The Quality Payment Program: Implications for Diabetes Management - PowerPoint PPT Presentation

Quality Payment Program The Quality Payment Program: Implications for Diabetes Management Patric tricia A. A. Meie eier, M.D. Ch Chie ief Med edic ical l Offi ficer, CM CMS Kansas City Regional Office November 17, 2016 1

Quality Payment Program What is “MACRA” ? MACRA stands for the Medicare Access and CHIP Reauthorization Act of 2015 , , bipartisan legislation signed into law on April 16, 2015. What does it do? Repeals the Sustainable Growth Rate (SGR) Formula • Streamlines multiple quality reporting programs into 1 new • system (MIPS) Provides bonus payments for participation in advanced • alternative payment models (APMs) 2

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 Clinicia Clin ians have tw two tr tracks to o ch choose fr from: 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 How Are MIPS Performance Categories Weighted? Weights assigned to each category based on a 1 to 100 point scale Tran ansition Year Weights — 25% 25% Quality Cost Improvement Advancing Activities Care Information 60% 15% 0% 25% NOTE: These are defaults weights; the weights can adjust in certain circumstances 4

Quality Payment Program MIPS Performance Category: Quality • Category Requirements - Replaces PQRS and Quality Portion of the Value Modifier - “So what?” — Provides for an easier transition due to familiarity Sel Select 6 of of abou about 300 qua quali lity me measures Different requirements (minimum of 90 days to be eligible for for groups reporting maximum payment adjustment); 1 must be: CMS Web Interface or • Outcome measure OR those in MIPS-APMs • High-priority measure — defined as outcome measure, appropriate use May also select May al also o sel elect 60% % of of fi fina nal l score measure, patient experience, patient specialty-specific set spe pecia ialt lty-specific ic set safety, efficiency measures, or care of measures of of mea measures coordination 5

Quality Payment Program MIPS Performance Category: Improvement Activities • Clinicians choose from about 90+ activities under 9 subcategories: 1. Expanded Practice Access 2. Population Management 3. Care Coordination 4. Beneficiary Engagement 5. Patient Safety and Practice Assessment 6. Participation in an APM 7. Achieving Health Equity 8. Integrating Behavioral and Mental Health 9. Emergency Preparedness and Response 6

Quality Payment Program Website walk-through: https://qpp.cms.gov

Quality Payment Program Quality Measures: Diabetes Search 8

Quality Payment Program Quality Measures: Diabetes Eye Exam 9

Quality Payment Program Quality Measures: Diabetes Foot Exam 10

Quality Payment Program Quality Measures: HbA1c Control 11

Quality Payment Program Clinical Improvement: Diabetes Search 12

Quality Payment Program Improvement Activities: Diabetes Search 13

Quality Payment Program Improvement Activities: Diabetes Search 14

Quality Payment Program Improvement Activities: Diabetes Search 15

Quality Payment Program Medicare Diabetes Prevention Program

Quality Payment Program Proposed Medicare Diabetes Prevention Program Benefit Description 12 month Maintenance CDC-approved Core Benefit Sessions DPP curriculum • Monthly AFTER 1 st YEAR: monthly • Minimum of 16 maintenance maintenance sessions IF core sessions sessions patient achieves & maintains • • Second 6 months First 6 months minimum weight loss 17

Quality Payment Program Proposed Beneficiary Eligibility • Must meet Body Mass Index (BMI) Criteria: – ≥ 25 (≥ 23 for Asian beneficiaries) • Must have Blood T est Results: Have within the 12 months prior to the first core session: – Hemoglobin A1c of 5.7-6.4%; or – Fasting plasma glucose of 110-125 mg/dL; or – Two-hour plasma glucose of 140 – 199 mg/dL • No previous diagnosis of diabetes (gestational diabetes is allowable) or End-Stage Renal Disease (ESRD). 18

Quality Payment Program MDPP Conference Call: November 30 19

Quality Payment Program Contact Info Patricia A. Meier, M.D. Chief Medical Officer CMS Kansas City Regional Office patricia.meier@cms.hhs.gov 20