Quality Payment Program Millie Suk, JD, MPP AANE M He a lth Po - - PowerPoint PPT Presentation

Quality Payment Program

Millie Suk, JD, MPP AANE M He a lth Po lic y Dire c to r

American Association of Neuromuscular & Electrodiagnostic Medicine - 2016

Quality Payment Program (QPP): What Is It?

• Me dic a re Ac c e ss a nd CHI

P Re a utho riza tio n Ac t (MACRA) o f 2015

• Re fo rms Me dic a re Pa rt B pa yme nts
• Clinic ia ns ha ve two tra c ks to c ho o se fro m:
• T

he Me rit-b a se d I nc e ntive Pa yme nt Syste m (MI PS)

• Adva nc e d Alte rna tive Pa yme nt Mo de ls (APMs)

American Association of Neuromuscular & Electrodiagnostic Medicine - 2016

QPP: MIPS vs. Advanced APMs

• MI

PS = Mo difie d fe e -fo r-se rvic e mo de

• Ma jo rity o f c linic ia ns will pa rtic ipa te in MI

PS fo r a t le a st the first c o uple o f ye a rs

• Clinic ia ns will ha ve pa yme nts inc re a se d, ma inta ine d, o r de c re a se d b a se d
• n re la tive pe rfo rma nc e in fo ur c a te g o rie s
• Adva nc e d APMs = ne w pa yme nt mo de ls tha t

re duc e c o sts o f c a re a nd/ o r suppo rt hig h-va lue se rvic e s no t typic a lly c o ve re d unde r the Me dic a re fe e sc he dule

• Clinic ia ns re c e ive inc e ntive pa yme nts fo r the ir pa rtic ipa tio n

American Association of Neuromuscular & Electrodiagnostic Medicine - 2016

Details MIPS Advanced APMs Payment Adjustment +/- 4% in 2019, increases to +/- 9% by 2022 N/A Bonus Payments Clinicians w/ total MIPS score in top 25% receive additional payment adjustment of up to 10% (available 2019-2024) 5% Incentive Payment (available 2019-2024) Annual Fee Schedule Update 0.25% beginning in 2026 0.75% beginning in 2026

QPP: MIPS vs. Advanced APMs

American Association of Neuromuscular & Electrodiagnostic Medicine - 2016

QPP: MIPS – Who Participates?

• No t just physic ia ns
• E

lig ib le Clinic ia ns:

• Physic ia ns
• Physic ia n Assista nts
• Nurse Pra c titio ne rs
• Clinic a l Nurse Spe c ia lists
• Ce rtifie d Re g iste re d Nurse Ane sthe tists

American Association of Neuromuscular & Electrodiagnostic Medicine - 2016

QPP: MIPS – Who is EXEMPT?

• Clinic ia ns b e lo w lo w-vo lume thre sho ld
• Me dic a re Pa rt B a llo we d c ha rg e s le ss tha n o r e q ua l $30,000 OR 100 or

fe we r Me dic a re Pa rt B pa tie nts

• Ne wly-e nro lle d Me dic a re c linic ia ns
• Clinic ia ns who e nro ll in Me dic a re fo r the first time during a pe rfo rma nc e

pe rio d.

• Clinic ia ns sig nific a ntly pa rtic ipa ting in Adva nc e d

APMs

American Association of Neuromuscular & Electrodiagnostic Medicine - 2016

QPP: MIPS Components

• Qua lity (re pla c e s PQRS)
• Adva nc ing Ca re I

nfo rma tio n (ACI ) (re pla c e s “Me a ning ful Use ” o f E HRs)

• I

mpro ve me nt Ac tivitie s (I A) (NE W!)

• Co st (re pla c e s the c o st c o mpo ne nt o f VM)

American Association of Neuromuscular & Electrodiagnostic Medicine - 2016

QPP: MIPS – 2017 Scoring

American Association of Neuromuscular & Electrodiagnostic Medicine - 2016

QPP: MIPS – 2017 “Pick Your Pace” Transition Year

American Association of Neuromuscular & Electrodiagnostic Medicine - 2016

QPP: MIPS – Individual v. Group Reporting

• I

ndividua l: re po rt unde r NPI numb e r a nd T I N whe re yo u a ssig n b e ne fits

• Gro up: 2+ c linic ia ns (NPI

s) who ha ve re a ssig ne d the ir b illing rig hts to a sing le T I N

• Gro ups will b e a sse sse d a s a g ro up a c ro ss a ll 4 MI

PS pe rfo rma nc e c a te g o rie s

American Association of Neuromuscular & Electrodiagnostic Medicine - 2016

QPP: MIPS – Get Your Data to CMS

American Association of Neuromuscular & Electrodiagnostic Medicine - 2016

QPP: MIPS – Getting Started

• De te rmine yo ur e lig ib ility sta tus
• Ga ug e yo ur re a dine ss
• Cho o se if yo u will b e re po rting a s a n individua l o r a g ro up
• De c ide if yo u will wo rk with a third pa rty inte rme dia ry (E

HR ve ndo r, QCDR, Qua lifie d Re g istry, CMS Appro ve d CAHPS Ve ndo r)

• Re vie w the pro g ra m time line fo r da te s
• Cho o se a da ta sub missio n o ptio n
• Re a c h a g re e me nt with b o nus pa yme nts a nd re po rting pe rio ds
• Asse ss yo ur fe e db a c k

(https:/ / po rta l.c ms.g o v/ wps/ po rta l/ una uthpo rta l/ ho me / )

American Association of Neuromuscular & Electrodiagnostic Medicine - 2016

QPP: MIPS – Calculating the Final Score

American Association of Neuromuscular & Electrodiagnostic Medicine - 2016

QPP: MIPS – Timeline

American Association of Neuromuscular & Electrodiagnostic Medicine - 2016

QPP: Advanced APMs

• Wha t is a n Adva nc e d APM?
• APM = pa yme nt a ppro a c h, de ve lo pe d in pa rtne rship

with the c linic ia n c o mmunity, tha t pro vide s a dde d inc e ntive s to c linic ia ns to pro vide hig h-q ua lity a nd c o st- e ffic ie nt c a re . APMs c a n a pply to a spe c ific c linic a l c o nditio n, a c a re e piso de , o r a po pula tio n.

• Adva nc e d APM = te rm e sta b lishe d b y CMS; the se APMs

ha ve g re a te st risks a nd o ffe r po te ntia l fo r g re a te st re wa rds.

American Association of Neuromuscular & Electrodiagnostic Medicine - 2016

QPP: Advanced APMs – CMS Criteria

• 50% o f pa rtic ipa nts must use c e rtifie d E

HR te c hno lo g y

• Must re po rt a nd a t le a st pa rtia lly b a se c linic ia n

pa yme nts o n q ua lity me a sure s c o mpa ra b le to MI PS

• Be a r “mo re tha n no mina l risk” fo r mo ne ta ry lo sse s
• L

e ss o f 8% o f to ta l Me dic a re re ve nue s o r 3% o f to ta l Me dic a re e xpe nditure s

• Prima ry Ca re Me dic a l Ho me s ha ve diffe re nt sta nda rds

American Association of Neuromuscular & Electrodiagnostic Medicine - 2016

QPP: Advanced APMs – Participation Thresholds

American Association of Neuromuscular & Electrodiagnostic Medicine - 2016

QPP: Advanced APMs – 2017 Models

• Co mpre he nsive E

nd Sta g e Re na l Dise a se Ca re Mo de l (2-side d risk)

• Co mpre he nsive Prima ry Ca re Plus (CPC+1)
• Sha re d Sa ving s Pro g ra m T

ra c k 2

• Sha re d Sa ving s Pro g ra m T

ra c k 3

• Ne xt Ge ne ra tio n ACO Mo de l
• Onc o lo g y Ca re Mo de l (2-side d risk)

T he list o f Adva nc e d APMs is po ste d a t q pp.c ms.g o v a nd will b e upda te d with ne w a nno unc e me nts o n a n a d ho c b a sis.

American Association of Neuromuscular & Electrodiagnostic Medicine - 2016

QPP: MIPS APMs

• APM with a t le a st o ne MI

PS e lig ib le c linic ia n tha t pa rtic ipa te s unde r a g re e me nt with CMS (b ut do e sn’ t q ua lify a s a n Adva nc e d APM)

• Pa yme nt inc e ntive s b a se d o n pe rfo rma nc e o n c o st

a nd q ua lity

• Adva nc e d APM b e ne fits do NOT

a pply – must still pa rtic ipa te in MI PS

• I

n 2017, MI PS APMs re c e ive full I mpro ve me nt Ac tivitie s c re dit

• Ha ve simplifie d MI

PS re po rting

American Association of Neuromuscular & Electrodiagnostic Medicine - 2016

QPP: Additional Information

https:/ / www.a a ne m.o rg / Pra c tic e / Me dic a re / MACRA

American Association of Neuromuscular & Electrodiagnostic Medicine - 2016

QPP: Questions?

E

• ma il: po lic y@ a a ne m.o rg

Pho ne : 507- 288-0100 (a sk fo r Millie o r Ca rrie )

American Association of Neuromuscular & Electrodiagnostic Medicine - 2016