artery Embolization Technique: Documentation of Angiographic Endpoints and Interrogation of Ovarian Arteries
8.
Q467: Developmental Screening in the First Three Years of Life
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QUALITY AND COST: IMPROVEMENT SCORING
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SPECIAL MIPS SCORING PROVISIONS FOR SMALL AND RURAL PROVIDERS IN 2018
Category Scores
Quality: Small practices receive 3 points for measures
not meeting data completeness requirements
ACI: Hardship exemptions available for small and
rural providers
IA: Report on no more than 2 medium or 1 high-
weighted activity to reach the highest score
Final Score Bonuses
Small Practice Bonus: 5 bonus points to final score for
practices of 15 or fewer clinicians
No Rural Bonus Complex Patient Bonus (not specific to small or rural
providers): Up to 5 bonus points
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MIPS DATA SUBMISSION
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VIRTUAL GROUPS IN CY 2018
Eligibility: A solo practitioner or a group of 10 or fewer eligible
clinicians
May join one virtual group for a performance period Election to join applies to all MIPS-eligible clinicians in the group Solo practitioners or group must be MIPS-eligible
Election Deadline: December 31, 2017 for 2018 participation Election Process: A two-stage virtual group election process for
2018 and 2019
Stage 1 (optional): Virtual group eligibility determination Stage 2: Virtual group formation
Agreement: Virtual groups must execute a written formal and
contractual agreement between each member of a virtual group meeting specified criteria
Reporting Requirements: Assessed at the virtual group level
across all four MIPS performance categories
CMS Estimate: 765 MIPS eligible clinicians will join 16 virtual groups in 2018
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ALTERNATIVE PAYMENT MODELS
Extends the revenue-based nominal amount standard for two
additional years (through performance year 2020)
Changes the nominal amount standard for Medical Home Models
so that the minimum required amount of total risk increases more slowly
Gives more detail about how the All-Payer Combination Option
will be implemented
Allows clinicians to become Qualifying APM Participants (QPs)
through a combination of Medicare participation in Advanced APMs and participation in Other Payer Advanced APMs
Available beginning in performance year 2019
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BUDGET ESTIMATES
MIPS
CMS estimates 96.8% of MIPS eligible clinicians will report in 2018
97.1% to receive positive or neutral payment adjustments 74.4% to receive “exceptional payment adjustment”
CMS estimates that small practices are somewhat less likely to reportin 2018 and avoid negative payment adjustments
90.0% of MIPS eligible clinicians in small practices expected to report 90.9% to receive positive or neutral payment adjustments 61.3% to receive “exceptional payment adjustment”
CMS hopes to achieve budget neutrality with equally distributed negative and positive payment adjustments (both $118 million)
With approximately $500 million in exceptional performance payments
Advanced APMs
CMS estimates between $675 million and $900 million APM incentive payments in 2020 24
RESOURCES
QPP Website QPP CY 2018 Final Rule QPP CY 2018 Executive Summary QPP Year 2 Overview Fact Sheet
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DISCUSSION QUESTIONS
What are your thoughts on CMS increasing the low volume
threshold?
What expectations do you have for rural participation in
MIPS and virtual groups?
What approaches could help simplify the scoring
approach?
What considerations exist for the addition of the cost
category and rural providers for year 2?
Are there changes that could encourage greater rural
participation in APMs? 26
Workgroup was formed to provide recommendations on issues related to measurement challenges in the rural population.
core set of the best available (i.e., “rural relevant”) measures and identify rural- relevant gaps in measurement.
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November 2017 – August 2018, and will have met twice prior to the January 4th Council call.
th_Workgroup.aspx
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Jennifer Lundblad, Karla Weng
MBQIP – Yvonne Chow
Slabach
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What items related to quality measurement and reporting would Council members like to share/discuss today, or put on a future Council agenda? As we move through the year, are there topics you anticipate will emerge that we can plan to address?
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– Approximately 50 per month – Most common topics:
– Median days to resolution: 0 (zero), Mean 1.08
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– MBQIP Quality Reporting Guide and Data Submission Deadlines Chart – MBQIP Measures Fact Sheets
– Using Patient and Family Engagement Strategies for Improvement – Abstracting for Accuracy
– 2017 UDS Crosswalk to Quality Reporting Programs – Quality Improvement Basics for Rural Health Care Organizations – Online Abstraction Training and “Ask Robyn” Open Office Hours – Study of HCAHPS Best Practices in High Performing CAHs
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What other tools and resources would be useful based on your experience and needs?
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– Thursday, April 5 – Wednesday, July 11 – Thursday, October 4
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Karla Weng, MPH, CPHQ Senior Program Manager Stratis Health 952-853-8570 kweng@stratishealth.org
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Jennifer Lundblad, PhD, MBA President and CEO Stratis Health 952-853-8523 jlundblad@stratishealth.org
Stratis Health, based in Bloomington, Minnesota, is a nonprofit
care quality and safety, and serves as a trusted expert in facilitating improvement for people and communities.
This project is supported by the Health Resources and Services Administration (HRSA) of the U.S. Department of Health and Human Services (HHS) under grant number U1RRH29052, Rural Quality Improvement Technical Assistance Cooperative Agreement, $500,000 (0% financed with non-governmental sources). This information or content and conclusions are those of the author and should not be construed as the official position or policy of, nor should any endorsements be inferred by HRSA, HHS, or the U.S. Government.