Quality Payment Program MIPS: Advancing Care Information Deep Dive April 4, 2017 1
Quality Payment Program Feedback Information • A Q&A session will take place after the presentation. - Use the phone number provided later in the webinar to ask questions over the phone. • The slides, recording, and transcript from the webinar will be posted on the Quality Payment Program website in the next week or so. • The speakers will answer as many questions as time allows. Any questions not answered on the phone should be directed to the QPP Service Center at: qpp@cms.hhs.gov or 1-866-288-8292. 2
Quality Payment Program Eli lizabeth S. . Holland Senior Technical Advisor, Division of Health Information Technology, Quality Measurement & Value-Based Incentive Group Center for Clinical Standards and Quality 3
Quality Payment Program Major Topics Covered The Merit-based Incentive Payment System at-a-glance Overview of Advancing Care Information 4
Quality Payment Program What is the Merit-based Incentive Payment System? Perf erformance Ca Categories Quality Cost Improvement Advancing Care Activities Information • Moves Medicare Part B clinicians to a performance-based payment system • Provides clinicians with flexibility to choose the activities and measures that are most meaningful to their practice • Reporting standards align with Advanced APMs wherever possible 5
Quality Payment Program What are the Performance Category Weights? Weights assigned to each category based on a 1 to 100 point scale ights — 25% 25% Transiti tion Year Weig Advancing Care Quality Cost Improvement Information Activities 60% 0% 15% 25% Not Note: : These are default weights; the weights can be adjusted in certain circumstances 6
Quality Payment Program Clinicians who Participate in MIPS include: • Clinicians billing more than $30,000 to Medicare Part B a year AND providing care for more than 100 Medicare patients a year. These clinicians include: Certified Physician Nurse Clinical Nurse Registered Physicians Assistants Practitioners Specialists Nurse Anesthetists 7
Quality Payment Program Who is excluded from MIPS? Clinicians who are: Newly-enrolled Below the low-volume Significantly in Medicare threshold participating in Advanced APMs • Enrolled in Medicare • Medicare Part B allowed • Receive 25% of your for the first time during charges less than or equal Medicare payments the performance period to $30,000 a year OR OR OR OR (exempt until following • See 20% of your Medicare • See 100 or fewer performance year) patients through an Medicare Part B patients a Advanced APM year 8
Quality Payment Program Pick Your Pace for Participation for the Transition Year Participate in an MIPS Advanced Alternative Payment Model Fu Full ll Yea ear Tes est Part artia ial Year ear Some practices may • Submit som some data after • Report for 90-day • Fully participate January 1, 2017 choose to participate period after January 1, starting January 1, in an Advanced 2017 2017 • Neutral or small Alternative Payment payment adjustment • Small positive payment • Modest positive Model in 2017 adjustment payment adjustment Not Not par partic icip ipatin ing in n the the Quali uality Payment Prog ogram for or the the Tran ansit itio ion Year ear wi will l resu esult lt in n a a neg negative 4% % pa payment adj adjustment. 9
Quality Payment Program MIPS: Choosing to Test for 2017 • Submit minimum amount of 2017 data to Medicare • Avoid a downward adjustment You ou Ha Have Ask sked: “What is a minimum amount of data?” OR OR OR OR 4 or 5 1 1 Required Advancing Quality Improvement Care Activity Measure Information Measures 10
Quality Payment Program MIPS: Partial Participation for 2017 • Submit 90 days of 2017 data to Medicare • May earn a positive payment adjustment “So what?” - If you’re not ready on January 1, you can start anytime between January 1 and October 2 Need to send performance data by Mar arch 31 31, , 20 2018 18 11
Quality Payment Program MIPS: Full Participation for 2017 • Submit a full year of 2017 data to Medicare • May earn a positive payment adjustment • Best way to earn largest payment adjustment is to submit data on all MIPS performance categories Key Takeaway: Positive adjustments are based on the performance data on the performance information submitted, not the amo amount of information or length of of tim ime sub submitted. . 12
Quality Payment Program Individual vs. Group Reporting OPTI TIONS Individual Group 1. 1. In Individ idual — under an 2. As 2. s a a Gr Group NPI number and TIN a) 2 or more clinicians where they reassign (NPIs) who have benefits reassigned their billing rights to a single TIN* b) As an APM Entity * If clinicians participate as a group, they are assessed 13 as group across all 4 MIPS performance categories
Quality Payment Program Get your Data to CMS Individual Group QCDR (Qualified Clinical Data QCDR (Qualified Clinical Data Registry) Quality Registry) Qualified Registry Qualified Registry EHR EHR Administrative Claims Claims CMS Web Interface (groups of 25 or more) CAHPS for MIPS Survey Advancing Attestation Attestation QCDR QCDR Care Qualified Registry Qualified Registry Information EHR EHR CMS Web Interface (groups of 25 or more) Improvement Attestation Attestation Activities QCDR QCDR Qualified Registry Qualified Registry EHR EHR 14
Quality Payment Program When Does the Merit-based Incentive Payment System Officially Begin? Performance year submit Feedback available adjustment 2017 March 31, 2018 January 1, 2019 Feedback Performance Year Data Submission Payment Adjustment Pe Perfo rformance ce: The first Send in n pe perfo rformance ce da data ta: : To Feedback: Medicare gives Pa Payment: : You may earn a performance period opens potentially earn a positive you feedback about your positive MIPS payment January 1, 2017 and closes payment adjustment under performance after you send adjustment beginning January 1, December 31, 2017. During MIPS, send in data about the your data. 2019 if you submit 2017 data by 2017, you will record quality care you provided and how March 31, 2018. If you data and how you used your practice used technology participate in an Advanced APM technology to support your in 2017 to MIPS by the in 2017, then you could earn 5% practice. If an Advanced APM deadline, March 31, 2018. In incentive payment in 2019. fits your practice, then you order to earn the 5% incentive can provide care during the payment for participating in an year through that model. Advanced APM, just send quality data through your Advanced APM. 15
Quality Payment Program Understanding Advancing Care Information Performance Category 16
Quality Payment Program Advancing Care Information Who can participate? or All MIPS Eligible Participating Individual Group Clinicians as an… Hospital-based MIPS clinicians, Nurse Optional for 2017 Practitioners, Physician Assistants, Clinical Nurse Specialists, Certified Registered Nurse Anesthetists (CRNAs) Facilities (i.e. Skilled Nursing facilities) Not Eligible 17
Quality Payment Program MIPS Performance Category: Advancing Care Information • Promotes patient engagement and the electronic exchange of information using certified EHR technology • Ends and replaces the Medicare EHR Incentive Program for eligible professionals (also known as meaningful use) • Greater flexibility in choosing measures • In 2017, there are 2 2 meas easure re se sets ts for r rep reportin ing ba based on on EHR edition: 2017 Advancing Care Information Advancing Care Information Transition Objectives and Objectives and Measures Measures 18
Quality Payment Program MIPS Performance Category: Advancing Care Information • Clinicians must use certified EHR technology to report For those using EHR Technology For those using EHR Technology Certified to the 2015 Edition: Certified to the 2014 Edition: Option 1 Option 2 Option 1 Option 2 Combination Combination Advancing 2017 of the two of the two Care Advancing measure sets measure sets Information Care Objectives and Information Measures Transition Objectives and Measures 19
Quality Payment Program Advancing Care Information Requirements for the Transition Year • Test means… • Par artial l an and fu full ll par articip ipation means… Submitting 4 or 5 base score measures • Depends on use of 2014 or 2015 Edition • • Submitting more than the base score in year 1 Reporting all required measures in the • base score to earn any credit in the Advancing Care Information performance category For a full list of measures, please visit qpp.cms.gov 20
Quality Payment Program MIPS Scoring for Advancing Care Information (25% of Final Score) Advancing Care Information Performance Category Score = Base ase Sc Score Performance Sc Score Bon onus Sc Score 21
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