MIPS Collaborative: Clinical Practice Improvement Activities April 19, 2017 Francis R Colangelo, MD

MIPS Collaborative: Clinical Practice Improvement Activities April 19, 2017 Francis R Colangelo, MD

Outline of Presentation Introduction Overview of MACRA/MIPS Clinical Practice Improvement Activities Tools/Resources Conclusion 2

INTRODUCTION 3

Premier Medical Associates Formed 1993 100 providers 23 specialties 1:1 ratio PCP to specialists Affiliation with Highmark Health since late 2011 A member of the Allegheny Health Network

Premier Medical Associates Has provided care to over 100,000 lives in Pittsburgh s eastern suburbs 2016 377,000 patient visits All adult and pediatric offices havelevel 3 PCMH certification

Healthcare in Western PA Significant Medicare Advantage penetration MSSP/Track 1 8

Best Practice Sharing Chronic care challenges Analytics for improvement RA collaborative HF collaborative 9

MACRA/MIPS OVERVIEW 10

Quality Payment Program 2015: Medicare Access and CHIP Reauthorization Act (MACRA) ended SGR formula Replaced a patchwork of collection of reporting programs with a single system Providers can choose between two tracks Advanced Payment Models (APMs) Merit-based Incentive Payment System Part of broader push towards payments being tied to quality and value 11

https://qpp.cms.gov 12

MIPS Track 13

Relative Weight for Each Category-2017 14

MIPS Timeline 2017: Baseline performance Year. Can start collecting data between 1/1/17 and 10/2/17 Later in 2018: Receive Feedback from CMS Submit data by March 31, 2018 2019: Payment Adjustment from CMS 15

MIPS: Pick Your Pace Don t participate: -4% adjustment Submit something(one quality measure and one improvement activity): 0% Submit for a partial year (submit 90 days of data): neutral to positive adjustment Submit for a full year: a positive adjustment may be earned 16

Increasing Stakes Over Time 17

Exceptional Performance MACRA allows for an additional $500 million in payments from 2019-2014 18

CLINICAL PRACTICE IMPROVEMENT ACTIVITIES 19

CPIA-New Kid on the Block Does not replace a current program Thus far little detail and lots of uncertainty Assesses how much providers participate in activities that improve care provision Providers can choose from many activities that demonstrate performance There are incentives to drive participation into certified PCMH s and APMs in 2017 20

Activity Weighting Maximum score is 40 points for CPIAs Each activity is weighted either medium (10 points) or high (20 points) Earn maximum score by: Reporting on two high weighted activities Reporting on one high and two medium weighted activities Reporting on four medium weighted activities 21

High vs Medium Weighted Activities? High weighted activities align with: CMS national priorities A Quality Improvement Network or Quality Improvement Organization Priorities Comprehensive Primary Care Initiative Priorities Public health priority (PDMP) 22

90+ Available Activities in Nine Subcategories Expanded practice access Population management Care coordination Beneficiary engagement Patient safety and practice assessment Participation in an APM Achieving health equity Integrating behavioral and mental health Emergency preparedness and response You can choose to attest to the set of activities that are most meaningful to your practice since there are no subcategory reporting requirements. That is, you don t have to select activities in each subcategory or select activities from a certain number of subcategories. https://qpp.cms.gov/docs/qpp_2017_improvement_activities_fact_sheet.pdf 23

14 activities are high weighted Anticoagulation management improvements Systematic anticoagulation program Consultation of the PDMP (>60%) Engagement and timely follow up of new Medicaid patients Glycemic management services Co-locating PCPs and BH Implement PCBH model Participation in a domestic or international humanitarian effort (>60 days) Participation in CAHPS or similar survey Follow up plans based on results of patient experience and satisfaction data Provide clinicians with 24/7 real-time access to patient records Participate in RHC,IHS,FQHC QI activities Transforming Clinical Practice Initiative participation Use QCDR to create population health reports 24

Medium weighted activities to possibly report if already part of your work flow Annual registration for PDMP TOC improvements in first 30 days post discharge Depression screening (part of AWV) Fall screening assessment (part of AWV) Alcohol misuse screening/brief counseling (part of AWV) Enhancing patient portal capabilities Managing medications (MTM) Closing referral loop through receipt of specialist reports Participation in CMMI demonstration projects such as the MHI Participation in MOC Part IV Population empanelment 25

For outpatient Medicare beneficiaries with diabetes and who are prescribed antidiabetic agents (e.g., insulin, sulfonylureas), MIPS eligible clinicians and groups must attest to having: For the first performance year, at least 60 percent of medical records with documentation of an individualized glycemic treatment goal that: a) Takes into account patient-specific factors, including, at least 1) age, 2) comorbidities, and 3) risk for hypoglycemia, and b) Is reassessed at least annually. The performance threshold will increase to 75 percent for the second performance year and onward. Clinician would attest that, 60 percent for first year, or 75 percent for the second year, of their medical records that document individualized glycemic treatment represent patients who are being treated for at least 90 days during the performance period. 26

Automatic Credit for CPIA (40 points) 2017 Participant in MSSP Track 1 Participant in Oncology Care Model Participant in certified PCMH Accreditation Association for Ambulatory Health Care; National Committee for Quality Assurance (NCQA) The Joint Commission Designation Utilization Review Accreditation Commission (URAC) Other certifying body that has certified 500 or more practices and meeting national guidelines 27

Submission Requirements for CPIAs Clinicians may report their activities by attestation via: CMS Quality Payment Program website A Qualified Clinical Data Repository (QCDR) A qualified registry Or from their own EHR when possible 28

Submission Requirements for CPIAs Must attest yes to any CPIAs that meet the 90 day requirement for the reporting year(activity was performed for 90 consecutive days) Must maintain documents supporting such activities for up to six years after submission per the CMS document retention policy 29

TOOLS AND RESOURCES 30

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CONCLUSION 33

Future Plans CMS admits that this first year will be the easiest for this category Yes/no answers of 2017 may be replaced by a requirement that this realm be similar to the quality one Reporting data/improved outcomes as a result of CPIAs Submitting workflows used to improve performance 34

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Contact fcolangelo@pmamail.com 412-380-2800 36