2017 Transition Into Value Based Care

Transcription

1 2017 Transition Into Value Based Care Provider Meeting August 3 rd, 2017

2 Objectives Define MACRA, MIPS, and APM Overview of MIPS Performance Categories within the Quality Payment Program (QPP) Provide Reference & Resource Information

3 MACRA, MIPS & APM Definitions MACRA: Medicare Access and CHIP Reauthorization Act of 2015 Establishes new ways to pay physicians for caring for Medicare beneficiaries. Also referred to as Quality Payment Program (QPP). MIPS: Merit-based Incentive Payments System Combines PQRS, the Value Modifier and the Medicare EHR incentive programs into one w providers are compensated for Medicare Part B reimbursements adjusted up for superior performance or down for performance that falls short of established mean. APM: Alternative Payment Models Payment arrangement developed in partnership with the clinician community that provides added incentives to clinicians to provide high-quality & cost-efficient care. For example, the focus of an APM is on providing care to a specific clinical condition, care episode or a patient population. T are two types of alternative payment models: MIPS-APM and Advanced APM.

4 What is MIPS?

5 What are the 2017 Performance Category Weights?

6 Quality Measures Replaces PQRS and Quality Portion of the Value Modifier NQS Domains: Communication & Care Coordination, Community/Population Health, Effective Clinical Care, Efficiency & Cost Reduction, Patient Safety, and Person & Caregiver-Centered Experience & Outcomes

7 Cost No reporting requirement 0% of final score in 2017 Calculated from Medicare Claims data CMS will still provide feedback on how you performed in this category in 2017, but will not affect your 2019 payments

8 Improvement Activities Attest to participation in activities that improve clinical practice Patient Centered Medical Home (PCMH) gets full credit Choose from 90+ activities (weighted High/Medium) under 9 subcategories:

9 Advancing Care Information Score is combined total of 3 scores:

10 Transition Year 2017 Final Score

11 How to achieve a Neutral Payment Adjustment for 2017 Retrieved from Charlotte AHEC Website: Calculating Your Composite Score for MIPS

12 Take Away s MIPS provides measures and activities that providers choose from to accumulate points toward a composite score The composite score determines what adjustment, if any, in 2019 Most Eligible providers will be participating in the MIPS program this year (2017) T are benefits for participating in an APM as well as financial risk Important: Submit Something to receive a neutral payment adjustment for 2017 and to avoid penalty. You can do more than just getting a neutral payment. Take the next year to do process improvement. T are proposed rules for the 2018 performance period (Located in Resource Library on QPP website)

13 References & Resources Quality Payment Program Quality Payment Program Service Center (TTY ) available Monday Friday 8:00am-8:00PM ET Via at Charlotte Area Health Education Center (AHEC) Payment Programs: MACRA Quality Payment Program/ Merit-Based Incentive Payment System (MIPS) MLN Connects Webinar: Transitioning from the Physician Quality Reporting System (PQRS) to the Merit-based Incentive Payment System (MIPS) MIPS-Presentation.pdf CMS.GOV Based-Programs/MACRA-MIPS-and-APMs/MACRA-MIPS-and-APMs.html No Cost Assistance with QPP through Alliant Quality & MIPS Measures for Primary Care Clinicians (reference handouts)

14 Case Study

15 Case Study WHO: Busy primary care practice with working EMR and/or good billing/coding system that wants to avoid penalties and possibly benefit from MACRA. Also interested in improving management of chronic pain. FOR ALIGNMENT: One option is to choose activities that focus on related issues: Opioid prescribing Patient safety Substance use disorder screening and referral

16 Review of Performance Category Weights 2 examples provided

17 6 Quality measures related to chronic pain using EHR Example 1: Using EHR type measure title definition process cross-cutting high priority process process Documentation of Current Medications in the Medical Record Use of High-Risk Medications in the Elderly Falls: Screening for Future Fall Risk Percentage of visits for patients aged 18 years and older for which the eligible professional attests to documenting a list of current medications using all immediate resources available on the date of the encounter. This list must include ALL known prescriptions, over-the-counters, herbals, and vitamin/mineral/dietary (nutritional) supplements AND must contain the medications' name, dosage, frequency and route of administration. Percentage of patients 66 years of age and older who were ordered high-risk medications. Two rates are reported. a. Percentage of patients who were ordered at least one high-risk medication. b. Percentage of patients who were ordered at least two different high-risk medications. Percentage of patients 65 years of age and older who were screened for future fall risk during the measurement period. process process outcome Initiation and Engagement of Alcohol and Other Drug Dependence Treatment Closing the Referral Loop: Receipt of Specialist Report Controlling High Blood Pressure* Percentage of patients 13 years of age and older with a new episode of alcohol and other drug (AOD) dependence who received the following. Two rates are reported. a. Percentage of patients who initiated treatment within 14 days of the diagnosis. b. Percentage of patients who initiated treatment and who had two or more additional services with an AOD diagnosis within 30 days of the initiation visit. Percentage of patients with referrals, regardless of age, for which the referring provider receives a report from the provider to whom the patient was referred Percentage of patients years of age who had a diagnosis of hypertension and whose blood pressure was adequately controlled (<140/90mmHg) during the measurement period *note that this measure not specific for chronic pain but necessary to meet the outcome measure requirement using EHR reporting

18 Example 2: Using Claims 6 Quality measures related to chronic pain using claims type measure title definition process cross-cutting high priority Documentation of Current Medications in the Medical Record Percentage of visits for patients aged 18 years and older for which the eligible professional attests to documenting a list of current medications using all immediate resources available on the date of the encounter. This list must include ALL known prescriptions, over-the-counters, herbals, and vitamin/mineral/dietary (nutritional) supplements AND must contain the medications' name, dosage, frequency and route of administration. process Falls: Plan of Care Percentage of patients aged 65 years and older with a history of falls that had a plan of care for falls documented within 12 months process Falls: Risk Assessment Percentage of patients aged 65 years and older with a history of falls that had a risk assessment for falls completed within 12 months process Pain Assessment and Follow-Up Percentage of visits for patients aged 18 years and older with documentation of a pain assessment using a standardized tool(s) on each visit AND documentation of a follow-up plan when pain is present process Care Plan* Percentage of patients aged 65 years and older who have an advance care plan or surrogate decision maker documented in the medical record or documentation in the medical record that an advance care plan was discussed but the patient did not wish or was not able to name a surrogate decision maker or provide an advance care plan outcome Controlling High Blood Pressure* Percentage of patients years of age who had a diagnosis of hypertension and whose blood pressure was adequately controlled (<140/90mmHg) during the measurement period *note that this measure not specific for chronic pain but necessary to meet the requirements using claims reporting

19 4 Improvement Activities related to Chronic Pain code title definition IA_PSPA_5 IA_PSPA_6 IA_PSPA_21 IA_PSPA_8 Annual registration in the Prescription Drug Monitoring Program Consultation of the Prescription Drug Monitoring program Implementation of fall screening and assessment programs Use of patient safety tools* Annual registration by eligible clinician or group in the prescription drug monitoring program of the state w they practice. Activities that simply involve registration are not sufficient. MIPS eligible clinicians and groups must participate for a minimum of 6 months. Clinicians would attest that, 60 percent for first year, or 75 percent for the second year, of consultation of prescription drug monitoring program prior to the issuance of a Controlled Substance Schedule II (CSII) opioid prescription that lasts for longer than 3 days. Implementation of fall screening and assessment programs to identify patients at risk for falls and address modifiable risk factors (e.g., Clinical decision support/prompts in the electronic health record that help manage the use of medications, such as benzodiazepines, that increase fall risk). Use of tools that assist specialty practices in tracking specific measures that are meaningful to their practice, such as use of the Surgical Risk Calculator. *several different tools available DIRE, SOAPP and Tampa Scale for Kinesthiology

20 Advancing Care Information If you receive the base score (50%), 40% performance score and no bonus score, they would earn a 90% towards Advancing Care Information performance category. When weighted by 25%, this would contribute 22.5 points to their overall MIPS final score (90 X.25 = 22.5)

21 Calculating Final Score Under MIPS

22 Transition Year 2017 Final Score