We will begin at 12:30 PM EST Follow us on Twitter: @KentuckyREC - - PowerPoint PPT Presentation
WELCOME! 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
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
WELCOME!
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
Rebecca Cheatham QIA Robin Curnel QIA Brent Doom QIA
Your REC Advisors & Presenters
Year 4 Merit-Based Incentive Payment System (MIPS) Basics Year 4 Quality Category Deep Dive Next Steps
Objectives
QPP 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
Polling Question #1
Enter your answer into the polling window on the right side of your screen
MIPS Clinician Eligibility
Merit-Based Incentive Payment System (MIPS)
$90K Part B Billing 200 Medicare Patients 200 Covered Services under PFS
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
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!!!
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
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
Polling Question #2
Enter your answer into the polling window on the right side of your screen
Quality Overview
Historical Context: Formally known as PQRS (2011-2018), the Quality Category covers the quality of care delivered based on performance measures best-suited for your organization/practice. Basic Requirements: Submit at least 6 Quality Measures w/ > 1 outcome or high priority measure 12-Month Performance Period 70% Data Completeness Scoring: Measure achievement points are earned based on a measure’s performance in comparison to a benchmark, exclusive
Program Year Weight Multiple Submissions Collection Types Level of Reporting 2019 45% Yes eCQMs, MIPS CQMs, QCDR, Claims, CAHPS for MIPS Survey Group AND/OR Individual 2020 45% Yes eCQMs, MIPS CQMs, QCDR, Claims, CAHPS for MIPS Survey Group AND/OR Individual 2021 TBD TBD eCQMs, MIPS CQMs, QCDR, Claims, CAHPS for MIPS Survey, MVP(s), TBD Group, Individual, AND/OR MVP(s)
Web Interface Web Interface Bonus Opportunities CAHPS for MIPS Survey
measures
March 31st
additional high priority measure
end-to-end submission
practice does not meet the minimum threshold for survey (reduced by 10)
Web Interface
Multiple Collection Types Considerations Possible Advantages
Potential Challenges Workflow(s) Cost Uncertainty
QPP Y4: Changes to Quality
Final Score:
Measures
CMS Web Interface Set
for PY21
2019+
Requirements
Requirement to 70%
Controlling High Blood Pressure & A1C Poor Control
Part B Claims & MIPS CQM Measure Submissions
What is Data Completeness?
Data Completeness
Cherry Picking: Using data selection criteria to misrepresent a clinician or group’s performance for a performance period results in data that is not true, accurate, or complete
What Not To Do
CMS will assign zero points for any measure that does not meet data completeness requirements for the quality performance
practices will continue to receive 3 points
Score Impact
Claims:
Medicare Part B patients for the performance period
QCDR, MIPS CQMs, & eCQMs:
clinician's or group's patients across all payers for the performance period
MIPS Requirements
Public Reporting
Quality measures will not be publicly reported for the first two years in use, starting with Performance Year 2 Providers & Organizations have the opportunity to view data before it gets publicly published
Bonus Points
High Priority Measures
Reporting 3 Point Floor for Scoring Improvement Scoring Reweighting Opportunities
Claims reporting still available Minimum of 1 measure reported is required to get the bonus
submit all 6 to get base Quality score Data completeness threshold not met= still gets 3 points rather than the 0 if 70 % is not met
Quality Category Flexibilities
Quality 85% IA 15%
No Cost & No PI
Quality 60% IA 15% PI 25%
No Cost
Quality 70% Cost 15% IA 15%
No PI
Reweighting Opportunities
Quality 45% Cost 15% IA 15% PI 25% 2020 Weights
2020 MIPS Category Weights w/o Any Reweighting 3 Most Common Reweighting Scenarios
Polling Question #3
Enter your answer into the polling window on the right side of your screen
Select Measures Each Year Measures are updated each year so make sure you review and select your measures appropriately Pull Specification Sheets Do this each year & keep with documentation of submission & eligibility Use these Specification Sheets Assure your are accurately tracking your numerator & denominator populations for each measure Pull Your Data Track your data regularly to be able to make improvements throughout the year
Next Steps
Put in Process Flow Verify Documentation Method Pull Specification Sheet Pull Decile Scoring Benchmarks Verify Internal Workflows
Measure Deep Dive
Process Workflows
measure impacts
workflows
Submission Workflows
Submission Methods
measure/submission method
eCQI Resource Center: https://ecqi.healthit.gov/eligible- professional/eligible-clinician- ecqms?field_year_value=1 CMS Resource Library: https://qpp.cms.gov/about/resource- library
Quality Resource Locations
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
Polling Question #4
Enter your answer into the polling window on the right side of your screen
QPP Y4: Questions
COVID-19 Update
Upcoming QPP Webinars