Quality Payment Program: Advancing Clinical Information

Transcription

1 Quality Payment Program: Advancing Clinical Information July 2017 In Partnership with Alliant Quality South Carolina Office of Rural Health Center for Practice Transformation

2 MACRA/QPP Medicare Access and CHIP Reauthorization Act of 2015 New framework of physician reimbursement rewards better care (value) rather than more care (volume) Repeals and replaces sustainable growth rate (SGR) Primarily still based on fee-for-service architecture Consolidates Medicare quality programs Meaningful Use Physician Quality Reporting System (Quality) Value Based Payment Modifier Program (Cost)

3 Quality Payment Program better care, smarter spending, and healthier people and communities Aims: (1) Support care improvement by focusing on better outcomes for patients, decreased provider burden & preservation of independent clinical practice (2) Promote alternate payment models (3) Support delivery system changes high quality, patient-centered care with useful feedback in a continuous cycle of improvement Source: APMs/MACRA-LAN-PPT.pdf

4 Quality Payment Program Medicare Physician Reimbursement MACRA MIPS MIPS APM APM MIPS (Merit-Based Incentive Program): Based on fee-for-service Performance score based on value FFS payment adjusted based on performance score APMs (Alternate Payment Models): Moves to population-based and episode-based payment Requires shared two-sided risk Incentives for organizations to move towards APMs (bonus) Source:

5 Merit-Based Incentive Program Each physician or eligible professional or group will receive a composite performance score: 0-100; score will determine reimbursement Final Score (0-100) Quality 60% Cost 0% Advancing Clinical Information 25% Improvement Activities 15% Source:

6 MIPS Source:

7 Pick Your Pace Transitional Year Source: Programs/MACRA-MIPS-and-APMs/MIPS-ACI-and-IA-presentation.pdf

8 Pick Your Pace Transitional Year Source: Programs/MACRA-MIPS-and-APMs/MIPS-ACI-and-IA-presentation.pdf

9 ACI Transitional Year Source: Based-Programs/MACRA-MIPS-and-APMs/MIPS-ACI-Deep-Dive-Webinar-Slides.pdf

10 MIPS Quality: 6 performance measures (1 outcome); or one specialty-specific or subspecialty-specific measure set; (PQRS) ACI: 5/4 core measures of EHR functionality & how well you are using EHR/HIT/HIE; no longer pass/fail (MU); performance measures; bonus points Cost: Claims-based; total per capita cost per attributed beneficiary & Medicare spending per beneficiary (VM); Performance Year % to 30% by 2021 IA: 92 practice improvement activities high and medium activities

11 Advancing Clinical Information Source: Based-Programs/MACRA-MIPS-and-APMs/MIPS-ACI-Deep-Dive-Webinar-Slides.pdf

12 Measure Sets Two measure set options for reporting. The option you use depends on the edition of your EHR Option 1: ACI Objectives and Measures Technology certified to the 2015 Edition; or a combination of technologies from 2014 and 2015 Editions that support these measures Option 2: ACI Transition Objectives and Measures If you have technology certified to the 2015 Editions; or technology certified to the 2014 Edition; or a combination of technologies from the 2014 and 2015 Editions To determine which measure set you should use, use the following lookup tool:

13 ACI Measures Source:

14 ACI Measure Specifications Source:

15 Base Measures Base Measures Transition Measures Source: Based-Programs/MACRA-MIPS-and-APMs/MIPS-ACI-Deep-Dive-Webinar-Slides.pdf

16 Must fulfill all the requirements of all base measures to receive base score If all measures are not met than you will receive 0 points in the performance category To receive base score (50% of overall score), must affirm a security risk analysis and at least 1 in numerator for the remaining measures Base Measures

17 Performance Measures Performance Measures Transition Performance Measures

18 Performance Measures Performance score is calculated by using the numerators and denominators submitted for each performance measure Total available performance score is 90% Performance score is determined by the performance rate for each measure All but two performance measures are worth 10% points Example: EC submits a performance rate of 85/100 patients received a summary of care; Performance rate: 85% which would result in 9% points for this measure

19 Bonus Measures Bonus Measures Transition Bonus Measures Source: Based-Programs/MACRA-MIPS-and-APMs/MIPS-ACI-Deep-Dive-Webinar-Slides.pdf

20 ACI/PIA Bonus Points Source: Programs/MACRA-MIPS-and-APMs/MIPS-ACI-and-IA-presentation.pdf

21 Bonus Measures Bonus points can be achieved by reporting yes to 1 or more additional public health and clinical data registries Reporting yes to the completion of at least 1 Improvement Activity using CEHRT

22 Scoring ACI Source: Based-Programs/MACRA-MIPS-and-APMs/MIPS-ACI-Deep-Dive-Webinar-Slides.pdf

23 Base Scoring Source: Based-Programs/MACRA-MIPS-and-APMs/MIPS-ACI-Deep-Dive-Webinar-Slides.pdf

24 Performance Scoring Source: Based-Programs/MACRA-MIPS-and-APMs/MIPS-ACI-Deep-Dive-Webinar-Slides.pdf

25 Performance Scoring Source: Based-Programs/MACRA-MIPS-and-APMs/MIPS-ACI-Deep-Dive-Webinar-Slides.pdf

26 Bonus Point Scoring Source: Based-Programs/MACRA-MIPS-and-APMs/MIPS-ACI-Deep-Dive-Webinar-Slides.pdf

27 Source: Based-Programs/MACRA-MIPS-and-APMs/MIPS-ACI-Deep-Dive-Webinar-Slides.pdf

28 Reweighting To have ACI category to be reweighted to 0%, ECs/groups must meet the following: Insufficient Internet Connectivity Extreme or Uncontrolled Circumstances Lack of control over the Availability of CEHRT Must submit application to CMS To qualify for automatic reweighting: Hospital-based MIPS clinician PA NP CNS CRNA Clinician who lack face-to-face interactions with patients ACI Category will be reweighted at 0% with the 25% assigned to the Clinical Quality Category

29 Group Reporting Groups report ACI measures as a group not by individual clinician Hospital-based clinicians do not have to included in the group calculation for ACI

30 Contact Information 107 Saluda Pointe Dr Lexington, SC Phone: Fax: