Lake Superior Quality Innovation Network (LSQIN)

Transcription

1 Transitioning from MU / PQRS / VM to the Quality Payment Program Candy Hanson, BSN, PHN, LHIT-HP Stratis Health Reid Haase Healthcare IT Consultant Stratis Health November 29, 2016 Lake Superior Quality Innovation Network (LSQIN) Three quality improvement organizations: MPRO in Michigan Stratis Health in Minnesota MetaStar in Wisconsin Collaboration to improve health care for Medicare consumers, share best practices, and maximize efficiencies 1

2 Objectives Provide an overview of the Quality Payment Program (QPP) Understand the two paths for QPP MIPS & APMs (Merit-based Incentive Payment System and Alternative Payment Models) Review the QPP timeline and important dates Understand CMS Pick your Pace options & MIPS Scoring Determine eligibility requirements for the QPP Gain knowledge about key resources and tools 2 Pick Your Pace CMS is offering Pick Your Pace for 2017 a set of on ramps for MIPS participation. 3

3 Overview of the Quality Payment Program (QPP) 4 Medicare Access and CHIP Reauthorization Act of 2015 ( Doc fix ) 5

4 Current Programs to be Integrated Into MIPS 6 CMS Goals for Medicare Part B Fee For Service Source: Programs/MACRA-MIPS-and-APMs/MACRA-LAN-PPT.pdf 7

5 Medicare Quality Payment Program Fee For Service payment not going away Value and positive outcomes will be rewarded Moves away from all or nothing under Meaningful Use to method of scoring from for 4 MIPS Categories (Lowered scoring thresholds for 2017) 2017 is considered a transition year Negative/neutral/positive payment adjustments Exceptional care bonus for first few years ($500M to be divided amount highest performers) 8 Who Is Impacted by MIPS & APMs? Current Meaningful Use EHR Incentive Program MU for Medicaid EHs, CAHs MU for Medicaid EPs MU for Medicare EHs, CAHs MU for Medicare EPs Advanced APMs MIPS APMs MIPS 60% 15% 0% 25% 9

6 QPP Program High Level View Quality Payment Program Advanced APMs MIPS APMs MIPS Qualified Participants Eligible Clinicians Eligible Clinicians *5-8% of providers 2017 *92%- 95% of providers in Medicaid EP: Possibly (MU + MIPS) MU for Medicaid EPs STOP MU for Medicare EPs ACI for Medicare ECs Medicaid EPs continue on Meaningful Use path (AIU first year plus six incentive years) and can skip years New Medicaid EPs can still start in 2016!...it s the last year to start MU Medicaid EPs that bill Medicare Part B as well need to report to BOTH programs Medicaid MU AND MIPS What you re doing in Medicaid MU is, in part, a larger set of MIPS requirements 11

7 Payment Adjustments 12 Source: Minnesota Medical Association, Jan. 26, 2016, Janet Silversmith: Making Sense of MACRA (webinar presentation) The Two Paths for QPP: MIPS & APMs 13

8 The Two Paths for QPP: MIPS & APMs MIPS: Quality category 14 Quality 6 measures (no domains) rather than 9 under the proposed rule 15 measures are required for groups (rather than 18 currently) who submit measures using the CMS Web Interface For the transition year CY 2017, higher measure points may be awarded based on achieving higher performance in the measure (3-10pts for each of the 6 measures 60 points max.) 15

9 Quality measures 16 Quality measures 17

10 The Two Paths for QPP: MIPS & APMs MIPS: Improvement Activities (CPIA) category 18 Improvement Activities New category Up to four activities (from a menu of 90+) Activities are weighted: medium (10pts) or high (20pts) Improvement activities are designed to help participants prepare to transition to APMs 19

11 Improvement Activities 20 Improvement Activities 21

12 Improvement Activities 22 Improvement Activities 23

13 Improvement Activities 24 Improvement Activities Selected Improvement Activities involving CEHRT can boost your Advancing Care Information category score but only in transition year 2017: 10% bonus for completing 1 or more Improvement Activities (completing 2 more still only results in 10% bonus toward the Advancing Care Information category score) Approx. 18 activities to choose from that involve the use of CEHRT and provide the bonus 25

14 The Two Paths for QPP: MIPS & APMs MIPS: Advancing Care Information (ACI) category 26 ACI Category 27

15 ACI Category * 18 Improvement Activities to choose from for this bonus 28 ACI Objectives/Measures 29

16 MU to ACI 30 ACI Category MU Stage 3 Objectives (*2018 req d) MU Modified Stage 2 Objectives 31

17 ACI Category: Base Measures 2015 CEHRT 2014 CEHRT 32 ACI Category: Performance Measures 2015 CEHRT 2014 CEHRT 33

18 ACI Category Quality Category then moves from 60% to 85% 34 Exemptions from ACI Exemptions available for ACI category (just this category, not all MIPS categories!) There are no longer individual objective or measure exclusions (as was the case for Meaningful Use) only whole ACI category exemption Applications must be submitted annually (date TBD) Categories of hardship exemption will be similar to hardship exemptions under Meaningful Use EHR Incentive program 35

19 The Two Paths for QPP: MIPS & APMs MIPS: Cost category 36 Cost: (Cancelled for 2017) 37

20 Cost: (Cancelled for 2017) The Cost category has been set to 0% for episode measures being finalized As of 2018, performance feedback will be available annually Category score will increase from 0 to 30% by 2021 (required by MACRA law) Clinicians will not select Cost measures Measures will be based on services delivered Based on TIN and NPI combination (previously only TIN in Value Based Measure method in 2016 and prior) 38 The Two Paths for QPP: MIPS & APMs Advanced APMs & MIPS APMs 39

21 Alternative Payment Models Quality Payment Program Advanced APMs MIPS APMs MIPS Qualified Participants Eligible Clinicians Eligible Clinicians *More downside risk *5-8% of providers *92%- 95% of providers 40 Alternative Payment Models APMs are a new way to compensate providers for care and services rendered to Medicare beneficiaries Promotes value and quality over volume by moving away from the traditional Medicare FFS structure Goal of APMs is to reduce spending while improving patient care Source: Programs/MACRA-MIPS-and-APMs/MACRA-MIPS-and-APMs.html 41

22 Alternative Payment Models APMs ACOs Bundled Care Models PCMH 42 Advanced APM Track 43

23 Advanced APMS 44 Advanced APMS in

24 Advanced APMS in MIPS Timeline & Important Dates 47

25 2017 Is a Transition Year! QPP / MIPS / APMs begins Jan. 1, 2017 Pick Your Pace offers a set of on ramps for MIPS participation in 2017.which allows for starting even late in Dec to avoid % adjustment for doing nothing Option to start as late as Oct 2, 2017 to do 90 day period 2014 CEHRT is acceptable for 2017 but be ready with your 2015 CEHRT for Jan. 1, Dates for QP Determination 49

26 Similar 2 Year Measurement/ Payment Adjustment cycle 50 Annual Measurement Periods MU for Medicaid EPs MU for Medicaid EHs, CAHs MU for Medicare EHs, CAHs MU for Medicare EPs ACI for Medicare ECs 51

27 Pick Your Pace Options: 2017 Transition Year & MIPS Scoring 52 MIPS Pick your Pace NOT RECOMMENDED! 4. Engage as a Qualified Participant (QP) in an Advanced APM no MIPS requirements! 53

28 MIPS Scoring Category weighting for 2017 Weights can be adjusted (ACI exemptions application could reweight category to zero) 54 MIPS 2017 Scoring (0-100 Points) >-70 points Eligible for positive payment adjustment and exceptional performance bonus 4-69 points Positive payment adjustment. No exceptional performance payment. No negative 3 points Neutral payment adjustment 1-2 points Negative payment adjustment Do nothing 0 points -4% payment adjustment 55

29 Ways to Get to 3 points Score at least 3 points Report to ACI 5 required base objectives OR- Report Quality Measures 1 quality measure OR 15 required for groups doing CMS web interface 1 or 2 improvement activities or PCMH/MHM 2 medium or 1 high for practices over 12 1 medium or 1 high for small, rural, non-patient facing clinicians 56 Eligibility Requirements for the QPP 57

30 Eligibility 58 Groups 59

31 Eligibility 60 Excluded Clinicians 61

32 MIPS Impact on Providers Working in RHCs, FQHCs, and CAHs Subject to MIPS Payment Adjustments if provider: Is an Eligible Clinician (EC) AND Sees than 100 Medicare patients AND Bills more than $30,000 to Medicare PBPFS in the performance year Method 2 Billing 62 Resources and Tools 63

33 LSQIN Role in QPP Education Technical Assistance Physician/Eligible Clinician Engagement Beneficiary Engagement 64 Understanding MACRA Quality Payment Program (QPP) Webinar Series 1/26/16 MIPS, Advancing Care Information Objectives for 2017 & /16/16 MIPS, Improvement Activities 3/29/16 MIPS, Quality Component 4/20/16 Calculating a MIPS Score 65

34 MACRA/QPP Office Hours Office Hours Technical Assistance Forum 2 nd Thursday of each month 11:30-12:30 CT/12:30-1:30 ET January 12, 2016 first call 66 QPP Help Desk Quality Payment Program Help Desk (866) am 8pm EST / 7am 7pm EST QPP@cms.hhs.gov 67

35 Quality Payment Program Resources MACRA (CMS) Home Page and links to materials: Based-Programs/MACRA-MIPS-and-APMs/MACRA-MIPS-and-APMs.html CMS Quality Payment Program Home Page (NEW!) 68 Resources QPP Final rule published Oct. 14, 2014 (2,398 pages) QPP Executive Summary (24 pages) QPP: Quality Measures page: QPP resources page (past and upcoming webinars about QPP) Programs/MACRA-MIPS-and-APMs/Quality-Payment-Program-Events.html Lake Superior Quality Innovation Network Previous and upcoming webinars: 69

36 CMS Acronyms AAPM Advanced Alternative Payment Model ACI Advancing Care Information (New MU) APM Alternative Payment Model CPIA Clinical Practice Improvement Activities MACRA - Medicare Access & CHIP Reauthorization Act MIPS Merit-Based Incentive Program PBPFS Part B Physician Fee Schedule PQRS Physician Quality Reporting System VBM or VM Value Based Modifier 70 Wrapping up Thanks for your time today! 71

37 LSQIN Contacts Michigan - MPRO Holly Standhardt hstandhardt@mpro.org Minnesota - Stratis Health Candy Hanson chanson@stratishealth.org Wisconsin - Metastar Mona Mathews mmathews@metastar.com 72 This material was prepared by Lake Superior Quality Innovation Network, under contract with the Centers for Medicare & Medicaid Services (CMS), an agency of the U.S. Department of Health and Human Services. The materials do not necessarily reflect CMS policy. 11SOW-MN-D