MIPS Checkpoint Beth Hickerson Quality Improvement Advisor PHA Lunch and Learn May 19, 2017
Check Your MIPS Eligibility QPP.CMS.GOV 2
MIPS Category Weights Over Time : Quality Advancing Care Information Improvement Activities Cost Replaces PQRS Replaces MU New (PCMH) Replaces VBM 2017 60% 25% 15% 0% 2018 50% 25% 15% 10% 2019+ 30% 25% 15% 30% 3
MIPS Final Score for 2017 Performance Year Final Score Payment Adjustment 70 points Positive adjustment Eligible for exceptional performance bonus minimum of additional 0.5% 4-69 points Positive adjustment Not eligible for exceptional performance bonus 3 points Neutral payment adjustment 0 points Negative payment adjustment of -4% 0 points = does not participate 4
Pick Your Pace Options Three options to participate in MIPS in 2017: Don t submit 5
Three Ways to Avoid the Penalty in 2017 1 Quality Measure OR 1 Improvement Activity OR 5 Required Advancing Care Information Measures 6
REPORTING OPTIONS AND METHODS Understanding How to Report
Reporting Options Individual defined as a single NPI tied to a single TIN May protect incentive potential for high-performing providers May be easier if you have NPIs not required to report Group multiple NPIs that share a common TIN May ease administrative burden Beneficial if you have some providers with reporting obstacles Register only if using CMS web interface or CAHPS for MIPS Note: Reporting option applies for all four categories; NPIs must report for each TIN separately 8
Reporting Methods Claims EHR Registry Qualified Clinical Data Registry CMS Web Interface CAHPS for MIPS Survey Note: You may only report via one method per category 9
Reporting Methods (cont.) Claims Add modifier codes to your Medicare claims Can be added manually by billers or automatically by EHR or billing software EHR Directly submit a QRDA III file through the CMS portal Register with your EHR to submit on your behalf as/through a Data Submission Vendor (DSV) This category does not include EHRs who submit via registry 10
Reporting Methods (cont.) Registry Entity that collects data and submits to CMS Clinical data can be extracted from EHR or manually entered via registry web form Claims data can be submitted via registry Qualified Clinical Data Registry (QCDR) CMS-approved entity that collects medical and/or clinical data for the purpose of patient disease tracking to foster improvement in quality of care Usually includes specialty measures not on the general MIPS measures list Clinical data can be extracted from EHR or manually entered 11
Reporting Methods (cont.) CMS Web Interface (GPRO) Groups of 25 or more Populate data (manually or electronically) and report all GPRO measures on 248 identified attributed patients Must register by June 30, 2017 CAHPS for MIPS Survey of patients administered and submitted by approved vendor Counts as one of six required measures Must submit remaining five measures via other method Earn extra bonus points 12
Data Completeness Rule Claims 50% of all Medicare Part B patients EHR, Registry, QCDR 50% of all patients GPRO all patients assigned, up to 248 13
Reporting Methods 14
QUALITY CATEGORY Requirements and Scoring
Quality Reporting Requirements 60 Points Report six measures, including at least one outcome or high priority measure Select from full list of 291 MIPS measures Or select from a set of specialty specific measures 3-10 points per measure based on performance against a benchmark 60 possible points Bonus points for high-priority and EHR reporting 16
Measure Choices https://qpp.cms.gov/measures/quality 17
Selecting Measures 1. Decide on your reporting method Claims, EHR, Registry, QCDR Reporting via EHR is easiest but may limit choice of measures 2. Compile list of all available measures for your chosen method 3. Narrow your list to include only applicable measures Specialty/scope of practice Patient population Data collection limitations 18
Selecting Measures (cont.) 4. Print a 2016 (or 2017 year-to-date) Quality report from your EHR to see your past performance on applicable measures 5. Use your Quality report to calculate your estimated MIPS points per measure by downloading the 2017 Quality Benchmarks file from https://qpp.cms.gov/resources/education Measure_Name Submission Method Decile 3 Decile 4 Decile 5 Decile 6 Decile 7 Decile 8 Decile 9 Decile 10 Pneumonia Vaccination Status for Older Adults Claims 39.78-51.32 51.33-61.67 61.68-70.47 70.48-77.77 77.78-84.49 84.50-91.99 92.00-99.06 >= 99.07 Pneumonia Vaccination Status for Older Adults EHR 14.13-23.25 23.26-33.02 33.03-43.58 43.59-53.96 53.97-63.60 63.61-74.54 74.55-85.52 >= 85.53 Pneumonia Vaccination Status for Older Adults Registry/QCDR 12.24-24.02 24.03-36.34 36.35-48.51 48.52-58.95 58.96-68.05 68.06-77.77 77.78-90.19 >= 90.20 19
Quality Scoring Basics Each measure earns between 3 to 10 points Minimum 20 cases for a measure to earn performance points above the minimum Some measures may have a maximum < 10 Reporting additional outcome and high priority measures yields bonus points Measures reported via electronic end-to-end method earn 1 bonus point 20
Quality Category Score 21
Quality Scoring Tips If you submit > six measures, CMS will use the highest scoring six for your base score Measures submitted but not scored are still eligible for bonus points Groups with 16 or more providers and 200+ eligible cases will have All-Cause Hospital Readmission 22
ADVANCING CARE INFORMATION CATEGORY Requirements and Scoring
ACI Basics 50 90 15 Required base score (50) Performance score (up to 90) Bonus score (up to 15) Security risk analysis e-prescribing Provide patient access Send summary of care Request/accept summary of care Submit nine measures for 90 days for performance credit 5 percent per measure for public health/clinical data registry reporting 10 percent for improvement activity alignment 24
Choosing Your Objectives/Measures List https://qpp.cms.gov/measures/aci 25
2017 Transition Objectives and Measures Core 1. Security Risk Analysis 2. e-prescribing 3. Provide Patient Access 4. Health Information Exchange Performance 1. Provide Patient Access 2. Health Information Exchange 3. View, Download, or Transmit (VDT) 4. Patient-Specific Education 5. Secure Messaging 6. Medication Reconciliation 7. Immunization Registry Reporting 26
Performance Measure Scoring Performance Rates for Each Measure 1-10% = 1 11-20% = 2 21-30% = 3 31-40% = 4 41-50% = 5 51-60% = 6 61-70% = 7 71-80% = 8 81-90% = 9 91-100% = 10 27
ACI Category Score 28
ACI Scoring Tips Start improving your performance measure scores above previous MU thresholds Provide Patient Access Health Information Exchange Patient Specific Education Medication Reconciliation Consider implementing an Improvement Activity using your EHR to get 10 bonus points Consider reporting to a specialized registry or public health department for 5% bonus 29
IMPROVEMENT ACTIVITIES CATEGORY Requirements and Scoring
Improvement Activities Basics Attest to completing up to four activities at least 90 days during the year 1. Expanded Practice Access 2. Population Management 3. Care Coordination Rural, health professional shortage area (HPSA), or group practices with 15 or fewer clinicians attest to only two activities 4. Beneficiary Engagement 5. Patient Safety and Practice Assessment 6. Participation in an APM Eligible clinicians choose from 92 activities in nine categories 7. Achieving Health Equity 8. Integrating Behavioral and Mental Health 9. Emergency Preparedness and Response 31
Examples of Improvement Activities Same day appointments Extended office hours After hours access to care Test tracking system 32
Improvement Activities Scoring 40 points needed to maximize this category Medium-weighted activities worth 10 points High-weighted activities worth 20 points Points doubled for rural, HPSA, or small group practices (15 or fewer providers) Full credit for clinicians in CPC+, in a PCMH, or in similar specialist practice PCMH certifications for MIPS include: a national program, a regional or state program, a private payer, or other body that certifies at least 500 practices Participation in Transforming Clinical Practice Initiative is a high-weighted activity 33
Selecting Improvement Activities https://qpp.cms.gov/measures/ia 34
COST CATEGORY Requirements and Scoring
Cost Basics In 2017, cost does not impact MIPS score Clinicians are not required to submit cost data to CMS CMS assesses clinicians based on Medicare claims data CMS compares resources used to treat similar care episodes and clinical condition groups across practices Cost measures adjusted for geographic payment rates and beneficiary risk factors Find previous cost information for your practice in your 2015 Annual Quality Resource and Use Report (QRUR) 36
Questions? 24
Beth Hickerson bhickerson@medadvgrp.com Angela Hale lahale@medadvgrp.com advantagm Kelley Montague kmontague@medadvgrp.com