Navigating the 2017 MIPS Roadmap FALCON PHYSICIAN

Transcription

1 Navigating the 2017 MIPS Roadmap FALCON PHYSICIAN DISCLAIMER: This material is provided for informational purposes only and should not be regarded as legal or compliance advice. If legal advice or other expert assistance is required, the services of a competent professional person should be sought.

2 2017 First performance period opens Jan. 1, 2017 and closes Dec Quick Glance March 31, Jan. 1, 2019 March 31, 2018 is the submission deadline for the first performance year. Feedback about performance data will be sent out. Payment adjustments go into effect 2 years after the performance year. Don t Participate -% If you don t send in any 2017 data, then you receive a negative 4% payment WHAT IS MIPS? Some Data 0 If you submit a portion of the 2017 required data, you can avoid a downward payment Partial Year +% If you submit 90 days of 2017 data to Medicare, you may earn a neutral or positive payment Full yr. +% If you submit a full year of 2017 data to Medicare, you may earn a positive payment 60% 0% 25% 15% QUALITY COST ADVANCING CARE IMPROVEMENT MEASURES INFORMATION ACTIVITIES Previously PQRS Previously VBM Previously MU New Category

3 60% Quality The Quality Performance Category is very similar to the legacy Physician Quality Reporting System (PQRS). In 2017, the Quality category is worth 60% of the Merit-based Incentive Payment System (MIPS) Composite Score and requires the submission of quality measure information to CMS. Reporting Quality DETERMINE YOUR LEVEL OF PARTICIPATION & SELECT WHICH MEASURES TO SUBMIT DETERMINE REPORTING PERIOD AND RECORD QUALITY MEASURE DATA REVIEW DATA Test Option report 1 Quality Measure to avoid the MIPS downward adjustment Partial or Full Option report data from a 90 day period or a full year Report at least 6 Quality Measures Include at least one Outcome measure, and if no Outcome measure is applicable, report at least 1 High Priority measure Select additional measures to report - Bonus points awarded for selecting Outcome or High Priority measures - 6 highest scoring measures will be used to calculate your score Your 2017 reporting period must be at least 90 consecutive days between Jan. 1, 2017 and Dec. 31, 2017 October 2, 2017 is the deadline to begin collecting data for a 90- day reporting period Clinicians receive 3 to 10 points for each quality measure based on performance against benchmarks If a measure cannot be reliably scored against a benchmark, only 3 points will be awarded If a measure can be reliably scored against a benchmark 3 to 10 points will be awarded Reliable scores means: Benchmarks exist Sufficient case volume (>=20 cases for most measures; >=200 cases for readmissions) Data completeness is met (at least 50 % of possible data is submitted) Benchmarks: There are separate benchmarks for the quality measures based on the data submission method All reporters, individuals and groups, regardless of specialty or practice size are combined into one benchmark If no benchmark exists then only 3 points will be awarded

4 Advancing Care Information (ACI) The Advancing Care Information Category (ACI) replaces the Medicare EHR Incentive Program (also known as Meaningful Use). ACI is designed to provide clinicians with flexibility to choose the activities and measures that are the most relevant to them and their practices. The ACI category is worth 25% of your MIPS Composite Score. 25% CERTIFIED EHR **Eligible Clinicians must use certified EHR technology to report ACI measures. Falcon Physician is currently certified to the 2014 Edition, therefore Falcon users will report on the 2017 Transition ACI Measures and Objectives. Falcon is in the process of updating our systems to meet the new certification criteria and we intend to be certified for the 2018 performance year of MIPS. 1ATTEST & REPORT ON ALL THE BASE SCORE MEASURES Reporting the base score measures is mandatory in order to receive the 50% base score Failure to report all of the base score measures will result in a zero for the ACI performance category To receive the 50% base score, clinicians must attest that they met the requirements of the security risk analysis measure and capture at least 1 patient in the numerator for the numerator/denominator of the remaining measures Some base score measures can also contribute toward the performance score 2017 TRANSITIONAL BASE MEASURES FOR 2014 EDITION CEHRT eprescribing Security Risk Analysis Provide Patient Access Health Information Exchange 50% REQUIRED BASE SCORE 2 3 REPORT PERFORMANCE SCORE MEASURES The performance score is calculated by using the numerators and denominators submitted for measures included in the performance score, or for one measure, by the yes or no answer submitted The potential total performance score is 90% For each measure with a numerator/ denominator, the percentage score is determined by the performance rate. Most measures are worth a maximum of 10 percentage points, except for two measures reported under the 2017 Transition measures, which are worth up to 20 percentage points The only performance score measure that is yes/no is Immunization Registry Reporting measure 90% 15% + + = PERFORMANCE SCORE BONUS SCORE DETERMINE BONUS POINTS Reporting yes to 1 or more additional public health and clinical data registries beyond the Immunization Registry Reporting measure will result in a 5% bonus Reporting yes to the completion of at least 1 of the specified Improvement Activities using CEHRT will result in a 10% bonus MIPS eligible clinicians who meet both requirements will receive a 15% bonus Advancing Care Information Performance Category Score To ensure flexibility, clinicians may earn a maximum of 155% in the ACI category, however, any score over 100% will be capped at 100%

5 15% Improvement Activities The Improvement Activities Performance Category is new for 2017, and assesses how much you participate in activities that improve clinical practice. Examples include ongoing care coordination, patient safety practices, and expanding practice access. The Improvement Activities Performance Category is worth 15% of the MIPS Composite Score in Groups with 15 or fewer clinicians, nonpatient facing clinicians and/or clinicians located in a rural area or HPSA Each activity is weighted either medium or high. To achieve the maximum 40 points for the Improvement Activity score, you may select either of these combinations: 1 high-weighted activity 2 medium-weighted activities High-weighted activities are worth 40 points Medium-weighted activities are work 20 points Groups with more than 15 clinicians Each activity is weighted either medium or high. To get the maximum score of 40 points for the Improvement Activity score, you may select any of these combinations: 2 high-weighted activities 1 high-weighted activity and 2 medium-weighted activities Up to 4 medium-weighted activities High-weighted activities are worth 20 points Medium-weighted activities are worth 10 points 2 3 UNDERSTAND SCORE CHOOSE ACTIVITIES ATTEST TO ACTIVITIES Select from a list of 90+ activities listed on the Quality Payment Program website For each activity that meets the 90-day requirement (activities that you performed for at least 90 consecutive days during the 2017 performance period) attest that you met the measure by indicating yes