MIPS and Physician Value Programs

Transcription

1 MIPS and Physician Value Programs Cathie Biga, President/CEO CMI Howard Walpole, MD, VP of Clinical Effectiveness at Northeast Georgia Health System Cathleen Biga, MSN, RN: Disclosures: Co-chair: ACC CV Administrator Work Group Member: Cardiovascular Management Council Member: Health Affairs Committee Member: BOT Work Group on Medical and Professional Liability Insurance Member: CQC AUC Implementation & Evaluation Member: CQC FOCUS Committee Member: Partners in Quality Committee Member: Task Force on MACRA Ownership Interest/Partnership/Principal: Cardiovascular Management of Illinois Consultant Fees/Honoraria: Medaxiom Organizational (Non-Commercial): Cardiology Advocacy Alliance Organizational (Non-Commercial): Medaxiom Advisory Board 1

2 Bo Walpole, MD, FACC: Disclosures: Cardiovascular Summit Course Director Member: Cardiovascular Management Council Member: Blue Ribbon Nominating Committee Member: Finance Committee Personal Commercial: Zoll Medical (Spouse) Arrhythmias and Clinical EP Other, Salary 4 Navigating the Valley between Volume and Value MACRA Readiness Cathie Biga ACC s Practice Administers Work Group cbiga@cardiacmgmt.com 2

3 5/12/2016 FACC 6 Triple Aim in

4 The March to Value.. Thetrainhasleftthestation,anditain tcomingback 7 The Basics of MACRA MACRA = Medicare Access & CHIP Reauthorization Act Eliminate SGR Effective 1/1/19 BUT data collection begins 1/1/17 Payment updates 2016 was negated MACRA APM MIPS 4

5 HHS mandate followed by MACRA 9 Triple Aim Manage Population Health Ideal Care System Reduce Per Capita Cost Enhance the Experience of Care 10 5

6 MACRA moves us closer to meeting these goals 11 Rapid Pace of Change Continues 12 MIPS changes APM changes Episodes of Care Attribution 6

7 What are we seeing in this proposal 13 Reduce reporting burdens Adds flexibility Accountability Negative performance can NOT be > 4% Positive performance should be 4% with some bonuses If in a qualifying APM BUT don t qualify for incentive you can elect MIPS 1/1/17 data collection begins for MIPs and APM MIPS Composite Score Advancing Care Information: 25% 131 points (100 = 25% credit) Removed all or nothing approach Customized set of measures Base score + performance Clinical Practice Improvement (15%) 60 points Weighted activities points 90 activities APM s = ½ credit Quality 50% Quality Use: 50% Quality/PQRS: 50% points 6 measures (1 cross cutting) OR specialty measure set Population measures Resource Use: 10% 10 points per measure Claims based Total cost per capita MSPB Episode-based measures 7

8 Allocation change announced: 4/8/16 Summary: Quality 16 Quality 50% of total Replaces PQRS and quality component of VM Changes will allow for variances between specialties 6 measures Includes outcome measure + cross cutting Measures will be released annually 80 or 90 possible points 8

9 Core Measure set 17 Announced in April 2016 Measure sets: Cardiology Gastroenterology HIV and Hepatitis C Medical Oncology Obstetrics and Gynecology Orthopedics ACO Measure Development Plan recently released Summary 18 Advancing Care Information aka MU Replaces the Medicare EHR program New emphasis on interoperability and information exchange Eliminates the current all or nothing program 'Failure to meet the submission requirements, or measure specifications for any measure in any of the objectives would result in a score of zero for the Advancing Care Information performance category base score Removed ecqm s from requirements There will be a total of 130 points available + 1 bonus point available 100 points will allow you to claim the 25% of this category 9

10 Summary of ACI 19 Is meaningful use Dead 20 How about reinvented? Criteria are streamlined What we need to do: Protect Patient Health Information - Security Risk Analysis Electronic Prescribing Patient Electronic Access - Patient Access, Patient-specific education Coordination of Care through Patient Engagement - View/Download/Transmit, Secure Messaging, Patient Generated Health Data Health Information Exchange - Patient Care Record Exchange, Request/Accept Patient Care Record, Clinical Information reconciliation Public Health and Clinical Data Registry Reporting - Immunization Registry Reporting 10

11 What do I need to do NOW 21 Make sure your base measures are in place Make sure you have a 2014 or 2015 edition for your EHR Report on either eight stage 2 or six stage 3 advancing care information objectives and measures Attest to their cooperation in good faith with the surveillance and ONC direct review of their EHR Attest to their support for health information exchange and the prevention of information blocking. Make sure the performance measures are ready Continue to practice medicine Base component of ACI 22 11

12 The 6 measures in the base score 23 Performance Score: 80/

13 Clinical Practice Improvement: CPI 25 Clinical Practice Improvement New in MIPS 60 points 90 options Million Hearts is classified as moderate Rated as High and Medium 26 13

14 Are your clinics ready? Will be yes/no for year one Should evolve to modifier use so as to collect electronically. (GT = telehealth) Highly rated activities = 20 points Medium activities = 10 points Exceptions for groups <15 or rural Need 2 CPI activities (either hi or medium) Cost 28 Each cost measure worth up to 10 points If 20 pt. sample not met revert to average MSPB Total cost per beneficiary 40 episodes BOTTOM LINE: No Outcome.No Income 14

15 Transparency 29 MACRAeconomics 30 Current PQRS report cards 43% of cardiology was Unsuccessful in 14 Current MU report cards VM (5,477 providers were penalized 14 data) QRUR Supplemental QRUR Is physician comp tied to quality? 15

16 Physician Value Agenda Meaningful Use PQRS Value modifier QRUR report Exhibits Supplemental QRUR Drill Down exhibits Physician Compare Know the interaction amongst and between these What we don t have time for 32 Risk Adjusted scores Your documentation matters It only counts if it is BILLED What is your average number Dx/claim It MUST have specificity What are your top 10 diagnosis Attribution Two step process Total cost in QRUR Cost per the 4 index conditions MSPB 3 days pre and 30 days post Condition Episodes Procedural Episodes 16

17 MIPs: Putting it all together 33 ACO update ACO s as of 1/31/16 (433 MSSP) 8.9% of the population is in an ACO Top states: Il, CA, FL, MA, TX, PA, NY ACO s in 49 states MSSP welcomed 100 new ACOs, adding 15,000 more participating physicians, on January 1, 2016 With the new group of ACOs, CMS will have 434 ACOs participating in the Shared Savings Program next year, serving more than 7.7 million beneficiaries 17

18 The APM categories 35 Alternative Payment Models 18

19 ACO s Pioneer model Medicare: 3 models MSSP model Next Generation model (proposed) Medicaid Commercial Where are we in ACO s including MSSP, Pioneer, NG, ESRD 64 are in a Qualifying APM (22 in MSSP 2/3) 19

20 Distribution of ACO s 39 BPCI NextGen Advanced Alternative Payment Models Data year 2017 Data year 2019 (2021) private payer/medicaid Everyone will report MIPS yr. 1 Qualifying APM s: Comprehensive ESRD Care Model Comprehensive Primary Care Plus (CPC+) Medicare Shared Savings Program Track 2 & 3 Next Generation ACO Model Oncology Care Model Two-Sided Risk Arrangement (available in 2018) 40 20

21 Pulling it all together: Value Based Future *Potentially Qualified APM Shared Risk APM * Must have more than nominal risk & threshold dependent 2021 includes Non-Medicare population 41 Decision points 42 Working/reporting individually vs as a group Attribution Documentation Risk scores CMI Episodes of care RFI completed Proposed ruling coming 21

22 How we report now 43 PQRS: Individual reporting: combination of TIN and NPI GPRO: TIN level EHR: Uses NPI VM: Use TIN Proposed: Use TIN/NPI Things to Ponder 44 How are your TIN s structured? Do we report individually or as a Group? Are all your providers billed appropriately? 22

23 Are you MACRA ready? 45 Organizational focus Currently successful in PQRS MU VM You have found your data You know your numbers Reducing variability is a priority Understanding cost Understanding episodes of care Care coordination is an organizational priority Documentation is a focus clinic & hosp. Save the Date for our Upcoming Webinars! -Sponsored by the CV Administrator Workgroup May 18 th at 1pm ET: Navigating the QRUR (your basis for MIPS) Speakers: Dr. Charles Brown and Cathie Biga June 8 th at 1pm ET: Navigating the s-qrur (supplemental QRUR Speakers: Dr. Charles Brown and Cathie Biga September 8 th at 1pm ET: The AUC Mandate Speakers: Dr. Thomas Stuckey and Sheryl Booth December 8 th at 1pm ET: Latest Trends in the CV Service Line Speakers: Dr. Charles Brown and Michael Schroyer 23

24 47 Questions?? QRUR May 18 th 1 pm EST 24

25 Supplemental QRUR. June 8 th 1 pm EST 25