MIPS Tips: Q & Answer Series Feb. 28, Presented by HealthInsight and Mountain Pacific Quality Health

Transcription

1 MIPS Tips: Q & Answer Series Feb. 28, 2018 Presented by HealthInsight and Mountain Pacific Quality Health QualityPaymentHelp@mpqhf.org qpp@healthinsight.org

2 Slide Deck Available Today s slide deck and recording will be made available a few days following the event. Watch your to be notified when they are available or visit to find all past MIPS Tips and QPP webinar recordings.

3 HealthInsight Our business is redesigning health care systems for the better HealthInsight is a private, non-profit, community based organization dedicated to improving health and health care in the western United States (Nevada, New Mexico, Oregon, Utah).

4 Mountain-Pacific Quality Health We are the Medicare Quality Innovation Network-Quality Improvement Organization (QIN-QIO) for Montana Guam Wyoming American Samoa Hawaii The Commonwealth of the Alaska Northern Mariana Islands

5 Agenda 2017 MIPS Submission/EIDM Improvement Activity opportunity Cost category information Balanced budget act information Q&A Appendix Significant 2018 changes

6 Poll #1 Do you intend to participate in MIPS for 2017?

7 MIPS Submission When: 1/2/2018 3/31/18 Registries may shorten this time frame CMS Web Interface closes March 16 Where: QPP Submission Portal What s Included: Quality, Advancing Care Information (ACI) and Improvement Activities (IA) What s New: Real time feedback on submission and scoring

8 QPP Submission Portal QPP Submission portal (

9 Question Can the data be submitted as a group or does it have to be individually? How do I upload the file? Teri from Reno, NV

10 QPP Submission Portal If uploading quality measure data, a valid QRDA-3 file will be needed from your EHR Portal will check QRDA3 format, report errors to your EHR vendor CLARIFY: Some vendors may provide a QRDA3 at the individual level only CAUTION: Vendors may charge for the QRDA3 report You can submit quality measures using more than one method the system will select whichever method gives you the higher score Use the portal to submit IA and ACI information if you have been using claims to submit quality measure data

11 Portal Newsflash Quality measures submitted through the Claims method can now be viewed in the QPP portal Review NOW to ensure your claims submission was successful Scores may be adjusted slightly when the claims run-out period has ended and the remainder of the submissions are included in the portal

12 Accessing the Submission Portal Enterprise Identity Management system (EIDM) If you already have an EIDM account from previous reporting programs - test your log-in at In some cases the EHR vendor/registry will submit clinics will still want an account to check the submission and pull down feedback reports later in the year

13 Creating an Organization or Individual Practitioner You will need to provide: Tax Identification Number (TIN) National Provider Identifier Must use Individual NPI, not facility NPI For groups, need at least two NPIs to proceed PTANs Must use Individual PTAN, not facility PTAN To find your individual PTAN, call your Medicare carrier (ie, Noridian)

14 EIDM Basics Application access is at the TIN level Each person needs only one EIDM account: You can access multiple TINs under your account Multiple people can have access to the same TIN Role selection is critical: Must start with Provider Approver Group (Security official) Individual (Individual Practitioner)

15 EIDM Account (Resources) New fact sheet on submission EIDM guide (page 12 has info to get started): Program/Resource-Library/Enterprise-Identity-Data- Management-EIDM-User-Guide.pdf New video on EIDM and submission - be Describes group process so if Individual Practitioner, there may be subtle differences.

16 Creating a New EIDM Account Budget time to do this Cannot be done in a few minutes or one day Plan for an hour or two over a couple days For solo practice may need your practitioner nearby to answer a few questions Read the section on which role you need (starting on page 5) HealthInsight/Mountain Pacific can walk you through this process Contact the QPP Help Desk at (faster response) or via at qpp@cms.hhs.gov

17 COST CATEGORY

18 2018 Cost Category Total Per Capita Cost Risk-adjusted per capita Part A and B costs Attributed based on primary care service volume Includes inpatient hospital, outpatient hospital, skilled nursing facility, home health, hospice, durable medical equipment, prosthetics, orthotics, supplies and Part B carrier claims Medicare Spend Per Beneficiary Risk-adjusted Part A and B costs per inpatient admission Attributed based on service volume during hospitalization Includes the period immediately prior to, during, and following a hospital stay ( episode ). Includes all Part A and Part B claims

19 2019 Cost Category Proposed to add eight episode-based cost measures Routine cataract removal with intraocular lens implantation Screening/surveillance colonoscopy Knee arthroplasty ST-elevation myocardial infarction (STEMI) with percutaneous coronary intervention (PCI) Revascularization for lower extremity chronic critical limb ischemia Elective outpatient percutaneous coronary intervention (PCI) Intracranial hemorrhage or cerebral infarction Simple pneumonia with hospitalization

20 Preparing for MIPS Cost Scoring Tuesday, March 20, 2018, 9 to 10 a.m. MT/8 to 9 a.m. PT Thursday, March 22, to 6 p.m. MT/4 to 5 p.m. PT How cost scores will be calculated by CMS How to identify the factors most heavily impacting the cost score you will receive Cost containment practices that work in small group practices Practical tips for how small group practices can earn a high MIPS cost score

21 BALANCED BUDGET ACT 2018

22 Transition Phase Extended Transition Phase extended another three years ( Performance Years) Pre-selected performance threshold (neutral point) must increase gradually towards the calculated performance threshold Cost can vary from 10 to 30 percent No improvement bonus for the cost category

23 Changes First post-transition performance year will be 2022 (rather than 2019) Performance threshold (neutral point) will be national historical mean or median Cost will have weight of 30 percent

24 Adjustment and Exclusion Payment adjustments and low-volume exclusion will include only Medicare Part B services (was items and services ) Retroactive to 2018 and the future Now excludes Part B drugs

25 Important Messages MIPS is here to stay Expect rising thresholds and measure benchmarks to drive continuous improvement No change to basic program structure No change to Physician Compare public reporting Link to the rule:

26 IMPROVEMENT ACTIVITY OPPORTUNITY

27 2018 Burdens Associated with Reporting Quality Measures Study Purpose of the study: Examine clinical workflows and data collection methods using different submission systems Understand the challenges clinicians face when collecting and reporting quality data Make future recommendations for changes that will: Attempt to eliminate clinician burden Improve quality data collection and reporting Enhance clinical care

28 Benefits of Participating Clinicians and groups who are eligible for the Merit-based Incentive Payment System (MIPS) that participate successfully in the study will Receive full credit for the 2018 MIPS Improvement Activities performance category. Applications for this study will be accepted through March 23, 2018 and will be notified in spring of 2018 if selected. Activity-IA-Study-Application

29 Poll Value of information/session

30 Please Fill Out Our Evaluation An evaluation link for this session is currently being place in the chat. Please take a few minutes before you leave the meeting today to fill out an evaluation and help us improve our offerings.

31 Submitted Questions We don t know how to register and what we need to do for 2018? Delia from Las Vegas, NV We need clarification on the qualifying criteria. Kathy from Dallas, OR

32 Submitted Questions What is required for hospital based providers to report? Do hospital based providers automatically receive exemption for ACI? Are APRN's required to report ACI/ improvement activities? Katie from Carson City, NV

33 Submitted Questions Where can I find documentation pertaining to measure information specific to non-patient facing providers? For example for the Improvement Activities category I learned that non-patient facing providers are only required to complete two medium or one high activity within this category. Is the TCPi measure is weighted as high or medium? The 2018 Improvement Activities spreadsheet has it listed as medium; however, the 2018 IA PDF has it listed as high. Leah from Forest Grove, OR

34 Submitted Questions As a specialist can you participate in multiple ACO/APM s? Stephen from Reno, NV

35 Questions This material was prepared by HealthInsight, the Medicare Quality Innovation Network-Quality Improvement Organization for Nevada, New Mexico, Oregon and Utah, 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. 11SOW- D

36 Assessment Get customized support for your practice by filling out a short assessment HealthInsight: Mountain-Pacific:

37 For More Information Contact a QPP Expert in Your State Mountain-Pacific Quality Health Please contact us for assistance! QualityPaymentHelp@mpqhf.org Montana Amber Rogers arogers@mpqhf.org (406) Wyoming Brandi Wahlen bwahlen@mpqhf.org (307) Alaska Miranda Burzinski mburzinski@mpqhf.org (907) Region/Senior Account Manager Sharon Phelps sphelps@mpqhf.org (307) Hawaii and Territories Cathy Nelson cnelson@mpqhf.org (808) Visit us online at

38 For More Information Contact a QPP Expert in Your State HealthInsight QPP Support Call: qpp@healthinsight.org Web: Nevada Aaron Hubbard Call: ahubbard@healthinsight.org New Mexico Ryan Harmon Call: rharmon@healthinsight.org Oregon David Smith Call: dsmith@healthinsight.org Utah Brock Stoner Call: bstoner@healthinsight.org

39 2018 CHANGES

40 2018 Low Volume Threshold or fewer unique Medicare Part B beneficiaries OR $30,000 or less in Medicare Part B charges During 1 of 2 Eligibility periods or fewer unique Medicare Part B beneficiaries OR $90,000 or less in Medicare Part B charges During 1 of 2 Eligibility periods

41 2018 Participation Levels points or greater to avoid negative payment adjustment in 2019 Pick Your Pace options: Test (minimum participation) 90 Day Full Year points or greater to avoid negative payment adjustment in 2020 Quality Category: Report for full year IA: Report for a minimum of 90 days ACI: Report for a minimum of 90 days

42 Scoring Scale

43 The Quality Category percent of final score Data completeness 50 percent of applicable patients 3 point floor for any quality measure submitted (including not meeting data completeness) percent of final score Data completeness 60 percent of applicable patients 3 point floor for any quality measure submitted except: 1 point for any quality measures which does not meet data completeness* (*CMS Web Interface, CAHPS for MIPS, and Small Practice excluded)

44 The Cost Category percent of final score Cost report will contain information on: Medicare Spend per Beneficiary (MSBP) Total per capita cost 10 Episode-based cost measures percent of final score Cost report will contain information on: Medicare Spend per Beneficiary (35 case minimum) Total per capita cost (20 case minimum) If only 1 measure can be scored, that score will be the performance category score.

45 Improvement Activities percent of final score 92 activities Selected groups get double points: Small practice (15 or fewer NPIs/TINs) Practices in Rural and Health Professional Shortage areas Non-patient facing clinicians PCMH only 1 practice in TIN needed for entire TIN percent of final score 112 activities Selected groups get double points: Small practice (15 or fewer NPIs/TINs) Practices in Rural and Health Professional Shortage areas Non-patient facing clinicians PCMH 50 percent of Practice sites in TIN needed for entire TIN

46 Advancing Care Information percent of final score Can use 2014 or 2015 Edition CEHRT or combination Up to 10 percent bonus points if CEHRT used on selected Improvement Activities Reweighted to Quality for selected groups percent of final score Can use 2014 or 2015 Edition CEHRT or combination Bonus if just 2015 used Up to 10 percent bonus points if CEHRT used on selected Improvement Activities Reweighted to Quality for selected groups

47 Other Changes Improvement scoring in Quality and Cost Can receive a score for performance plus improvement if selected conditions are met (removed in Balanced Budget Act) Complex patient bonus Based on Hierarchical Condition Categories (HCCs) and number of dually eligible patients treated. Small practice bonus Add 5 points to any MIPS EC or small group As long as data submitted in at least one performance category

48 2018 Changes - Resources Overview of 2018 rule: Payment-Program/Resource-Library/QPP- Year-2-Final-Rule-Fact-Sheet.pdf 2018 Resources page: Payment-Program/Resource-Library/2018- Resources.html

49 2018 Strategies Quality: New benchmarks now available on quality measures show improvement Costs: Focus on Medicare spending per beneficiary and total cost of care outside of your organization, improve care coordination to see results, reduce duplicated tests ACI: Manage your electronic inbox and outbox IA: Align quality and ACI with your IAs