Steps toward Sustainability with the second year of the Quality Payment Program
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1 Steps toward Sustainability with the second year of the Quality Payment Program Deanna Graham, QI Consultant, Qualis Health March 27, 2018
2 Speaker Deanna Graham QI Principal Qualis Health 2
3 Qualis Health A leading national population health management organization The Medicare Quality Innovation Network - Quality Improvement Organization (QIN-QIO) for Idaho and Washington The QIO Program One of the largest federal programs dedicated to improving health quality at the local level 3
4 Objectives Understand changes in Sustain your efforts in the second year of the QPP Set goal for Exceptional Performance (or know what to do to avoid a penalty) Learn more about the Cost Category Become familiar with the support available for small practices, and those in rural and health professional shortage areas 4
5 Year One How did it go? 5
6 Your Expertise Matters! Recent AMA Survey says.. 1 in 4 physicians do not feel prepared to meet QPP requirements in 2017 Of 1,000 practicing physicians involved in decision making about the QPP for their practice... 51% feel somewhat knowledgeable 8% feel deeply knowledgeable 6
7 Which Fork? Merit-Based Incentive Payment System (MIPS) or Advanced Alternative Payment Models (APMs) 7
8 2018 Recognized Advanced APM s Comprehensive ESRD Care (CEC) (LDO and Non-LDO) Comprehensive Care for Joint Replacement (CJR) Payment Model (Track 1- CEHRT) Comprehensive Primary Care Plus (CPC+) Medicare Accountable Care Organization Track 1+ Medicare Shared Savings Program - Track 2 and 3 Next Generation ACO Model Oncology Care Model (OCM) - Two-Sided Risk Vermont Medicare ACO Initiative (as part of the Vermont All-Payer ACO Model) Bundled Payments for Care Improvement (BPCI Advanced) 8
9 MIPS Eligible Clinicians 2018 Eligibility is assessed at the NPI and NPI/TIN Combination Low-Volume Threshold > $90,000 Medicare Part B allowed charges, AND >200 Part B Medicare Enrolled Beneficiaries MIPS Eligible Clinicians Physicians o MD, DO (Dentist, Podiatrist, Optometrist, Chiropractor) Physician Assistants Nurse Practitioners Clinical Nurse Specialists Certified Registered Nurse Anesthetists 9
10 Timing & Range of Adjustments 10
11 Reporting Options
12 MIPS Performance Categories Year 2 (2018) 12 Month Reporting Min 90 Day Reporting 12
13 2018 Final Score Thresholds 13
14 Quality 50% of Final Score Most participants: Report up to 6 quality measures, including an outcome measure Groups using web interface: 15 measures for a full year Groups in APMs qualifying for special scoring under MIPS, such as Shared Savings Track 1: Report quality measures through your APM. You do not need to do anything additional for MIPS quality 14
15 Advancing Care Information 15% of Final Score Most participants: Fulfill the base requirements to receive 50% of the points. And choose up to 9 measures for a minimum of 90 days for additional credit. Eligible for bonus points: Report Public Health and Clinical Data Registry measures Use certified EHR technology to complete certain Improvement activities OR: You may not need to submit if these measures do not apply 2018 A 10% bonus is available if you only use the 2015 CEHRT edition. 15
16 Improvement Activities 25% of Final Score Most participants: Attest to up to 4 activities Groups with <15 participants or in small, rural or underserved areas: Attest to up to 2 activities Groups in Certified PCMH and APMs qualifying for special scoring under MIPS, such as Shared Savings Track 1: Automatically earn full credit. For group participation, only 1 MIPS EC has to perform the activity for full credit 16
17 Cost Performance Category 10% of Final Score 2 Cost Measures Medicare Spending Per Beneficiary Episode based by Practice/Group (TIN) 3 days prior to admission + 30 days post admission Total Per Capita Cost Practitioner Based (TIN-NPI) Full Year 17
18 Medicare Spending Per Beneficiary (MSPB) Updated from the Value Modifier Program Assesses the Cost to Medicare for services performed during an MSPB Episode (Requires Index Admission) Reported at the individual (TIN-NPI) or group (TIN) level. If few than 35 episodes, this measure will not be scored, regardless of reporting level Calculated from claims no data submission required 18
19 Claims Attributed to an Episode Requires Index Admission 19
20 Total Per Capita Cost (TPCC) Updated from the Value Modifier Program Overall cost of care provided to beneficiaries attributed to clinicians as identified by a unique Tax ID/National Provider ID (TIN/NPI). Payment-standardize Annualized Risk-adjusted Specialty adjusted Reported at the clinician (TIN-NPI) or clinician group (TIN) level. Minimum for reporting is 20 episodes, regardless of reporting level. 20
21 TPCC numerator & Denominator Sum of the annualized, risk-adjusted, specialty-adjusted Medicare Part A and Part B costs across all Medicare beneficiaries attributed to a TIN-NPI, within a TIN or TIN-NPI* # of all Medicare beneficiaries who received Medicare-covered services and are attributed to a TIN-NPI, within a TIN or TIN-NPI* during the performance period *Depends on the level of reporting 21
22 Bonus Opportunities Bonus for Improvement Quality : applies to category-level (1-10%) Cost: applies to measure-level (1%) +5 points to Final Score Small Practice bonus Complex Patient bonus 22
23 MIPS PLAN Final Score of >70 points 6 Quality Measures (12 months) Advancing Care Information (90 days) Up to 4 Improvement Activities (90 days) Leverage 2017 MIPS feedback report All available Bonus Points Calculators, etc. 23
24 Resources CMS Quality Payment Program Website Quality Payment Program Resource Center Qualis Health, Washington State Medical Association (WSMA) & Washington State Hospital Association (WSHA) Qualis Health Toolkit Qualis Health Quality Payment Program Toolkit Qualis Health MIPS Minute Video Series MIPS Minute video series MIPS Calculator Estimate of your MIPS final score 24
25 Q & A 25
26 Start early Develop a plan Action / Next Steps Track your progress throughout the year. Leverage information to reach 70 points i.e. Exceptional Performance 26
27 Take Home Points MACRA is a milestone effort towards payment reform The Quality Payment Program rewards high quality care through 2 pathways Advanced Alternative APMs Merit-Based Incentive Program MIPS It s critical to understand how this applies to your practice 27
28 Contact Deanna Graham QI Consultant PLEASE FILL OUT YOUR SURVEY FEEDBACK IS GOOD! For more information: This material was prepared by Qualis Health, the Medicare Quality Innovation Network - Quality Improvement Organization (QIN-QIO) for Idaho and Washington, 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. ID/WA- SURS-QH
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