quality payment program (macra/mips)166.78.170.144/sites/default/files/2018 nuc quality... ·...

Quality Payment Program (MACRA/MIPS)

May 29, 2018

National Client Conference May 14th - 17th

Title of Presentation

Target audience:General

- Sarah RichardsonBS R.T.R, CMUP, CMHP, CMQPA Software Development/Client Services Manager, Evident Promoting Interoperability, MIPS, and PCMH

- Camille PattonSoftware Development/Client Services Clinical Specialist, Evident Promoting Interoperability and MIPS

Session presenters target audience:

Quality Payment Program (MACRA /MIPS)


Learning Objectives

What do I need to know about MIPS and Alternative Payment Models?

Objective 1How did the program change from the 2017 reporting period?

Objective 2How do I prepare for and participate in MIPS?

Objective 3

Learning Objectives


Quality Payment Program Overview


Icon TreatmentsQuality Payment

Program Overview

MIPS

Physician Quality Reporting System (PQRS)

Value-Based Payment Modifier (VM)

Medicare EHR Incentive Program (EHR)

Combines legacy programs into single reporting program



Program Overview

The Merit-based IncentivePayment System (MIPS) If you decide to participate in

traditional Medicare, you may earn a performance-based payment

adjustment through MIPS

MIPS

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

Advanced APMs

Clinicians have two tracks to choose from:



Program Overview

Eligible Clinicians for MIPS

You are eligible to participate in the MIPS track of the Quality Payment Program if you:

• Bill more than $90,000 in Medicare Part B allowed charges

AND

• Provide care to more than 200 Medicare patients per year

These clinicians include:



Program Overview

Eligible Clinicians for MIPS

Change to the Low-Volume Threshold for 2018.



Program Overview

Eligibility Examples:

Dr. “A” is:• An eligible clinician• Billed $100,000 in Medicare Part B Charges• Saw 80 PatientsDr. A would be EXEMPT from MIPS due to seeing less than 200 patients

Dr. “B” is:• An eligible clinician• Billed $100,000 in Medicare Part B Charges• Saw 210 PatientsDr. B would be ELIGIBLE for MIPS due to billing more than $90,000 and seeing more than 200 patients



Program Overview

Exclusions from MIPS payment adjustments:

• Medicare Part A

• Medicare Advantage Part C and Part D

• Federally Qualified Health Centers (FQHC)

• Rural Health Clinics that bill under the all-inclusive methodology

• CAH Method I facility payments



Program Overview

Merit-Based Incentive Payment System (MIPS)Performance Categories

*qpp.cms.gov

⁻ Comprised of four Performance Categories⁻ Provides clinicians with flexibility to choose the activities and

measures that are most meaningful to their practice

Promoting Interoperability



Program Overview

Merit-Based Incentive Payment System (MIPS)A single MIPS composite performance score will be generated based on the

performance in the 4 performance categories on a 0-100 point scale.

MIPS Composite

Performance Score (CPS)




Program Overview

How much can MIPS adjust payments?

Based on a MIPS Composite Performance Score, clinicians will receive +/- or neutral adjustments up to the percentages below.

Adjusted Medicare Part B payment to

clinician

The potential maximum adjustment % will increase each

year from 2019 to 2022



Program Overview

2018 MIPS Performance Threshold



Program Overview

2018 Performance Period





Program Overview

MIPS 2018 Timeline



Program Overview

Individual vs. Group vs. Virtual Reporting

Individual Group Virtual Group

1. Individual Under a National Provider Identifier (NPI) number and Taxpayer Identification Number (TIN) where they reassign benefits.

2. Groupa) 2 or more

clinicians (NPIs) who have reassigned their billing rights to a single TIN

b) As an APM Entity

3. Virtual Groupa) 2 or more TINs

made up of solo practitioners and groups of 10 or fewer eligible clinicians who come together virtually.


MIPS Performance Categories


Title and TextMIPS Performance Category

Overview

MIPS Performance Category: Quality

• 50% of Final Score in 2018

• Report up to 6 quality measures

• 1 must be an outcome measure

OR• High-priority measure

• Groups in APMs qualifying for special scoring under MIPS: Report quality measures through your APM. You do not need to do anything additional for MIPS Quality.



Overview

MIPS Performance Category: Quality

All Quality Measures must be submitted with the same data submission method

• Data Submission Methods

• Administrative Claims

• Claims

• CSV

• CMS Web Interface

• EHR

• Registry

All measures are listed with detailed information about data submission, measure set, and priority on qpp.cms.gov



Overview

MIPS Scoring for Quality

Select 6 of the approximately 300 available qualitymeasures (minimum of 90 days)• Or a specialty set• Or CMS Web Interface Measures

Clinicians receive 3 to 10 points on each quality measure based on performance against benchmarks

Failure to submit performance data for a measure = 0 points

Quick Tip:Easier for a clinicianthat participates longer to meet casevolume criteria needed to receivemore than 3 points

Bonus points are available



Overview

MIPS Scoring for Quality How are measure points determined?

If a measure can be reliably scored against a benchmark, then clinicians

can receive 3-10 points

Reliable score means for following:• Benchmarks exist Sufficient case

volume(>=200 cases for readmissions)

• Data completeness met (at least 60 percent of possible data is submitted)

If a measure cannot be reliably scored against a benchmark,

then clinician receives 3 points

• Measures that don’t meet the data completeness criteria will earn 1 point, except for a measure submitted by a small practice, which will earn 3 points



Overview

MIPS Scoring for Quality Bonus Points

Clinicians receive bonus points for either of the following:

Submitting an additional high-priority measure

• Up to 10% of denominator for performance category

Using CEHRT to submit measures to registries or CMS

• Up to 10% of denominator for performance category



Overview

MIPS Scoring for Quality

Total Quality Performance

Category Score

=

Points earned onrequired 6 qualitymeasures

+ Any bonus points

Maximum number of points*

Quick Tip: Maximum score cannot exceed 100%*Maximum number of points = # of required measures x 10



Overview

MIPS Performance Category: Improvement Activities


• Attest that you completed up to 4 improvement activities• Groups with fewer than 15 participants or if you are in a rural or health

professional shortage area: Attest you completed up to 2 activities

• Participants in certified patient-centered medical homes, comparable specialty practices, or an APM designated as a Medical Home Model automatically earn full credit

• Participants in certain APMs under the APM scoring standard will automatically receive points based on the requirements of participating in the APM



Overview

MIPS Performance Category: Advancing Care Information to Promoting Interoperability

• On April 24, 2018 CMS released a proposed rule that established a new name for the MIPS Advancing Care Information performance category – the Promoting Interoperability performance category.



Overview

MIPS Performance Category: Promoting Interoperability


• The PI category is divided into base measures and performance measures. Base measures are required in order to receive any points in this category.

• Reporting on all base measures will earn the clinician 50%. Reporting to the performance measures in addition to the base measures will allow the clinician to earn a higher score.

• Measure sets will depend on the EC’s version of CEHRT: version 2014 or version 2015



Overview

MIPS Performance Category: Promoting Interoperability

2018 Base measures based on CEHRT version: 50 percentage points

• Promoting Interoperability Objectives and Measures (2015 edition)• Security Risk Analysis• E-Prescribing• Provide Patient Access• Send Summary of Care• Request/Accept Summary of Care

• 2018 Promoting Interoperability Transition Objectives and Measures (2014 edition)• Security Risk Analysis• E-Prescribing• Provide Patient Access• Health Information Exchange



Overview

Promoting Interoperability Information Scoring

Performance Score: 80 percentage points determined based on achievement above the base score requirements for the 3 objectives:

• Patient Electronic Access

• Coordination of Care Through Patient Engagement

• Health Information Exchange

• The performance category score is capped at 100 percentage points (out of a possible 131 percentage points)



Overview

Promoting Interoperability Scoring

Bonus Points

Bonus points are awarded toward this category for:

• 5% bonus score is available for submitting to an additional public health agency or clinical data registry not reported under the performance score.

• 10% bonus score when you use CEHRT to complete certain Improvement Activities.

• 10% bonus points score for using 2015 Edition exclusively.



OverviewMIPS Performance Category: Promoting Interoperability

• CMS will automatically reweight the Promoting Interoperability performance category to zero for:• Hospital-based MIPS clinicians

• Non-Patient Facing clinicians

• Ambulatory Surgical Center

• Physician assistants

• Nurse practitioners

• Clinical nurse specialists

• Certified registered nurse anesthetists

These MIPS eligible clinicians can still choose to report if they would like, and if data is submitted, CMS will score their performance and weight the PI performance.



OverviewMIPS Performance Category: Promoting Interoperability

• A MIPS eligible clinician’s performance score may be reweighted for the following reasons:• Insufficient Internet Connectivity

• Extreme and Uncontrollable Circumstances

• Lack of Control over the Availability of CEHRT

• New hardship exception for clinicians in small practices (15 or fewer clinicians)

• New decertification exception

These MIPS eligible clinicians must submit an application for CMS to reweight the PI performance category to 0%.


MIPS Performance Category Overview



Overview

MIPS Performance Category: Cost


• Two cost measures to measure performance:

• Medicare Spending per Beneficiary (MSPB)

• Determines what Medicare pays for services performed by an individual clinician during an MSPB episode: the period immediately before, during, and after a patient’s hospital stay.

• Total Per Capita Cost (TPCC)

• Measures all Medicare Part A and Part B costs during the MIPS reporting period.



Overview


Scoring

• To calculate your Cost performance score CMS will:

• Assign 1 to 10 points to each measure

• Compare your performance to other MIPS-eligible clinicians’ and groups’ during the performance period, not on a past year

• Performance category score is the average of the 2 measures. If only 1 measure can be scored that score will be the performance category score.



Overview


• No data submission required. Calculated from administrative claims data if you meet the case minimum of attributed patients for a measure and if a benchmark has been calculated for a measure.

• If you participate in a MIPS APM, the MIPS APM will apply a 0% weight to the Cost performance category.

• Cost is reweighted to Quality if case minimums aren’t met for either measure.



Program Overview

2018 MIPS Performance Threshold

• Complex Patients Bonus: Up to 5 bonus points • Small Practice Bonus: 5 points

Final Score Payment Adjustment

≥70 points • Positive adjustment• Eligible for exceptional performance bonus

15-69 points • Positive adjustment• Not eligible for exceptional performance bonus

15 points • Neutral payment adjustment

14-3 • Negative payment adjustment

3-0 points • Negative payment adjustment of -5%



Program Overview

• Approach #1: Submit 6 Quality Measures that meet data completeness

• 18/60 Quality points x 50% = 15 CPS points

• Approach #2: Meet PI base score and submit 1 quality measure that meets data completeness

• 50/100 PI Points x 25% = 12.5 CPS points

• 3/60 Quality points x 50% = 2.5 CPS points

• Approach #3: Meet PI base score and submit one medium-weighted improvement activity

• 50/100 PI points x 25% = 12.5 CPS points

• 10/40 IA points x 15% = 3.75 CPS points

• Approach #4: Earn 100% in the Improvement Activities category

• 40/40 IA points x 15 = 15 CPS points



Program OverviewAlternative Payment Models

Advanced APMs:• Comprehensive ESRD Care (CEC) – Two-Sided Risk• Comprehensive Primary Care Plus (CPC+)• Next Generation ACO Model• Shared Savings Program – Track 2• Shared Savings Program – Track 3• Oncology Care Model (OCM) – Two-Sided Risk • Comprehensive Care for Joint Replacement (CJR) Payment Model –Track• Vermont Medicare ACO Initiative (as part of the Vermont All-Payer ACO Model)

Qualifying APM Participant

• Receive 25% of Medicare Part B payments through an Advanced APM

OR

• See 20% of Medicare patients through an Advanced APM



Program Overview

MIPS APM • Shared Savings Program – Track 1

• Will be available in Evident beginning in 2018.

MIPS APM Benefits: APM Scoring Standard• Quality Performance Category is reported through the APM and requires no

additional reporting to CMS

• Automatically receive full credit for the Improvement Activity Performance Category without additional reporting to CMS

• Cost will remain at 0% for future QPP reporting years.


How do I prepare and participate in MIPS?



Program Overview

Participation Status for Year 2Start by checking your participation status using the National Provider Identifier (NPI) Look-up Tool on qpp.cms.gov



Program Overview

Participation Status for Year 2



Program Overview

When preparing for the Quality Payment Program you first need to determine if you will be participating in MIPS or an Advanced APM.

• Advanced APM Path

• If you receive 25% of Medicare payments or see 20% of your Medicare patients through an Advanced APM in 2017, then you earn a 5% incentive payment .

• Merit Based Incentive Payment System (MIPS)

• If you bill more than $90,000 in Medicare part B allowed charges and see more than 200 Medicare patients annually you will earn a performance-based payment adjustment.



Program Overview

• If there are multiple Eligible Clinicians working in a practice, decide whether to report as a group, individually, or as a virtual group. If considering group or virtual group reporting: all measures must be reported as a group.

• Virtual Groups are a new option for the 2018 reporting period. The election period was October 11 to December 31, 2017. To learn more about Virtual Groups see the 2018 Virtual Groups

Toolkit.

Eligibility and Reporting

https://www.cms.gov/Medicare/Quality-Initiatives-Patient-Assessment-Instruments/Value-Based-Programs/MACRA-MIPS-and-APMs/2018-Virtual-Groups-Toolkit.zip



Program Overview

Our customers are wanting to know how to best meet the MIPS requirements.

• Performance Categories:

• Quality

• Cost

• Improvement Activities

• Promoting Interoperability



Program Overview

Quality Reporting

• If reporting with CPSI: Review the list of Quality Measures that CPSI has programmed for the 2018 reporting period, determine if those measures align with your practice. If so, contact your CSM with the measures you will be reporting with the EHR data submission method

• If choosing to report using a submission method other than the EHR submission method:

• Determine which quality measures you plan to report. All measures are listed with detailed information about data submission, measure set, and priority on qpp.cms.gov

• Ensure all measures will be reported via the same submission method


22: Screening for High Blood Pressure and Follow-up 134: Diabetes: Medical Attention for Nephropathy

50: Closing the Referral Loop: Receipt of Specialist Report 137: Initiation and Engagement of Alcohol and Other Drug

Dependence Treatment

56: Functional Status for Total Hip Replacement 138: Tobacco Use: Screening and Cessation Intervention

66: Functional Status Assessment for Total Knee

Replacement

139: Falls: Screening for Future Fall Risk

68: Documentation of Current Medications 146: Appropriate Testing for Children with Pharyngitis

69: Body Mass Index Screening and Follow-Up Plan 147: Preventive Care and Screening: Influenza Immunization

177: Childhood Immunization Status 154: Appropriate Treatment for Children with Upper Respiratory

Infection (URI)

122: Diabetes: Hemoglobin A1c (HbA1c) Poor Control (>9%) 155: Weight Assessment and Counseling for Nutrition and

Physical Activity for Children and Adolescents

124: Cervical Cancer Screening 156: Use of High-Risk Medication in the Elderly

125: Brest Cancer Screening 158: Pregnant Woman that had HBsAg testing

127: Pneumococcal Vaccination Status for Older Adults 164: Ischemic Vascular Disease (IVD): Use of Aspirin or another

Antiplatelet

130: Colorectal Cancer Screening 165:Controlling High Blood Pressure



Program Overview

Improvement Activities

• Determine how many activities you will be required to report:

• Most participants: Attest you completed up to 4 activities.

• Groups with fewer than 15 participants or if you are in a rural or health professional shortage area will attest to completing up to 2 activities.

• Participants in certified patient-centered medical homes, comparable specialty practices, or an APM designated as a Medical Home Model: You will automatically earn full credit.

• Participants in certain APMs under the APM scoring standard, such as Shared Savings Program Track 1: You will automatically be scored based on the requirements of participating in the APM. For all current APMs under the APM scoring standard, this assigned score will be full credit.

• Participants in any other APM: You will automatically earn half credit and may report additional activities to increase your score.



Program Overview

Improvement Activities

• Review the Clinical Practice Improvement Activities (CPIAs) to determine the ones you may already be doing listed on qpp.cms.gov. Consider implementing `high weight’ activities to boost your potential score.

• The reporting period required to get full points in this category is 90 days. Consider the timing that would be best for your practice to conduct the activities and monitor results.



Program Overview


• Determine which set of measures you will be reporting

• If you are using certified 2014 edition for the entire reporting period you will be qualified to report to the“2018 Promoting Interoperability transition Objectives and Measures”

• If you load 2015 certified edition during the reporting period you will be qualified to report to the 2018 Transition Objectives as well as the “Promoting Interoperability Objectives and Measures”

• Ensure that you can report at least one unique patient (or answer “yes”, as applicable) for each measure of the base score

• Determine what additional measures you will report to increase the performance score



Program Overview2018 Transition Objectives and Measures

Security Risk Analysis Secure Messaging

E-Prescribing Medication Reconciliation

Provide Patient Access Immunization Registry Reporting

Health InformationExchange

Syndromic Surveillance Reporting

View, Download Transmit Specialized Registry Reporting

Patient-Specific Education

Note: Bolded measures are required for base score



Program OverviewObjectives and Measures

Note: Bolded measures are required for base score

Security Risk Analysis Patient-Generated Health Data

E-Prescribing Clinical Information Reconciliation

Provide Patient Access Immunization Registry Reporting

Send a Summary of Care Syndromic Surveillance Reporting

Request/Accept Summary of Care Electronic Case Reporting

Patient- Specific Education Public Health Registry Reporting

View, Download, Transmit (VDT) Clinical Data Registry Reporting

Secure Messaging


Where can I learn more?

Technical Assistance


The following links are excellent resources for our customers to use.

• https://qpp.cms.gov/

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

• https://www.cms.gov/Medicare/Quality-Payment-Program/Resource-Library/Resource-library.html

• https://innovation.cms.gov/initiatives/ACO

• http://www.evident.com/

• http://healthlandlearning.com

Resources

https://qpp.cms.gov/

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

https://www.cms.gov/Medicare/Quality-Payment-Program/Resource-Library/Resource-library.html

https://innovation.cms.gov/initiatives/ACO

http://www.evident.com/


Questions?


For questions about the presentation or the Quality Payment Program please contact:

• Sarah Richardson: [email protected]

• Camille Patton: [email protected]

• Kellee Ellisor: [email protected]

Resources

mailto:[email protected]

mailto:[email protected]

Thank you!

quality payment program (macra/mips)166.78.170.144/sites/default/files/2018 nuc quality... ·...

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