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

  1. Rural Quality Advisory Council Rural Quality Improvement Technical Assistance (RQITA) Program January 4, 2018

  2. Agenda • Welcome • 2018 Final MIPS Rule: Implications for Rural • NQF MAP Rural Health Workgroup Update • From the Field • RQITA Overview • Wrap-Up 1

  3. Rural Quality Advisory Council • Convened by RQITA team on behalf of FORHP • Purpose: – 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. 2

  4. Council Structure • 11 members and 7 key partners, plus RQITA and FORHP staff – Representation across FORHP programs, different types of rural providers, geography • Membership Terms – Key Partners (ongoing) – Rural In-the-Field Leaders (2-year terms) – Subject Matter Experts (2-year terms) 3

  5. Welcome to the 2018 Council • Review of Council background and purpose • Introduction of Council members: a 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?” 4

  6. 2018 Final MIPS Rule: Implications for Rural • A re-cap of the 2018 final MIPS rule focused on key features relevant to rural providers, including measure changes and virtual group reporting. • Link to final rule: Payment-Program/Resource- Library/Resource-library.html 5

  7. 2018 QUALITY PAYMENT PROGRAM FINAL RULE Rural Quality Advisory Council Meeting January 4, 2018 6


  9. 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 8

  10. MIPS YEAR 2 PARTICIPATION ESTIMATES MIPS Eligibility by Practice Size  >600,000 clinicians are estimated to (2018 Estimate) be MIPS-eligible in year 2  These clinicians represent 40% of TIN/NPIs and 66% of Medicare Part 19% 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 1-15 Clinicians 16-24 Clinicians 25-99 Clinicians 100 or More Clinicians 9

  11. QUALITY PAYMENT PROGRAM FINAL RULE FOR CY 2018  MIPS Policies of Interest to Rural Providers: • Increasing the low-volume threshold • Increasing the performance threshold and payment adjustment • Adding cost as a component of the MIPS score • Addressing policies for “topped out” measures • Allowing for bonus points to be added to the MIPS score • Giving solo practitioners and small practices the choice to form Virtual Groups • Clarifying rural and HPSA practice designations • Delaying facility-based measurement until year 3 10


  13. 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 12  0.25% non-qualifying APM conversion factor

  14. MIPS YEAR 2 SCORING Performance Period in Year 2 • Quality and Cost: 12 months • IA and ACI: 90 Days 13

  15. COST YEAR 2 SCORING  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 14




  19. QUALITY: NEW MEASURES FOR 2018 Q459: Average Change in Back Pain following Lumbar 1. Discectomy / Laminotomy Q460: Average Change in Back Pain following Lumbar Fusion 2. Q461: Average Change in Leg Pain following Lumbar 3. Discectomy / Laminotomy Q462: Bone Density Evaluation for Patients with Prostate Cancer 4. and Receiving Androgen Deprivation Therapy Q463: Prevention of Post-Operative Vomiting (POV) - 5. Combination Therapy (Pediatrics) Q464: Otitis Media with Effusion (OME): Systemic Antimicrobials - 6. Avoidance of Inappropriate Use Q465: Uterine Artery Embolization Technique: Documentation of 7. Angiographic Endpoints and Interrogation of Ovarian Arteries Q467: Developmental Screening in the First Three Years of Life 8. 18


  21. 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 20


  23. 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 22

  24. 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 23

  25. 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

  26. RESOURCES QPP Website QPP CY 2018 Final Rule QPP CY 2018 Executive Summary QPP Year 2 Overview Fact Sheet 25

  27. 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

  28. NQF MAP Rural Health Workgroup Update • Newly launched MAP Rural Health Workgroup was formed to provide recommendations on issues related to measurement challenges in the rural population. • Additionally, the Workgroup will identify a core set of the best available (i.e., “rural relevant”) measures and identify rural - relevant gaps in measurement. 27

  29. NQF MAP Rural Health Workgroup (cont.) • The workgroup meets approximately monthly November 2017 – August 2018, and will have met twice prior to the January 4th Council call. • th_Workgroup.aspx 28


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