Title: Advanced APMs & MIPS APMs

Transcription

1 Title: Advanced APMs & MIPS APMs Date June 8 th, 2017 This material was prepared by Telligen, the Medicare Quality Innovation Network Quality Improvement Organization, under contract with the Centers for Medicare & Medicaid Services (CMS), an agency of the U.S. Department of Health and Human Services. The contents presented do not necessarily reflect CMS policy 11SOW-CO-D1-06/07/

2 Telligen QIN QIO Telligen: Quality Innovation Network-Quality Improvement Organization (QIN-QIO) for Colorado, Illinois and Iowa Subject Matter Experts for CMS Quality Performance Initiatives Courtnay Ryan Colorado Temaka Williams Illinois Linda Brewer Illinois Sandy Swallow Iowa 2

3 Objectives Quality Payment Program General Updates Provide an overview of the Quality Payment Program Advanced Alternative Payment Model Track Benefits, criteria, 2017 approved models, qualifying professionals, resources Provide an overview of the MIPS APM track Participation, criteria, qualifying professionals, scoring, resources , Telligen, Inc.

4 QPP Updates - Stay Informed! Predictive Qualifying APM Participants (QP) Fact Sheet: Quality Payment Program Overview Online Course Quality Payment Program Pick Your Pace Online Course Based-Programs/MACRA-MIPS-and-APMs/Quality-Payment-Program-Events.html 2017 Clinical Quality Data Registry Approved List Released: , Telligen, Inc.

5 Disclaimer The information in this presentation is what we currently know as it has been explained by Centers for Medicare and Medicaid Services (CMS). The program is evolving with new rules and regulations to come. Slide Credits: Thank you to Dr. Mark Levine, CMS Region VII 5

6 The Quality Payment Program (QPP) Medicare Access and CHIP Reauthorization Act MACRA Passed with Bipartisan Congressional Support Repealed the Sustainable Growth Rate Reforms Medicare Part B payments Provides Two Tracks: MIPS and APMs 6

7 Quality Payment Program Strategic Goals Improve Beneficiary Outcomes Enhance Clinician Experience Increase Adoption of Advanced APMs Improve Data & Information Sharing Maximize Participation Ensure operational excellence in program implementation 7

8 Advanced Alternative Payment Models (APMs) nc 8

9 What is an Alternative Payment Model? New approach to paying for medical care through Medicare that incentives quality and value. Developed by CMS Innovation Center Participants in APMs receive greater reward for taking on risk related to patient outcomes 9

10 What are Advanced APMs? The Basics of Advanced APMs APM Requirements to be Considered an Advanced APM Uses certified EHR technology Collects quality measures data comparable to MIPS Advanced APM Either:(1) is a Medical Home Model expanded under CMS Innovation Center authority OR (2) requires participants to bear more than a nominal amount of financial risk , Telligen, Inc.

11 Advanced APM Criterion 1 1. Requires participants to use certified EHR technology Requires that at least 50% of the clinicians in each APM Entity use certified EHR technology to document and communicate clinical care information with patients and other health care professionals. 11

12 Advanced APM Criterion 2 Bases payments on quality measures that are comparable to those used in the MIPS quality performance category. Ties payment to quality measures that are evidencebased, reliable, and valid. At least one of these measures must be an outcome measure if an appropriate outcome measure is available on the MIPS measure list. 12

13 Advanced APM Criterion 3 (2 Parts) is a Medical Home Model expanded under CMS Innovation Center authority, OR requires participants to bear a more than nominal amount of financial risk. 13

14 Benefits of a Participant in an Advanced APM Are excluded from MIPS Receive a 5% Lump Sum Bonus Advanced APM Specific Rewards Receive a higher Physician Fee Schedule Update starting in

15 2017 Advanced APMs: Eligible Advanced APMs Include: Comprehensive ESRD Care Model Comprehensive Primary Care Plus (CPC+) Medicare Shared Savings Program Track 2 and 3 Next Generation ACO Model Oncology Care Model Two- Sided Risk Arrangement 15

16 What is a Qualifying APM Participant? Qualifying APM Participants (QPs) are clinicians who have a certain % of Part B payments for professional services or patients furnished Part B professional services through an Advanced APM Entity. 16

17 Quality Payment Program How do Eligible Clinicians become Qualifying APM Participants? Step 1 Qualifying APM Participant determinations are made at the Advanced APM Entity level, with certain exceptions: individuals participating in multiple Advanced APM Entities, none of which meet the QP threshold as a group, and eligible clinicians on an Affiliated Practitioner List when that list is used for the QP determination because there are no eligible clinicians on a Participation List for the Advanced APM Entity. For example, gain sharers in the Comprehensive Care for Joint Replacement Model will be assessed individually. 17

18 Quality Payment Program How do Eligible Clinicians become Qualifying APM Participants? Step 2 CMS will calculate a percentage Threshold Score for each Advanced APM Entity using two methods (payment amount and patient count). Methods are based on Medicare Part B professional services and beneficiaries attributed to Advanced APM CMS will use the method that results in a more favorable QP determination for each Advanced APM Entity. These definitions are used for calculating Threshold Scores under both methods. Attributed (beneficiaries for whose cost and quality of care the APM Entity is responsible) Attribution-eligible (all beneficiaries who could potentially be attributed) 18

19 Quality Payment Program How do Eligible Clinicians become Qualifying APM Participants? Step 2 The two methods for calculation are Payment Amount Method and Patient Count Method. Payment Amount Method Patient Count Method $$$ for Part B professional services to attributed beneficiaries $$$ for Part B professional services to attributioneligible beneficiaries = Threshold Score % # of attributed beneficiaries given Part B professional services # of attribution-eligible beneficiaries given Part B professional services = Threshold Score % 19

20 Quality Payment Program How do Eligible Clinicians become Qualifying APM Participants? Step 3 The Threshold Score for each method is compared to the corresponding QP threshold table and CMS takes the better result. Requirements for Incentive Payments for Significant Participation in Advanced APMs (Clinicians must meet payment or patient requirements) Performance Year and later Percentage of Payments through an Advanced APM Percentage of Patients through an Advanced APM 20

21 Quality Payment Program What is the Performance Period for QPs? The QP Performance Period is the period during which CMS will assess eligible clinicians participation in Advanced APMs to determine if they will be QPs for the payment year. The QP Performance Period for each payment year will be from January 1 August 31 st of the calendar year that is two years prior to the payment year. Performance Period: QP status based on Advanced APM participation Incentive Determination: Add up payments for Part B professional services furnished by QP Payment: +5% lump sum payment made (excluded from MIPS adjustment) 21

22 Quality Payment Program What are the three Snapshots for QPs during the Performance Period? During the QP Performance Period (January August), CMS will take three snapshots (March 31, June 30, August 31) to determine which eligible clinicians are participating in an Advanced APM and whether they meet the thresholds to become Qualifying APM Participants. MAR 31 JUN 30 AUG 31 22

23 Quality Payment Program When Will Clinicians Learn their QP Status? Reaching the QP threshold at any one of the three QP determinations will result in QP status for the eligible clinicians in the Advanced APM Entity Eligible clinicians will be notified of their QP status after each QP determination is complete (point D). #1 #2 #3 May Jan 2017 Feb 2017 Mar 2017 Apr 2017 Jun 2017 Jul 2017 Aug 2017 Sep 2017 Oct 2017 Nov 2017 Dec A B C D A B C D A B C D 23

24 Quality Payment Program What if Clinicians do not meet the QP Payment or Patient Thresholds? Clinicians who participate in Advanced APMs, but do not meet the QP threshold, may become Partial Qualifying APM Participants (Partial QPs). Partial QPs choose whether to participate in MIPS. Payment Year Percentage of Payments Medicare-Only Partial QP Thresholds in Advanced APMs and later Percentage of Patients 24

25 MIPS-APMs the third track MIPS Advanced APM MIPS-APM 25

26 MIPS-APM Basics Requirements to be considered a MIPS-APM include: Participate in the APM under an agreement with CMS Include one or more MIPS eligible clinicians on a Participation List Bases payment incentives on performance (either at the APM Entity or eligible clinician level) on cost/utilization and quality 2017 Eligible MIPS- APMs CEC Model CPC+ Model MSSP Track 1,2 & 3 Next Gen ACO OCM All arrangements Note: APM scoring standard applies to APMs that meet these criteria 26

27 How Do We Participate as a MIPS APM? Quality Performance Category Cost Performance Category Improvement Activities Performance Category Advancing Care Information Category 27

28 Shared Saving Program (SSP) (All Tracks) under the APM Scoring Standard Performance Category Quality Cost Improvement Activities (IA) Advancing Care Information 28 Reporting Requirements ACOs submit quality measures to the CMS Web Interface on behalf of their participating MIPS eligible clinicians MIPS clinicians will not be assessed on cost No additional reporting necessary All ACO participant TINS in the ACO submit under this category according to the MIPS group reporting requirements. Performance Score Weight The MIPS quality performance category requirements and benchmarks will be used to score quality at the ACO level 50% N/A 0% CMS will assign the same IA score to each APM entity group based on the activities required of the participants in the SSP. All of the ACO Participant TIN scores will be aggregated as a weighted average based on the # of MIPS clinicians in each TIN to yield one APM Score 20% 30%

29 Next Generation ACO Model under the APM Scoring Card Performance Category Quality Cost Improvement Activities (IA) Advancing Care Information 29 Reporting Requirements ACOs submit quality measures to the CMS Web Interface on behalf of their participating MIPS eligible clinicians MIPS clinicians will not be assessed on cost No additional reporting necessary Each MIPS clinician in the APM Entity group reports ACI to MIPS through either group reporting at the TIN level or individual reporting Performance Score Weight The MIPS quality performance category requirements and benchmarks will be used to score quality at the ACO level 50% N/A 0% CMS will assign the same IA score to each APM entity group based on the activities required of the participants in the SSP. CMS will attribute one score to each MIPS clinician in the APM group. 20% 30%

30 All other MIPS APMs under the APM Scoring Card Performance Category Quality Reporting Requirements The APM Entity group will not be assessed on quality under MIPS in the first performance period. Performance Score Weight N/A 0% Cost Improvement Activities (IA) Advancing Care Information MIPS clinicians will not be assessed on cost No additional reporting necessary Each MIPS clinician in the APM Entity group reports ACI to MIPS through either group reporting at the TIN level or individual reporting N/A 0% CMS will assign the same IA score to each APM entity group based on the activities required of the participants in the SSP. CMS will attribute one score to each MIPS clinician in the APM group. 25% 75% 30

31 MIPS APM Summary Goals Reduce eligible clinician reporting burden Maintain focus on the goals and objectives of APMs Tactics Streamlined MIPS reporting and scoring for eligible clinicians in certain APMs Aggregates eligible clinician MIPS scores to the APM Entity level All eligible clinicians in an APM Entity receive the same MIPS final score Uses APM-related performance to the extent practicable 31

32 QPP APM Track Summary 32

33 Quality Payment Program The Quality Payment Program provides additional rewards for participating in APMs. Potential financial rewards Not in APM In APM In Advanced APM MIPS adjustments MIPS adjustments + APM-specific rewards If you are a Qualifying APM Participant (QP) = APM-specific rewards + 5% lump sum bonus 33

34 Telligen QIN-QIO is Here to Help! Experienced quality improvement advisors to provide expert technical assistance and quality improvement support for participating providers across the state Join the monthly webinars Coffee Talks with subject matter experts: Focused QPP topic Open discuss with Q & A dedicated to your questions 2 nd Thursday every month 11:00 a.m. CST for 1 hour July 13 th Aligning Quality Measures selection to ALL MIPS performance categories for more efficient outcomes. Register here Partner with Telligen QIO on practice improvement activities Participation with a QIO in a self-management training program (diabetes) Implementation of antibiotic stewardship program Implementation of a cardiac quality improvement program 34

35 Resources The Innovation Center s Learning Systems provides specialized information on: Successful Advanced APM participation The benefits of APM participation under MIPS 35

36 CMS Help Desks 36 QPP Service Center

37 Q & A Session! Contacts: Iowa Sandy Swallow Sandy.swallow@area-d.hcqis.org Illinois Linda Brewer Linda.brewer@area-d.hcqis.org Illinois -Temaka Williams Temaka.williams@area-d.hcqis.org Colorado Courtnay Ryan Courtnay.ryan@area-d.hcqis.org 37