MIPS Checkpoint Beth Hickerson Quality Improvement Advisor PHA Lunch and Learn May 19, 2017 Value Driven.Health Care. Solutions.
Check Your MIPS Eligibility QPP.CMS.GOV Value Driven.Health Care. Solutions. 2
MIPS Category Weights Over Time : Advancing Care Improvement Quality Information Activities Cost Replaces PQRS Replaces MU New (PCMH) Replaces VBM 2017 60% 25% 15% 0% 2018 50% 25% 15% 10% 2019+ 30% 25% 15% 30% Value Driven.Health Care. Solutions. 3
MIPS Final Score for 2017 Performance Year Final Score Payment Adjustment – Positive adjustment ≥ 70 points – Eligible for exceptional performance bonus – minimum of additional 0.5% – Positive adjustment 4-69 points – Not eligible for exceptional performance bonus – Neutral payment adjustment 3 points – Negative payment adjustment of -4% 0 points – 0 points = does not participate Value Driven. Health Care. Solutions. 4
Pick Your Pace Options Three options to participate in MIPS in 2017: Don’t submit Value Driven.Health Care. Solutions. 5
Three Ways to Avoid the Penalty in 2017 1 1 5 OR OR Quality Improvement Required Measure Activity Advancing Care Information Measures Value Driven.Health Care. Solutions. 6
REPORTING OPTIONS AND METHODS Understanding How to Report
Reporting Options Individual – defined as a single NPI tied to a single TIN – May protect incentive potential for high-performing providers – May be easier if you have NPIs not required to report Group – multiple NPIs that share a common TIN – May ease administrative burden – Beneficial if you have some providers with reporting obstacles – Register only if using CMS web interface or CAHPS for MIPS Note: Reporting option applies for all four categories; NPIs must report for each TIN separately Value Driven.Health Care. Solutions. 8
Reporting Methods Claims EHR Registry Qualified Clinical Data Registry CMS Web Interface CAHPS for MIPS Survey Note: You may only report via one method per category Value Driven.Health Care. Solutions. 9
Reporting Methods (cont.) Claims – Add modifier codes to your Medicare claims – Can be added manually by billers or automatically by EHR or billing software EHR – Directly submit a QRDA III file through the CMS portal – Register with your EHR to submit on your behalf as/through a Data Submission Vendor (DSV) – This category does not include EHRs who submit via registry Value Driven.Health Care. Solutions. 10
Reporting Methods (cont.) Registry – Entity that collects data and submits to CMS – Clinical data can be extracted from EHR or manually entered via registry web form – Claims data can be submitted via registry Qualified Clinical Data Registry (QCDR) – CMS-approved entity that collects medical and/or clinical data for the purpose of patient disease tracking to foster improvement in quality of care – Usually includes specialty measures not on the general MIPS measures list – Clinical data can be extracted from EHR or manually entered Value Driven.Health Care. Solutions. 11
Reporting Methods (cont.) CMS Web Interface (GPRO) – Groups of 25 or more – Populate data (manually or electronically) and report all GPRO measures on 248 identified attributed patients – Must register by June 30, 2017 CAHPS for MIPS – Survey of patients administered and submitted by approved vendor – Counts as one of six required measures – Must submit remaining five measures via other method – Earn extra bonus points Value Driven.Health Care. Solutions. 12
Data Completeness Rule Claims – 50% of all Medicare Part B patients EHR, Registry, QCDR – 50% of all patients GPRO – all patients assigned, up to 248 Value Driven. Health Care. Solutions. 13
Reporting Methods Value Driven.Health Care. Solutions. 14
QUALITY CATEGORY Requirements and Scoring
Quality Reporting Requirements 60 Points Report six measures, including 3-10 points per measure at least one outcome or high based on performance priority measure against a benchmark Select from full list of 291 60 possible points MIPS measures Bonus points for high-priority Or select from a set of and EHR reporting specialty specific measures Value Driven.Health Care. Solutions. 16
Measure Choices https://qpp.cms.gov/measures/quality Value Driven.Health Care. Solutions. 17
Selecting Measures Decide on your reporting method – Claims, EHR, 1. Registry, QCDR – Reporting via EHR is easiest but may limit choice of measures 2. Compile list of all available measures for your chosen method 3. Narrow your list to include only applicable measures – Specialty/scope of practice – Patient population – Data collection limitations Value Driven.Health Care. Solutions. 18
Selecting Measures (cont.) 4. Print a 2016 (or 2017 year-to-date) Quality report from your EHR to see your past performance on applicable measures 5. Use your Quality report to calculate your estimated MIPS points per measure by downloading the “2017 Quality Benchmarks” file from https://qpp.cms.gov/resources/education Submission Measure_Name Decile 3 Decile 4 Decile 5 Decile 6 Decile 7 Decile 8 Decile 9 Decile 10 Method Pneumonia Vaccination 39.78 - 51.33 - 61.68 - 70.48 - 77.78 - 84.50 - 92.00 - Claims >= 99.07 Status for Older Adults 51.32 61.67 70.47 77.77 84.49 91.99 99.06 Pneumonia Vaccination 14.13 - 23.26 - 33.03 - 43.59 - 53.97 - 63.61 - 74.55 - EHR >= 85.53 Status for Older Adults 23.25 33.02 43.58 53.96 63.60 74.54 85.52 Pneumonia Vaccination 12.24 - 24.03 - 36.35 - 48.52 - 58.96 - 68.06 - 77.78 - Status for Older Adults Registry/QCDR >= 90.20 24.02 36.34 48.51 58.95 68.05 77.77 90.19 Value Driven.Health Care. Solutions. 19
Quality Scoring Basics Each measure earns between 3 to 10 points Minimum 20 cases for a measure to earn performance points above the minimum Some measures may have a maximum < 10 Reporting additional outcome and high priority measures yields bonus points Measures reported via “electronic end -to- end” method earn 1 bonus point Value Driven.Health Care. Solutions. 20
Quality Category Score Value Driven.Health Care. Solutions. 21
Quality Scoring Tips If you submit > six measures, CMS will use the highest scoring six for your base score Measures submitted but not scored are still eligible for bonus points Groups with 16 or more providers and 200+ eligible cases will have All-Cause Hospital Readmission Value Driven.Health Care. Solutions. 22
ADVANCING CARE INFORMATION CATEGORY Requirements and Scoring
ACI Basics 50 90 15 Bonus score Required base Performance (up to 15) score (50) score (up to 90) – – Security risk analysis Submit nine measures – 5 percent per measure – e-Prescribing for 90 days for for public health/clinical – Provide patient access performance credit data registry reporting – – Send summary of care 10 percent for – Request/accept summary of improvement activity care alignment Value Driven. Health Care. Solutions. 24
Choosing Your Objectives/Measures List https://qpp.cms.gov/measures/aci Value Driven.Health Care. Solutions. 25
2017 Transition Objectives and Measures Core Performance 1. Security Risk Analysis 1. Provide Patient Access 2. e-Prescribing 2. Health Information Exchange 3. Provide Patient Access 3. View, Download, or 4. Health Information Transmit (VDT) Exchange 4. Patient-Specific Education 5. Secure Messaging 6. Medication Reconciliation 7. Immunization Registry Reporting Value Driven.Health Care. Solutions. 26
Performance Measure Scoring Performance Rates for Each Measure 1-10% = 1 51-60% = 6 11-20% = 2 61-70% = 7 21-30% = 3 71-80% = 8 31-40% = 4 81-90% = 9 41-50% = 5 91-100% = 10 Value Driven.Health Care. Solutions. 27
ACI Category Score Value Driven.Health Care. Solutions. 28
ACI Scoring Tips Start improving your performance measure scores above previous MU thresholds – Provide Patient Access – Health Information Exchange – Patient Specific Education – Medication Reconciliation Consider implementing an Improvement Activity using your EHR to get 10 bonus points Consider reporting to a specialized registry or public health department for 5% bonus Value Driven.Health Care. Solutions. 29
IMPROVEMENT ACTIVITIES CATEGORY Requirements and Scoring
Improvement Activities Basics Attest to completing up to four activities at least 90 days 1. Expanded 2. Population 3. Care Practice during the year Management Coordination Access Rural, health professional shortage area (HPSA), or 5. Patient group practices with 15 or 4. Beneficiary Safety and 6. Participation Engagement Practice in an APM fewer clinicians attest to only Assessment two activities Eligible clinicians choose from 92 activities in nine categories 8. Integrating 9. Emergency 7. Achieving Behavioral and Preparedness Health Equity Mental Health and Response Value Driven. Health Care. Solutions. 31
Examples of Improvement Activities Same day Extended After hours Test tracking appointments office hours access to care system Value Driven.Health Care. Solutions. 32
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