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) o Adva nc e d Alte rna tive Pa yme nt Mo de ls (APMs) o 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 o 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 o o 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 o American Association of Neuromuscular & Electrodiagnostic Medicine - 2016

QPP: MIPS vs. Advanced APMs 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 5% Incentive Payment adjustment of up to 10% (available (available 2019-2024) 2019-2024) Annual Fee Schedule Update 0.25% beginning in 2026 0.75% beginning in 2026 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 o Physic ia n Assista nts o Nurse Pra c titio ne rs o Clinic a l Nurse Spe c ia lists o Ce rtifie d Re g iste re d Nurse Ane sthe tists o 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 o 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 o 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 o 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 o e xpe nditure s Prima ry Ca re Me dic a l Ho me s ha ve diffe re nt sta nda rds o 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 o Ha ve simplifie d MI PS re po rting o 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