Event ID: WEBINAR- Measuring MIPS Performance: What s Your Score? Event Started: 4/12/ pm

Transcription

1 Event ID: WEBINAR- Measuring MIPS Performance: What s Your Score? Event Started: 4/12/ pm All right good afternoon my name is Olivia Henze from the New England QIN-QIO and I am your moderator for the WEBINAR- Measuring MIPS Performance: What s Your Score?. The organization works with healthcare providers stakeholders in communities across New England on data-driven quality initiatives to improve patient safety engage patients and families and improve clinical care at the community level. Make for joining the webinar. Before we start just a few housekeeping items of call is recorded for training purposes I will provide details on accessing the recording at the end of the webinar. Phone lines are muted for the presentation. We will take questions at the end of the presentation and I will provide instructions on how to ask a question over the phone or in the chat box. At this time I will send it over to Thushara James who will begin. Thank you Olivia for the introduction. The webinar Measuring MIPS Performance: What s Your Score? will focus on how performance is measured and methodology for each performance. Next during the webinar these are brief overview of the quality payment program and MIPS will discuss requirements of methodology for the performance categories quality improvement activities and advancing care information. We will also discuss possible payment adjustments and there will be a Q&A session afterwards. Will use a lot of acronyms in the presentation some are listed here on this slide. The Medicare access and chip reorganization act of 2015 our MACRA put into place several changes in created the quality payment program. This is a new framework for providing high quality care by establishing payment MIPS or APN. Physicians have an opportunity to review and sent to based on their performance. MIPS consolidates several quality reporting programs physician quality reporting system value-based modifier and meaningful use. The categories that make up the MIPS final scores are quality, advancing care information, improvement activities that the new category and cost coming from the value modifier. Each performance category is weighted and rolled into the status core. The rate of each category 2017 reporting period the categories are weighted as follows. Quality which calls 60% of the total score and must report on six measures including one outcome or high priority measure. Advancing care information accounts for 25% of the MIPS score and should report on required base measures depending on the

2 specification. Improvement activities account for 15% and must report on one to four activities depending on the practice site. The final category cost is 0% for transitional year 2017 but for the performance 2018 cost will account for 10% of the MIPS score. Eligibility and exclusion criteria. Most practitioners are eligible for MIPS physicians including MDs, physician assistant, nurse practitioners, clinical nurse specialist and certified registered nurse are eligible. There are exceptions. Exceptions include clinicians that submit payments of payments falling below the volume threshold that is 100 Medicaid patients are $30,000 or less in Medicare part B charges are excluded. Similarly clinicians in the first year of Medicare are excluded. Again clinicians who qualified for a bonus payment are also excluded. Your reporting pace. To ease the transition to MIPS CMS has reporting case options for The options are don't participate failed to report data to CMS are subject to the full negative payment adjustment of 4%. Reported at least one quality measure one improvement activity under the required measure and award the negative payment adjustment that is reported at least 90 days of data for more than one quality measure more than one improvement activity or for our five required ACI measures. The negative payment adjustment is a small positive adjustment. You can start reporting any time between January 1 and not over second The last one is full participation for the calendar year or six quality measures for improvement activities than are required based measures. Full participation optimizes ineligible clinicians in Scoring methodology all handed over to Rachel for more in-depth discussion. Rachel. Now I will walk you through the MIPS scoring methodology and will go category by category. We'll talk about how this overall composite score can translate into a payment adjustment for the payment year The majority of the scoring we will talk about is going to be doubtful participation are the 90 day reporting period and will talk a little bit about the pace options as well that we will mostly focus on if you're submitting for 90 day or full period. The first category we will talk about is a quality category which we mentioned is 60% of the final score in the transition year. Aix of approximately 300 available quality measures and reporting data on a minimum of 90 days. You also have the option to select a specialty set which may include greater than six measures or less than six measures. If the category has less than six euro my required to report the measures within that specialty set. You can also opt to report through the CMS web interface measures. There is also a readmission measure that will be calculated by CMS for group that have greater than 16 clinicians and sufficient cases. This would be greater

3 than or equal to 200 cases. So clinicians can receive anywhere between 3 to 10 points on each quality measure they submit and that is based on performance against benchmarks. If you are doing the pick your pace reporting for the transition year and you choose to submit one measure out one point in time to try to avoid negative penalty you can just submit that one measure and you will receive the minimum of three points. Failure to submit any performance data for a measure zero points. In this category like a few of the others there are bonus points that are available. A little bit more about receiving points for measures. Your one participants automatically receive three points for any measure they submit for regardless of performance and regardless of the amount of data that you actually are submitting but you can earn more points based on performance if there is a benchmark available. We will talk more in depth about benchmarks because we get a lot of questions about those. If the measure can be reliably scored against a benchmark than a clinician can receive between three and 10 points. Reliable scoring would be if there is a benchmark that exists also if you are submitting sufficient case volume which would be submitting at least data on 20 patients for most of the measures. Also the data complete messes met so this is a little different than PQRS so this would be 50% of possible data submitted for this particular measure. If the measure cannot be reliably scored against the benchmark some of the measures that are not benchmarks to compare your performance to, you can receive that three points for submitting the measure. A little bit more about benchmarks. You can go to the Tran10.gov website to learn more about the benchmark third download a file that shows all of the different benchmarks for each quality measure. There are different benchmarks depending on the reporting mechanisms so EHR based reporting they all have different benchmarks. I would encourage you to go to the QPP website to look when you determine what quality measures you want to submit because you will be able to estimate the amount of points and where your performance lies based on those benchmarks. The benchmarks are created based on all reporters it's not separated into practice size or specialty they are all combined into one benchmark. Like I mentioned there are not necessarily benchmarks for every single quality measure. They are looking to create new benchmarks and may need at least 20 reporters and their specific criteria that needs to be Matt and a few meter exceed that minimum case volume which in most cases is 20 patients they need to ask the Army the criteria which is 50% of possible data being submitted and the performance in that category has to be greater than 0% unless it happens to be an inverse measure which would have to be less than 100%. This is looking at benchmarks. So if you were to go to the website and download the file on benchmarks this is what you will see. For example you see the measure name

4 this one is diabetes hemoglobin A-1 C for control and we know this is an inverse measure because you want the majority of patients to be an control you don't want a high number to be in poor control. For this particular measure we are looking at a claims-based benchmark. So if you go down to the right hand side you can see it is separated into different decibles so those are based off of your numerator and denominator so basically your performance. As you can see as you get a smaller number so less of your patient control you fall within[ No audio ] Sorry everyone I will get to the next slide. As Rachel mentioned there are decibels scores a come for each of the quality measures your reporting on. This is a slide to show you how those decibels fall in the number of points you can earn. You can see if you were to fall into the decibels six group you can get between six and 6.9 points. If you're at the lower end you would get closer to six are closer to 70. The higher-end. Bonus points you can earn for each quality measure of you submit high priority or outcome measures you can get one or two points for each of those. There is a requirement to have at least one out, or high priority measure in your six measures you select anything outside of that you would get bonus points for. If you report using your certified EHR for all of your measures you can get one bonus point per measure you report for using Matt EHR and that means you are not doing any manual abstraction that data is pulled from the EHR and sent to the MS. This is how the quality score is calculated the total points per measure following the decibels score. Any bonus points you are and divided by the maximum points you could earn for the category. If you're in a group of 16 are more that points to 70 because there is at resubmission measuring fluted. Appear in a larger group are using the web interface you need to report additional measures. If you use the web interpose its 15 measures as you can see that the hundred and 20 points. Groups that don't have that if the hundred and 10 points and as I mentioned for the 15 and under groups that 60 points because you don't have the readmission measure and nephew are 16 and above you have 70 point. We have a question for you to test your knowledge. If an eligible clinician scores of 70 out of 97 on the pneumonia vaccination status and they submit that using EHR direct what is their performance score currently and what performance decibels do they fall into. This is thus screenshot of the decibels scoring. Test your knowledge and I will show you the answer in just one moment.

5 All right so a is an 80.41% and based on that measure deciles scoring May reported EHR direct so they would fall in the ninth decile and because they are toward the higher middle range they would get about 9.5 points. I'm sorry so to take up where she left off. I think she explained this slide. Sorry to everyone listening. You have to love the technical issues we come across. This next question and again type your answer in chat and eligible clinician in a group of less than 15 reports on for outcome measures and uses their certified EHR brand and reporting on all six measures they submit. How many bonus points would they earn? Please type in your answer in chat. All right I'm not saying too many answers so we will move ahead. So the answer if your reporting on an additional three outcome measures and as we mentioned the outcome measures you can get to bonus points per measure so that would be a total of six bonus points. With the end to end reporting you would get one bonus point per measure and they used it for all six measures so that is an additional six bonus points. That gives you a total number of 12 bonus points earned. So that completes the quality category. Now we will move on to improvement activities which is a little less complex. As we mentioned improvement activities account for 15% of the final score. You can earn a maximum number of 40 points and there are over 90 improvement activities and a variety of different categories you can choose from. Each activity has a specific weight designation so it could be a medium weight category or highway category. Typically a media weight category Aaron's 10 points and a high weight earns 20 points. There are alternative ways for clinicians in small rural practicesso the points would double in those categories. You can look online again on the QPP website to see each weight is worth. Also certain clinicians earn self credits for this category so if you are part of a patient centered medical home a medical home model or similar specialty practice you earn 40 points. For this year current earn the point so if you're part of a Medicare shaved program you also earn enough all 40 points for this year. Okay so the scoring for this category to figure out your overall improvement activities score you would obviously take the total number of points you earned for your completed act Hebrides divided by the maximum number of points which is 40 and the score cannot exceed 100% so if you do extra activities you cannot get over a 100% score.

6 Here is another question. Again if you can type your answer in chat. And eligible clinician works with the New England QIN QIO to implement antibiotic stewardship as well as the diabetes self-management education program for their diabetic patients. How many improvement act to be points will they earn? Keep in mind that both of these activities are medium weight activities. How many activity points with eight earn? Moving forward again the antibiotic stewardship and diabetes self-management programs are medium weight activities which would earn 20 points, 10 points each. These are programs that we actually help practices with sofa something you want more information on you can talk to us after the presentation. Here is another question so looking for some keywords a model group of eligible clinicians: participation in transforming clinical practice initiative as one of their improvement activities. How many more activities will they need to attest to implementing? Another hand this is considered a high weight activity. Again I want to reiterate that we are recording the webinar and it will be available if it's something you want to look at later. Sometimes it's hard to answer questions right on the spot. I see a couple of answers and those are correct. They do not have to attest improvement activities they have already met the 40 point maximum. They are small and rural eligible clinicians the activity of the high weight activity which normally earns 20 points it would double to 40 point so they have reached the maximum points. Moving on to advancing care information and we get a lot of questions on this. It's a little more complex than the improvement act cavity. I'll try my best to explain it in no way that everyone can understand. There are three categories for scoring on the advancing care information section. Overall it accounts for 25% of the final score and the categories are this slide is talking about the base score so thiscategory so clinicians must submit a numerator and denominator or a yes or no or response for each measure and can choose from one of each of these measures so on the left-hand side juicy advancing care information measures and those are based off of EHR technologies certified for the 2015 at edition and then there is a 2017 transition measures for those EHR's that are certified for that digestion. Essentially you have to submit information on each of these measures and failure to submit on one of the measures within the measures that would actually result in a zero score so it is all or nothing for the base score. Also furthermore if you are not able to meet the base score you get an overall zero score for the advancing care information category. It's important to take a look at

7 this category and see if you are able to meet the base score and if not you will not be able to get points for the performance or bonus score. Again if you are doing your own pace for this category and this is the one category you have to submit for advancing care information you would have to submit all the measures within the measures that and complete the base score in order to get that score for that particular case. So moving on to the performance score so this gives you the option or availability to earn more points based on adding additional measures and performance on those measures. Again there is a number of similarities between the measures but they are based off of the nine measures and the seven measures are based off of 2014 so there are a few slight differences. You can get additional percentage points based on your performance rate so you would submit one of these measures and then you would determine your performance rate and look at this table on the right-hand side and based on where your performance falls you would add additional percentage points and earn additional percentage points or measures. So for example if you submit a measure and your performance grade is in the 60s you get an additional 7%. So you would look at the table for all of the additional measures you are submitting and you would add that that would be your percentage score. There are couple of measures that would give you double the points on this table and those include the providing patient access measure and the health information exchange measure and you can get more information on that from the QPP website. Then there is a bonus score so you can get five additional percentage points for reporting public health and clinical data registry electronic cases then you can also get 10 percentage points for using CEHRT to report some certain improvement activities so you can get up to 15 percentage points bonus for the advancing care information category. You have to look at all the scores you got within the base score the performance score in the bonus score and add them so the base score would be 0 to 50 if it's narrow you know the overall score for the category will be a zero. If use 50% you can add whatever you had scored within the performance category in the bonus score and again it is going to be capped at 100%. We another question. Again type your answer in chat. And eligible clinician reports the following on the required base measures. They said yes to the security risk analysis four E-prescribing zero out of 17 for provide patient access and two out of 19 for health information exchange. Will this meet the base requirements? Some people are typing in chat and you are correct no they will not meet the

8 requirements because they answered with a zero numerator and the patient access category and you have to have at least one patient to meet the reporting requirements. So this is a little tricky question if you don't have the table in front of you. We will probably just walk through it. A group of eligible clinicians report 625/723 on measure provide patient access using a 2014 certified EHR. What is their performance rate and what will their percentage score be? I'll jump ahead their performance rate you will divide the numerator by the denominator and you will get Looking at the table you will see their performance rate fell between 81 and 90 so they will get the nine percentage points if it were a normal measure however this particular patient access measure is actually one of the measures you get double the points for so then you would double it to 18 percentage points. Now that we have talked about the advancing care information category we will talk about cost. In terms of your MIPS score for the transition year for 2017 it does not affect your overall score so it's 0% of the final score but again as we mentioned 10% of the final score next year so it's important to pay attention to this category as well. There is no or reporting requirements clinicians are assessed based on Medicare claims data and even though it ways into the final score CMS will still provide feedback on how you perform so you have an idea of where you might need to focus moving forward. It will not affect your 2019 payments. They determine this based on previously used physician value-based modifier measures and those measures that are reported in the quality and resource use report so we encourage you to download and look at your report to get an idea of what those types of measures are looking like. Okay so putting it all together. We talked about how to find out your score for each of the four categories. Then you need to put it all together so you would take your performance score for each category and multiplied it by the category and you would add those altogether multiplied by 100 and then gives you the final MIPS score. We will walk through an example to demonstrate how it is done. Again the best way to do this is to look at each category and figure out your score within each category and combine those. And eligible clinician or the following scores they earned 45 out of 60 and quality, 40 points in improvement activities and 75% in the advancing care information category. So what is this eligible clinicians final MIPS score? So 45 out of a possible 60 points gives you 75% and that quality category. You take that.75 and multiply it by the 60% which is the weight of the quality category. For improvement categories you get 40 out of 40 points a 100% so you take that multiply it by the category weight of 15%. In advancing care information you get 75% so you

9 would take the 0.75 and multiply it by the category weights of 25% and again you have the cost category which is zero percentage weight for the transition year. So once you add those together you get a final MIPS score of 78 of 78.75%. We have one more example and this reminds me of a problem-solving example from back when we were in school so we will walk through this as well I don't expect you to know it off the top of your head but I would encourage you to look at this at some point and use it as a reference. And eligible clinician within a patient centered medical home of less than 15 clinicians submit six quality measures that they are unable to achieve data completeness for any of the measures. The same clinician met the reporting requirements for the Tran to base measures and submitted to additional ACI performance measures with the performance rate of 35 and 60. We will break this down a little bit. Looking at the quality category so this particular clinician submitted six measures however we stated they did not reach data completeness for each measure therefore they would only get the minimum of three points for each measure so that would give them eight teen out of a possible 60 points. We know the resubmission measure would come into play because we mentioned in less than 15 clinicians in this practice and then now that we have seen what the scores for quality moving through improvement act cavities we mentioned this is a medical home so that gives them the ball 40 points. Advancing care information this particular practice met that they score at 50% and then they also submitted it to show measures which if you have the table in front of you could determine the additional percentage points based on that performance rate they had so we stated that a performance rate for the additional measures they submitted was 35 and 60 which gives an additional 10 percentage points for the ACI category so that the total of 60% for that category. Then again you would multiply by the weight of each category and add everything together to come up with the final MIPS composite score of 48%. So what is this final score? We know in order to get a payment adjustment that is negative or positive you how to look at your overall performance score. For the 2017 transition year if you do nothing and get zero points that is how you will get a negative payment adjustment of -4%. If you do something you said that one measure and manage to get three points you will have neutral payment adjustment. For this table for 2019 payment you're so you can estimate a little bit on whether you will get a neutral adjustment, negative, positive or positive with an exceptional performance bonus as well. When we look at the two examples we did the first example we did that performance total composite score was 78 total composite score was 78.25% so if you were to score a 78 total composite score was 78.25% so if you were to score a you fall within that category that would be eligible for the positive payment adjustment in addition to the exceptional performance bonus which is another pool of money available. In the second example we gave the clinician for the 48% final score

10 so he would get a positive adjustment but he would not be eligible for the exceptional performance bonus. This is a graph of what the MIPS payment adjustment factor looks like based on your final scores for the 2019 payment year. You can see there is a performance line which equals three so that is where the performance threshold is set for the first transition year which means if you get three points you are neutral and you avoid a negative payment adjustment you don't get a positive payment adjustment. In the coming years that performance threshold will change and it is going to change based on a budget neutral performance and you are going to fall below or above it there will not be that many people that fall on the performance thresholds. That is essentially the number of points you would need to get to avoid a negative payment adjustment. You see at the far right that is the additional adjustment fact. At 70 points and if you fall within that category you get a positive payment adjustment in addition to the exceptional performance incentive. I know this is a lot of information and sometimes when you do math you can get confused especially. Again this webinar is being recorded and will be available on the website. We have a number of other resources and we have staff in each state so I encourage you to contact one of us if you have additional questions. The website is a great resource so if you've not been on that website I encourage you to look at it. You can look at the quality measures improvement act cavities and more information on the information categories. With that we would like to open it up for any questions you might have. Thank you for listening in. Thank you Rachel. It's Olivia. Thank you for a great presentation. We will take questions and if you would like to ask a question you can post your question in the chat box and send it to all participants. If you want to ask a question over the phone press pound six to unmute your line. Rachel that looks there is a question from Sandra O'Brien. I practice at multiple locations reporting under two different things how is my performance scored do I need to participate for both TIN Founder of the first question would be under each TIN do you meet the low volume threshold that was mentioned earlier in the presentation? If either of those fall below the threshold you are excluded at that location. If it's about the $30,000 in Medicare claims than 100 Medicare patients you need to report there so depending where you fall in that criteria you would need to adjust your reporting. In terms of being scored if you report you fall under those same decile scores Rachel mentioned based on the measures you selected each of those

11 locations. So a little bit bookkeeping and tracking quandary but if you have good records we can help you with that as well. Thank you Leila. I know Lisa had asked Rachel can you describe the QPP support services available cost? We have a number of services available throughout the region. We have dedicated staff in each state and we offer tech equal assistance, one on one, education assistance. Our services are completely free of charge. We offer these webinars monthly and we have a number of resources available on the website. You can submit questions if you have one general question and we won't get that to the appropriate person within your state. So there are a lot of different resources including individualized health it selecting quality measures, looking at your performance, or in general QPP questions. We have one more question from Joan. What date of the included if either of the practice locations reported as a group? I'm thinking Joan are you referring to the group reporting under multiple TIN? Okay outlooks like I am -- referring to the previous scenario. If each TIN reports as a group and they meet the inclusion criteria $30,000 or 100 Medicare beneficiaries ESF providers data would be included in both of those groups that they report as a group. Thank you Leila. Does anyone else have a question or does anyone want to make a comment? You can press*six. While we are waiting Rachel or Leila or Thushara does anyone have a question. Even if she does not exceed the low volume threshold as an individual? At the practice reports as a group in a clinician within the group even if they do not exceed the low volume threshold is included in reporting for that group. The only time they would be included is if everyone in the group was excluded. The only time they would be asked it is if everyone in the group was excluded. I sent a question but it was during the presentation. I wanted to clarify information that I was presented and that's with the ACI component. There could be a maximum of 155 points and if you are reporting as a group that would benefit the group. I understand it's capped at 100% but if you have performers in your group you potentially could offset that with the capped out score of 155.

12 Yes we have ones that are doing really well and they got close to 155 and we have some that faulty below performers can pull up those lower performers. In particular for those physicians in a track one ACO where the ACI component stands alone and cannot report under the ACO directly I think it would have a huge impact on those practices. You bring up a great point under the Medicare that is weighted by the size of the group that is reporting so a group that is not performing as well and is small if there is a larger group reporting than their score would help. If it's a large group not performing well they could have some pretty detrimental effects on the overall score of the ACO. Thank you. Absolutely. IA did you see the question do we still have to report for 2017? Is that been answered already? It has not. Can 2017 I'm not sure what date you are referring to. Before October ACO's report for the full year so you would not report until the beginning of next year. I think the act over 2017 date may be in reference to the last full 90 days reporting period. So I think October 2 would be the last date to fulfill the 90 day reporting period. Great thank you guys. Again please feel free to continue asking your questions in chat or over the phone, pound six to unmute your phone line. As I was saying before is there anything else you would like to add before we wrap up today? Any closing remarks or statements?

13 I guess I could say thank you for attending to look for additional webinars in the upcoming months. I apologize for our technical difficulties and also again I encourage you to check out the website for more information. I did type that into the chat box so you can directly link in through there and also again the website is a great resource if you are looking for measures and improvement activities. It is actually a really nice easy to navigate website as compared to some of the previous CMS website so I encourage you to look at that. Thank you Rachel. Thank you all for joining us and please tune in for future webinars and contact us if you have any questions. Thank you to everyone and again thank you Rachel and Leila and Thushara. I want to thank everyone for a great discussion. I have a few announcements. When you close out of the webinar the evaluation pops up on your computer. If you could please fill that out we would appreciate it. If you don't have time right now or you are sharing a computer you will receive an tomorrow morning with that link as well as only to the about page on the website. The PowerPoint was in your and is posted on the website and within the next few days the recording and transcript of the webinar will be added. Thank you to everyone and I hope everyone has a fantastic day. [ Event concluded ]