The Quality Payment Program: Implications for Diabetes Management - - PowerPoint PPT Presentation

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The Quality Payment Program: Implications for Diabetes Management - - PowerPoint PPT Presentation

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Quality Payment Program The Quality Payment Program: Implications for Diabetes Management Patric tricia A. A. Meie eier, M.D. Ch Chie ief Med edic ical l Offi ficer, CM CMS Kansas City Regional Office November 17, 2016 1 Quality

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Quality Payment Program

Patric tricia A.

  • A. Meie

eier, M.D. Ch Chie ief Med edic ical l Offi ficer, CM CMS Kansas City Regional Office November 17, 2016

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The Quality Payment Program: Implications for Diabetes Management

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Quality Payment Program

What is “MACRA”?

MACRA stands for the Medicare Access and CHIP Reauthorization Act of 2015, , bipartisan legislation signed into law on April 16, 2015. What does it do?

  • Repeals the Sustainable Growth Rate (SGR) Formula
  • Streamlines multiple quality reporting programs into 1 new

system (MIPS)

  • Provides bonus payments for participation in advanced

alternative payment models (APMs)

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Quality Payment Program

The Merit-based Incentive Payment System (MIPS)

If you decide to participate in traditional Medicare, you may earn a performance-based payment adjustment through MIPS.

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

Clin Clinicia ians have tw two tr tracks to

  • ch

choose fr from:

OR OR

Advanced Alternate Payment Models (APMs)

If you decide to take part in an Advanced APM, you may earn a Medicare incentive payment for participating in an innovative payment model. 5

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Quality Payment Program

How Are MIPS Performance Categories Weighted?

Weights assigned to each category based on a 1 to 100 point scale Tran ansition Year Weights— 25% 25%

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Quality

60%

Improvement Activities

15%

Advancing Care Information

25%

Cost

0%

NOTE: These are defaults weights; the weights can adjust in certain circumstances

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Quality Payment Program

MIPS Performance Category:

Quality

  • Category Requirements
  • Replaces PQRS and Quality Portion of the Value Modifier
  • “So what?”—Provides for an easier transition due to familiarity

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Different requirements for groups reporting CMS Web Interface or those in MIPS-APMs May also select specialty-specific set

  • f measures

Sel Select 6 of

  • f abou

about 300 qua quali lity me measures (minimum of 90 days to be eligible for maximum payment adjustment); 1 must be:

  • Outcome measure OR
  • High-priority measure—defined as
  • utcome measure, appropriate use

measure, patient experience, patient safety, efficiency measures, or care coordination 60% % of

  • f fi

fina nal l score May al also

  • sel

elect spe pecia ialt lty-specific ic set

  • f
  • f mea

measures

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Quality Payment Program

MIPS Performance Category: Improvement Activities

  • Clinicians choose from about 90+ activities under 9 subcategories:

1. Expanded Practice Access 2. Population Management 3. Care Coordination 4. Beneficiary Engagement 5. Patient Safety and Practice Assessment 6. Participation in an APM 7. Achieving Health Equity 8. Integrating Behavioral and Mental Health 9. Emergency Preparedness and Response

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Quality Payment Program

Website walk-through: https://qpp.cms.gov

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Quality Payment Program

Quality Measures: Diabetes Search

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Quality Payment Program

Quality Measures: Diabetes Eye Exam

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Quality Payment Program

Quality Measures: Diabetes Foot Exam

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Quality Payment Program

Quality Measures: HbA1c Control

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Quality Payment Program

Clinical Improvement: Diabetes Search

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Quality Payment Program

Improvement Activities: Diabetes Search

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Quality Payment Program

Improvement Activities: Diabetes Search

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Quality Payment Program

Improvement Activities: Diabetes Search

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Quality Payment Program

Medicare Diabetes Prevention Program

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Quality Payment Program

Proposed Medicare Diabetes Prevention Program Benefit Description

CDC-approved DPP curriculum

12 month Core Benefit

  • Monthly

maintenance sessions

  • Second 6 months
  • Minimum of 16

core sessions

  • First 6 months

AFTER 1st YEAR: monthly maintenance sessions IF patient achieves & maintains minimum weight loss

Maintenance Sessions

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Quality Payment Program

  • Must meet Body Mass Index (BMI) Criteria:

– ≥ 25 (≥ 23 for Asian beneficiaries)

  • Must have Blood T

est Results: Have within the 12 months prior to the first core session:

– Hemoglobin A1c of 5.7-6.4%; or – Fasting plasma glucose of 110-125 mg/dL; or – Two-hour plasma glucose of 140–199 mg/dL

  • No previous diagnosis of diabetes (gestational diabetes is

allowable) or End-Stage Renal Disease (ESRD).

Proposed Beneficiary Eligibility

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Quality Payment Program

MDPP Conference Call: November 30

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Quality Payment Program

Patricia A. Meier, M.D. Chief Medical Officer CMS Kansas City Regional Office patricia.meier@cms.hhs.gov

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Contact Info