Quality Reporting Initiatives Part 1 - Physicians Quality Reporting - PowerPoint PPT Presentation

Quality Reporting Initiatives Part 1 - Physicians Quality Reporting Systems 2

Purpose ✦ Overview of the Quality Reporting Initiatives to gain an understanding of the requirements to report successfully and avoid negative/downward payment adjustments in 2018. ✦ Review changes coming to Quality Reporting Initiatives starting in the 2017 reporting year.

Agenda • Overview of Quality Reporting • Quality Reporting changes • PQRS measures and requirements for 2016 • PQRS reporting options for 2016 • Value-Based Modifier • Available resources

Acronyms MACRA -Medicare Access & CHIP Reauthorization Act of 2015 MIPS - Merit-Based Incentive Payment System APM - Alternative Payment Models EP - Eligible Professional CHIP - Children’s Health Insurance Program PQRS - Physician Quality Reporting System VBM - Value-Based Modifier QCRD - Qualified Clinical Data Registry CAHPS - Consumer Assessment of Healthcare Providers & Systems

Quality Reporting Initiatives

Quality Reporting Initiatives For over a decade the Department of Health and Human Services (HHS) along with CMS began launching Quality Initiatives in 2001 to assure quality health care for all Americans through accountability and public disclosure. The various Quality Initiatives touch every aspect of the healthcare system. The goal is to achieve better outcomes for beneficiaries and communities by driving care improvements.

What is Quality Reporting? • Health care providers report quality measures to CMS about health care services provided to Medicare beneficiaries. • Quality measures are tools that help CMS assess various aspects of care such as health outcomes, patient perceptions, and organizational structure. • The measures reported by health care professionals inform CMS on the ability to provide high-quality health care and relate to the goal of effective, safe, efficient, patient- centered, equitable, and timely care.

Future of Quality Reporting Initiatives 2017

MACRA ★ Medicare Access & CHIP Reauthorization Act 2015 MACRA was passed by congress on March 26, 2015 and was signed into law on April 16, 2015 by president Obama, as part of the Medicare payment reform. T he MACRA makes three important changes to how Medicare pays provider who care for Medicare beneficiaries. These changes include: • Ending the Sustainable Growth Rate (SGR) formula for determining Medicare payments for health care providers’ services. • Making a new framework for rewarding health care providers for giving better care, not more just more care. • Combining the existing quality reporting programs into one new system.

MACRA • The separate applications of payment adjustments under PQRS, EHR Meaningful Use and Value-Based Modifier will sunset on Dec. 31, 2018 (2016 reporting year) • January 1, 2019 - Merit Based Incentive payment system (MIPS) and Alternative Payment Model (APM) incentive payments begin (2017 reporting year) • Eligible Professionals (EPs) can participate in MIPS or meet requirements to qualify for APM participation

Merit-Based Incentive Payment System (MIPS) Merit-Based Incentive Payment System (MIPS) is a new program that combines parts of the Physician Quality Reporting System (PQRS), the Value Modifier (VM or Value-based Payment Modifier), and the Medicare Electronic Health Record (EHR) Meaningful Use incentive program into one single program based on: • Quality • Resource use • Clinical practice improvement • Meaningful use of certified EHR technology

Merit-Based Incentive Payment System (MIPS) } Applied to individual EP, groups of EPs or vital groups Year Quality Resource Clinical EHR MU MIPS Adj. Improvement Factor (+/-) Measures Use Activites 2019 50% 10% 15% 25% +/- 4% 2020 45% 15% 15% 25 +/- 5% 2021 30% 30% 15% 25% +/- 7% 2022+ 30% 30% 15% 25% +/- 9%

Merit-Based Incentive Payment System (MIPS) • The composite performance score will range from 0-100 • Statute established formula for calculating payment adjustment factors are relative to performance and establish “applicable percent” amounts • EPs receive a positive/upward adjustment if score above the performance threshold and a negative/downward adjustment if score is below threshold • Upward payment adjustments will remain budget neutral

Alternative Payment Models (APM) Alternative Payment Models (APM) give new ways to pay health care providers for the care they give Medicare beneficiaries. For example: • From 2019-2024, pay some participating health care providers a lump-sum incentive payment. • Increased transparency of Physician-Focused payment models • Starting in 2026, offers some participating health care providers higher annual payments. Accountable Care Organizations (ACOs), Patient Centered Medical Homes, and bundled payment models are some examples of APMs.

Alternative Payment Models (APM) Beginning in 2019 and for 6 years 5% incentive payment for: • EPs or groups of EPs who participate in certain types of APMs and who meet specified payment amounts or patient count thresholds • Payment is made in a lump sum on an annual basis • EPs or groups of EPs meeting criteria to receive APM incentive payments are excluded from the requirements of MIPS

Alternative Payment Models (APM) To earn the incentive payment, an EPs must participate in an APM that meets the following criteria: • Requires participants to use certified EHR technology • Provides payment for covered professional services based on quality measures “comparable to” MIPS quality measures AND Either • a) Entities participating in the APM bear financial risk for monetary losses that are in excess of a normal amount, OR • b) APM is a medical home model expanded under section 1115A(c) of the SSA https://www.ssa.gov/OP_Home/ssact/title11/1115A.htm

Quality Reporting Initiatives 2016

Quality Reporting Initiatives 2016 • Physician Quality Reporting System (PQRS) • Value-Based Payment Modifier (VM) • EHR Meaningful Use incentive Program (MU)

About PQRS The Physician Quality Reporting System (PQRS) is a quality reporting program that encourages individual eligible professionals (EPs) and group practices to report information on the quality of care to Medicare. PQRS gives participating EPs and group practices the opportunity to assess the quality of care they provide to their patients, helping to ensure that patients get the right care at the right time. By reporting on PQRS quality measures, individual EPs and group practices can also quantify how often they are meeting a particular quality metric. Beginning in 2015, the program began to apply a negative payment adjustment to individual EPs and group practices who did not satisfactorily report data on quality measures for Medicare Part B Physician Fee Schedule (MPFS) covered professional services in 2013. Those who report satisfactorily for the 2015 program year will avoid the 2017 PQRS negative payment adjustment.

Who Can Participate? The following are considered “eligible professionals” who can participate in the Physician Quality Reporting System: • Doctors of medicine or osteopathy • Doctors of dental surgery or dental medicine • Doctors of podiatry • Doctors of optometry • Chiropractors

Why do I need to report? Those who do not satisfactorily report data on quality measures for covered Medicare Physician Fee Schedule (MPFS) services furnished to Medicare Part B beneficiaries (including Railroad Retirement Board, and Medicare Secondary Payer) will be subject to a negative payment adjustment under PQRS. Medicare Part C–Medicare Advantage beneficiaries are not included. All EPs who do not meet the criteria for satisfactory reporting or participating for 2016 PQRS will be subject to the 2% 2018 negative payment adjustment with no exceptions.

How-To Get Started to Report 2016 To avoid the 2018 negative payment adjustment, individual EP reporters may choose from the following reporting mechanisms to submit data: • Medicare Part B claims based reporting • EHR data submission vendor (DSV) that is CEHRT • EHR direct product that is CEHRT • Qualified PQRS Registry

How-To Get Started to Report 2016 There is no prior registration is needed to begin reporting. To review feedback reports during and after reporting will need to register with Quality Net. Complete feedback reports are available in the fall of the following year. www.qualitynet.org - PQRS Quality Net Help Desk 7 a.m. - 7 p.m. CT Monday - Friday Phone: (866) 288-8912*

What are Quality Measures? • Quality measures are indicators of the quality of care provided by physicians. • They are tools that help CMS measure or quantify health care processes, outcomes, patient perceptions, and organizational structure and/or systems that are associated with the ability to provide high-quality health care • And/or relate to one or more quality goals for health care. These goals include: effective, safe, efficient, patient centered, equitable, and timely care