The Quality Payment Program: What You Need to Know Now Jenn Gordon, - - PowerPoint PPT Presentation

The Quality Payment Program: What You Need to Know Now

This material was prepared by the New England QIN-QIO, the Medicare Quality Innovation Network-Quality Improvement Organization for New England, under contract with the Centers for Medicare & Medicaid Services (CMS), an agency of the U.S. Department of Health and Human Services. The contents presented do not necessarily reflect CMS policy. CMSMA_D1_201611_0804

Jenn Gordon, MSW Project Lead, QIN-QIO Miriam Sheehey, RN Director of Clinical Operations OneCare VT

Overview

What is MACRA? Merit-based Incentive Payment Systems and Alternative Payment Models

Eligibility and exclusion criteria Reporting options Performance categories Alignment with NCQA-PCMH Scoring methodology

How to prepare for 2017 Resources, Tools and Support

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Disclaimer

This material was prepared by the New England Quality Innovation Network-Quality Improvement Organization (QIN- QIO), the Medicare Quality Improvement Organization for New England, under contract with the Centers for Medicare & Medicaid Services (CMS), an agency of the U.S. Department of Health and Human Services. The contents presented do not necessarily reflect CMS policy.

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* Sustainable Growth Rate

*

Sound Familiar?

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The foundation of the Quality Payment Program is high-quality, patient-centered care followed by useful feedback, in a continuous cycle of improvement.

Merit-based Incentive Payment System (MIPS)

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Existing Program PQRS Meaningful Use Value-Based Payment Modifier MIPS Performance Categories Quality Advancing Care Information (ACI) Cost (Resource Use) Improvement Activities (IAs)

Timeline

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Event Begin Date End Date PQRS & MU 2016 Data Submission 1/2/17 3/31/17 MIPS 2017 Performance Year 1/1/17 12/31/17 PQRS & MU 2017 Payment Year from 2015 Performance Year 1/1/17 12/31/17 MIPS 2017 Data Submission 1/2/18 3/31/18 MIPS 2018 Performance Period 1/1/18 12/31/18 PQRS & MU 2018 Payment Period from 2016 Performance Year 1/1/18 12/31/18 MIPS 2018 Data Submission 1/2/19 3/31/19 MIPS 2019 Performance Period 1/1/19 12/31/19 MIPS 2019 Payment Year from 2017 Performance Year 1/1/19 12/31/19

Two Payment Model Tracks

MIPS

All Non - One Care VT Practices and

APMs

MIPS APMs: MSSP Track 1

and Advanced APMs: MSSP Tracks 2 and 3, Next Gen, CPC+, Comprehensive ESRD Model, Oncology Care Model

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None in VT

Eligibility and Exclusion Criteria for 2017

Who is eligible for MIPS? What is the low-volume exclusion? Submit < $30,000 in Medicare Part B claims Care for fewer than 100 Medicare patients In first year of submitting Medicare claims Participate in a qualified advanced APM

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Physician Physician Assistant Nurse Practitioner Clinical Nurse Specialist Certified Registered Nurse Anesthetist

Non-Patient Facing Clinicians

ECs with ≤ 100 Patient Facing Encounters Groups where > 75% of individual clinicians have ≤ 100 Patient Facing Encounters 25% of MIPS ECs are considered NPF

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Pathologist Anesthesiologist Nuclear Medicine Diagnostic Radiologist

MIPS – Pick Your Pace Reporting

Don’t Participate

Receive a 4% negative payment adjustment

Submit Something

Submit one quality measure or IA and avoid a downward payment adjustment

Submit a Partial Year

Report on 90 continuous days and earn a neutral or small incentive

Submit a Full Year

Earn a moderate payment adjustment

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MIPS Program in 2017

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60% 25% 15%

MIPS

Quality ACI IA 50% 30% 20%

MIPS APM

Quality ACI IA

Data Submission Mechanisms

Performance Category Individual Reporting Group Reporting

Quality Claims, QCDR, Qualified Registry, EHR, Administrative Claims (no submission required) QCDR, Qualified Registry, EHR, CMS Web interface (25+), CMS- approved CAHPS for MIPS survey vendor, Administrative Claims Cost Administrative Claims Administrative Claims Advancing Care Information Attestation, QCDR, Qualified Registry, EHR Attestation, QCDR, Qualified Registry, EHR Web interface (25+) Improvement Activities Attestation, QCDR, Qualified Registry, EHR, Administrative Claims (if technically feasible, no submission required) Attestation, QCDR, Qualified Registry, EHR, Web interface (25+), Administrative Claims (if technically feasible, no submission required)

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MIPS Quality Measures

Choose 6 measures Include 1 outcome measure (intermediate outcome or high priority)

• r

1 specialty specific measure set

https://qpp.cms.gov/measures/quality

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Larger Practices Report More

≥ 25 ECs + web interface

Report 15 quality measures

≥ 15 ECs and ≥ 200 attributed hospitalizations

All Cause Readmissions is being scored through administrative claims

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Fewer Points Earned If…

Does not have a benchmark Does not have at least 20 episodes Does not meet data completeness criteria

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Scoring Methodology

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Quality Point System

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Measure Name Measure Type Performance Points Total Possible Points Potential High Priority Bonus Points Potential CEHRT Bonus Points Measure 1 Outcome 3 to 10 10 0 (required) 1 Measure 2 High priority 3 to 10 10 0 (required if

• utcome is

N/A) 1 Measure 3 Outcome or patient experience 3 to 10 10 2 1 Measure 4 High priority 3 to 10 10 1 1 Measure 5 ? 3 to 10 10 ? 1 Measure 6 ? 3 to 10 10 ? 1 Total ? 60 ? ? Cap applied to each bonus category (10% of total possible points) Up to 6 Up to 6 Total with high priority and CEHRT bonus Up to 72

MIPS Quality Scoring in a Nutshell

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Topped Out Measures

Measures with a median performance rate ≥ 95% 2018 is first year that a measure will be scored using this methodology

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MIPS APM Quality Measures

OCV submits 31 measures on behalf of practice

https://s3.amazonaws.com/publicinspection.federalregister.gov/2016-26668.pdf (pages 1125-1127)

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• No. of Measures

Domain

8 Pt/Caregiver Experience 10 Care Coordination/ Pt Safety 5 Clinical Care for At-Risk Population 8 Preventive Health

Current Process

First week of January Patient records randomly identified

Medicare: 616 per measure Medicaid and Commercial: 348 per measure

7k total patients OCV clinical consultants extract data CMS audit possible

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Improvement Activities

MIPS

PCMH? Earn full credit points (40) Maximum credit earned by reporting on activities totaling 40 points Activities weighted as medium (10 points) or high (20 points) Select from over 90 IAs

MIPS APM

MSSP? Earn full credit points (40) CMS will assign same score to all practices

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MIPS IMPROVEMENT ACTIVITY OPTIONS

https://qpp.cms.gov/measures/ia

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MIPS IA Scoring in a Nutshell

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Advancing Care Information

MIPS and MIPS APMs

Required Base Score Measures Report yes/no and ≥1 in numerator

Performing a Security Risk Analysis E-Prescribing Providing Patient Access to Their Data Sending Summary of Care via HIE Requesting/Accepting Summary of Care (required 2018)

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Advancing Care Information

Performance Score Measures Example

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ACI Scoring in a Nutshell

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What if I’m in a MIPS APM?

Attest using the same method as MIPS Practice scores are aggregated on a weighted average Will result in one group score

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Cost/Resource Use

2017 = 0% 2018 = 10% Collected from adjudicated claims Total per capita costs for all attributed beneficiaries

Annual costs per beneficiary from all sources Attributed to one Primary Care Provider group

Medicare Spending Per Beneficiary

Charges attributed to inpatient stays Attributed to provider (group) with plurality of charges

Episodes of Care

10 anticipated and more being monitored

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Financial Impact of MIPS

What does budget neutral mean? Incentives are funded by penalties.

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Example of Final MIPS Score Calculation

Quality = (42 of 60 points) x 60% weight x100 = 42 points ACI = (50 of 100 points) x 25% weight x 100 = 12.5 points IA = (40 of 40 points) x 15% weight x 100 = 15 points Total MIPS points = 42 + 12.5 + 15 = 69.5 Final Score = 69.5

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Program Performance Year Payment Adjustment Year Maximum -% Payment Adjustment Maximum +% Payment Adjustment PQRS/VBM 2016 2018

• 4% penalty

+4%*X incentive MIPS 2017 2019

• 4% penalty

+4%*X incentive MIPS 2018 2020

• 5% penalty

+5%*X incentive MIPS 2019 2021

• 7% penalty

+7%*X incentive MIPS 2020 2022

• 9% penalty

+9%*X incentive

Medicare Part B payment adjustments only For MIPS, X capped at 3.0 plus a 10% "exceptional performance bonus" For Performance Year 2020, up to 9% x 3.0 + 10% = 37% bonus

Reputational Impact

https://www.medicare.gov/physiciancompare/

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What can I do now?

If reporting MIPS, choose 10 measures now that matter Inquire with your EHR vendor about reporting capabilities Monitor and manage your data

Document consistently in captured fields Extract reliable data efficiently Analyze frequently Submit automatically

Reach out to your QIN-QIO, ACO, PTN or other practice consultant for assistance

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Tools & Resources

QIN-QIO website http://www.healthcarefornewengland.org/initiatives/macra/

Complete the MIPS Readiness Assessment Get your personalized questions answered within 24 hours by our team members

Vermont Payment Model Mapping Database

Locate your practice Identify your practice payment model and corresponding reporting requirements Contact jgordon@qualidigm.org for access

MIPS/PCMH/MSSP Links Database

Reduce your work burden Identify measure alignment between three pay-for-performance programs Contact jgordon@qualidigm.org for access

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Links Database: in Development

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Questions?

Jennifer Gordon, MSW

Project Lead, QIN-QIO jgordon@qualidigm.org

Miriam Sheehey, RN

Director of Clinical Operations OneCare VT miriam.sheehey@onecarevt.org

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