PHA/KPP Kettering Health Network: “A Deep Dive on the Quality Category of MIPS” Dr. Troy Tyner, D.O. April 6,2017
Goals for Session • CMS Grant Update for PHA Members • Overview of our PHA/KPP goals • Ensure You Pay NO Penalties • Overview of MIPS • Update on MIPS and Data Submission • Ensure you know your practice scores • Ensure You Pay NO Penalties Value Driven.Health Care. Solutions. 2
PHA CMS Grant Status Clinicians: 496 involved Successes: • 300 site interactions in Q1 2017 with practices • Practices made strong progress • Several practices that would have failed to submit PQRS in 2016 were able to successfully meet requirements. • All practices have taken the minimum required steps to avoid the MIPS penalty. • Opportunities: • Practices using Epic Ambulatory EHR report difficulty getting quality reports, determining reportable measures, and access to understanding Epic reporting requirements and capabilities. Value Driven.Health Care. Solutions. 3
PCP Phase Scores PHA/KPP 2017 Goal Phase 1 (Action Plan) • Set Aims – 23 Drive 100% that desire • Phase 2 to Phase 3 • Use Data to Drive Care – 106 • Phase 3 • Achieve Progress on Aims – 19 Phase 4 • Achieve Benchmark Status – 0 Phase 5 • Thrive as a Business in Pay-for-Value Approached – 0
Specialist Phase Scores from PAT PHA/KPP 2017 Goal Phase 1 (Action Plan) Drive 100% that desire • Set Aims – 51 to Phase 3 Phase 2 • Use Data to Drive Care – 413 Phase 3 • Achieve Progress on Aims – 3 Phase 4 • Achieve Benchmark Status – 0 Phase 5 • Thrive as a Business in Pay-for-Value Approached – 0
Medical Advantage Group Experienced team brings years of success and knowledge in areas that align with the requirements of MIPS Medical Advantage Group’s CIPA PGIP INCENTIVE/ADMINISTRATIVE $18.00 experience has resulted in: PAYMENTS TO PHYSICIANS AND $17.00 $14.51 $16.00 – 196,445 gaps closed from end of 2014 $15.00 $14.00 $13.00 $11.80 to Nov. 2016. From 45% to 69% in $12.00 $11.00 $10.00 gaps closured. $9.00 $8.00 $5.36 – 176 PCMH practices $7.00 $6.00 $5.00 – Increased PMPM earning to our $4.00 $3.00 $2.00 physicians. In 1 contract alone, $1.00 $0.00 increase of $9.15 PMPM in 2 years. Total 2014 Total 2015 Total 2016 – PCPs earned > $1,900,000 and specialists earned $1,800,000 in value-based incentive payments Value Driven.Health Care. Solutions. 6
Deep Dive into MIPS Beth Hickerson and Angela Hale Quality Improvement Advisors PHA Physicians April 6, 2017 Value Driven.Health Care. Solutions.
MIPS SUMMARY Acronyms and Basics
Medicare Access and CHIP Reauthorization Act of 2015 (MACRA) Supported by organized medicine – Repealed the Sustainable Growth Rate (SGR) methodology – Passed with over 90 percent support in both the House and Senate; bi-partisan legislation Created Quality Payment Program which moves Medicare into value-based payments Value Driven.Health Care. Solutions. 9
Quality Payment Program (QPP) Quality Payment Program (QPP) Alternative Payment Model Merit-based Incentive (APM) Payment System (MIPS) Advanced APM MIPS APM January 1, 2019 – physicians enter the APM track or the MIPS track For the first few years, majority of clinicians in MIPS Value Driven.Health Care. Solutions. 10
Acronym Reference Value Driven.Health Care. Solutions. 11
MIPS Payment Adjustments Final score of 0-100 calculated for each eligible clinician/group based on performance in four categories Final score compared against 4x% 5x% 7x% 9x% threshold to determine Threshold payment adjustment to MPFS First MIPS performance year- 2017 First MIPS payment year-2019 -4x% -5x% -7x% -9x% 2019 2020 2021 2022 Value Driven.Health Care. Solutions. 12
Example of MIPS Negative Adjustment MPFS 2017 data/ 2018 data/ 2019 data/ 2021 2020 data/ Reimbursement 2019 payment 2020 payment payment 2022 payment Maximum Loss 4% 5% 7% 9% $50,000 $2,000 $2,500 $3,500 $4,500 $100,000 $4,000 $5,000 $7,000 $9,000 $400,000 $16,000 $20,000 $28,000 $36,000 Value Driven.Health Care. Solutions. 13
Example of MIPS Positive Adjustment MPFS 2017 data/ 2018 data/ 2019 data/ 2020 data/ Reimbursement 2019 payment 2020 payment 2021 payment 2022 payment Plus or Minus 4% 5% 7% 9% Bonus 10% 10% 10% 10% 10% $50,000 $7,000 $7,500 $8,500 $9,500 $100,000 $14,000 $15,000 $17,000 $19,000 $400,000 $56,000 $60,000 $68,000 $76,000 Value Driven.Health Care. Solutions. 14
MIPS Final Score for 2017 Performance Year Final Score Payment Adjustment – Positive adjustment ≥ 70 points – Eligible for exceptional performance bonus – minimum of additional 0.5% – Positive adjustment 4-69 points – Not eligible for exceptional performance bonus – Neutral payment adjustment 3 points – Negative payment adjustment of -4% 0 points – 0 points = does not participate Value Driven. Health Care. Solutions. 15
MIPS Category Weights Over Time : Advancing Care Improvement Quality Information Activities Cost Replaces PQRS Replaces MU New (PCMH) Replaces VBM 2017 60% 25% 15% 0% 2018 50% 25% 15% 10% 2019+ 30% 25% 15% 30% Value Driven.Health Care. Solutions. 16
MIPS Eligible Providers Years 1 and 2 Medicare Part Year 3+ Medicare Part B B clinicians: clinicians: Physicians MD, DO Occupational Therapists Podiatrists Physical Therapists Optometrists Speech Therapists Chiropractors Audiologists Dentists Nurse Midwives Physician Assistants Clinical Social Workers Nurse Practitioners Dietitians Clinical Nurse Specialists Certified Registered Nurse Anesthetists Value Driven.Health Care. Solutions. 17
MIPS Exempt Providers 3 groups of clinicians: Certain First year of Below low patient participants in Medicare Part B volume threshold ADVANCED participation Alternative Payment Models 100 or fewer Part B patients OR billing no more than $30k/year NOTE: MIPS does not apply to hospitals or facilities Value Driven.Health Care. Solutions. 18
Pick Your Pace Options Three options to participate in MIPS in 2017: Don’t submit Value Driven.Health Care. Solutions. 19
Three Ways to Avoid the Penalty in 2017 1 1 5 OR OR Quality Improvement Required Measure Activity Advancing Care Information Measures Value Driven.Health Care. Solutions. 20
Physician Compare Website Shows MIPS composite scores and individual performance category scores Patients can see health care providers rated on a scale of 0 to 100 and how physician compares to peers nationally Value Driven.Health Care. Solutions. 21
REPORTING OPTIONS AND METHODS Understanding How to Report
Reporting Options Individual – defined as a single NPI tied to a single TIN – May protect incentive potential for high-performing providers – May be easier if you have NPIs not required to report Group – multiple NPIs that share a common TIN – May ease administrative burden – Beneficial if you have some providers with reporting obstacles – Register only if using CMS web interface or CAHPS for MIPS Note: Reporting option applies for all four categories; NPIs must report for each TIN separately Value Driven.Health Care. Solutions. 23
Reporting Methods Claims EHR Registry Qualified Clinical Data Registry CMS Web Interface CAHPS for MIPS Survey Note: You may only report via one method per category Value Driven.Health Care. Solutions. 24
Reporting Methods (cont.) Claims – Add modifier codes to your Medicare claims – Can be added manually by billers or automatically by EHR or billing software EHR – Directly submit a QRDA III file through the CMS portal – Register with your EHR to submit on your behalf as/through a Data Submission Vendor (DSV) – This category does not include EHRs who submit via registry Value Driven.Health Care. Solutions. 25
Reporting Methods (cont.) Registry – Entity that collects data and submits to CMS – Clinical data can be extracted from EHR or manually entered via registry web form – Claims data can be submitted via registry Qualified Clinical Data Registry (QCDR) – CMS-approved entity that collects medical and/or clinical data for the purpose of patient disease tracking to foster improvement in quality of care – Usually includes specialty measures not on the general MIPS measures list – Clinical data can be extracted from EHR or manually entered Value Driven.Health Care. Solutions. 26
Reporting Methods (cont.) CMS Web Interface (GPRO) – Groups of 25 or more – Populate data (manually or electronically) and report all GPRO measures on 248 identified attributed patients – Must register by June 30, 2017 CAHPS for MIPS – Survey of patients administered and submitted by approved vendor – Counts as one of six required measures – Must submit remaining five measures via other method – Earn extra bonus points Value Driven.Health Care. Solutions. 27
Data Completeness Rule Claims – 50% of all Medicare Part B patients EHR, Registry, QCDR – 50% of all patients GPRO – all patients assigned, up to 248 Value Driven. Health Care. Solutions. 28
Reporting Methods Value Driven.Health Care. Solutions. 29
QUALITY CATEGORY Requirements and Scoring
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