MIPS Scoring: Explanation and Estimation 2/7/2017 and 2/10/2017

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1 CMS Transforming Clinical Practices Initiative and The Southern New England Practice Transformation Network (SNE PTN) MIPS Scoring: Explanation and Estimation 2/7/2017 and 2/10/2017 2

2 Review Determine eligibility status Pick Your Pace for the 2017 Transition Year Choose to report as an individual or a group Review available data submission methods Visit the QPP website shopping cart and select measures for Quality and Improvement Activities Confirm your EHR s certification year and review associated Objectives and Measures Adapted from: CMS. The Merit-based Incentive Program. November PowerPoint presentation 2

3 Agenda Explain the scoring methods proposed for the Quality, Cost, Improvement Activities, and Advancing Care Information performance categories for the 2017 Transition Year Apply the scoring methodology to a test practice example and calculate a MIPS performance score Interpret the resultant MIPS performance score with respect to proposed payment adjustment categories 3

4 Example of 2017 Full Year Participation Primary Care Clinician Quality Measures Cost Improvement Activities Advancing Care Information Diabetes: Hemoglobin A1c Poor Control (>9%) (outcome measure) Falls: Risk Assessment Preventive Care and Screening: Influenza Immunization Breast Cancer Screening Colorectal Cancer Screening Preventive Care and Screening: Tobacco Use: Screening and Cessation Intervention N/A TCPI Participation (high-weighted) E-Prescribing Health Information Exchange Provide Patient Access Security Risk Analysis Medication Reconciliation (performance score) Assumptions: Small practice: 1 MIPS eligible clinician EHR certification: 2014 Patient panel: 1,700 Participating in TCPI All quality measures have benchmarks Quality measures will be submitted through a registry and qualify as end-to-end electronic submissions Adapted from: CMS. The Merit-based Incentive Program. November PowerPoint presentation 4

5 Performance Category: Quality Measures (60%) Not submitting performance data for a measure will receive 0 points If no benchmark exists or case volume is not met measure will receive 3 points Clinicians receive 3 to 10 points on each quality measure based on performance against benchmarks Must also have sufficient case volume ( 20) AND Data completeness met (50% of possible data submitted) Adapted from: CMS. The Merit-based Incentive Program. November PowerPoint presentation 5

6 Performance Category: Quality Measures (60%) Benchmarks presented in deciles, points awarded within each decile Separate benchmarks for the different data submission methods Decile Below Decile 3 Decile 3 Decile 4 Decile 5 Decile 6 Decile 7 Decile 8 Decile 9 Decile 10 Number of Points Assigned for 2017 MIPS Performance Period 3 points points points points points points points points 10 points Topped out measures: performance rates historically have been high and may be scored differently in future years. Source: CMS Quality Benchmarks. December 29,

7 Performance Category: Quality Measures (60%) Bonus points are available for either of the following: 1. Submitting an additional high-priority measure o o 2 points for each additional outcome and patient experience measure 1 point for each additional high-priority measure 2. Using CEHRT to submit measures to registries or CMS o 1 point for submitting electronically end-to-end Adapted from: CMS. The Merit-based Incentive Program. November PowerPoint presentation 7

8 Performance Category: Quality Measures (60%) Description Diabetes: Hemoglobin A1c Poor Control (>9%) High Priority (Y/N) Outcome Measure (Y/N) Case Minimum Met (Y/N) Points Based on Performance Total Possible Points Bonus Points for High Priority Bonus Points for CEHRT Y Y Y (required) 1 Falls: Risk Assessment Y N Y Preventive Care and Screening: Influenza Immunization N N Y Breast Cancer Screening N N Y Colorectal Cancer Screening N N Y Preventive Care and Screening: Tobacco Use: Screening and Cessation Intervention N N Y Total Points Total Quality Performance Category Score = (Points earned on required 6 quality measures) + (bonus points) Maximum number of points (37+1+6)/60 = 73 points 8

9 Performance Category: Cost (0%) No reporting requirement assessed through Medicare claims data CMS will provide feedback on how you performed in 2017 but it will not affect your 2019 payment adjustment Source: CMS. The Merit-based Incentive Program. November PowerPoint presentation 9

10 Performance Category: Improvement Activities (15%) 92 improvement activities are available Total points available = 40 Small, rural, underserved practices Medium Weight Activity = 20 points High Weight Activity = 40 points Large practices Medium Weight Activity = 10 points High Weight Activity = 20 points Participants in certified PCMH = 40 points Source: CMS. The Merit-based Incentive Program. November PowerPoint presentation 10

11 Performance Category: Improvement Activities (15%) Activity Activity Weight Total Possible Points Total Score TCPI Participation High Total Points for Improvement Activities 40 Total Quality Performance Category Score = Total number of points scored for completed activities Total maximum number of points (40/40)*100 = 100 points 11

12 Performance Category: Advancing Care Information (25%) Can earn up to 155% but score will be capped at 100% Base Score = 50% Required to receive a score in this category Submit yes/no and 1 in numerator Performance Score = Up to 90% Based on performance rate for each measure Bonus Score = Up to 15% 5% bonus for reporting to one of four Public Health and Clinical Data Registry reporting measures 10% for using CEHRT to report certain improvement activities Source: CMS. The Merit-based Incentive Program. November PowerPoint presentation 12

13 Performance Category: Advancing Care Information (25%) Adapted From: CMS. The Merit-based Incentive Program. November PowerPoint presentation 13

14 Performance Category: Advancing Care Information (25%) Measure Type Measure Name Met (Y/N) Score Relative Weight Total Score e-prescribing Y Base Score Health Information Exchange Provide Patient Access Y Y 100% 50% 50% Security Risk Analysis Y Performance Score Medication Reconciliation Completed for 1500/1700 patients** Total Advancing Care Information Performance Category Score (Base Score) + (Performance Score) + (Bonus Score) = 50% + 9% + 0% 9% - 9% 59% Performance Rates for Each Measure Worth Up to 10% Performance Rate 1-10 = 1% Performance Rate = 2% Performance Rate = 3% Performance Rate = 4% Performance Rate = 5% Performance Rate = 6% Performance Rate = 7% Performance Rate = 8% Performance Rate = 9% Performance Rate = 10% **To calculate the performance score divide the numerator by the denominator to get the measures performance rate. Cross reference the performance rate with the table to the left to determine your percentage score 1500/1700 = 0.88 * 100 = 88 9% 14

15 How do I calculate my final score for Transition Year 2017? Source: CMS. The Merit-based Incentive Program. November PowerPoint presentation 15

16 How do I calculate my final score for Transition Year 2017? Performance Category Performance Category Score or Rate Category Weight Estimated Points Earned Quality 73 60% 43.8 Cost 0 0% 0 Improvement Activities Advancing Care Information Estimated MIPS Final Score % % 14.8 Estimated MIPS Final Score = Final Score 70 points 4 69 points 3 points 0 points Payment Adjustment Positive adjustment Eligible for exceptional performance bonus minimum of additional 0.5% Positive adjustment Not eligible for exceptional performance bonus Neutral payment adjustment Negative payment adjustment of -4% 0 points = does not participate Adapted from: CMS. Quality Payment Program Final Rule MLN Connects Call. November PowerPoint presentation 16

17 Summary Determine eligibility status Pick Your Pace for the 2017 Transition Year Choose to report as an individual or a group Review available data submission methods Visit the QPP website shopping cart and select measures for Quality and Improvement Activities Confirm your EHR s certification year and review associated Objectives and Measures Apply the scoring methodology for the 4 performance categories Interpret the final calculated score Adapted from: CMS. The Merit-based Incentive Program. November PowerPoint presentation 17

18 QUESTIONS? For additional questions please reach out to 18

19 Appendix 19

20 Improvement Activities Eligible for Advancing Care Information Bonus Score 20 Source: CMS. MIPS Performance Categories: Advancing Care Information & Improvement Activities. December 13, PowerPoint presentation