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Quality Payment Program Year 4: Quality Deep Dive 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 Rebecca Cheatham Robin Curnel Brent Doom QIA QIA QIA
Objectives Year 4 Merit-Based Incentive Payment System (MIPS) Basics Year 4 Quality Category Deep Dive Next Steps
QPP Program Tracks By law, MACRA requires CMS to implement an incentive program, referred to as the Quality Payment Program, which provides two participation tracks for clinicians: MIPS MIPS ECs are subject to a performance-based payment Merit-based Incentive adjustment through MIPS Payment System Quality Payment Program (QPP) Advanced APMs QPs may earn an incentive payment for participating in Advanced Alternative one of these models Payment Models
Polling Question #1 What are your performance goals for the Quality Payment Program for 2020? Enter your answer into the polling window on the right side of your screen
2020 Merit-Based Incentive Payment System (MIPS) Basics
MIPS Clinician Eligibility QPP Track Eligibility Requirements Eligible Clinician Types: $90K Physicians ( including Doctors of Part B Medicine, Osteopathy, Dental Surgery, Billing Dental Medicine, Podiatric Medicine, and Optometry ), Osteopathic Merit-Based Practitioners, Chiropractors, PA, NP, 200 Incentive CNS, CRNA, PT, OT, Qualified Medicare Payment Speech-Language Pathologist, Patients System Qualified Audiologist, Clinical (MIPS) Psychologist, Registered Dietitian or Nutrition Professional 200 Covered Services under PFS
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
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
Reporting Options • Under an NPI • > 2 clinicians • Combination Individual Group Virtual Group number & TIN (NPIs) who of > 2 TINs where they have assigned to > 1 reassign reassigned individual benefits their billing MIPS ECs, or rights to a to > 1 groups single TIN consisting of < 10 ECs with > 1 • As an APM MIPS EC Entity
Polling Question #2 How many Eligible Clinicians (ECs) are at your practice? Enter your answer into the polling window on the right side of your screen
Year 4 Quality Category
Quality Overview Historical Context: Formally known as PQRS (2011-2018), the Quality Category covers the quality of care delivered based on performance measures best-suited for your organization/practice. Basic Requirements: Submit at least 6 Quality Measures w/ > 1 outcome or high priority measure 12-Month Performance Period 70% Data Completeness Scoring: Measure achievement points are earned based on a measure’s performance in comparison to a benchmark, exclusive of bonus points. Decile scoring range is based on national performance dependent on method of submission. Program Year Weight Multiple Submissions Collection Types Level of Reporting 2019 45% Yes eCQMs, MIPS CQMs, QCDR, Claims, CAHPS Group AND/OR Individual for MIPS Survey 2020 45% Yes eCQMs, MIPS CQMs, QCDR, Claims, CAHPS Group AND/OR Individual for MIPS Survey 2021 TBD TBD eCQMs, MIPS CQMs, QCDR, Claims, CAHPS Group, Individual, for MIPS Survey, MVP(s), TBD AND/OR MVP(s)
Web Interface • Exempt from topped out measures Web Interface • Reporting deadline extended to March 31 st • No bonus points awarded for Web Interface Bonus additional high priority measure Opportunities • No bonus points awarded for end-to-end submission • Adjustment to Denominator if CAHPS for MIPS practice does not meet the Survey minimum threshold for survey (reduced by 10)
Multiple Collection Types Considerations Possible Advantages Potential Challenges Additional Measure(s) Workflow(s) Flexibility Cost Mix & Match Uncertainty
QPP Y4: Changes to Quality Measures Requirements • Adding: • Increase of Data Completeness Requirement to 70% • 3 New Measures Final Score: • Scoring: • 7 New Specialty Measure Sets • Flat percentage benchmarks • Add 1 New Measure to the • 45% for 2020 Controlling High Blood CMS Web Interface Set • TBD for 2021 Pressure & A1C Poor Control • Added Claims-Based Measure • This only applicable for • 30% for 2022 & Beyond for PY21 Part B Claims & MIPS CQM • Removing: Measure Submissions • 42 Measures • Altering: • 83 Significantly for 2020+ • 1 Retroactive Change for 2019+
Data Completeness What is Data Completeness? What Not MIPS To Do Score Impact Requirements Cherry Picking: CMS will assign Claims: zero points for any Using data • 70% sample of measure that does Medicare Part B selection criteria to patients for the not meet data misrepresent a performance period completeness clinician or group’s requirements for performance for a the quality QCDR, MIPS performance period performance CQMs, & eCQMs: results in data that category. Small is not true, • 70% sample of practices will clinician's or group's accurate, or patients across all continue to receive complete payers for the 3 points performance period
Public Reporting Quality measures will not be publicly reported for the first two years in use, starting with Performance Year 2 Providers & Organizations have the opportunity to view data before it gets publicly published on Physician Compare
Quality Category Flexibilities Category Flexibilities Bonus Points • Additional Small Practice Specific Flexibilities High Priority Measures • End-to-End Minimum of 1 Reporting measure reported is Data completeness required to get the threshold not met= still 3 Point Floor Claims reporting still bonus gets 3 points rather for Scoring available than the 0 if 70 % is • Non Small MUST Improvement not met submit all 6 to get Scoring base Quality score Reweighting Opportunities
Reweighting Opportunities 2020 MIPS Category 3 Most Common Reweighting Scenarios Weights w/o Any Reweighting PI 25% No Cost IA PI 15% 25% Quality Quality 60% 2020 IA 45% IA 15% Weights 15% IA 15% Cost No Cost Cost 15% No PI & 15% No PI Quality Quality 70% 85%
Polling Question #3 How are you collecting data for Quality for the 2020 Program Year? Enter your answer into the polling window on the right side of your screen
Next Steps
Next Steps Use these Select Measures Pull Specification Specification Sheets Each Year Pull Your Data Sheets Assure your are Measures are updated Track your data Do this each year & accurately tracking each year so make regularly to be able to keep with your numerator & sure you review and make improvements documentation of denominator select your measures throughout the year submission & eligibility populations for each appropriately measure
Measure Deep Dive Put in Process Flow Process Workflows • Verify all reporting mechanisms align Verify • Validate denominators Documentation • Confirm data across all programs to Method measure impacts • Ensure consistency across clinical Pull workflows Specification Sheet Pull Decile Scoring Benchmarks Verify Internal Workflows
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