We will begin at 12:30 PM EST Follow us on Twitter: @KentuckyREC - - PowerPoint PPT Presentation

We will begin at 12:30 PM EST

Follow us on Twitter: @KentuckyREC Like us on Facebook: facebook.com/KentuckyREC Follow us on LinkedIn: linkedin.com/company/kentucky-rec Check out our Website: www.kentuckyrec.com Call us: 859-323-3090 Email us: kyrec@uky.edu

Connect w ith Kentucky REC!

Quality Payment Program Y4: Planning for Success

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:

• Assisting more than 5,000 individual providers

across Kentucky, including primary care providers and specialists

• Helping more than 95% of the Federally Qualified

Health Centers (FQHCs) and Rural Health Clinics (RHCs) within Kentucky

• Working with more than 1/2 of all Kentucky

hospitals

• Supporting practices and health systems across the

Commonwealth with practice transformation and preparation for value based payment

Physician Services

• 1. Promoting Interoperability (MU) & Mock Audit
• 2. HIPAA SRA, Project Management & Vulnerability Scanning
• 3. Patient Centered Medical Home (PCMH) Consulting
• 4. Patient Centered Specialty Practice (PCSP) Consulting
• 5. Value Based Payment & MACRA Support
• 6. Quality Improvement Support
• 7. Telehealth Services

Hospital Services

• 1. Promoting Interoperability (Meaningful Use)
• 2. HIPAA Security Analysis & Project Management
• 3. Hospital Quality Improvement Support

Kentucky REC Description

Kentucky Regional Extension Center Services

MIPS Y4 Program Essentials MIPS Category Planning Additional Reminders

Objectives

QPP Y4: QPP Clinician Eligibility

Merit-Based Incentive Payment System (MIPS) $90K Part B 200 Medicare Patients 200 PFS Advanced Alternative Payment Models (APMs) Advanced APM Participant 50% Payment 35% Medicare Patients QPP Track Eligibility Requirements

Eligible Clinician Types: Physician, PA, NP, CNS, CRNA, PT, OT, Qualified Speech-Language Pathologist, Qualified Audiologist, Clinical Psychologist, Registered Dietitian or Nutrition Professional OR

QPP Y4: MIPS Thresholds

0 Points = Full 9% Penalty 45 Points Minimum Threshold = No Penalty, No Reward Between 46-84 Points = No Penalty 85+ = Exceptional Performance Split $500M Pool

Year 5 Minimum Threshold = 60 Points

QPP Y4: MIPS Overview

Program Year Payment Year

Quality Improvement Activities Promoting Interoperability Cost

Adjustment Factor + / -

2020 (Y4) 2022 45% 15% 25% 15% 9% Reporting Timeframes 365- Days 90-Day Minimum 90-Day Minimum 365- Days

Applied During Payment Year

Must Submit by March 31st, 2021

QPP Y4: Reporting Options

Individual

Under an NPI number & TIN where they reassign benefits

Group

> 2 clinicians (NPIs) who have reassigned their billing rights to a single TIN As an APM Entity

Virtual Group

Combination of > 2 TINs assigned to > 1 individual MIPS ECs, or to > 1 groups consisting of < 10 ECs with > 1 MIPS EC

Quality:

6 Measures Required except for: CMS Web Interface report 10 quality measures At least 1 Outcome measure 7th Measure based on claims for large groups

IA:

40 points raw score required

• Combination of

medium & highly weighted activities

• 50% ECs must

participate in same activity

• 50% of the

locations under the TIN are Certified PCMH/PCSP

Cost:

Score is based on Medicare claims, including: Measure 1: Medicare Spending per Beneficiary (MSPB) Measure 2: Total per capita costs (TPCC) for all attributed beneficiaries 18 Episode-Based Measures

QPP Y4: Reporting Categories: Basics

PI:

100 points raw score required

• 4 Objectives, 5

Measures Scoring:

• Performance

Score

• Bonus

2015 CEHRT Required

Year 4: Minimum Threshold = 45 Points; 9% Risk

QPP Y4: Quality Planning & Action Steps

Choose Submission Method(s) Analyze 2019 Quality Performance Review 2020 Decile Scoring Pick Quality Measures & Study Measure Specifications Validate Reporting Integrate Improvement Methodology

QPP Y4: Quality Example

Analyze Previous Quality Performance Data

QPP Y4: Quality Example

Study Measure Specifications & Integrate Improvement Methodologies

QPP Y4: IA Planning & Action Steps

Determine Special Statuses Decide 50% NPI Population

(Group Only)

Select IAs Choose Timeframe Collect Evidence

QPP Y4: IA Example

Determine Special Status & Select IAs

QPP Y4: PI Planning & Action Steps

Choose Submission Method(s) Determine Special Status, Hardship & Bonus Possibilities Study Measure Specifications Validate Reporting Clinician Documentation Training

QPP Y4: PI Example

Determine Special Status & Study Measure Specs

QPP Y4: Cost Planning & Action Steps

Review Measure Specifications Familiarize Measure Attribution Methodology Analyze Past Cost Performance Confirm Coding/Billing Practices Consider Relevant QI Improvement Processes

QPP Y4: Cost Example

Review Specs & Attribution & Confirm Coding Practices

QPP Y4: Resources

Planning

• Y3 Performance Data – QPP Portal
• https://qpp.cms.gov/login
• Eligibility & Special Status– QPP Website
• https://qpp.cms.gov/participation-lookup
• Quality & Cost Measure Specs., Scoring, Imp. Activities, Data

Validation & Hardship Exceptions – QPP Resource Library

• https://qpp.cms.gov/about/resource-library

Action

• Kentucky Health Information Exchange (KHIE)
• https://khie.ky.gov/cwkhie/Pages/getstarted.aspx
• QI Methodologies
• PDSA, Lean, Six Sigma, etc.

Additional Reminders

QPP Y4: CMS Timeline

Snapshots

CMS provides a Minimum of Two Snapshots Throughout the Performance Year – 1: April 2: December

Legislative Updates

Notice for Proposed Rule Making (NPRM) – Late August QPP Final Rule – Early November

Performance Feedback

Typically Released in June – July Following Performance Period

QPP Y4: Planning for Success

Q1

• Check Eligibility
• Determine Quality

Measures

• Map & Track
• Establish

Submission Level & Method(s)

Q2

• Audit for Data

Accuracy

• Plan Improvement

Activities

• Capture

Documentation

• Check Eligibility
• Capture

Documentation from w/in QPP Portal

• Review Feedback

Reports

Q3

• Review NPRM

Proposals

• Place Comments
• Check Quality & PI

Reports

• Capture IA

Documentation

• Review Feedback

Reports

Q4

• Review QPP Final

Rule Changes

• Final Eligibility

Check

• Attestation Prep
• Documentation to

Retain

QPP Y4: It’s that Time!

QPP Y4: Questions

Value-Based Payment Support Services

QPP SURS Technical Assistance: Free, high-level resources for organizations with 15 or fewer eligible clinicians as they navigate the Quality Payment Program. The Resource Center include: straightforward, self-directed resources and tools, up-to-date materials, and access to expert Quality Improvement Advisors. Sign up: www.qppresourcecenter.com VBP Individualized Assistance: 12 months of planning and transformation support tailored to meet specific client needs and support success in value-based payment. This includes current state analysis, recommendations for action, collaborative goal setting and project planning, education, strategic decision support and ongoing advisory services. Advanced APM Support: Ongoing support, research, work plan development and application support for transition to advanced alternative payment models (APM).

Like us on Facebook: facebook.com/KentuckyREC Follow us on Twitter: @KentuckyREC Follow us on LinkedIn: linkedin.com/company/kentucky-rec Check out our Website: www.kentuckyrec.com

• Call us: 859-323-3090
• Email us: kyrec@uky.edu

Connect w ith Kentucky REC!