Elaine Towle Lecture Northern New England Clinical Oncology Society - - PowerPoint PPT Presentation
Elaine Towle Lecture Northern New England Clinical Oncology Society October 28, 2016 Stephen S. Grubbs, MD Vice President Clinical Affairs American Society of Clinical Oncology Why is it Important Now? Completely changes basis for
Elaine Towle Lecture
Northern New England Clinical Oncology Society October 28, 2016
Alternative Payment Models Merit Based Incentive Payment System
Medicare Access and CHIP Reauthorization Act
Program
Based Incentive Payment System (MIPS)
(APMs)
6
7
Physician Quality Reporting System (PQRS)
Meaningful Use Electronic Health Records Incentive Program (MU) Value Based Modifier
(VBM)
MU VBM
Physican Fee Schedule Payment
PQRS
8
Adjustments
Final Payment
Value Based Modifier Scoring and Comparison
10 The Merit Based Incentive Payment System (MIPS)
Physician Quality Reporting System (PQRS) Meaningful Use (MU) Value Based Modifier (VBM)
TODAY SUNSETS DEC 2018
VBM MU PQRS
Adds Clinical Practice Improvement Activity (CPIA) Consolidates penalties Increases incentives Ranks peers nationally Reports publicly
JAN 2019
Not included in 2017
Clinical Practice Improvement Activity Categories
Expanded Practice Access Population Management Care Coordination Beneficiary Engagement Patient Safety & Practice Assessment Achieving Health Equity Emergency Response and Preparedness Integrated Behavioral & Mental Health
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Low Performers ‐9%
Top Performers +27%
National Median Composite Score Medicare Provider Composite Score
High Performers +9%
MIPS Exceptional Performance
Physican Fee Schedule Payment
MIPS Composite Score Adjustment
13
Adjustments
Final Payment
Source: CMS
Source: CMS Source: CMS
16
2016 2019 2024 2026
+/‐ 4% 2019
2020
2030+ 2025
+/‐ 5% 2020 +/‐ 7% 2021
+/‐ 9% 2022+ 2017 2018 2021 Year 1 = Performance Year 2 = Analysis Year 3 = Adjustment
17
Medicare Part A
(Hospital, SNF, Hospice)
Medicare Part B
(Physician Services)
Medicare Part C
(Medicare Advantage)
Medicare Part D
(OP Prescription Drugs)
18
Low Volume (<$30K ) or Low Patient Count (<100 Patients)
Medicare Part B (Physician Services)
19
from MIPS
Sum Bonus
Rewards
Qualifying Physicians Advanced APM CMS Recognized Alternative Payment Models (APM)
20
MIPS Only
adjustment APMs
Treatment in MIPS Advanced APMs
rewards
bonus
21
MIPS Exceptional Performance
Physican Fee Schedule Payment
MIPS Composite Score Adjustment
22
Adjustments
Final Payment
5% Lump Sum APM Bonus
23
23
Not in APM
In non-advanced APM
Qualifying Physician (QP) in APM
Note: Figure not to scale.
Some people may be in APMs but not have enough payments
the APM to be a QP. In APM, but not a QP
payment models (APMs)
Merit‐Based Incentive Payment System (MIPS) and Advanced APMs – Appropriate episode groups for
– Excluding all drug costs – Delay application
quality data
25 2015 2019 2024 2026
APMs 5% Payment Bonus
+/‐ 4% 2019
2020 2030+ 2025
+/‐ 5% 2020 +/‐ 7% 2021 +/‐ 9% 2022+
MIPS Max Adjustment APM Adjustment
points
Payment Program
calendar year
APM
payment adjustment Any applicable Value Modifier payment adjustment is separate from payment adjustments made under the Physician Quality Reporting System (PQRS) or EHR Incentive Program.
− QRUR is provided for each TIN (tax i.d. number)
period (fall 2017 for calendar year 2016)
QRUR
− http://www.cms.gov/Medicare/Medicare‐Fee‐for‐Service‐ Payment/PhysicianFeedbackProgram/Obtain‐2013‐QRUR.html
what is required for above average performance
help meet your chosen quality measures for PQRS and the quality and cost measures used under the VM program
– Implement workflows to introduce patients to patient portal and encourage utilization
– Establish processes to monitor hospitalizations and measure length of stay – Consider medical home‐type services to reduce hospitalizations
– Is the specialty correct? – Is the address correct? – Is the group affiliation correct?
– All Medicare Part B physicians are subject to MACRA – Use hospital’s quality reporting system and pay for performance programs to measure participation in MIPS
– Will directly bear the cost of implementation and ongoing compliance – Will bear the risk of MIPS and adjustments – Will be called upon to participate in APMs in order for physicians to qualify from exemption
Practice Leadership
Communication & training –
readiness for value‐ based practice
Payer Relationships
payment on
– physician compensation – contracts, professional services agreements with hospitals – commercial payer contracts
reporting, practice improvement?
– Patient Portal – e‐prescribing capability – Health Information Exchange (HIE) capability
and costs
resources available
VOLUNTEER TASKFORCE
task force leading key areas, including:
performance measures
payment model strategy (PCOP)
EDUCATION AND RESOURCES
assessment
Practice Conference: The Business of Cancer Care launching in March 2, 2017
INFLUENCING POLICYMAKERS
Comments
CMS and Policymakers
education,
testimony
STATUS Update:
that will qualify under MACRA
payers
– Includes Oncology Specific Measures
reporting
participation and with continuous practice reporting
measures
www.asco.org/macra
MACRA: Learn the basics, get ready for a post‐SGR world
NEW 2017 ASCO Oncology Practice Conference
Improvement Activities
Delivery Systems, TBD
New webinar series “Are You Ready for MACRA? ” REGISTER HERE
under planning
QOPI
Practice transformation tools for MACRA
Webinar December 2016
Prepare NOW Affects most practices ASCO will HELP
Visit www.asco.org/macra for more information