WELCOME! We will begin at 12:30 PM Eastern Follow us on Twitter: @KentuckyREC Like us on Facebook: facebook.com/KentuckyREC Follow us on LinkedIn: linkedin.com/company/kentucky-rec Check out our Website: www.kentuckyrec.com Call us: 859-323-3090 Email us: kyrec@uky.edu
QPP Year 4: Understanding the Cost Performance Category The information contained in this presentation is for general information purposes only. The information is provided by UK HealthCare’s Kentucky Regional Extension Center and while we endeavor to keep the information up to date and correct, we make no representations or warranties of any kind, express or implied, about the completeness, accuracy, reliability, suitability or availability with respect to content.
Kentucky Regional Extension Center Services UK’s Kentucky REC is a trusted advisor and partner to healthcare organizations, supplying expert guidance to maximize quality, outcomes and financial performance. Kentucky REC Description Physician Services 1. Promoting Interoperability (MU) & Mock Audit 2. HIPAA SRA, Project Management & Vulnerability Scanning To date, the Kentucky REC’s activities include: 3. Patient Centered Medical Home (PCMH) Consulting • Assisting more than 5,000 individual providers 4. Patient Centered Specialty Practice (PCSP) Consulting across Kentucky, including primary care providers and specialists 5. Value Based Payment & MACRA Support • Helping more than 95% of the Federally Qualified 6. Quality Improvement Support Health Centers (FQHCs) and Rural Health Clinics (RHCs) within Kentucky 7. Telehealth Services • Working with more than 1/2 of all Kentucky hospitals Hospital Services • Supporting practices and health systems across the Commonwealth with practice transformation and 1. Promoting Interoperability (Meaningful Use) preparation for value based payment 2. HIPAA Security Analysis & Project Management 3. Hospital Quality Improvement Support
Your REC Advisors & Presenters Jessica Elliott Robin Curnel, RN Vance Drakeford, MHI QIA QIA QIA
QPP Y4: Cost Merit-Based Incentive Payment System (MIPS) Track • Overview • Cost Category Updates 2020 Cost Category Analysis • Understanding Cost Measures • Attribution Methodologies Planning for the Future & Driving Improvement • Benchmarking • Driving Improvements & Controlling Cost Q&A
QPP 2020 Merit-Based Incentive Payment System (MIPS) Track Overview & Cost Category Update
QPP Y4: MIPS Clinician Eligibility QPP Track Eligibility Requirements Eligible Clinician Types: • Physician: • Qualified Speech- Doctor of Medicine, Language $90K Osteopathy, Dental Pathologist Surgery, Dental • Qualified Part B Medicine, Podiatric Audiologist Billing Merit- Medicine, & • Clinical Optometry Psychologist Based • Osteopathic • Registered 200 Incentive Practitioner Dietitian or Medicare • Chiropractor Nutrition Payment Patients • PA Professional System • NP • CNS (MIPS) 200 Covered • CRNA • PT/OT Services under PFS
QPP Y4: MIPS Thresholds NEW for 2020 –/+ 9% Adjustment Factor!!! Exceptional Performance Threshold Minimum 46 - 84 +85 Performance Points Points Threshold 0 - 44 45 Points Points – Payment Potential + + Payment Avoid Penalty Adjustment Adjustment Adjustment
QPP Y4: MIPS Overview 365 Quality 45% Days Promoting CATEGORY WEIGHT 2020 25% 90 REPORTING TIMEFRAMES Interoperability PROGRAM Days YEAR & Improvement 2022 15% 90 PAYMENT Activities Days YEAR 365 15% Cost Days Must Submit by March 31 st , 2021
QPP Y4: Cost Glossary of New Terms Measure Information Form: • Formerly known as Measure Specification Sheet. • Resource with all Cost measure information, including: Cost Measure Code List: Attribution, Exclusions, Trigger Codes, and Risk Adjustment Codes. MSPBC – MS-DRG • System of classifying a Medicare patient's hospital stay into (Medicare Severity – Diagnosis various groups in order to facilitate payment of services. Related Group): • Start of a primary care relationship between clinician & beneficiary; identified by the occurrence of two Part B TPCC – Candidate Event: Physician/Supplier (Carrier) claims with particular CPT/HCPCS codes. (E&M primary care services and primary care services). • Begins on the date of the candidate event and continues until one year after that date. A beneficiary’s costs are attributable to a TPCC – Risk Window: clinician during months where the risk window & measurement period overlap.
QPP Y4: Why Consider Cost? PI: Quality: Cost: IA: Measure Alterations: Added: Removed/Modified: Removed: • MSPBC New Measures & Bonus Measure(s) 15 Activities • TPCC Specialty Measure Hospital-Based as 75% Added/Modified: Attribution: Sets or More of ECs 9 Activities Set at Measure level Removed/Altered: Under TIN 50% of ECs in Group Added: 125 Measures MUST Perform Activity 10 New Episode-based Increase of Data Measures Completeness = 70% Why It Matters… Increased Every Measure Reduced Bonus Opp. Most Measures Documentation Burden Impacted Updated Impacting 105 Possible Pts. Num/Den & Workflows Requires Added Patient-Relationship Prep/Planning Process Expanded Flexibility for Pull Measure Spec Hospital-Based ECs Sheets to Verify Expanded Measures
QPP Y4: Cost Measures Overview Case Data Type Cost Measure Adjustments Minimum Source(s) Payment Medicare Spending Per Beneficiary Clinician Medicare Part MSPBC Standardized 35 Episodes Cost Composite Score (MSPBC) A & B Claims Risk Adjusted Payment Standardized 20 Medicare Medicare Part TPCC Risk Adjusted Total Per Capita Cost (TPCC) Patients A & B Claims Specialty- Adjusted Procedural Episode- 10 Episodes Payment Based 13 Episode-Based Procedural Measures Medicare Part Standardized Acute- Measures 5 Episode-Based Acute-Inpatient Measures A & B Claims Risk Adjusted Inpatient (18 Total) 20 Episodes Final Score: Submission: 15% for 2020 No Attestation Required TBD for 2021 30% for 2022 & Beyond
QPP Y4: Cost Measure Updates Medicare Spending per Total per Capita Cost Episode-Based Measures Beneficiary Clinician Updated attribution Attribution at Measure methodology Updated the attribution Level: methodology New terms: Candidate • Procedural Measures Event & Risk Window • Inpatient Measures Multiple TINs to one beneficiary Medical vs surgical episode Service category & specialty exclusions Risk Adjustment No change in case Methodology Change thresholds Added service exclusions Monthly Cost Evals
QPP Y4: Getting Started Understanding the Cost Category Using Cost Performance Cost Measure Calculating Cost Performance Measures Attribution Measures Feedback
QPP 2020: MIPS Cost Category Analysis
Cost Analysis: MSPBC Patient Attribution Medical Surgical Clinician(s) performing TIN Billing > 30% of IP any related surgical E/M services procedure during IP stay Any clinician in TIN Billing TIN for procedure billing >1 IP E/M service
Cost Analysis: Medicare Spending per Beneficiary Clinician Episode 3 days prior to the index admission & ends 30 days after discharge Window Pre-Admission Period Post-Discharge Period 3 days 30 days Measure Assesses the cost to Medicare of services provided to a beneficiary during an episode, which comprises the period immediately prior to, during & following the beneficiary’s Overview hospital stay, with exceptions for services identified as unlikely to be influenced by the clinician's care decisions. 1 3 4 5 2 • Define • Attribute • Exclude • Exclude • Risk Adjust The Population Episodes to Unrelated Episodes Based Calculate of Index Clinicians Services on Data Validity Expected Admissions Criteria Episode Costs
Cost Analysis: MSPBC Clinician Attribution Examples Surgical Attribution Example: Medical MS - DRG Attribution Example: ID TINs & Clinicians TIN A Clinician 1 TIN E&M Services billing CPT/HCPCS provided during TIN A Clinician 2 Clinician 1 codes during Index TIN B Clinician 3 Index Admission Clinician 2 Admission TINs Billing >30% of ID TINs & Clinicians Clinician 1: Yes E&M services during TIN A – 71% TIN B – 29% billing RELEVANT TIN: Yes Clinician 2: No Index Admission CPT/HCPCS codes Clinicians in TIN billing E&M during Clinician 1: Clinician 2: Final Attribution Clinician 1 Clinician 2 Clinician 3 TIN Attributed Index Admission for Attributed Not Attributed episode Final Clinician Attributed Attributed Not Attributed Attribution
Recommend
More recommend
