Overview of the Development and Implementation of CAHPS for ACOs and PQRS. Sandra Adams, RN, BSN Lauren Fuentes, MPH.

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1 CAHPS for ACOs and PQRS Overview of the Development and Implementation of CAHPS for ACOs and PQRS Sandra Adams, RN, BSN Lauren Fuentes, MPH July 10-11, 2014

2 Agenda Overview of the Medicare Shared Savings Program Quality Measurement and Reporting CAHPS for ACO Survey Development and Content CAHPS for ACO Survey Administration Timeline Overview of Physician Quality Reporting System (PQRS) and 2014 Requirements CAHPS for PQRS Implementation Public Reporting Resources and Help

3 Medicare Shared Savings Program Goals The Shared Savings Program is an new approach to the delivery of health care aimed at reducing fragmentation, improving population health, and lowering overall growth in expenditures by: Promoting accountability for the care of Original Medicare beneficiaries Improving coordination of care for services provided under Medicare Parts A and B Encouraging investment in infrastructure and redesigned care processes

4 Shared Savings Program Quality Standard Measure Domains Quality measures are separated into the following four key domains that serve as the basis for assessing, benchmarking, rewarding, and improving ACO quality performance: Better Care for Individuals 1. Patient/Caregiver Experience 2. Care Coordination/Patient Safety Better Health for Populations 3. Preventive Health 4. At-Risk Population 4

5 CAHPS for ACOs: Survey Development The Shared Savings Program Rule required that the patient experience survey for the program be based on the CAHPS Clinician & Group Survey (CG-CAHPS) These survey domains are required: o Getting Timely Care, Appointments, & Information o How Well Your Providers Communicate o Patient s Rating of Provider o Access to Specialists o Health Promotion and Education o Shared Decision-making o Health Status & Functional Status To identify relevant items within each of these domains, as well as possible new domains, a Technical Expert Panel (TEP) was convened Focus groups were conducted with fee-for-service Medicare beneficiaries to allow them to share what is important to them when they receive care

6 CAHPS for ACOs: Survey Development (cont.) Combining input from these sources, a draft survey instrument developed Cognitive interviews were conducted with beneficiaries to refine item wording and a field test was conducted in the spring of 2012 We revised the survey based on analyses of the field test data The first national survey administration with all ACOs occurred January April 2013

7 Summary Survey Measures in CAHPS for ACOs Number Summary Survey Measure (SSM) Source 1-7 Getting Timely Care, Appointments, & Information How Well Your Providers Communicate Patient s Rating of Provider Access to Specialists Health Promotion and Education Shared Decision-making Health Status & Functional Status* CG CAHPS Core, CG CAHPS Supplemental, New Items These SSMs are part of the ACO quality performance score, there are 14 possible points for CAHPS 8 Courteous & Helpful Office Staff CG CAHPS Core- Not part of the ACO quality performance score 9-12** Care Coordination CAHPS Supplemental Between Visit Communication and new questions Not Educating Patient about Medication Adherence part of the ACO quality Stewardship of Patient Resources performance score *Remains pay for reporting in 2014 **There are 2 versions of the survey for 2014, these summary survey measures are optional

8 CAHPS Survey Content: Focal Provider Survey asks respondents to describe their experiences with a named focal provider The focal provider provides the most primary care services to the beneficiary based on the number of visits The focal provider can be a primary care provider or a specialist that provided primary care services Other survey questions ask about the health care team and practice staff 8

9 CAHPS for ACOs Key Dates for 2014 Administration of the 2013 survey occurred January March 2014 Survey results will be available this summer and are reported with each ACO s quality report ACOs receive a detailed CAHPS specific report in the fall of 2014 CAHPS data may be reported on Physician Compare in late 2014 or early 2015 ACOs choose survey vendor from a list of CMS-certified vendors by September 22, 2014 for the survey administration period that begins in November

10 Quality Performance Feedback to ACOs ACOs receive an annual quality performance report with their scores on all 33 quality measures for 4 ACO quality domains ACOs receive a comprehensive CAHPS report in the fall that details ACO performance on each summary survey measure

11 Quality Scoring: Total Possible Points by Domain Domain Total Individual Measures Total Measures for Scoring Purposes Total Potential Points per Domain Domain weight (percent) Patient/Caregiver Experience 7 7 measures* Care Coordination/ Patient Safety 6 6 measures; the EHR measure double-weighted (4 points) Preventive Health 8 8 measures At-Risk Population 12 7 measures, including 5- component diabetes composite measure and 2-component CAD composite measure Total * The functional status measure remains pay-for-reporting for the entire agreement period 11

12 Pay for Performance Phase-In Complete and accurate reporting for the first reporting period/first performance year qualifies the ACO to share in the maximum available sharing rate for payment In future program years: Must meet minimum attainment level to receive points for measures Shared savings payments linked to quality performance based on a sliding scale High-performing ACOs receive higher sharing rate for payment Year 1 Year 2 Year 3 Pay for Performance Measures Pay for Reporting Measures Total

13 Physician Quality Reporting System (PQRS) Overview PQRS is a reporting program that uses incentive payments and payment adjustments to promote reporting of quality information Incentive payments continue through the 2014 program year Payment adjustments begin in 2015 and are based on prior years reporting Eligible professionals (EPs) can report individually or as a group practice participating in the group practice reporting option (GPRO) The creation of the PQRS program was mandated by federal legislation, but participation is voluntary for EPs

14 2014 Eligible Professionals The following professionals are eligible to participate in PQRS in 2014: Beginning in 2014, professionals who reassign benefits to Critical Access Hospitals (CAHs) that bill professional services at a facility level, such as CAH Method II billing, can now participate (in all reporting methods except for claims-based)

15 Incentives and Payment Adjustments in is the last year that EPs can earn payment incentives EPs who satisfactorily report quality-measures data for services provided in 2014 are: Eligible to earn an incentive payment of 0.5 percent of the EP's total Medicare Part B Physician Fee Schedule (PFS) covered services provided in is also the performance year for the 2016 PQRS payment adjustment Payment adjustment in 2016 is -2.0 percent of EP s Part B covered professional services under Medicare PFS

16 National Quality Strategy (NQS) Domains Most PQRS reporting options require an EP or group practice to report 9 measures covering at least 3 of 6 NQS domains: Patient Safety Person and Caregiver-Centered Experience and Outcomes Communication and Care Coordination Effective Clinical Care Community/Population Health Efficiency and Cost Reduction Same domains for EHR Incentive Programs Clinical Quality Measures

17 PQRS Reporting: Individuals To participate in the 2014 PQRS program, individual EPs may choose to report quality information to CMS through one of the following methods: 1. Medicare Part B claims 2. Qualified registry 3. Qualified Clinical Data Registry (QCDR) 4. Direct electronic health record (EHR) using certified EHR technology (CEHRT) 5. CEHRT via data submission vendor

18 PQRS Reporting: Groups To participate in the 2014 PQRS program, group practices may choose to report quality information to CMS through one of the following methods: 1. Qualified registry 2. Direct EHR using CEHRT (Certified EHR Technology) 3. CEHRT via data submission vendor 4. Web interface (for groups of 25+ only) 5. CAHPS CMS-certified survey vendor (for groups of 25+ only, supplement to other methods) A group practice under 2014 PQRS consists of a physician group practice, as defined by a single Tax Identification Number (TIN), with 2 or more individual EPs, as identified by individual National Provider Identifier or NPI, who have reassigned their billing rights to the TIN.

19 PY 2014 CAHPS for PQRS Requirements Group practices with 100+ EPs reporting GPRO web interface must: Report all 12 CAHPS for PQRS survey summary modules; AND Complete all 22 PQRS GPRO web interface quality measures CMS to bear cost of administering this required CAHPS for PQRS survey

20 PY 2014 CAHPS for PQRS Requirements Group practices with 25+ EPs can: Report all 12 CAHPS for PQRS survey summary modules; AND report at least 6 measures covering at least 2 of the NQS domains using a qualified registry, a CEHRT direct product, or a CEHRT data submission vendor; OR all 22 PQRS GPRO web interface measures CMS to bear cost of this optional CAHPS for PQRS survey

21 Summary Survey Measures in CAHPS for PQRS Number Summary Survey Measure (SSM) Source 1-7 Getting Timely Care, Appointments, & Information How Well Your Providers Communicate Patient s Rating of Provider Access to Specialists Health Promotion and Education Shared Decision-making Health Status & Functional Status CG CAHPS Core, CG CAHPS Supplemental, New Items 8 Courteous & Helpful Office Staff CG CAHPS 9-12 Care Coordination Between Visit Communication Educating Patient about Medication Adherence Stewardship of Patient Resources CAHPS Supplemental and new questions

22 CAHPS for PQRS Implementation PY 2013 CAHPS Implemented for group practices with 100+ EPs reporting through the GPRO web interface Same survey content as CAHPS for ACOs Data collected April July 2014 Detailed results will be shared with groups in early 2015

23 CAHPS for PQRS Implementation PY 2014 CAHPS Groups have until 9/30/14 to register and make reporting selection online at Option to include 2014 CAHPS data in 2016 physician value modifier calculation Same survey content as CAHPS for ACOs CMS aims to collect CAHPS data in early 2015 CMS aims to provide results to groups in the fall of 2015

24 2014 Sampling Considerations Medicare beneficiaries only Assigned to provider who provides the most primary care services to the beneficiary based on the number of visits Meet minimum number of beneficiaries Groups with 100+ EPs: 416 Groups with EPs: 255

25 Public Reporting on Physician Compare PQRS CMS may publically report 2014 CAHPS data for group practices of 100+ EPs reporting through PQRS GPRO web interface in 2015 CMS may publically report 2014 CAHPS data for groups of 25 to 99 EPs in 2015 ACOs Display of Quality Data for ACOs began with the 2012 reporting period for a subset of quality measures reported via the GPRO web interface ACO CAHPS data may be displayed on Physician Compare for the 2013 reporting period, displayed in late 2014 / early 2015

26 CMS Resources Materials available at CMS.gov/PQRS include: PQRS Overview Factsheet PQRS: What s New for 2014 Factsheet Made Simple Guides on Educational Resources webpage 2014 PQRS Implementation Guide

27 CMS Resources ACO quality website: Payment/sharedsavingsprogram/Quality_Measures_Standards.html ACO CAHPS website: PQRS CAHPS website: Instruments/PQRS/CMS-Certified-Survey-Vendor.html 27

28 Questions? For questions or assistance with PQRS reporting contact the QualityNet Help Desk, the help desk is available Monday Friday; 7:00 AM 7:00 PM CST to assist with: General CMS PQRS information Portal password issues Feedback report availability and access PQRI-IACS registration questions PQRI-IACS login issues Phone: TTY: CAHPS for PQRS Technical Assistance is available by ing