SVS QUALITY AND PERFORMANCE MEASURES COMMITTEE (QPMC) New Member Orientation 2017-2018
SVS QPMC Quality and Performance Measures Committee Policy and Advocacy Council (Chair Sean Roddy) Chair: Brad Johnson, Professor of Surgery, University of South Florida Vice chair: Karen Woo Staff: Jill Rathbun Scope of work Monitor national quality initiatives and implement SVS activities in quality and performance measures for vascular interventions
SVS QPMC Charges Perform testing of vascular performance measures submitted to NQF and CMS as needed. Perform required NQF and CMS maintenance on SVS measures and participate in other vascular surgeryrelated measures maintenance as needed. Participate in AMA Physician Quality Reporting Initiative process and investigate opportunities for partnership with AMA PQRS. As needed, interact with Health Policy, Outcomes and Comparative Effectiveness Committees.
SVS QPMC Charges Assess SVS and Committee participation in national quality activities, including: National Quality Forum AMA Physician Quality Reporting Initiative Surgical Quality Alliance National agencies such as AHRQ, CMS, NIH, IOM, and FDA Acumen MACRA Clinical Committees Communicate developments in national quality initiatives to SVS members. Determine SVS positions on legislative/regulatory issues that affect quality initiatives related to vascular surgery
Quality Measures What is a Measure? Quality Measures are indicators of the quality of care provided by physicians Measure specification construct Numerator: clinical action required by the measure for performance Denominator: describes the eligible cases for a measure or the eligible patient population
Examples of Measures Percent of patients undergoing open repair of small or moderate sized non-ruptured abdominal aortic aneurysms who do not experience a major complication (discharge to home no later than post-operative day #7) Percentage of patients aged 18 years and older undergoing infra-inguinal lower extremity bypass who are prescribed a statin medication at discharge
National Quality Forum (NQF) Not-for-profit, nonpartisan, membership-based organization that works to catalyze improvements in healthcare Reviews and approves quality measures In person meetings Committees
NQF measures Measure information form (initial measure submission) Definitions Measure maintenance Measure Testing (largely done using VQI) Evidence
Vascular Quality Initiative (VQI) Qualified Clinical Data Registry (QCDR) CMS approved Quality measures do not need 3 rd party approval Participation satisfies Quality and Clinical Performance portions of MIPS Work in conjunction with VQI on measure development and maintenance Measure submission form
Communicate to SVS Members Under the MACRAscope JVS- monthly JVS VL- bi-monthly 550 word limit No abstract 3 reference limit Referenced in PubMed Template and articles on Dropbox
Communicate to SVS Members Webinars in conjunction with VQI VAM sessions
Determine SVS Positions Regulatory Comments Proposed Rule 2017 MACRA proposed rule 1,058 pages Released 6.20.2017 Comments due 8.21.2017 Final Rule 2016 MACRA Proposed Rule comments
MACRA Medicare Access and Children s Health Insurance Program (CHIP) Reauthorization Act Signed into law 4/16/2015 Repeals Sustainable Growth Rate (SGR) Implements Quality Programs Merit-Based Incentive Payment System (MIPS) Alternative Payment Models (APMs)
MACRA Separate payment adjustments under PQRS, VM and EHR-MU will end 12/31/2018 Physician Quality Reporting System (PQRS) Value Based Modifier (VM/VBM) Electronic Health Record Meaningful Use (EHR-MU) 1/1/2019- MIPS and APM incentive payments begin 2 year reporting and payment delay EPs can participate in MIPS or meet requirements to be qualifying APM participant
MIPS 4 categories to calculate overall MIPS score
Eligible Provider (EP)/Eligible Clinician (EC) Criteria for 2017 (Performance Year 1) Inclusion Physicians (Includes MD, DO, DDS, DDM, DPM, Optometrists and chiropractors) Physician s assistants Nurse Practitioners Clinical nurse specialists Certified Registered Nurse Anesthetists Groups that include such clinicians Clinicians that have filled more than 30K in Medicare Part B charges and have more than 100 Part B- enrolled Medicare beneficiaries
Eligible Provider (EP)/Eligible Clinician (EC) Criteria for 2017 (Performance Year 1) Exclusion Clinicians who enroll in Medicare for the first time in 2017 Clinicians who participate in an Advanced APM and are either a Qualifying APM Participant (QP) or Partial QP Clinicians who bill Medicare for $30,000 or less Clinicians who have provided care for 100 Medicare patients or fewer Clinicians who are not in a MIPS-eligible specialty
Performance Year 2017 Transitional Year Pick Your Pace Four options for participation in 2017 Option 1 Submit any data to MIPS to avoid negative payment adjustment Test practice infrastructure Option 2 Participate fully for part of the year Potential to receive a small positive payment adjustment
Pick Your Pace Option 3 Participate fully starting January 1, 2017 Eligible for full positive payment adjustment Option 4 Qualify through an APM Receive a 5% incentive payment
Quality Category Full participation At least six measures Including at least one outcome measure if available Minimum 90 consecutive days Can choose the same 90 day period for various measures and activities or different time periods
Clinical Improvement Category 92 CPIA in 8 categories Achieving Health Equity Care coordination Beneficiary engagement Population management Behavioral and Mental Health Emerging response and preparedness Expanded practice access Patient Safety and practice assessment
Clinical Improvement Category Requirements 4 medium weight OR 2 high weight Small practices/ rural/ geographic health professional shortage areas One high weight or two medium
Clinical Improvement Category Examples
Advancing Care Information Required e-prescribing Health Information Exchange Provide patient access Security risk analysis
Advancing Care Information Optional Immunization Registry Reporting Medication Reconciliation Patient Specific Education Secure messaging Specialized registry reporting (bonus) Syndromic surveillance reporting (bonus) View, Download, or Transmit
Cost Will not be used in final score for 2017 Measures will be calculated and feedback given Will increase to 30% of the score by 2021
Measuring Cost Episodes Procedural Acute Condition Chronic Condition Triggers Acute inpatient stay- Evaluation and Management (E&M) codes Procedural episode- hospital stay/major outpatient service with surgical diagnosis-related groups (DRGs)
Measuring Cost Episode Trigger events Beginning and ending measurable period vs meaningful time window Homogeneous conditions/procedures Not all procedures/conditions measured High percentage of Medicare expenditure Opportunities for value improvement PAD, aortic aneurysm Acumen clinical committees
MIPS Identifier Must elect the same MIPS identifier for all categories Reporting as an Individual - combination of TIN/NPI Reporting as a Group Group s billing TIN as identifier Group = 2 or more Eligible Clinicians (EC) that have assigned billing rights to the same TIN No virtual groups until 2018 reporting year
MIPS Reporting Options Quality of Care MIPS Category Resource Use (Not in 2017) Available Reporting Mechanisms Qualified Clinical Data Registry (QCDR) Qualified Registry Electronic Health Record Claims Data GPRO (For groups, only) Claims Data Advancing Care Information (MU) Clinical Improvement Activities Attestations QCDR EHR Attestation QCDR Qualified Registry EHR
Timeline for 2019 Payment PERFORMANCE YEAR SUBMIT DATA FEEDBACK AVAILABLE PAYMENT ADJUSTMENT JANUARY 1 DECEMBER 31, 2017 MARCH 31, 2018 JANUARY 1, 2019
Baseline Medicare Payment Positive Updates for 4.5 Years 0.5 percent for July 2015 2019 2017 Conversion factor is $35.8887 Flat for 2020 through 2025 For 2026 and beyond 0.75 percent per year, if participating in APM 0.25 percent for all others
MIPS Payment MIPS applicable percent defined (positive or negative)
MIPS- Scaling for Budget Neutrality All positive adjustment factors are increased or decreased by a scaling factor Achieve budget neutrality with respect to aggregate application of negative adjustment factors
MIPS- Exceptional Performance Additional Adjustment for Exceptional Performance 6 years beginning in 2019 EPs with scores above additional performance threshold defined in statute additional positive adjustment factor up to 10% $500 million is available each year
MIPS 2019 Projections Payment adjustments to est 687,000-746,000 physicians in 2019 $833 million positive and $833 million negative $500 million exceptional performance
MACRA Payment Timeline
qpp.cms.gov
qpp.cms.gov
Alternative Payment Models (APM) New approach for paying for medical care through Medicare that incentivizes quality and value Advanced APM Requirements Provides payment based on quality measures comparable to MIPS quality measures Use certified EHR technology Bear financial risk in excess of a nominal amount OR is a Medical Home
Alternative Payment Models (APM)
Medical Home Participants include primary care Empanelment of each patient to a PCP At least 4 of following: Coordination of chronic and preventative care Patient access and continuity of care Risk stratified care management Coordination across specialties Patient and caregiver engagement Shared decision-making Payment arrangements
APM Examples Accountable Care Organization (ACO) Bundled Payments Pay for Performance (P4P) American College of Surgeons APM
ACO Accountable Care Organizations Networks of doctors, hospitals and other health care providers Share responsibility for coordinating care and meeting health care quality and cost metrics for a defined patient population Medicare and Private ACOs
Bundled Payments Providers are compensated with a single payment for an episode of care Examples Heart attack Hip/knee replacement Diabetes
P4P Pay for Performance Reimbursed on whether providers achieve a pre-determined set of quality measures Financial incentives Bonus for meeting goals Withholds Penalties Fee schedule adjustments Lack of payment for poor performance
Qualifying Provider (QP) in an Advanced APM