Quality Payment Program The Merit-based Incentive Program November 29, , 2016 1
Quality Payment Program The foundation of the program is delivery of high-quality patient care. Using a variety of tools, physicians report data to CMS, receive valuable feedback about their practice, and are eligible for payment adjustments 2
Quality Payment Program Major Topics Covered Quality Payment Program The The Merit-based Preparing for Quality Incentive Payment 2017 MIPS Payment System Participation Program at-a-glance 3
Quality Payment Program Medicare Payment Prior to MACRA Fee-for-service (FFS) payment system, where clinicians are paid based on volume of services, not value. The Sustainable Growth Rate (S (SGR) • Established in 1997 to control the c cost of f Medic icare payments to physicians > IF Target Medic icare Overall physic icia ian Physic icia ian payments s cut t exp xpenditures costs ts across ss th the board Each year, Congress passed temporary “doc fixes” to avert cuts (no fix in 2015 would have meant a 21% cut in Medicare payments to clinicians) 4
Quality Payment Program What is the Quality Payment Program? 5
Quality Payment Program The Quality Payment Program The Quality Payment Program policy will: • Reform Medicare Part B payments for more than 600,000 clinicians • Improve care across the entire health care delivery system Cli linic icia ians have two tracks to choose fr from: OR OR The Merit-based Incentive Advanced Alternate Payment Models Payment System (MIPS) (APMs) If you decide to participate in traditional If you decide to take part in an Advanced APM, you Medicare, you may earn a performance-based may earn a Medicare incentive payment for payment adjustment through MIPS. participating in an innovative payment model. 5
Quality Payment Program How Does the Quality Payment Program Benefit Clinicians and Patients? Clinicians Patients • Increases access to better care • Streamlines reporting • Enhances coordination through a • Standardizes measures (evidence- patient-centered approach based) • Improves results • Eliminates duplicative reporting, which allows clinicians to spend more time with patients • Promotes industry alignment through multi-payer models • Incentivizes care that focuses on improved quality outcomes 7
Quality Payment Program Quality Payment Program Bedrock High-quality patient-centered care Continuous Useful feedback improvement 8
Quality Payment Program Quality Payment Program Strategic Goals Improve beneficiary outcomes Enhance clinician experience Increase adoption of Maximize participation Advanced APMs Improve data and Ensure operational excellence information sharing in program implementation Quick Tip: For additional information on the Quality Payment Program, please visit QPP.CMS.GOV 9
Quality Payment Program What Does the Quality Payment Program Do? Creates Medicare payment methods that promote quality over volume by: Streamlining legacy Creating two tracks: programs Repealing Merit-based Incentive SGR Payment System formula (MIPS) Providing 5% incentive to Advanced Advanced Alternative APM Payment Models participants (Advanced APMS) Establishing PTAC, the Physician-focused Payment Model Technical Advisory Committee 10
Quality Payment Program The Quality Payment Program Allows Easier Access for Small Practices • Small practices Why? will be able to • Reducing the time and cost to participate successfully • Providing an on-ramp to participating through participate in Pick Your Pace the Quality • Increasing the opportunities to participate in Payment Advanced APMs Program • Including a practice-based option for participation in Advanced APMs as an alternative to total cost-based • Conducting technical support and outreach to small practices through the forthcoming Quality Payment Program, Small, Rural and Underserved Support (QPP-SURS) as well as through the Transforming Clinical Practice Initiative. 11
Quality Payment Program Exceptions for Small, Rural and Health Professional Shortage Areas (HPSAs) Reduced requirements Increased ability for Established low- clinicians practicing at for Improvement volume threshold Critical Access Hospitals Activities performance (CAHs), Rural Health • Less than or equal to category Clinics (RHCs), and $30,000 in Medicare Part B allowed charges • One high-weighted activity Federally Qualified Health OR Centers (FQHCs) to qualify OR • Less than or equal to 100 as a Qualifying APM Medicare patients • Two medium-weighted Participant (QP). activities 12
Quality Payment Program Flexible Start for Clinicians: Pick Your Pace MIPS Participate in an Advanced Alternative Full Year Test Pace Partial Year Payment Model • Some practices • Submit some data • Fully participate • Report for 90-day starting January 1, may choose to after January 1, period after 2017 2017 participate in an January 1, 2017 Advanced • Modest positive • Neutral or small • Small positive Alternative payment payment payment adjustment Payment Model in adjustment adjustment 2017 Not participating in the Quality Payment Program for the transition year will result in a negative 4% payment adjustment. 13
Quality Payment Program What is the Merit-based Incentive Payment System? Perf rformance Categories Quality Cost Improvement Advancing Care Activities Information • Moves Medicare Part B clinicians to a performance-based payment system • Provides clinicians with flexibility to choose the activities and measures that are most meaningful to their practice • Reporting standards align with Advanced APMs wherever possible 14
Quality Payment Program What are the Performance Category Weights? Weights assigned to each category based on a 1 to 100 point scale ights — 25% 25% Transit itio ion Year r Weig Advancing Care Quality Cost Improvement Information Activities 60% 0% 15% 25% Note: : These are defaults weights; the weights can be adjusted in certain circumstances 15
Quality Payment Program Ready, Set, Go! Preparing for 2017 participation in MIPS 16
Quality Payment Program Getting Started… Determine you eligibility status Gauge your readiness and choose “how” you want to start Choose if you will be reporting as an individual or group Decide if you will work with a third party intermediary Review the program timeline for dates Choose a data submission option Reach agreement with Bonus Payments and Reporting Periods Assess your Feedback Ready, set, go! 17
Quality Payment Program Eligible Clinicians: • Medicare Part B clinicians billing more than $30,000 a year AND providing care for more than 100 Medicare patients a year. These clinicians include: Certified Physician Nurse Clinical Nurse Registered Physicians Assistants Practitioner Specialist Nurse Anesthetists 18
Quality Payment Program Non-Patient Facing Clinicians • Non-patient facing clinicians are eligible to participate in MIPS as long as they exceed the low-volume threshold, are not newly enrolled, and are not a qualifying APM participant (QP) or partial QP that elects not to report data to MIPS • The non-patient facing MIPS-eligible clinician threshold for individual MIPS-eligible clinicians is < 100 patient facing encounters in a designated period • A group is non-patient facing if > 75 % of NPIs billing under the group’s TIN during a performance period are labeled as non-patient facing • There are special reporting requirements for non-patient facing clinicians 19
Quality Payment Program Who is excluded from MIPS? Clinicians who are: Newly-enrolled Below the low-volume Significantly in Medicare threshold participating in Advanced APMs • Enrolled in Medicare • Medicare Part B allowed • Receive 25% of your for the first time during charges less than or equal Medicare payments the performance period to $30,000 a year OR OR (exempt until following OR OR • See 20% of your Medicare • See 100 or fewer performance year) patients through an Medicare Part B patients a Advanced APM year 16
Quality Payment Program Pick Your Pace for Participation for the Transition Year Participate in an MIPS Advanced Alternative Payment Model Full Year Test Pace Part rtial Year Some practices may • Submit so some data after • Report for 90-day • Fully participate choose to participate January 1, 2017 period after January 1, starting January 1, in an Advanced 2017 2017 • Neutral or small Alternative Payment payment adjustment • Small positive payment • Modest positive Model in 2017 adjustment payment adjustment Not t part rticip ipating in in th the Quality Payment Program for r th the Transition Year r wil ill result in in a negative 4% payment adju justment. 21
Quality Payment Program MIPS: Choosing to Test for 2017 • Submit minimum amount of 2017 data to Medicare • Avoid a downward adjustment You Have Asked: “What is a minimum amount of data?” OR OR OR OR 4 or 5 1 1 Required Advancing Quality Improvement Care Activity Measure Information Measures 20
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