Denise Hudson, NR-CMA Health Informatics Specialist Health Services Advisory Group (HSAG) April 13, 2018

Transcription

1 Learning Forum Fridays Countdown to MIPS* Data Submission Webinar Series Spring Into Action Using Your First Quarter Data Denise Hudson, NR-CMA Health Informatics Specialist Health Services Advisory Group (HSAG) April 13, 2018 *Merit-based Incentive Payment System

2 To Submit Questions Via Q&A: 1. Click the [Q&A] option at the top right of the presentation. 2. The Q&A panel will open. 3. Indicate that you want to send a question to the HSAG QPP Service Center. 4. Type your question in the box at the bottom of the panel. 5. Click [Send]. 2

3 Objectives At the completion of this training, the attendee will be able to: Evaluate current measures to determine reporting goals for MIPS Year 2 (2018). Identify challenging performance areas that could be improved. 3

4 Acronyms Used In Today s Presentation Acronym Definition ACI APM CEHRT CMS CE EDIM EHR EOB HPSA IA JSON Advancing Care Information Alternative Payment Model Certified Electronic Health Record Technology Centers for Medicare & Medicaid Services Continuing Education Enterprise Identity Management System Electronic Health Record Explanation of Benefits Health Professional Shortage Area Improvement Activity JavaScript Object Notation Acronym Definition MFA MIPS MU NPI PCMH PQRS QCDR QPP QRDA TIN VBPM XML Multi-Factorial Authentication Merit-based Incentive Payment System Meaningful Use National Provider Identifier Patient Centered Medical Home Physician Quality Reporting System Qualified Clinical Data Registry Quality Payment Program Quality Reporting Document Architecture Tax Identification Number Value-based Payment Modifier Extensible Markup Language 4

5 Today s Presenter Denise Hudson, NR-CMA Health Informatics Specialist HSAG 5

6 6 Out With The Old...

7 Fact Check Quality Payment Program (QPP) Year 1 (2017) is in the books. Data has been submitted. CMS is rapidly working on providing overall final scores, feedback reports and calculating payment adjustments! How did you perform? We are only 263 days away from the start of calendar year days until the QPP s 2018 data submission window closes. We ve made it through the first quarter of 2018! We ll discuss what should you focus on. 7

8 Lessons Learned Didn t confirm submitted data/ relied on others Didn t take time to educate themselves Didn t have all staff onboard with the requirements Didn t monitor progress or switched measures to late Didn t have EIDM account set-up/let password expire Didn t submit early / waited to the last minute Didn t submit enough data or reach data completeness Didn t? fill in the blank Didn t prepare for vendor issues / delays (back-up plan) Didn t submit data under all TINs when Included 8

9 9 In With The New for 2018

10 MIPS Eligible Clinician Types MIPS eligible clinicians include: Physicians Physician Assistants Nurse Practitioners Clinical Nurse Specialists Certified Registered Nurse Anesthetists The following clinician types are slated to be MIPS Eligible Clinicians in 2019 (Year 3): Audiologists, Clinical Social Workers, Clinical Psychologists, Dietitians, Nurse Midwives, Nutritional Professionals, Occupational Therapists, Physical Therapists, Speech Pathologists 10 Source: CMS

11 Low-Volume Threshold In order to be included in MIPS, an Eligible Clinician must: Bill over $90,000 a year in Medicare Part B FFS allowed charges Provide care for more than 200 Medicare Part B FFS patients per year. AND Voluntary reporting remains an option for those Clinicians who are exempt from MIPS 11 Source: CMS *Medicare Part B Fee-for-Service allowed charges

12 Checking Your Eligibility CMS has updated the Website for 2018 s Participation Status! Visit to check your eligibility status. o Enter your individual NPI # in the search field and click [Check Your Participation Status]. 12

13 MIPS Category Highlights There is no TEST pace in 2018! Quality is worth 50% of the final score. Requires Eligible Clinician to report on 6 Quality measures One must be an outcome measure or a high-priority measure. The performance period is a full year. January 1 December 31, 2018 Improvement Activities is worth 15% of the final score The performance period is a minimum of 90 days. Large practices* must complete either two high-weighted activities, one high-weighted and two medium-weighted activities, or four medium-weighted activities. Small practices** must complete either one high-weighted activity or two medium-weighted activities. 13 *Defined by CMS as 16 or more Eligible Clinicians billing under a Tax Identification Number during the sampling period. **Defined by CMS as 15 or fewer Eligible Clinicians billing under a Tax Identification Number during the sampling period.

14 MIPS Category Highlights (cont.) Advancing Care Information is worth 25% of the final score. The performance period is minimum of 90 days. Use 2014 or 2015 Certified Electronic Health Record Technology (CEHRT). Complete base measures to earn a score in this category. Cost is worth 10% of the final score. The performance period is a full year. Based on Administrative Claims. No data submission is required. 14

15 Payment Adjustments MIPS Year 2 (2018) Final Score 2018 >70 points Change Y/N N Payment Adjustment in 2020 Positive adjustment greater than 0% Eligible for exceptional performance bonus Minimum of additional 0.5% Points* Y Positive adjustment greater than 0% Not eligible for exceptional performance bonus 15 points Y Neutral payment adjustment points* points Y Negative payment adjustment greater than -5% and less than 0% Y Negative payment adjustment of -5% 15 *Adjustments in this range are based on a sliding scale Source: CMS

16 Payment Adjustments 2017 and Beyond +/- 4% (2017*) Allowable Charges** Payment Adjustment $50, $2, $100, $4, $250, $10, $500, $20, $1,000, $40, /- 5% (2018*) Allowable Charges** Payment Adjustment $50, $2, $100, $5, $250, $12, $500, $25, $1,000, $50, /- 7% (2019*) Allowable Charges** Payment Adjustment $50, $3, $100, $7, $250, $17, $500, $35, $1,000, $70, The QPP must remain budget neutral. Should negative payment adjustments outweigh positive payment adjustments, positive payment adjustments may be increased up to three times. +/- 9% (2020*) Allowable Charges** Payment Adjustment $50, $4, $100, $9, $250, $22, $500, $45, $1,000, $90, *Payment year is 2 years behind the performance year shown. **Allowable charges billed to Medicare Part B (Fee-for-Service).

17 17 Time to Spring Into Action

18 Second Quarter Focus Generate Reports from your system(s). o Focus on Quality and Cost categories now. Full year reporting required Consider Data Submission Methods o o 60 days. o How did you submit last year? Do you plan to use the same submission method? Will your vendor(s) offer system upgrades/updates this year or have submission registration deadlines? Login to your EIDM Account every Create a calendar invite as a reminder. 18

19 19 Quality Focus

20 Quality Category Focus How are your selected measures scoring thus far? Compare measures to the 2018 benchmarks Benchmarks may be different based on submission method Download the 2018 benchmarks here: Share reports with all clinicians and staff. Make adjustments to workflows as needed. This may be your last chance to change up your measures in order to meet the 60% data completeness. Claims (Medicare Part B FFS only) Pick, stick and don t switch! EHR/Registry/QCDR (all patients/all payers) 20

21 How To Compare Measures to Benchmarks Example #1 Example #2 21

22 So, What s The Formula? Measure Performance Rate Points Awarded 88% (q) 8.25 Formula X + (q a) / (b a) 8 + ( ) / ( ) 8 + (.68) / (2.67) = 8.25 Benchmark Note: CMS will use normal rounding to one decimal but then truncate any scores above the top score for the decile to the top score for the decile. Example: if the above formula had turned out to be as the score, you wouldn t round up to 9.0 as it would cross to the next decile column. The score would stay at

23 Practice on Your Own Use the 2018 Quality Benchmark Spreadsheet located at to determine the points awarded based on the formula [X + (q a) / (b a)]. See slide 22 for the step-by-step. Measure Performance Rate Submission Method 53% Registry % EHR 87% Claims 65% EHR 6% Registry 98% EHR Points Awarded 23

24 24 Cost Focus

25 Why Focus on Cost? Measuring cost is an important part of MIPS because cost measures show: Beneficiary population increasing daily. Resources clinicians use to care for patients. Medicare payments for care (items and services) given to a beneficiary during an episode of care. 25 Source: CMS

26 Cost Highlights and Scoring The Cost category: Uses Medicare Administrative Claims data for the performance period. No data submission required Replaces Value Based Payment Modifier legacy program. Download 2016 QRUR at Listen to HSAG s past Learning Forum Friday event to learn how to retrieve and review your QRUR Is weighted at 10% of your final MIPS score in Based on two measures: Total Per Capita Cost (TPCC) and Medicare Spending Per Beneficiary (MSPB) Weight increases to 30% by 2022 (Bipartisan Budget Act of 2018) Access CMS s Cost Category fact sheet at 26 Source: CMS

27 Total Per Capita Cost Total Per Capita Cost (TPCC) Measures all Medicare Part A and Part B costs during the MIPS performance period for all attributed beneficiaries. Is calculated based on all Medicare Part A and B services provided during the performance period, including: Inpatient hospital, outpatient, skilled nursing facility, home health, hospice, durable medical equipment, prosthetics, orthotics, supplies Medicare part B carrier (non-institutional physician/supplier) claims during an episode. 27 Source: CMS

28 Total Cost Per Capita (cont.) In calculating the TPCC, there are two steps used to attribute beneficiaries to a TIN-NPI: Looks to see if the beneficiary received more primary care services from Primary Care Physicians (PCPs), Nurse Practitioners (NPs), Physician Assistants (PAs) and Clinical Nurse Specialists (CNS) in that TIN-NPI. If the beneficiary did not receive a primary care service from any PCPs, NPs, PAs or CNS during the performance period, he/she may be attributed to the most recent TIN-NPI in this second step if they received more primary care services from non-primary care physician within a TIN-NPI (i.e. a specialist). Requires 20 case minimum of attributed patients to be scored. 28 Source: CMS

29 Total Per Capita Cost Exclusions A beneficiary may be excluded if: Was not continuously enrolled in Medicare Parts A & B for every month during the performance period. Unless the part-year enrollment was the result of new enrollment and/or death. Was enrolled in a private Medicare health plan, such as a Medicare Advantage HMO/PPO or a Medicare private FFS, plan for any month of the performance period. Resided outside of the United States or its territories during any month of the performance period. 29 Source: CMS

30 Medicare Spending Per Beneficiary Medicare Spending Per Beneficiary (MSPB): Is what Medicare paid for services performed by an individual clinician during an MSPB episode (period immediately before, during, and after a patient s hospital stay). Is calculated based on all Medicare Part A and B claims during the performance period, including: Inpatient hospital, outpatient, skilled nursing facility, home health, hospice, durable medical equipment, prosthetics, orthotics, and supplies during an episode. Requires a 35 case minimum of attributed patients to be scored. 30 Source: CMS

31 Medicare Spending Per Beneficiary Exclusions A beneficiary may be excluded if: The beneficiary was not continuously enrolled in both Medicare Parts A and B from 93 days prior to the admission through 30 days after discharge. The beneficiary s death occurred during the episode The beneficiary is enrolled in a Medicare Advantage plan or Medicare is the secondary payer at any time during the episode window. The discharge of the admission occurred in the last 30 days of the performance period. The admission occurs within the 30-days post-discharge period of another episode. 31 Source: CMS

32 How Can You Reduce Cost? Download your QRUR Report. Review your attributed patients and identify those at greater risk for readmission (i.e., multiple chronic conditions). Educate patients and their families on when to call the office before presenting at the hospital. Refer patients to available community resources/services. Follow up with care coordination. Work with the care coordination team at the hospital and the patient s other clinicians. Encourage patients to see their primary care within a few days of discharge. Consider chronic care management programs. 32 Source: CMS

33 Advancing Care Information and Improvement Activity Preparation 33

34 Advancing Care Information Preparation Burden Reduction AIM: may use either the 2014 or 2015 CEHRT or a combination in A 10% bonus is available for using only 2015 Edition CEHRT. Must report base measures for a minimum of 90-days to receive a score; start no later than October 2, Join HSAG s Learning Forum Friday event on May 11, 2018, at 1:00 pm, Making Your EHR Work for You. 34 Source: CMS

35 Improvement Activities Preparation Burden Reduction Aim: Smallpractices and practices in rural areas will continue to report on no more than two activities to earn the highest score. Current measure inventory will increase to 112 measures soon; start no later than October 2, Join HSAG s Learning Forum Friday event on July 13, 2018 at 1 p.m. ET, Let s Talk Improvement Activities, for helpful hints on selecting Improvement Activities. 35 Source: CMS

36 Key Takeaways Stage Your Pace! Focus on the Quality and Cost categories as they require full year reporting. Gradually add in Advancing Care Information and Improvement Activities categories no later than October 2, Generate reports often to ensure you re hitting your targets and share results with Clinicians and staff! Motivate clinicians and staff to get involved. Keep your EIDM account active! Create a reminder calendar invite for every 60-days Call HSAG s QPP Service Center throughout the year! or HSAGQPPSupport@hsag.com 36 Source: CMS

37 HSAG QPP Service Center Available 37

38 QPP Technical Assistance Resource Guide 38 Source: CMS

39 Next Learning Forum Friday Event: May 11, 2018 Making Your EHR Work for You For additional event topics and registration information please visit: Topics and dates are subject to change, so please check the webpage for up-to-date information. 39

40 Resources CMS Quality Payment Program Website Subscribe to the QPP ListServe Guide for Obtaining an EIDM Account Medicare Learning Network (MLN) Learning Management System Booklet (LMS) FAQs Learning-Network-MLN/MLNProducts/Downloads/LMPOS-FAQs- Booklet-ICN pdf Associations offering credit for MLN events and training Learning-Network-MLN/MLNGenInfo/CE-Associations.html 40

41 HSAG Quality Initiatives Spotlight Behavioral Health Initiative Alcohol and Depression screenings among Medicare beneficiaries Reimbursable screenings MIPS IA Tobacco Cessation webinar series coming soon! Surveillance of adult immunizations is key at every patient visit. Health literacy resources available 41

42 CMS Announcements: Upcoming Webinar Using Improvement Activities to Enhance Performance Scores Tuesday, April 17, 2018, 3:30 4:30 p.m. ET Register at Thursday, April 19, 2018, 11 a.m. 12 Noon ET Register at Join this session to: Identify the IAs best suited for your practice. Recognize how IAs can enhance your overall performance score. To view past MIPS no-cost small practice webinars visit: 42

43 CMS Announcements: Group Registration CMS opened group registration on April 1 for the CMS Web Interface and CAHPS for MIPS Survey reporting options. Registration will be open through June 30, CMS Web Interface is a submission mechanism only available to groups of 25 or more eligible clinicians. The CAHPS for MIPS Survey is only an option for groups of 2 or more eligible clinicians and can only be administered by a CMS-approved CAHPS for MIPS survey vendor. For more information visit 43

44 Join HSAG QPP Community Mailing List! In the body of the , please include: Organization Name First and Last name address City State 44

45 CE Approval This program has been pre-approved for 1.0 CE unit for the following professional boards: National o Board of Registered Nursing (Provider #16578) Florida o Board of Clinical Social Work, Marriage & Family Therapy and Mental Health Counseling o Board of Nursing Home Administrators o Board of Dietetics and Nutrition Practice Council o Board of Pharmacy Please Note: To verify CE approval for any other state, license, or certification, please check with your licensing or certification board. 45

46 CE Credit Process 1. Register at in HSAG s Learning Management Center (LMC). 2. Once you have registered in the LMC, you must complete the evaluation that will appear in WebEx at the conclusion of the webinar. a. Following the event, please do not close the WebEx evaluation window. You will not be able to access the evaluation and request CE if you close the window. b. CEs are only available to attendees that participate in the live event. c. If for some reason you completed the evaluation and do not have the link to the new user registration, please refer to Step #1 or contact Debra Price at dprice@hsag.com for CE certificate questions. 46

47 CE Credit Process: Existing User To login to your existing LMC account visit 47

48 CE Credit Process (cont.) Following the conclusion of the webinar, you will also receive a Thank You for Attending using the address provided during registration. You will be requested to register in the HSAG Learning Management Center (LMC). This is a separate registration from WebEx. Please use your personal so you can receive your certificate. Your organization may have firewalls up that block our certificates. 48

49 CE Certificate Problems If you do not immediately receive a response to the that you signed up with in the Learning Management Center, you have a firewall up that is blocking the link that was sent. Please go back to the New User link and register your personal account. Personal s do not have firewalls. Contact Debra Price at dprice@hsag.com for CE certificate questions and or issues. 49

50 Wrap Up 50

51 Thanks for Attending! HSAG QPP Technical Assistance Line Toll free: Monday Friday 8 a.m. to 8 p.m. ET HSAG QPP Support: HSAGQPPSupport@hsag.com 51

52 This material was prepared by Health Services Advisory Group, the Medicare Quality Improvement Organization for Arizona, California, Florida, Ohio, and the U.S. Virgin Islands, 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. Publication No. QN-11SOW-D