March Data Jam: Using Data to Prepare for the MACRA Quality Payment Program Elizabeth Arend, MPH Quality Improvement Advisor National Council for Behavioral Health
CMS Change Package: Primary and Secondary Drivers Patient and Family- Centered Care Design Continuous, Data- Driven Quality Improvement Sustainable Business Operations 1.1 Patient & family engagement 1.2 Team-based relationships 1.3 Population management 1.4 Practice as a community partner 1.5 Coordinated care delivery 1.6 Organized, evidence-based care 1.7 Enhanced access 2.1 Engaged and committed leadership 2.2 QI strategy supporting a culture of quality and safety 2.3 Transparent measurement and monitoring 2.4 Optimal use of HIT 3.1 Strategic use of practice revenue 3.2 Staff vitality and joy in work 3.3 Capability to analyze and document value 3.4 Efficiency of operation
Outline Understand the major components of the Merit-based Incentive Payment System (MIPS), including how eligible clinicians will be assessed and reimbursed Pick your pace to report in 2017, and select your measures under the Quality and Improvement Activity performance categories Use Care Transitions Network tools and technical assistance, including your Data Dashboard, to enhance your 2017 performance and maximize your future Medicare Part B reimbursements. All eligible Care Transitions Network practices have to select their MIPS measures by April 28, 2017!
Review: What is MACRA? Medicare Access and CHIP Reauthorization Act (MACRA) of 2015 Repeals the Sustainable Growth Rate formula MACRA shifts payment for volume of services to payment for value Creates a new Quality Payment Program by streamlining existing programs
Two Paths to Payment: MACRA s New Quality Payment Program Clinicians can choose either: The Merit-Based Incentive Payment System (MIPS), which streamlines and modifies multiple quality programs An Advanced Alternative Payment Model (APM), which provides bonus payments for participation
In 2017, MIPS applies to: Clinicians who bill Medicare Part B using the physician fee schedule, including: Physicians (including psychiatrists) Physician assistants Nurse practitioners Clinical nurse specialists Certified registered nurse anesthetists MIPS participation is voluntary for other health care providers in 2017, but they will not receive a payment adjustment
In 2017, MIPS does NOT apply to: Providers billing Medicaid Clinicians who are newly enrolled in Medicare Clinicians who are significantly participating in an advanced APM Hospital-based and facility-based payment programs Clinicians and groups who are NOT paid under the Physician Fee Schedule (i.e. FQHCs and partial hospitalization programs)
In 2017, MIPS does NOT apply to: Individual clinicians and groups that fall beneath the low volume threshold who serve 100 or fewer Medicare recipients OR bill Medicare $30,000 or less per year Threshold will be applied at the individual clinician level among those who choose to report to MIPS as individuals Threshold will be applied at the group level for all clinicians who choose to report to MIPS as a group CMS will determine clinicians volume in advance through claims analysis
MIPS Performance Categories CMS will factor in four weighted performance categories to calculate a final score (0-100 points) Payments will be adjusted based on CMS s established threshold (3/100 points)
Individual Eligible Clinicians Defined as a single National Provider Identifier (NPI) tied to a single Tax Identification Number (TIN) Eligible Clinician Groups Defined as a set of 2+ clinicians, identified by their NPIs, who share a common TIN regardless of the specialty or practice site Low volume threshold determined at individual level Payment adjustment based on individual clinician s performance Low volume threshold determined for entire group Groups are assessed as a group across all performance categories and receive one payment adjustment based on the group s performance Have the option to report via Medicare claims Have the option to report via CMS Web Interface (groups 25+ only)
MIPS Payment Adjustments
Pick Your Pace Reporting Options in 2017
Quality (60%) If reporting for a partial or full year, you must submit data for six quality measures. Must include one outcome/ high priority measure Option to use behavioral/mental health measure set If the set includes less than six applicable measures, the eligible clinician or group should only report the measures that are applicable.
Quality (60%) The better your performance, the higher your score. CMS has set benchmarks for most quality measures, which they will use to determine your score on each measure Benchmarks will be published before every performance year; 2017 benchmarks can be found at: https://qpp.cms.gov/resources/education
MIPS Quality Measures: Overlap with Care Transitions Network Measure Definition High Priority? Adherence to Antipsychotic Medications For Individuals with Schizophrenia Follow-Up After Hospitalization for Mental Illness (FUH) Percentage of individuals at least 18 years of age as of the beginning of the measurement period with schizophrenia or schizoaffective disorder who had at least two prescriptions filled for any antipsychotic medication and who had a Proportion of Days Covered (PDC) of at least 0.8 for antipsychotic medications during the measurement period 1. The percentage of discharges for which the patient received follow-up within 30 days of discharge. 2. The percentage of discharges for which the patient received follow-up within seven days of discharge Yes Yes
Care Transitions Network Data Dashboard
Care Transitions Network Data Dashboard
Improvement Activities (15%) MIPS eligible clinicians can choose from a list of 90+ activities under nine sub-categories:
Improvement Activities: Integrated Behavioral and Mental Health Depression screening Diabetes screening EHR enhancements for behavioral health data capture Implementation of co-location of primary care and mental health services Implementation of integrated Primary Care Behavioral Health model Major depressive disorder prevention and treatment interventions Tobacco use Unhealthy alcohol use
Improvement Activity Scoring Activity weight for most clinicians: Attest to completing up to four activities for at least 90 days o High = 20 points o Medium = 10 points Activity weights for small/rural/hpsa practices: Attest to completing up to two activities for at least 90 days o High = 40 points o Medium = 20 points Full credit for clinicians in a patient-centered medical home, Medical Home Model or similar specialty practice
Improvement Activities Participation in the Transforming Clinical Practice Initiative counts as a high weighted measure! If you do nothing but attest to participating in TCPI in 2017, you will avoid a payment penalty in 2019
MIPS Improvement Activities: Overlap with CTN Technical Assistance Improvement Activity Implementation of episodic care management practice improvements Implementation of formal QI methods, practice changes and other practice improvement methods Definition Provide episodic care management, including management across transitions and referrals that could include one or more of the following: Routine and timely follow-up to hospitalizations, ED visits and stays in other institutional settings, including symptom and disease management, and medication reconciliation and management; and/or Managing care intensively through new diagnoses, injuries and exacerbations of illness. Adopt a formal model for quality improvement and create a culture in which all staff actively participates in improvement activities that could include one or more of the following: Train all staff in quality improvement methods Integrate practice change/quality improvement into staff duties Engage all staff in identifying and testing practices changes Designate regular team meetings to review data and plan improvement cycles; Promote transparency and accelerate improvement by sharing practice level and panel level quality of care, patient experience and utilization data with staff; and/or Promote transparency and engage patients and families by sharing practice level quality of care, patient experience and utilization data with patients and families. Weight Medium Medium
Improvement Activity Implementation of methodologies for improvements in longitudinal care management for high risk patients Definition Provide longitudinal care management to patients at high risk for adverse health outcome or harm that could include one or more of the following: Use a consistent method to assign and adjust global risk status for all empaneled patients to allow risk stratification into actionable risk cohorts. Monitor the risk-stratification method and refine as necessary to improve accuracy of risk status identification Use a personalized plan of care for patients at high risk for adverse health outcome or harm, integrating patient goals, values and priorities and/or Use on-site practice-based or shared care managers to proactively monitor and coordinate care for the highest risk cohort of patients. Weight Medium Practice improvements that engage community resources to support patient health goals Develop pathways to neighborhood/community-based resources to support patient health goals that could include one or more of the following: Maintain formal (referral) links to community-based chronic disease self-management support programs, exercise programs and other wellness resources with the potential for bidirectional flow of information; and/or Provide a guide to available community resources. Medium
Improvement Activity Definition Weight Diabetes Screening Depression Screening Engage patients and families Evidence-based techniques to promote selfmanagement into usual care Regularly assess the patient experience Shared decisionmaking Tools for selfmanagement Diabetes screening for people with schizophrenia or bipolar disease who are using antipsychotic medication. Depression screening and follow-up plan: Regular engagement of MIPS eligible clinicians or groups in integrated prevention and treatment interventions, including depression screening and follow-up plan (refer to NQF #0418) for patients with cooccurring conditions of behavioral or mental health conditions. Engage patients and families to guide improvement in the system of care. Incorporate evidence-based techniques to promote self-management into usual care, using techniques such as goal setting with structured follow-up, Teach Back, action planning or motivational interviewing. Regularly assess the patient experience of care through surveys, advisory councils and/or other mechanisms. Use evidence-based decision aids to support shared decision-making. Use tools to assist patients in assessing their need for support for self-management (e.g., the Patient Activation Measure or How's My Health). Medium Medium Medium Medium Medium Medium Medium
What about the Advancing Care Information Category? Two measure sets in 2017 for reporting based on EHR edition, with emphasis on: Protect patient health information Electronic prescribing Patient electronic access Health Information Exchange Coordination of Care through Patient Engagement
What about the Cost Category? CMS will conduct its own claims analysis in 2017, so no independent reporting is required Cost will not be weighted in 2017, but all eligible clinicians will receive feedback on their cost of care Measures will include: Total per capita cost for all attributed beneficiaries Medicare spending per beneficiary (MSPB) 10 episode of care measures (not yet finalized) Category weight will increase from 0 to 30 percent by 2019 performance year / 2021 payment year
Next Steps Choose your reporting option for 2017 Choose your measure(s) on the Quality Payment Program website Bare Minimum: Select one quality measure or one improvement activity Partial/Full Year Reporting: Select six quality measures (including at least one outcome or high priority measure), and up to four improvement activities The Care Transitions Network will conduct an online survey to collect your chosen reporting option and measures, as well as your technical assistance needs; please complete this survey by Friday, April 28 th Keep an eye out for the final final rule in June 2017!
Support for Small, Underserved and Rural Practices (SURS) Small practices (with 15 or fewer clinicians), practices located in medically underserved area, and practices located in CMS-designated rural locations, may be able to receive additional technical assistance to support MIPS participation from IPRO Visit www.nyqpphelp.org to request technical assistance according to practice size
CMS Resources Quality Payment Program Online Portal Quality Payment Program Service Center 1-866-288-8912 Open Monday-Friday, 8am-8pm ET
Questions?
Thank you! www.caretransitionsnetwork.org CareTransitions@TheNationalCouncil.org The project described was supported by Funding Opportunity Number CMS-1L1-15-003 from the U.S. Department of Health & Human Services, Centers for Medicare & Medicaid Services. Disclaimer: The contents provided are solely the responsibility of the authors and do not necessarily represent the official views of HHS or any of its agencies.