JANUARY 19, How to Read and Effectively Use Your QRUR to Prepare for 2017 MIPS

Transcription

1 JANUARY 19, 2017 How to Read and Effectively Use Your QRUR to Prepare for 2017 MIPS

2 QRUR and MIPS Panel BETH HOUCK, MBA Vice President, Client Services SA Ignite MATTHEW BARRON Director, Advisory Services SA Ignite

3 Agenda I QRUR Overview and MIPS Readiness A. Sections of QRUR B. How to obtain your 2015 Quality and Resource Use Report C. Understanding the Value Modifier D. Interpreting Exhibits II. III. QRUR Tables Review Benchmark Regulation Review IV. Next Steps: Optimizing for MIPS V. Appendix

4 2015 QRUR Overview and MIPS Readiness

5 2015 QRUR The 2015 Annual QRURs show how groups and solo practitioners performed in 2015 on the quality and cost measures used to calculate the 2017 Value Modifier. QRURs are identified by the TINs registration name and the last four digits of your Medicare-enrolled Taxpayer Identification Number. Key Learnings for MIPS: 1. Shows current performance on Quality measures; baseline for MIPS score 2. Gives insight into CMS-3 (All Cause Readmissions); a claims-based measure that will impact the MIPS Final Score QRUR tables contain beneficiary-level and provider-level information 4. Cost data will not have an immediate impact on your MIPS Final Score in 2017 but subsequent years will see the Cost category carry increasing levels of influence

6 Sections of QRUR I. Your TIN s Value Modifier A. Shows overall performance on quality and cost measures II. How does the Value Modifier apply to your TIN in 2017? III. IV. How does the high-risk bonus adjustment apply to your TIN? Your TIN s quality tier V. What quality measures are used to calculate the Quality Composite Score? A. Domain-specific scores VI. VII. Your TIN s cost tier What cost measures are used to calculate the Cost Composite Score? VIII. Accompanying tables IX. Glossary of terms

7 2015 QRUR: How to Obtain 1. Log in to the CMS Portal: 2. Create Enterprise Identity Management System (EIDM) account 3. QRURs are provided for each Medicareenrolled Taxpayer Identification Number (TIN) 4. CMS site on how to obtain a QRUR Quality measures = 60% of 2017 MIPS Final Score Cost = 10% of your 2018 MIPS Final Score Let s take a look at a Sample QRUR

8 Your TINs Value Modifier Shows how your TIN compares to a representative sample of other TINs Quality Score < -1 = Penalty -1 < Score < 1 = Neutral 1 < Score = Incentive Cost Score < -1 = Incentive -1 < Score < 1 = Neutral 1 < Score = Penalty low score is BAD for Quality, GOOD for Cost

9 How Does the Value Modifier Apply to Your TIN in 2017? Average Quality performance and average Cost performance in performance year 2015 result in no adjustment in payment year The Adjustment Factor under PQRS will change to the X Factor under MIPS. This will allow CMS to ensure the program remains budget neutral year over year.

10 Quality: Interpreting Exhibits Quality measures will remain the same under MIPS The number of eligible cases will impact how many MIPS points (3-10) are earned for a measures Under PQRS, benchmarks are ALL TINs in a peer group. Under MIPS, different reporting mechanisms will have different benchmarks Under MIPS, you will select 6 Quality measures (1 of which must be an Outcome measure but there will no longer be quality domain requirements); bonus points are available depending on the measures you select. It is also important to note that different reporting mechanisms (EHR Direct, Registry, etc.) will have different benchmarks.

11 Quality: CAHPS Not required under MIPS (will count as 1 measure if done; bonus points available if you complete CAHPS and at least one other high priority measure) The QRUR is the first time you will see what your performance was on CAHPS (CAHPS vendors are NOT allowed to share their results with you)

12 Quality: Claims-based Measures Eliminated under MIPS CMS-3 (All-cause Hospital Readmission) will survive under MIPS. Tables 2A and 2B will show us additional information about how to address

13 Cost Six cost measures (all of which are risk-adjusted) are used to calculate your TIN s Cost Composite Score based on performance in 2015; 2 cost measures (Per Capita Costs for all Attributed Beneficiaries and Medicare Spending per Beneficiary) will carry into MIPS: Your TIN Benchmark Per capita costs for all attributed beneficiaries: Medicare patients attributed to ONE TIN Sum of total Med A and Med B payments for those patients Total number of dollars / Total number of Medicare patients = per capita cost (which is compared to national standards)

14 QRUR Tables Overview

15 Tables Formerly known as Supplemental Exhibits, the QRUR tables contain a significant amount of information. Important notes:

16 Tables

17 Determining Eligibility: Table 1 CMS determines eligibility AFTER the conclusion of the performance year based on PECOS system and Medicare claims a subset of PQRS-eligible providers will be deemed MIPS-eligible clinicians Important to consider MIPS eligibility (specialties, low volume thresholds, etc.) MIPS exemptions should be published by CMS by end of 2017 Q1

18 Quality: Table 7 Shows all measures that were submitted for each individual provider

19 Quality: Table 7 Shows all measures that were submitted for each individual provider Unique line-item for each provider/measure that was submitted Shows the reporting mechanism and number of eligible cases for each measure; important reference for MIPS

20 Quality: Table 2 - All Cause Readmission Table 2 consists of three tables that shed light on the specific patients that are contributing to your CMS-3 score: 1. Table 2A: Beneficiaries Attributed to Your TIN for the Cost Measures (except Medicare Spending per Beneficiary) and Claims-Based Quality Outcome Measures, and the Care that Your TIN and Other TINs Provided 2. Table 2B: Admitting Hospitals: Beneficiaries Attributed to Your TIN for the Cost Measures (except Medicare Spending per Beneficiary) and Claims-Based Quality Outcome Measures 3. Table 2C: Hospital Admissions for Any Cause: Beneficiaries Attributed to Your TIN for the Cost Measures (except Medicare Spending per Beneficiary) and Claims-Based Quality Outcome Measures

21 Quality: Table 2 - All Cause Readmission Table 2 consists of three tables that shed light on the specific patients that are contributing to your CMS-3 score: Table 2A Beneficiaries Attributed to Your TIN for the Cost Measures (except Medicare Spending per Beneficiary) and Claims-Based Quality Outcome Measures, and the Care that Your TIN and Other TINs Provided Table 2B Admitting Hospitals: Beneficiaries Attributed to Your TIN for the Cost Measures (except Medicare Spending per Beneficiary) and Claims-Based Quality Outcome Measures Table 2C Hospital Admissions for Any Cause: Beneficiaries Attributed to Your TIN for the Cost Measures (except Medicare Spending per Beneficiary) and Claims-Based Quality Outcome Measures

22 Quality: Table 2A Identifies which physician billed the greatest number of primary care services for a given patient One row for each patient; based on an INDEX # (links patients across Tables)

23 Quality: Table 2B Which hospitals are my patients going to? Shows more summary-level data Good for understanding which hospitals are causing your readmission numbers to be good/bad Understanding your span of control is critical for addressing readmission rates; figuring out how to coordinate care with these hospitals will drive operational optimization under MIPS

24 Quality: Table 2C What diagnoses are causing my readmissions? Patient index # ties back to preceding tables and ties to each admission (along with diagnosis AND readmission information). What hospitals are involved in my readmissions? Is there a correlation between my readmission risk and the status under which they were discharged? You can tie this information back to the provider that was/is most involved in a particular patient s primary care how much influence do specific providers have?

25 Benchmark Regulation Review

26 Benchmark Regulation Review Benchmark values published for each submission method All performance values against benchmark are shown on a decile scale; Quality category scoring related to decile performance Measures without benchmarks receive 3 point minimum Topped out measures can receive 10 points

27 Benchmark Regulation Review

28 Comparison of Filing Methods Benchmarks and Topped-Out Measures Registry Registry EHR Direct EHR Direct Claims Claims 0% 50% 100% With Benchmark Without Benchmark 0% 50% 100% Non Topped-Out Measures Topped-Out Measures

29 Comparison of Filing Methods Registry EHR Direct Claims 0% 50% 100% With Benchmark Without Benchmark 77% 26% 73% Registry EHR Direct Claims 0% 50% 100% Non Topped-Out Measures Topped-Out Measures

30 Example Benchmark Scale: EHR Direct Use of Imaging Studies for Low Back Pain

31 Example Benchmark Scale: Claims Reporting Chronic Obstructive Pulmonary Disease (COPD): Long-Acting Inhaled Bronchodilator Therapy

32 Example Benchmark Scale: Registry Reporting Colorectal Cancer Resection Pathology Reporting: pt Category (Primary Tumor) and pn Category (Regional Lymph Nodes) with Histologic Grade

33 How hard is it to get 10 points for a measure? Characteristic EHR Direct Registry Claims Measures with a benchmark Measures requiring >90% performance to achieve 10 points Measure requiring 100% to achieve 10 points Average performance threshold to achieve 10 points % 95.7% 99.7%

34 What s the average performance I need to achieve to get the minimum? Characteristic EHR Direct Registry Claims Measures with a benchmark Measures requiring >50% performance to achieve 3 points Average performance threshold to achieve >=3 points % 56.7% 72.3%

35 Claims Submission Under Claims Submission, a clinician performing at the benchmark under PQRS would score no higher than 5.5 points for these four measures.

36 EHR Direct Under EHR Direct, a clinician performing at benchmark under PQRS would score between 8-9 points

37 Registry Under Registry, a clinician performing at benchmark under PQRS would score between 5-8 points

38 Next Steps: Optimizing for MIPS

39 Actions to Take 1. Estimate your MIPS score A. How does the MIPS Final Score differ from PQRS and MUA? B. What is the impact of the individual clinician versus group provider reporting option across all categories? C. How will Improvement Activities influence scoring? D. How does Quality measure selection change under MIPS? 2. Determine MIPS eligibility for your clinicians 3. Identify which Quality measures to focus for your clinical operations A. The Quality category is 60% of your overall MIPS Final Score; optimizing these measures is critical for success under MIPS 4. Investigate outlier clinicians and beneficiaries

40 SA Ignite On-going Education 10 FAQs about MIPS 10 FAQs About Alternative Payment Models (APMs) Free MIPS Financial Calculator (plus video and user guide) ABCs of MIPS monthly webinar videos and PDF presentations LinkedIn Group: Merit-Based Incentive Payment System (MIPS)

41 Thank you for joining us Connect with SA Ignite

42 Appendix

43 Setting up an EIDM account to access a group s QRUR 1. A group is defined as a TIN with 2 or more eligible professionals (EPs), as identified by their National Provider Identifier (NPI), that bill under the TIN. 2. To access a group's QRUR, one person from the group must first sign up for an EIDM account with the Security Official role. 3. If additional persons are needed to access the group's QRUR, then they can also request the Security Official role or the Group Representative role in EIDM. 4. If you do not have an IACS or EIDM account, then follow the instructions provided here to sign up for an EIDM account with the correct role. 5. If you already have an EIDM account, then follow the instructions provided here to sign up for the correct role in EIDM.

44 Setting up an EIDM account to access a solo practitioner s QRUR 1. A solo practitioner is defined as a TIN with only 1 EP, as identified by a NPI, that bills under the TIN. 2. To access a solo practitioner's QRUR, one person must first sign up for an EIDM account with the Individual Practitioner role. 3. If additional persons are needed to access the solo practitioner s QRUR, then they can also request the Individual Practitioner role or the Individual Practitioner Representative role in EIDM. 4. If you do not have an IACS or EIDM account, then follow the instructions provided here to sign up for an EIDM account with the correct role. 5. If you already have an EIDM account, then follow the instructions provided here to sign up for the correct role in EIDM.

45 Cost: Tables 3A and 3B Screen-shot provides sample of table. Key findings: o Provides information related to Costs by Service Type and procedure o How is your TIN doing on a per attributed beneficiary? o How much Higher (or Lower) your TINs Costs were than Peer Group (3A by TIN, 3B by provider) o Explains how Cost category is broken out by services, revenue leakage, and compares your TINs performance to other TIN Note that all terms with a Cross are defined on the Hover-over_Terms tab

46 Quality: Tables 6A and 6B - Quality Tracking for ACOs No data is available if hospital admission was the result of an emergency department evaluation, an Ambulatory Care-Sensitive Condition admission, or a readmission within 30 days of prior admission; LESS GRANULAR DATA No eligible provider information (all data is at ACO level)

47 CMS Resources 1. DETAILED METHODOLOGY FOR THE 2017 VALUE MODIFIER AND THE 2015 QUALITY AND RESOURCE USE REPORT: Payment/PhysicianFeedbackProgram/Downloads/Detailed-Methodology-forthe-2017-Value-Modifier-and-2015-Quality-and-Resource-Use-Report-.pdf 2. How to understand your 2015 Annual Quality and Resource Use Report: Payment/PhysicianFeedbackProgram/Downloads/2015- UnderstandingYourAQRUR.pdf QRUR FAQs: Payment/PhysicianFeedbackProgram/Downloads/2015-FAQs-QRUR.pdf 4. Computation of the 2017 Value Modifier: Payment/PhysicianFeedbackProgram/Downloads/2017-VM-factsheet.pdf

48 CMS Technical Assistance For questions about setting up an EIDM account, and/or resetting your EIDM password, or for questions about the 2015 PQRS Feedback Report content, please contact the QualityNet Help Desk: Monday Friday: 7:00 am 7:00 pm Central Time Phone: 1 (866) (TTY ) Fax: 1 (888) qnetsupport@hcqis.org For questions about the content of the QRUR, please contact the Physician Value Help Desk: Monday Friday: 8:00 am 8:00 pm EST Phone: 1 (888) , press option 3; (TTY ) Fax: (469) pvhelpdesk@cms.hhs.gov