Quality Payment Program Quality Payment Program 1
Quality Payment Program Icebreaker What is your level of comfort in being able to discuss the Quality Payment Program to someone who may be interested in learning about the program? 2
Quality Payment Program What is the Quality Payment Program? 3
Quality Payment Program The Quality Payment Program The Quality Payment Program policy will: • Reform Medicare Part B payments for more than 600,000 clinicians • Improve care across the entire health care delivery system Clin inic icia ians ns ha have two o trac acks to to choos hoose from om: OR OR The Merit-based Incentive Advanced Alternate Payment Models Payment System (MIPS) (APMs) If you decide to participate in traditional If you decide to take part in an Advanced APM, you Medicare, you may earn a performance-based may earn a Medicare incentive payment for payment adjustment through MIPS. participating in an innovative payment model. 5
Quality Payment Program Quality Payment Program Bedrock High-quality patient- centered care Continuous Useful improvement feedback 5
Quality Payment Program Quality Payment Program Strategic Goals Improve beneficiary outcomes Enhance clinician experience Increase adoption of Maximize participation Advanced APMs Improve data and Ensure operational excellence information sharing in program implementation Qui Quick Tip: For additional information on the Quality Payment Program, please visit QPP.CMS.GOV 6
Quality Payment Program Introduction to the Merit-based Incentive Payment System (MIPS) 7
Quality Payment Program Lesson Objectives By the end of this lesson, you will be able to: • Explain the Merit-based Incentive Payment System, including: • Structure • Eligibility • Participation • Performance Categories • Scoring 8
Quality Payment Program What is the Merit-based Incentive Payment System? Com ombin ines s legacy cy pr progr grams into o si single le, , imp mproved re report rtin ing g pr progr gram PQRS VM EHR Le Legacy Progr ogram Ph Phase Out Out Last Performance Period PQRS Payment End 2016 2018 9
Quality Payment Program What is the Merit-based Incentive Payment System? Perf rform rmance Ca Categori ries 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 10
Quality Payment Program When Does the Merit-based Incentive Payment System Officially Begin? Performance year submit Feedback available adjustment 2017 March 31, 2018 Feedback January 1, 2018 Performance Year Data Submission Payment Adjustment Perform Pe rmance: The first Se Send in perf rforman ance dat ata: a: To Feedbac ack: Medicare gives Payment: Pay : 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. 11
Quality Payment Program Who Participates in the Merit-based Incentive Payment System? 12
Quality Payment Program Eligible Clinicians: Quick Tip : Physician means doctor of medicine, doctor of Medicare Part B clinicians billing osteopathy (including osteopathic practitioner), more than $30,000 a year AND AND doctor of dental surgery, doctor of dental medicine, doctor of podiatric medicine, or doctor providing care for more than of optometry, and, with respect to certain 100 Medicare patients a year. specified treatment, a doctor of chiropractic legally authorized to practice by a State in which he/she performs this function. These clinicians include: Certified Physician Nurse Clinical Nurse Registered Physicians Assistants Practitioner Specialist Nurse Anesthetists 13
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 for the first time during charges less than or equal • Receive 25% of your the performance period to $30,000 a year Medicare payments (exempt until following OR OR OR OR • See 100 or fewer performance year) • See 20% of your Medicare Medicare Part B patients a patients through an year Advanced APM 16
Quality Payment Program Eligibility Scenario You ou Have e Ask sked: “I would like to know whether I am exempt from the Merit-based Incentive Payment System if I exceed EIT EITHER the Physician-Fee-Schedule charges or or beneficiary count, but not BOTH.” 15
Quality Payment Program Eligibility Scenario BILLING To be eligible for the Quality Payment ≥$ 30,000 Quick ck Tip: Program, a clinician must bill more than “And” is the key $30,000 AND see more than 100 Medicare to eligibility beneficiaries. ≥100 In the example provided in this incident where a clinician billed $29,000 and saw EXEMPT BILLING + + = = 101 patients, this clinician would be From the Quality $29,000 EXEM XEMPT from the program because the 101 Payment Program clinician did not bill more than $30,000. 16
Quality Payment Program Non-Patient Facing Clinicians • Non-patient facing clinicians are eligible to participate in MIPS as long as they exceed the low-volume threshold, are not newly enrolled, and are not a Qualifying APM Participant (QP) or Partial QP that elects not to report data to MIPS • The non-patient facing MIPS-eligible clinician threshold for individual MIPS-eligible clinicians is < 100 patient facing encounters in a designated period • A group is non-patient facing if > 75 % of NPIs billing under the group’s TIN during a performance period are labeled as non-patient facing • There are more flexible reporting requirements for non-patient facing clinicians 17
Quality Payment Program How do Eligible Clinicians Participate in the Merit-based Incentive Payment System? 18
Quality Payment Program Pick Your Pace for Participation for the Transition Year Participate in an MIPS Advanced Alternative Payment Model Ful ull Year Test Pace ce Part rtia ial Year • Some practices may • Submit 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 t parti articipati ting in the Quality ty Paym yment t Pro rogram for r the Tran ransi siti tion Year ar wi will re resu sult in a a negati tive 4% payment ad adju justm tment. t. 19
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 As Asked: “What is a minimum amount of data?” OR OR OR OR 5 1 1 Requir ired Advancing Quality Improvement Care Activity Measure Information Measures 20
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 March 31, 2018 21
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 y Tak akeaway: Positive adjustments are based on the performance data on the performance information submitted, not the amou mount of information or length of of time su submit itted. . 22
Quality Payment Program Bonus Payments and Reporting Periods MIPS payment adjustment is based on data submitted. Clinicians should pick what's best for their practice. Full year participation Partial participation (report for 90 days) Is the best way to get the max adjustment • You can still earn the max adjustment • Gives you the most measures to choose from • Prepares you the most for the future of the • program 23
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