Connect w ith Kentucky REC! We will begin at 12:30 PM EST 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
Quality Payment Program Y4: Planning for Success 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
Objectives MIPS Y4 Program Essentials MIPS Category Planning Additional Reminders
QPP Y4: QPP Clinician Eligibility Eligible Clinician Types: Physician, PA, NP, CNS, CRNA, PT, OT, Qualified Speech-Language Pathologist, Qualified Audiologist, Clinical Psychologist, Registered Dietitian or Nutrition Professional QPP Track Eligibility Requirements Merit-Based Incentive Payment Advanced Alternative Payment System Models (MIPS) (APMs) 200 Advanced 35% $90K 50% Medicare 200 PFS APM Medicare OR Payment Part B Patients Participant Patients
QPP Y4: MIPS Thresholds 45 Points 85+ = Minimum Between 46-84 0 Points = Exceptional Threshold = Points = Performance Full 9% Penalty No Penalty, No Penalty Split $500M Pool No Reward Year 5 Minimum Threshold = 60 Points
QPP Y4: MIPS Overview Quality Improvement Promoting Cost Activities Interoperability Adjustment Program Payment Factor Year Year + / - 2020 2022 45% 15% 25% 15% 9% (Y4) Applied Reporting 365- 90-Day 90-Day 365- During Payment Timeframes Days Minimum Minimum Days Year Must Submit by March 31 st , 2021
QPP Y4: Reporting Options Virtual Individual Group Group Combination of > 2 clinicians > 2 TINs Under an NPI (NPIs) who assigned to > 1 number & TIN have individual MIPS As an APM where they reassigned ECs, or to > 1 Entity reassign their billing groups benefits rights to a consisting of < single TIN 10 ECs with > 1 MIPS EC
QPP Y4: Reporting Categories: Basics PI: Quality: Cost: IA: 100 points raw score 6 Measures Required Score is based on 40 points raw score except for: Medicare claims, required required including: • Combination of CMS Web Interface • 4 Objectives, 5 medium & highly report 10 quality Measure 1: Medicare Measures weighted activities measures Spending per Scoring: Beneficiary (MSPB) • 50% ECs must At least 1 Outcome • Performance Measure 2: Total per participate in measure Score capita costs (TPCC) same activity • Bonus for all attributed 7 th Measure based on • 50% of the beneficiaries claims for large groups locations under 2015 CEHRT the TIN are 18 Episode-Based Required Certified Measures PCMH/PCSP Year 4: Minimum Threshold = 45 Points; 9% Risk
QPP Y4: Quality Planning & Action Steps Integrate Improvement Methodology Validate Reporting Pick Quality Measures & Review 2020 Study Measure Decile Specifications Analyze 2019 Scoring Quality Performance Choose Submission Method(s)
QPP Y4: Quality Example Analyze Previous Quality Performance Data
QPP Y4: Quality Example Study Measure Specifications & Integrate Improvement Methodologies
QPP Y4: IA Planning & Action Steps Collect Evidence Choose Timeframe Select IAs Decide 50% NPI Determine Population Special (Group Only) Statuses
QPP Y4: IA Example Determine Special Status & Select IAs
QPP Y4: PI Planning & Action Steps Clinician Documentation Training Validate Reporting Study Measure Specifications Determine Special Status, Hardship & Choose Bonus Submission Possibilities Method(s)
QPP Y4: PI Example Determine Special Status & Study Measure Specs
QPP Y4: Cost Planning & Action Steps Consider Relevant QI Confirm Improvement Coding/Billing Processes Analyze Past Practices Cost Familiarize Performance Measure Review Attribution Measure Methodology Specifications
QPP Y4: Cost Example Review Specs & Attribution & Confirm Coding Practices
QPP Y4: Resources Planning • Y3 Performance Data – QPP Portal • https://qpp.cms.gov/login • Eligibility & Special Status– QPP Website • https://qpp.cms.gov/participation-lookup • Quality & Cost Measure Specs., Scoring, Imp. Activities, Data Validation & Hardship Exceptions – QPP Resource Library • https://qpp.cms.gov/about/resource-library Action • Kentucky Health Information Exchange (KHIE) • https://khie.ky.gov/cwkhie/Pages/getstarted.aspx • QI Methodologies • PDSA, Lean, Six Sigma, etc.
Additional Reminders
QPP Y4: CMS Timeline Snapshots Legislative Updates Performance Feedback CMS provides Notice for Typically a Minimum of Proposed Rule Released in Two Making June – July Snapshots Following (NPRM) – Late Throughout the Performance August Performance Period QPP Final Year – Rule – Early 1: April November 2: December
QPP Y4: Planning for Success Q1 Q2 Q3 Q4 • Check Eligibility • Audit for Data • Review NPRM • Review QPP Final Accuracy Proposals Rule Changes • Place Comments • Determine Quality • Final Eligibility Measures • Plan Improvement Activities Check • Map & Track • Check Quality & PI • Capture Reports Documentation • Attestation Prep • Establish Submission Level • Capture IA & Method(s) • Check Eligibility Documentation • Documentation to Retain • Capture Documentation • Review Feedback from w/in QPP Reports Portal • Review Feedback Reports
QPP Y4: It’s that Time!
QPP Y4: Questions
Value-Based Payment Support Services QPP SURS Technical Assistance: Free, high-level resources for organizations with 15 or fewer eligible clinicians as they navigate the Quality Payment Program. The Resource Center include: straightforward, self-directed resources and tools, up-to-date materials, and access to expert Quality Improvement Advisors. Sign up: www.qppresourcecenter.com VBP Individualized Assistance: 12 months of planning and transformation support tailored to meet specific client needs and support success in value-based payment. This includes current state analysis, recommendations for action, collaborative goal setting and project planning, education, strategic decision support and ongoing advisory services. Advanced APM Support: Ongoing support, research, work plan development and application support for transition to advanced alternative payment models (APM).
Connect w ith Kentucky REC! Like us on Facebook: facebook.com/KentuckyREC Follow us on Twitter: @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
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