The Future of Physician Reimbursement EBG (PQRS-Quality Measures) yield Outcome Report Yield Increased Quality Yield Decreased Cost yield Increased Patient Satisfaction - CAHPS Consumer Assessment of Healthcare Provider & System yield Increase Payment thorough VBM VBP based on participation in PQRS VBP based on PQRS Quality VBP based on PQRS Cost VBP based on MU 1
MACRA Medicare Access & CHIPS Reauthorization Act FFS vs APM 1-1-2019 PQRS Physician Quality Reporting System Quality Reporting Tool PQRS has 256 different Q Measures a. chronic and acute care b. procedure related care c. resource utilization c. care coordination Developed by ACC ADA NCQA NQF etc. EP GP APM all chose which Of the PQRS QM to report on need report on 9 PQRS QM need be specific to your field of practice 2
Need to understand NQS - National Quality Strategy 6 Domains CAHPS Consumer Assessment of Healthcare Provider System 12 Modules NQS 6 Domains will need choose 3 of these NQS 1. patient safety 2. Effective care 3. patient centered care 4. population health 5. care coordination 6.decreased cost CAHPS Consumer Assessment of Healthcare providersystem 12 Module - need address all 12 module Access SDM Access Specialty Functional status Patient Resources Between Visit Summary Communication Health education Rating of provider Nice Med Reconciliation Care Coordination 3
Jenks 9 PQRS also called CQM (Clinical Quality Measure) Controlling high BP Tobacco Colon Screening Flu vaccine Pneumonia vaccine HgA1C Depression Screen Falls ALL NEED 9 PQRS THAT IS EP GP AND APM 3 DOMAINS 12 MODULES THE ABOVE PQRS DOMAINS AND CAHPS MODULES DIFFICULT TO DOUCMENT IN IN CURRENT FFS MODEL 4
MACRA Medicare Access & CHIPS Reauthorization Act Doc fix it bill 7-1-2015 no more SGR part B Pay.5%/yr update 2016,2017,2018 Give physicians 3 year window to implement the pardigm shift in your practice to address the new Payment Model MACRA - implemented 1-1-19 FFS MIPS 2 choices MIPS Merit based Incentive Payment System Implement 1-1-2019 ( based on 2017 data ) Based on PQRS 9 CQM Clinical Outcome Clinical Cost NQS 3 domain CAHPS 12 module Note CMS Has Strengthened the finical impact of these programs BUDGET NEUTRAL All practices will be scoured and compared to peers - 0 to 100 points a. VBM Q ( PQRS ) Up to 30 points b. VBM Cost ( PQRS) Up to 30 points c. VBM MU ( EHR ) Up to 25 points d. CPI Clinical Practice Improvement Up to 15 points 5
FFS - MIPS 1-1-2019 payment based on 2017 data 2019 +/- 4 % 2022 +/- 9% Budget neutral Top 1/4 2019 gain 4 % bottom 1/4 lose 4 % MACRA APM 1-1-2019 - CPCI Eligible for 5% annual bonus /year 2019-2024 After 2025-.75% update compared to MIPS.25% update Exempt from MIPS Requires a paradigm shift CMMI has a number of demonstration projects CPCI 7 markets state-wide (AK, CO, NJ, OR) Mid-Hudson/Capital NY Cinncinati/Dayton, OH Greater Tulsa Oklahoma 45 payors 500 primary care practices 2,100 providers 313,000 Medicare beneficiaries 6
MACRA APM CPCI CPCI one of the best at delivering the triple AIM Better Quality Better Cost Better Patient Satisfaction MACRA APM CPCI Practices must have ability to do: EHR PQRS- like MIPC Financial Risk- shared savings, etc. 7
MACRA APM CPCI Closely resembles PCMH CPCI 9 milestones PCMH- 6 standards MACRA APM CPCI CPCI Access Coordinated Care Patient Centered Caregiver Centered Increased Quality Decreased Costs Increased Patient Satisfaction - CAHPS PCMH Access Coordinated Care Patient Centered Caregiver Centered Increased Quality Decreased Costs Increased Patient Satisfaction- CAHPS 8
9 MILESTONES CPCI 1 Budget 2 Hi Risk Patient SI severity index AAFP Tool DM Registry CHF Registry COPD Registry 3 Access 4 Patient Experience CAHPS 5 QI Quality Improvement 6 Care Coordination TCM 7 SDM Statin Mayo Clinic Tool 8 Participate in CPCI Training 9 HER MU 2 9
CPCI Payment CMS/CMMI 4 year pilot project (2013-2017) FFS PBPM-NFTF Shared Savings-NFTF CMS/BCBS/CommunityCare 60% of practice CPCI recognized as APM 10
CPCI Payment PBPM payment average $25 (2014) $25 (2015) $17 (2016) $17 (2017) Shared Savings in 2015 Is NOT budget neutral Risk of Financial loss based on above budget, PBPM and shared savings CPCI Payment Quality Reporting VBM PQRS-CAHPS, NQS 30 points VBM Cost PQRS 30 points VBM MU HER 25 points CPI (clinical practice improvement) 15 points Must have shared savings Payment will be based on quartile performance Top quartile gets most Bottom quartile gets least 11
CPCI SUCCESS Impliment 9 CPCI MILESTONES Physician Commitment - Paradigm Shift in Practice CGN Care Guidance Nurse Risk Stratification of Patients Implement Milestone 2 EMR must be able to support these registry's Risk Stratification Registry of all patients CDM Registry DM, CHF. COPD CQM Registry PQRS Based on EBG ALL STAFF INVOLVED HUDDLES 12
Hospital Admissions for any Cause Hospital 30 day Readmissions 13
Practice-Level Rates of Outpt ED visits EHR Interoperability 2018 Hospitals will not be able to block information sharing Hospitals blocking their information is the most significant barrier to HIE- MyHealth 14