Quality Payment Program Year 4: Final Rule Highlights The information contained in this presentation is for general information purposes only. The information is provided by UK HealthCare’s Kentucky Regional Extension Center and while we endeavor to keep the information up to date and correct, we make no representations or warranties of any kind, express or implied, about the completeness, accuracy, reliability, suitability or availability with respect to content.
Kentucky Regional Extension Center Services UK’s Kentucky REC is a trusted advisor and partner to healthcare organizations, supplying expert guidance to maximize quality, outcomes and financial performance. Kentucky REC Description Physician Services 1. Promoting Interoperability (MU) & Mock Audit 2. HIPAA SRA, Project Management & Vulnerability Scanning To date, the Kentucky REC’s activities include: 3. Patient Centered Medical Home (PCMH) Consulting • Assisting more than 5,000 individual providers 4. Patient Centered Specialty Practice (PCSP) Consulting across Kentucky, including primary care providers and specialists 5. Value Based Payment & MACRA Support • Helping more than 95% of the Federally Qualified 6. Quality Improvement Support Health Centers (FQHCs) and Rural Health Clinics (RHCs) within Kentucky 7. Telehealth Services • Working with more than 1/2 of all Kentucky hospitals Hospital Services • Supporting practices and health systems across the Commonwealth with practice transformation and 1. Promoting Interoperability (Meaningful Use) preparation for value based payment 2. HIPAA Security Analysis & Project Management 3. Hospital Quality Improvement Support
Your REC Advisors & Presenters Vance Drakeford Megan McIntosh Jessica Elliott QIA QIA QIA
2020 QPP Final Rule On November 1 st , 2019 CMS released the QPP Final Rule •These changes went into effect on January 1 st , 2020* *Some changes are retrospective
Objectives Year 4 Quality Payment Program Overview Merit-Based Incentive Payment System (MIPS) Track Updates MIPS Value Pathways (MVPs) Alternative Payment Model (APM) Track Update
Polling Question #1 What is your greatest QPP concern for this year? Enter your answer into the polling window on the right side of your screen
2020 Quality Payment Program (QPP) Overview
QPP Y4: Program Tracks By law, MACRA requires CMS to implement an incentive program, referred to as the Quality Payment Program, which provides two participation tracks for clinicians: MIPS ECs are subject to a MIPS performance-based Merit-based Incentive payment adjustment Payment System through MIPS Quality Payment Program (QPP) QPs may earn an Advanced APMs incentive payment for Advanced Alternative participating in one of Payment Models these models
QPP Y4: QPP Clinician Eligibility Eligible Clinician Types: Physicians ( including Doctors of Medicine, Osteopathy, Dental Surgery, Dental Medicine, Podiatric Medicine, and Optometry ), Osteopathic Practitioners, Chiropractors, PA, NP, CNS, CRNA, PT, OT, Qualified Speech-Language Pathologist, Qualified Audiologist, Clinical Psychologist, Registered Dietitian or Nutrition Professional QPP Track Eligibility Requirements Advanced Alternative Payment Merit-Based Incentive Program Model (MIPS) (APMs) 200 Advanced 50% 35% $90K Medicare 200 PFS APM Payment Medicare OR Part B Patients Participant or Patients
Polling Question #2 Have you already submitted for Program Year 2019? Enter your answer into the polling window on the right side of your screen
2020 Merit-Based Incentive Payment System
QPP Y4: MIPS Thresholds NEW for 2020 –/+ 9% Adjustment Factor!!! Exceptional Performance Threshold Minimum 46 - 84 +85 Performance Points Threshold Points 0 - 44 45 Points Points – Payment Potential + + Payment Avoid Penalty Adjustment Adjustment Adjustment
QPP Y4: MIPS Overview 365 Quality 45% Days CATEGORY WEIGHT Promoting 2020 REPORTING TIMEFRAMES 25% 90 Interoperability PROGRAM Days YEAR & Improvement 2022 15% 90 PAYMENT Activities Days YEAR 365 15% Cost Days Must Submit by March 31 st , 2021
QPP Y4: Reporting Options Individual Group Virtual Group • Under an NPI • > 2 clinicians • Combination number & TIN (NPIs) who of > 2 TINs where they have assigned to > 1 reassign reassigned individual benefits their billing MIPS ECs, or rights to a to > 1 groups single TIN consisting of < 10 ECs with > 1 • As an APM MIPS EC Entity
QPP Y4: MIPS Performance Categories Changes PI: Quality: Cost: IA: Added: Removed/Modified: Attribution: Removed: New Measures & Bonus Measure(s) Set at Measure level 15 Activities Specialty Measure Hospital-Based as 75% Added: Added/Modified: Sets or More of ECs 10 New Episode-based 9 Activities Removed/Altered: Under TIN Measures 50% of ECs in Group 125 Measures MUST Perform Activity Increase of Data Completeness = 70% Why It Matters… Increased Every Measure Reduced Bonus Opp. Most Measures Documentation Burden Impacted Updated Impacting 105 Possible Pts. Num/Den & Workflows Requires Added Patient-Relationship Prep/Planning Process Expanded Flexibility for Pull Measure Spec Hospital-Based ECs Sheets to Verify Expanded Measures
Polling Question #3 What is your overall QPP performance goal for 2020 ? Enter your answer into the polling window on the right side of your screen
MIPS Value Pathw ays (MVPs)
QPP Y4: MIPS Value Pathw ays (MVPs) A conceptual participation framework that would apply to future proposals beginning with the 2021 performance year. The goal is to move away from siloed activities and measures and move towards an aligned set of measure options more relevant to a clinician’s scope of practice that is meaningful to patient care. Administrative MIPS Historical Enhanced Data & Claims-Based Categories Feedback Quality Measures Increase in Quality, Cost, Population & Comparable Improvement Public Health Performance Activities Priorities Data Promoting Condition Fewer Interoperability Specific Variations in (Foundational) Measures Submissions
QPP Y4: MVPs Framework
2020 APM Updates
QPP Y4: APM Overview 365 Quality 50% Days CATEGORY WEIGHT Promoting 2020 REPORTING TIMEFRAMES 30% 90 Interoperability PROGRAM Days YEAR & Improvement 2022 20% 90 PAYMENT Activities Days YEAR 365 0% Cost Days Must Submit by March 31 st , 2021
QPP Y4: Advanced APM Requirements QP Risk Benefits: Payment Use of Bearing / tied to • 5% bonus MIPS APM certified Medical • APM-specific Quality EHR Home reward Measures Model • Exclusion from MIPS Partial QP Qualified Participant (QP) 40% Payments 50% Payments APM OR 35% Patients 25% Patients Part of Advanced APM Part of Advanced APM
QPP Y4: Advanced APMs for 2020 Bundled Payments for Care Comprehensive ESRD Care Comprehensive Primary Care Improvement (BPCI) Advanced (CEC) – Two-Sided Risk Plus (CPC+) Medicare Accountable Care Medicare Shared Savings Organization (ACO) Track 1+ Next Generation ACO Model Program – Tracks 2 and 3 Model Comprehensive Care for Joint Vermont Medicare ACO Initiative Oncology Care Model (OCM) – Replacement (CJR) Payment (as part of the Vermont All-Payer Two-Sided Risk Model (Track 1-CEHRT) ACO Model) Maryland Models • All-Payer Model (Care Redesign Program) Comprehensive ESRD Care • Total Cost of Care Model (Maryland Primary (CEC) Model Care Program) • Total Cost of Care Model (Care Redesign Program
QPP Y4: Changes to APM IA CMS will assign scores to MIPS eligible clinicians in the improvement activity performance category for participating in MIPS APMs. For the 2020 performance period, the list of MIPS APMs include: Maryland Primary Care Program (MD PCP) Oncology Care Model (OCM; all Tracks) Next Generation Accountable Care Organization (NGACO) Model Comprehensive End-Stage Renal Disease Care (CEC) Model (all Tracks) Bundled Payments for Care Improvement (BPCI) Advanced Independence at Home (IAH) Demonstration Comprehensive Primary Care Plus (CPC+) Model (all Tracks) Vermont All-Payer ACO (VT ACO) Model Medicare Shared Savings Program (MSSP) (all Tracks, including the Medicare ACO Track 1+ Model) APM Entities participating in this list of MIPS APMs above will receive a full score for the Improvement Activities performance category in performance period 2020, and therefore will not need to submit additional improvement activity information under MIPS. All MIPS APMs will receive 50% points for IA automatically
QPP Y4: Advanced APMs Update • Partial QPs will now be • Other Payer MIPS APMs • Alignment of MSSP & deemed Partial with the Web Interface Measure • Due to reporting one TIN Sets issues the practice • May be eligible for MIPS may submit Quality • Non-ACO Group with other TIN/NPI data Reporters: score for combinations each of the measures • Will receive a score > they report & 0 pts for 50% of the Quality unreported measures category total points Qualifying Medicare Participant MIPS APMs Shared Status Savings
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