Quality Payment Program Year 4: Final Rule Highlights The - - PowerPoint PPT Presentation
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 HealthCares Kentucky Regional Extension Center and while we
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.
UK’s Kentucky REC is a trusted advisor and partner to healthcare organizations, supplying expert guidance to maximize quality, outcomes and financial performance.
To date, the Kentucky REC’s activities include:
across Kentucky, including primary care providers and specialists
Health Centers (FQHCs) and Rural Health Clinics (RHCs) within Kentucky
hospitals
Commonwealth with practice transformation and preparation for value based payment
Physician Services
Hospital Services
Kentucky REC Description
Kentucky Regional Extension Center Services
Vance Drakeford QIA Megan McIntosh QIA Jessica Elliott QIA
Your REC Advisors & Presenters
2020 QPP Final Rule
*Some changes are retrospective
Year 4 Quality Payment Program Overview Merit-Based Incentive Payment System (MIPS) Track Updates MIPS Value Pathways (MVPs) Alternative Payment Model (APM) Track Update
Objectives
Polling Question #1
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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: Quality Payment Program (QPP) MIPS
Merit-based Incentive Payment System MIPS ECs are subject to a performance-based payment adjustment through MIPS
Advanced APMs
Advanced Alternative Payment Models QPs may earn an incentive payment for participating in one of these models
QPP Y4: QPP Clinician Eligibility
Merit-Based Incentive Program (MIPS)
$90K Part B 200 Medicare Patients 200 PFS
Advanced Alternative Payment Model (APMs)
Advanced APM Participant 50% Payment
35% Medicare Patients
QPP Track Eligibility Requirements
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
OR
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QPP Y4: MIPS Thresholds
0 - 44 Points
Minimum Performance Threshold
45 Points 46 - 84 Points
Exceptional Performance Threshold
+85 Points
– Payment Adjustment Avoid Penalty Potential + Adjustment + Payment Adjustment
NEW for 2020 –/+ 9% Adjustment Factor!!!
QPP Y4: MIPS Overview
Must Submit by March 31st, 2021 Quality Promoting Interoperability Improvement Activities Cost
2020 PROGRAM YEAR & 2022 PAYMENT YEAR CATEGORY WEIGHT
15% 25% 45% 15%
REPORTING TIMEFRAMES
365 Days 365
Days
90 Days 90 Days
QPP Y4: Reporting Options
Individual
number & TIN where they reassign benefits
Group
(NPIs) who have reassigned their billing rights to a single TIN
Entity
Virtual Group
assigned to > 1 individual MIPS ECs, or to > 1 groups consisting of < 10 ECs with > 1 MIPS EC
Quality:
Added: New Measures & Specialty Measure Sets Removed/Altered: 125 Measures Increase of Data Completeness = 70%
IA: Cost:
Attribution: Set at Measure level Added: 10 New Episode-based Measures
QPP Y4: MIPS Performance Categories Changes
PI:
Removed: 15 Activities Added/Modified: 9 Activities 50% of ECs in Group MUST Perform Activity Removed/Modified: Bonus Measure(s) Hospital-Based as 75%
Under TIN Most Measures Updated Impacting Num/Den & Workflows Pull Measure Spec Sheets to Verify Every Measure Impacted Patient-Relationship Process Expanded Measures Increased Documentation Burden Requires Added Prep/Planning Reduced Bonus Opp. 105 Possible Pts. Expanded Flexibility for Hospital-Based ECs
Why It Matters…
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QPP Y4: MIPS Value Pathw ays (MVPs)
MIPS Historical Categories
Quality, Cost, Improvement Activities Promoting Interoperability (Foundational)
Administrative Claims-Based Quality Measures
Population & Public Health Priorities Condition Specific Measures
Enhanced Data & Feedback
Increase in Comparable Performance Data Fewer Variations in Submissions A conceptual participation framework that would apply to future proposals beginning with the 2021 performance
measure options more relevant to a clinician’s scope of practice that is meaningful to patient care.
QPP Y4: MVPs Framework
QPP Y4: APM Overview
Must Submit by March 31st, 2021 Quality Promoting Interoperability Improvement Activities Cost
2020 PROGRAM YEAR & 2022 PAYMENT YEAR CATEGORY WEIGHT
20% 30% 50% 0%
REPORTING TIMEFRAMES
365 Days 365
Days
90 Days 90 Days
MIPS APM Use of certified EHR Payment tied to Quality Measures Risk Bearing / Medical Home Model QP Benefits:
reward
from MIPS
QPP Y4: Advanced APM Requirements
Qualified Participant (QP)
50% Payments APM 35% Patients Part of Advanced APM
Partial QP
40% Payments 25% Patients Part of Advanced APM
OR
QPP Y4: Advanced APMs for 2020
Bundled Payments for Care Improvement (BPCI) Advanced Comprehensive ESRD Care (CEC) – Two-Sided Risk Comprehensive Primary Care Plus (CPC+) Medicare Accountable Care Organization (ACO) Track 1+ Model Next Generation ACO Model Medicare Shared Savings Program – Tracks 2 and 3 Oncology Care Model (OCM) – Two-Sided Risk Comprehensive Care for Joint Replacement (CJR) Payment Model (Track 1-CEHRT) Vermont Medicare ACO Initiative (as part of the Vermont All-Payer ACO Model) Comprehensive ESRD Care (CEC) Model Maryland Models
Care Program)
Program
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: 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: Changes to APM IA
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)
deemed Partial with the
with other TIN/NPI combinations
Qualifying Participant Status
issues the practice may submit Quality data
50% of the Quality category total points
MIPS APMs
Web Interface Measure Sets
Reporters: score for each of the measures they report & 0 pts for unreported measures
Medicare Shared Savings
QPP Y4: Advanced APMs Update
45 Points Threshold; 60 for Year 5 50% IA 85 Points to be Exceptional Performer Expanded Cost Measures; defined at measure level MVPs 2021; Mandatory 2022 QCDR Push Removal of IA’s PDMP Quality Measures adjustments and removal 70% Data Validation No Weight shifts
QPP Y4: Top 10 Final Rule Impacts
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QPP Y4: Questions
Proven Success w ith the REC
KY REC Clients As Reported By CMS 82% of our Small & Rural Clients were Exceptional Performers in 2018
13% of Small & Rural Practices NATIONWIDE will receive a NEGATIVE payment adjustment
Averaged a Score of 84.74%
Averaged a Score of 67.25%
Had a Median Score of 92.49%
Had a Median Score of 81.36%
CELEBRATING 10 YEARS OF SUCCESS!
100% of Contracted Clients Avoided the Penalty in 2018
Dive into YOUR Data & Documentation Examine Current Performance thru Gap Analysis Customized Recommendations & Action Planning Individualized Advisor for YOU Unlock your MAXIMUM Performance Potential
How We Help YOU!
TO BE THE TRUSTED ADVISOR AND STRATEGIC PARTNER IN KENTUCKY
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Finding the Right Fit for YOUR Practice CONTACT US! (859) 323-3090
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