Presents: The Quality Payment Program What it s about and where to begin
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1 Presents: The Quality Payment Program What it s about and where to begin Level: Introductory to Intermediate Douglas J. Jorgensen, DO, CPC, FAAO, FACOFP, CAQ Pain Medicine, Partner Pa#ent360, LLC All Rights Reserved.
2 QuesFon 1: Test Your Knowledge The PQRS program was started and now the Merit based IncenFve Payment System (MIPS) is in place to do which of the following: A. Create clinical change to improve care, reduced cost and improve quality. B. Detect and correct clinical shortcomings to improve access and care management. C. Create incenfves for top performing & reporfng providers in comparison to their peers D. Allow engaged providers to lead the way in healthcare reform reimbursement E. All of the above Pa#ent360, LLC All Rights Reserved. 2
3 QuesFon 2: Test Your Knowledge In 2017, the QPP payment adjustment will be a minimum of: A. 1% B. 2% C. 3% D. 4% E. 9% Pa#ent360, LLC All Rights Reserved. 3
4 QuesFon 3: Test Your Knowledge Which of the following is NOT one of the QPP categories? A. Quality B. EHR IntegraFon C. Advancing Care InformaFon D. Cost E. Improvement AcFviFes Pa#ent360, LLC All Rights Reserved. 4
5 QuesFon 4: Test Your Knowledge Which of the following is NOT an acronym used by CMS? A. MACRA B. LMAO C. MIPS D. QCDR E. NQS Pa#ent360, LLC All Rights Reserved. 5
6 QuesFon 5: Test Your Knowledge In 2017 parfcipafon the Merit- based IncenFve Payment System (MIPS) to avoid penalty requires: A. 100% parfcipafon for the whole year B. A full 90 day parfcipafon uflizing group measures C. None of the above D. All of the above Pa#ent360, LLC All Rights Reserved. 6
7 Walk away knowing: I. What is the QPP program? II. Why is QPP important? What QPP means to you, as a DO, now & in the future. III. How you can get started Pa#ent360, LLC All Rights Reserved. 7
8 Not everything that counts can be counted, and not everything that can be counted, counts. William Bruce Cameron Not Einstein as oe afributed Pa#ent360, LLC All Rights Reserved. 8
9 Kylo Ren Not the CEO or CMO of your insurance carrier Pa#ent360, LLC All Rights Reserved. 9
10 I. What is the Quality Payment Program? Modernizing Medicare to provide beder care and smarter spending for a healthier America. Pa#ent360, LLC All Rights Reserved.
11 The Quality Payment Program is Here! What is the QPP? The Quality Payment Program will reform Medicare Part B payments for more than 600,000 clinicians across the country, and is a major step in improving care across the enfre health care delivery system. Clinicians can choose how they want to parfcipate in the Quality Payment Program based on their pracfce size, specialty, locafon, or pafent populafon. Pa#ent360, LLC All Rights Reserved. 11
12 How will QPP Reform and Improve Clinical Outcomes and PaFent Care? Current PQRS = Reporting New QPP program = Modifying provider behavior Massive clinical improvement with reporting as a byproduct This results in: 1. More optimal care 2. Demonstrable improvement in patient outcomes 3. Decreased system costs, etc. Pa#ent360, LLC All Rights Reserved. 12
13 There are Two OpFons for ParFcipaFon: Registries like P360 help with MIPS Pa#ent360, LLC All Rights Reserved. 13
14 Here is Who MUST ParFcipate in MIPS for 2017 Office Volume Medicare Part B clinicians billing more than $30,000 a year and providing care for more than 100 Medicare pafents a year. Clinicians Physician Physician Assistant Nurse PracFFoners Clinical Nurse Specialists CerFfied Registered Nurse AnestheFst Pa#ent360, LLC All Rights Reserved. 14
15 How Your Points Will Be Calculated The 4 performance categories QUALITY 60% IMPROVEMENT ACTIVITIES 15% ADVANCING CARE INFORMATION 25% COST 0% - (this will change aner 2017) (Replaces PQRS) (New Category) (Replaces Meaningful Use) (Replaces VBM) Most ParFcipants: Report up to 6 measures, for a minimum of 90 days. Most parfcipants: Adest that you completed up to 4 improvement acfvifes for a minimum of 90 days. Fulfill the required measures for a minimum of 90 days. Choose to submit up to 9 measures for a min. of 90 days for addifonal credit. No data submission required. Calculated from adjudicated claims. Pa#ent360, LLC All Rights Reserved. 15
16 What Can We Lose Or Gain? Prac#ce 1 1 Provider $180,000 in Part B FFS Claims in /- $7,200 in Adjustments/ losses Prac#ce 2 4 Providers $600,000 Part B FFS Claims in /- $24,000 in Adjustments/ losses Prac#ce 3 7 Providers $840,000 in Part B FFS Claims in /- $33,600 in Adjustments/ losses CalculaFons are based on a 4% adjustment By 2022 the adjustment will likely be 9% Pa#ent360, LLC All Rights Reserved. 16
17 Let s Be VERY Clear Receive a negafve adjustment and the penalty is imposed against payments in the payment year, not the year of data capture. Successfully parfcipate NOW or penalty assessed later at elevated future income, not the lower income of the reporfng year. For example: ReporFng year = 2017 Unsuccessful reporfng means 4% negafve adjustment imposed 2019 Pa#ent360, LLC All Rights Reserved. 17
18 Understanding the 2 year Lag! 2014: Provider failed to report = payment reducfon 2% in 2016.! 2015: Provider failed to report = payment reducfon 2%- 4% in 2017.! 2016: Provider failed to report = payment reducfon 2%- 4% in 2018.! 2017: Provider fails to submit ANYTHING = payment reducfon 4% in payment reducfons will be 9%+ for non- parfcipafon. Pa#ent360, LLC All Rights Reserved. 18
19 Just do something! Your Data ParFal ParFcipaFon You will sfll have an opfon to report as an individual or as a group (as long as you have at least 2 clinicians). Key Takeaway: PosiFve adjustments are based on the performance data from the performance informafon submided, not the amount of informafon or length of Fme submided. Full ParFcipaFon Pa#ent360, LLC All Rights Reserved. 19
20 WHATS NEW? Stakes are higher on both ends (- 4% to 4%+) Points system Strategic SelecFon: Fewer measures reported based on category weight & top performance More money available for bonus payouts MU, VBM & PQRS are now rolled into QPP New helpdesk and QPP website First year flexibility Pa#ent360, LLC All Rights Reserved. 20
21 II. Why is QPP important? What QPP means to you, as a DO, now & in the future. Pa#ent360, LLC All Rights Reserved.
22 Enter: The Quality Payment Program PosiFve Outcomes Providers modified behavior = more opfmal care. Providers able to demonstrate improved pafent outcomes. Massive clinical improvement with reporfng as a byproduct Providers able to track system costs. ReporFng proves what is happening. Pa#ent360, LLC All Rights Reserved. 22
23 There Will Be Some Challenges (Don t worry, we can handle it!) Create measures that are challenging yet achievable Create QCDR (non- QPP) Unique Pain Measures Create high bar measures Pa#ent360, LLC All Rights Reserved. 23
24 Examples of 2017 QCDR measures for Osteopaths MEASURE 1: ObjecFfying pain and/or funcfonality to determine manipulafve medicine efficacy with correlafve treatment adjustment. Measure 2: Appropriate use of advanced imaging by ordering provider with glucocorfcoid management to spare motor neuron loss when physical findings suggest neuropathic efology. Measure 3: Appropriate controlled substance prescribing (definifve diagnosis(es)) via adherence to Controlled Substance Agreements (CSA) or Opiate Agreements (OA) with correcfve acfon taken for pain and/or substance use disorder pafents when violafons occur. Pa#ent360, LLC All Rights Reserved. 24
25 Examples of 2017 QCDR measures for Osteopaths Measure 4: Urine Drug Screen UFlizaFon in Pain Management and Substance Use Disorders; no less than quarterly for pain and no less than monthly for substance use disorders. Measure 5: Risk mifgafon via Urine Drug Screens in pain and/or substance use disorder pafents to idenffy and correct illicit behavior/acfvity. Measure 6: Imaging performed for LBP persisfng beyond 28 days rather than pure medical management to idenffy and avoid unidenffied pathology or pathologic progression. Pa#ent360, LLC All Rights Reserved. 25
26 Examples of 2017 QCDR measures for Osteopaths Measure 7: Addressing anxiety in pain pafents with SNRI and SSRIs and reducing/eliminafng benzodiazepines for chronic anxiety. Measure 8: Weight loss in pain pafents with BMI >30 with opiate uflizafon for weight related pain condifons rather than opiate dose escalafon for improved pain control. Measure 9: Treatment of spinal stenosis with manipulafve medicine and alternafve medicine modalifes. SNRI/SSRI Instead Pa#ent360, LLC All Rights Reserved. 26
27 AuthenFcity Replaces Coercion PQRS: Carrot then SFck QPP: SFck then Carrot QCDR: Home grown carrots Pa#ent360, LLC All Rights Reserved. 27
28 No More ReporFng for ReporFng s Sake! We are not robots! PQRS Avoid penalty simply by reporfng nearly anything. QPP Raises the bar and the stakes Cuts from 2% to 9% by 2022 AND reporfng is only 60% of scoring AND they bundled MU, PQRS, CEHRT, and VBM All coexist in the singular QPP. ReporFng to prove success, not just to report Bonus Goes to. The best reporters, not necessarily the best providers Pa#ent360, LLC All Rights Reserved. 28
29 Don t have Fme? It s not a priority Pa#ent360, LLC All Rights Reserved. 29
30 QCDR & Clinical IntegraFon New Measures QCDR Impact Pa#ent360, LLC All Rights Reserved. 30
31 Focusing On The Care We Provide OMM = OMT & NMM Despite headway many payers see DOs like PT/OT or DCs Require inifal E&T, plan of care - Treatment follows that plan. DOs are MSK experts and are trained just like MDs. New news to some administrators - E&M needed each Fme (not f/u OMT) - QCDR Measures gather clinical data to prove that clinical care is modified - VS. just repeat treatments w/o regard for changing pafent condifon - PaFent outcomes improve as a result. - Proving need for E&M with OMT The following 3 slides support this contenfon. Pa#ent360, LLC All Rights Reserved. 31
32 EVERY VISIT: Osteopathic Doctors Evaluate PaFents to Determine: How to Treat Them. On That Day. In That Moment in Time. Prove providers are paying adenfon to clinical changes and adjusfng care Not just giving care as usual. Clinical changes should adjust care Prove that OMT works Improve (prove) funcfonal outcomes by beder managing pain Engaged care means adjusfng treatment and diagnosfcs even in long term or chronic, well known pafents Pa#ent360, LLC All Rights Reserved. 32
33 EVERY VISIT: Osteopathic Doctors Evaluate PaFents to Determine: How to Treat Them. On That Day. In That Moment in Time. Prove OMT is changed or disconfnued just like any other treatment or medicine if it fails to produce results Or, it is confnued because like other meds/ treatments it IS improving funcfon and we can prove that via reporfng Pa#ent360, LLC All Rights Reserved. 33
34 EVERY VISIT: Pain & Recovery Providers Evaluate PaFents to Determine: How to Treat Them. On That Day. In That Moment in Time. Opiate Agreement/ Controlled Substance Agreement (OA/ CSA) Urine Drugs Screens (UDS) PrescripFon Monitoring Program (PMP) Remove clinical angst by implemenfng standardized methodologies U D S O A C S A P M P The Triad of Risk Mi#ga#on Pa#ent360, LLC All Rights Reserved. 34
35 Proper Risk Mi#ga#on Proves BeFer Outcomes Controlled Substances - Substance Disorder Pa#ents - Pain Pa#ents - Func#onality key determinate - OA/CSA Adherence Means: - UDS - Prescrip#on Monitoring Program - Pill Counts - Red Flags - Standardiza#on ALL pa#ents Regulatory Authori#es: - DEA - Licensing Board - FBI - OIG/DOJ - Avoidance via proper management you can prove - Don t forget ADHD/ADD or benzo managed anxiety - Risk Mi#gate and protect you and your prac#ce - Prove it with QCDR Pa#ent360, LLC All Rights Reserved. 35
36 III. How you can get started Pa#ent360, LLC All Rights Reserved.
37 What to expect when you re reporfng under the Quality Payment Plan PosiFve Adjustment P360 REGISTRY: ALL APPLICABLE MEASURES AVAILABLE vs ExcepFonal Performance Bonus! 4-69 points = posi#ve adjustment but ineligible for the excep#onal performance bonus! 70 points or greater = posi#ve adjustment AND eligible for the excep#onal performance bonus Pa#ent360, LLC All Rights Reserved. 37s
38 Did You Miss the 85 Slide PresentaFon from CMS on MIPS? We Will Throw You a Bone! Here are 3 Important Slides Pa#ent360, LLC All Rights Reserved. 38
39 Ini#a#ves- Pa#ent- Assessment- Instruments/Value- Based- Programs/MACRA- MIPS- and- APMs/Quality- Payment- Program- Long- Version- Execu#ve- Deck.pdf Pa#ent360, LLC All Rights Reserved. 39
40 Ini#a#ves- Pa#ent- Assessment- Instruments/Value- Based- Programs/ MACRA- MIPS- and- APMs/Quality- Payment- Program- Long- Version- Execu#ve- Deck.pdf Pa#ent360, LLC All Rights Reserved. 40
41 Ini#a#ves- Pa#ent- Assessment- Instruments/Value- Based- Programs/MACRA- MIPS- and- APMs/Quality- Payment- Program- Long- Version- Execu#ve- Deck.pdf Pa#ent360, LLC All Rights Reserved. 41
42 CalculaFng Your Scoring Score will be assessed against 4 categories. Final score is based on weights and points calcula#ons. 15% QUALITY ADVANCING CARE INFORMATION 25% 60% IMPROVEMENT ACTIVITIES COST (not calculated in transifon year) Pa#ent360, LLC All Rights Reserved. 42
43 PaFent360 s RecommendaFons For Newbies: MIPS Beginner Package For Pros: ParFal or Full ParFcipaFon Step 1 Sign up with PaFent360 for 2017 Step 2 Pick measures now Step 3 Add data to P360 portal beginning 1/1/17 Pa#ent360, LLC All Rights Reserved. 43
44 Get started! 1 Find a registry partner 2 Tell your colleagues to Pick Their Pace 3 Select opfmal measures for top performance. Pa#ent360, LLC All Rights Reserved. 44
45 QuesFon 1: Test Your Knowledge The PQRS program was started and now the Merit based IncenFve Payment System (MIPS) is in place to do which of the following: A. Create clinical change to improve care, reduced cost and improve quality. B. Detect and correct clinical shortcomings to improve access and care management. C. Create incenfves for top performing & reporfng providers in comparison to their peers D. Allow engaged providers to lead the way in healthcare reform reimbursement E. All of the above Pa#ent360, LLC All Rights Reserved. 45
46 QuesFon 2: Test Your Knowledge In 2017, the QPP payment adjustment will be a minimum of: A. 1% B. 2% C. 3% D. 4% E. 9% Pa#ent360, LLC All Rights Reserved. 46
47 QuesFon 3: Test Your Knowledge Which of the following is NOT one of the QPP categories? A. Quality B. EHR IntegraFon C. Advancing Care InformaFon D. Cost E. Improvement AcFviFes Pa#ent360, LLC All Rights Reserved. 47
48 QuesFon 4: Test Your Knowledge Which of the following is NOT an acronym used by CMS? A. MACRA B. LMAO C. MIPS D. QCDR E. NQS Pa#ent360, LLC All Rights Reserved. 48
49 QuesFon 5: Test Your Knowledge In 2017 parfcipafon the Merit- based IncenFve Payment System (MIPS) to avoid penalty requires: A. 100% parfcipafon for the whole year B. A full 90 day parfcipafon uflizing group measures C. None of the above D. All of the above Pa#ent360, LLC All Rights Reserved. 49
50 Thank You! We Hope You Have a Be7er Understanding of QPP and How to Navigate Going Forward. Please reach out if we can be of further assistance Pa#ent360, LLC All Rights Reserved.
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