MACRA 2020 Overview powered by Graphium Health Services MACRA - PowerPoint PPT Presentation

MACRA 2020 Overview powered by

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30+ Installed States 250+ Installed Facilities 200+ Production Integrations 300k+ of Daily Message Volume 10,000+ Providers and Surgeons 150k+ MACRA 2017 case submissions 500k+ MACRA 2019 case submissions ~2.5 million cases processed

MACRA 2020 Overview https://qpp.cms.gov/about/resource-library Quick fact sheets, FAQs, etc. (Not anesthesia focused) 2020 Final Rule (996 pages) CMS estimates $933 million in payments adjustments for 2020 $433 million in positive payment adjustments (budget neutral) $500 million additional funds for “Exceptional Performers”

CPS vs Payment Adjustment

CPS vs Payment Adjustment

MIPS 2018 Financial Results (All Participants) 2% Incentive Penalty 98%

CPS vs Payment Adjustment

CPS vs Payment Adjustment CPS Adjustment 0 - 10 -9% 11 - 40 -6.8% - 0% 40 - 84 0% - 0.89% 85 - 100 1.42% - 6.25%

CPS vs Payment Adjustment Negative Positive Exceptional 100 85 80 75 70 70 75 60 45 50 30 25 15 3 0 2017 2018 2019 2020 2021

Composite Performance Score Performance Category Weight Comments Promoting Interoperability 0% Re-weighted to 0% for non-patient facing Cost 15% Unclear how it will be determined. No additional data submitted Improvement Activities 15% Annual attestation of activities performed over the reporting period Quality 70% CMS will ONLY count top 6 measures

Composite Performance Score Performance Category Weight Comments Promoting Interoperability 0% Re-weighted to 0% for non-patient facing Cost 15% Unclear how it will be determined. No additional data submitted Improvement Activities 15% Annual attestation of activities performed over the reporting period Quality 70% CMS will ONLY count top 6 measures

Improvement Activities (15%) >50% of EPs fulfill the activity during any continuous 90-day period 106 activities available https://qpp.cms.gov/mips/explore-measures/improvement-activities?py=2020#measures Full credit 2 high-weighted activities 1 high-weighted activity and 2 medium-weighted activities At least 4 medium-weighted activities End of year attestation

Improvement Activities (15%) Weight Improvement Activity Title Collection and follow-up on patient experience and satisfaction data on beneficiary High engagement Medium Use of QCDR data for ongoing practice assessment and improvements High Use of QCDR for feedback reports that incorporate population health Provide 24/7 access to eligible clinicians or groups who have real-time access to patient’s High medical record. Medium Participation in an AHRQ-listed patient safety organization.

Quality Category (70%) Best 6 measures will be counted Each measure will count from 0 - 10 points Performance Met for each measure compared to national average. Points per measure allocated based on your decile Performance Met

Participation Status and Reporting Options Reporting Thresholds Bill more than $90,000 for Part B covered professional services, and See more than 200 Part B patients, and Provide more than 200 covered professional services to Part B patients https://qpp.cms.gov/about/eligibility-determination-periods-and-snapshots?py=2020 https://qpp.cms.gov/participation-lookup

2020 MACRA Measures

2019 MACRA MEASURES ABG 7: Immediate Adult Post-Operative Pain AQI 63: Neuromuscular Blockade: Documented Assessment of Neuromuscular Function Prior to Extubation ABG 16: Planned use of difficult airway equipment AQI 64: Neuromuscular Blockade: Reversal Administered ABG 37: Pre-Operative Screening for Anesthetic Risk Factors AQI 66: Obstructive Sleep Apnea: Mitigation Strategies MIPS 404: Anesthesiology Smoking Abstinence AQI 59: Multimodal Pain Management MIPS 430: Prevention of Post-Operative Nausea and Vomiting AQI 61: Ambulatory Post-Discharge Patient Follow-Up MIPS 424: Perioperative Temperature Management AQI 62: Obstructive Sleep Apnea: Patient Education

2020 MACRA MEASURES ABG 16: Planned use of difficult airway equipment AQI 48: Patient-reported experience with Anesthesia ABG 38: Second Provider Present for difficult airway AQI 61: Ambulatory Post-Discharge Patient Follow-Up MIPS 404: Anesthesiology Smoking Abstinence AQI 62: Obstructive Sleep Apnea: Patient Education MIPS 430: Prevention of Post-Operative Nausea and Vomiting AQI 68: Obstructive Sleep Apnea: Mitigation Strategies MIPS 424: Perioperative Temperature Management 10 reported to CMS MIPS 477: Multimodal Pain Management Only best 6 will count

40 OUTCOME MEASURES - MAJOR AND MINOR COMPLICATIONS Cardiac arrest (unplanned) Pneumothorax (related to anes) Wrong site surgery Myocardial ischemia Aspiration Wrong patient Myocardial infarction Wrong surgical procedure Temperature <95.9 or 35.5 Dysrhythmia requiring intervention Unplanned hospital admission Reintubation (planned trial extubation) Unplanned ICU admission Unexpected death Reintubation (no trial extubation) Uncontrolled HTN Inadequate reversal Dental trauma Stroke, CVA, or coma Intractable N/V Visual loss Vascular injury (arterial/pneumothorax) Unexpected postop ventilation MH Prolonged PACU stay Awareness under GA Failed regional anesthetic Unable to intubate Systemic local anesthesia toxicity Medication administration error Airway fire in OR Peripheral nerve injury following regional Adverse transfusion reaction Corneal abrasion Wet tap Anaphylaxis Equipment malfunction Opioid reversal required Fall in OR Other

5 PROCESS/QUALITY MEASURES Surgical safety checklist used Handoff protocol used Current medications documented in medical record PACU normothermia PACU pain control For use outside of the MACRA program: Support OPPE Requirements Generate required Joint Commission Quarterly Quality reports

MACRA Measures: Key Points ABG 16: Planned use of difficult airway equipment ABG 38: Second Provider Present for difficult airway MIPS 404: Anesthesiology Smoking Abstinence MIPS 430: Prevention of Post-Operative Nausea and Vomiting MIPS 424: Perioperative Temperature Management MIPS 477: Multimodal Pain Management AQI 48: Patient-reported experience with Anesthesia AQI 61: Ambulatory Post-Discharge Patient Follow-Up AQI 62: Obstructive Sleep Apnea: Patient Education AQI 68: Obstructive Sleep Apnea: Mitigation Strategies

MACRA Measures: Key Points ABG 16: Planned use of difficult airway equipment Difficult Airway: ABG 38: Second Provider Present for difficult airway The clinical situation in which a conventionally trained anesthesiologist experiences difficulty with face mask MIPS 404: Anesthesiology Smoking Abstinence ventilation of the upper airway, difficulty with tracheal MIPS 430: Prevention of Post-Operative Nausea and Vomiting intubation, or both. MIPS 424: Perioperative Temperature Management MIPS 477: Multimodal Pain Management AQI 48: Patient-reported experience with Anesthesia AQI 61: Ambulatory Post-Discharge Patient Follow-Up AQI 62: Obstructive Sleep Apnea: Patient Education AQI 68: Obstructive Sleep Apnea: Mitigation Strategies

MACRA Measures: Key Points ABG 16: Planned use of difficult airway equipment Second Provider: ABG 38: Second Provider Present for difficult airway Capable healthcare provider whose only responsibility at the time of induction is to provide assistance for MIPS 404: Anesthesiology Smoking Abstinence management of difficult airway. MIPS 430: Prevention of Post-Operative Nausea and Vomiting A dedicated second provider may include operating staff MIPS 424: Perioperative Temperature Management physician, certified registered nurse anesthetist, registered MIPS 477: Multimodal Pain Management nurse, resident, or anesthesia technician. AQI 48: Patient-reported experience with Anesthesia AQI 61: Ambulatory Post-Discharge Patient Follow-Up AQI 62: Obstructive Sleep Apnea: Patient Education AQI 68: Obstructive Sleep Apnea: Mitigation Strategies

MACRA Measures: Key Points ABG 16: Planned use of difficult airway equipment No changes. ABG 38: Second Provider Present for difficult airway MIPS 404: Anesthesiology Smoking Abstinence MIPS 430: Prevention of Post-Operative Nausea and Vomiting MIPS 424: Perioperative Temperature Management MIPS 477: Multimodal Pain Management AQI 48: Patient-reported experience with Anesthesia AQI 61: Ambulatory Post-Discharge Patient Follow-Up AQI 62: Obstructive Sleep Apnea: Patient Education AQI 68: Obstructive Sleep Apnea: Mitigation Strategies