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Denali v3.1b1/ONC 2015 Edition WebinarQPP/MU Settings Master & Reports

In this session…• CMS Quality Programs Overview

• https://www.qpp.cms.gov• CMS Quality Programs for 2017

• Quality Payment Program MIPS• Quality Payment Program AAPM• EHR Incentive Program Meaningful Use

• MIPS Eligibility/Participation• Pick Your Pace Reporting options• MIPS Requirements

• QPP/MU Settings Master• Clinic Setup• Provider Setup• Measure Selection & Requirements

• QPP/MU Reports• MIPS Quality Claims Based Screen• Appendix A – QPP MIPS Weightage/Scoring Examples

Overview of CMSQuality Programs

MIPS (Merit-based Incentive Payment System)• Combines 3 legacy programs + adds one new performance category

Note: For 2017 the Cost category is not applicable.• A performance MIPS Score is calculated for the EC from all categories

Quality Payment Programs for Medicare & Medicaid*

• https://www.qpp.cms.gov• Replaces EHR Incentive/Meaningful Use for Medicare providers • MACRA umbrella Includes two performance-based tracks: MIPS and AAPM

which replace traditional Medicare Fee For Service

AAPM (Advanced Alternative Payment Model)• Providers may register to participate and CMS must approve you• Incentive payments based on innovative payment models

QPP (Quality Payment Program)

2017 Focus

EHR Incentive Program/Meaningful Use (MU)• https://www.cms.gov/Regulations-and-Guidance/Legislation/EHRIncentivePrograms• Ended in 2016 for Medicare providers• Continues through 2021 for Medicaid providers• Check with your state agency for specifics

*See MACRA-MIPS & MU for 2017 Webinar for more details.

https://qpp.cms.gov/participation-lookuphttps://qpp.cms.gov/mips/individual-or-group-participation

Eligible Clinician’sNPI

MIPS Participation

MIPS Participation Status (Example)

• EC may be eligible individually• EC may be eligible as part of a

group but not individually• EC may be eligible both as an

individual & as part of a group

• EC may be part of multiple groups and have different designation with each one

• EC may be totally exempt

“Pick Your Pace” for 2017 – Participation Level• Payment adjustment in 2019 is based upon your level of participation in 2017

• No Participation – negative 4% payment adjustment in 2019Note: An ineligible EC will not receive a negative adjustment.

• Test/Minimal Participation – zero payment adjustment in 2019• Submit some data for at least 1 category for any number of days

• Base – all 5 measures required for any quantity of data/number of days• Quality/IA – at least 1 measure for any quantity of data/number of days

• Partial Participation – neutral or small positive payment adjustment in 2019• Submit at least 90 days worth of data (must begin collection by Oct. 2 at latest)

• Base – all 5 measures required• Quality – minimum of 6 measures required• IA – 40 points required

• Full Participation – up to possible maximum positive 4% payment adjustment in 2019• Submit a full year of data for all categories

• Same requirements as the Partial Participation above

Determines the amount of data you

must report

MIPS Requirements• Consists of 3 existing quality reporting programs combined with 1 new category

• Quality (60%) – replaces former PQRS (Physician Quality Reporting System)• Improvement Activities (15%) – new performance category• Advancing Care Information (25%) – replaces former MU (Meaningful Use)

Note: Consists of 3 categories; all Base measures are mandatory.• Cost – replaces the Value Based Modifier (n/a for 2017)

• ECs may choose the amount of data and duration of days for which to report data• CMS will apply payment adjustment based upon the EC’s final MIPS Score*.

*See Appendix A – QPP MIPS Weightage/Scoring

QPP/MU SettingsMaster

QPP/MU Settings*

Accordion UI reflects theselected provider’s programs & lets

you manage the measures accordingly.

*Settings Configuration MU/QPP Settings

Applicable to all providers for both QPP & MU.

Each reporting provider must be defined.

Clinic Setup

1. Displays status of each Encounter Type as relates to MU and QPP/MIPS ACINote: This requires setup in Encounter Type MU Details.

2. Identifies status of Public Health Reporting measures for MU and QPP/MIPS ACI• Immunization Information• Syndromic Information• NAMCS (National Ambulatory Medical Care Survey)

3. CCD Reporting fields• Height• Weight• BP• Smoking

4. Additional Setup lets you request interfaces as required if not already enabled.

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Additional Setup1. Controls the dashboards at they system and/or encounter level2. Allows user to request required setup directly from Interface Team 3. Displays the status of the various processes or interfaces

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Provider Setup

1. Select each (a) Provider and (b) Year for which specifications will be applied

2. Select the Program(s) the selected provider will be reporting for the indicated yearNote: A provider may choose QPP only, MU only, both, or None.

a. Quality Payment Program – for Medicare-eligible clinicians/providers▪ MIPS (Merit-based Incentive Payment System)▪ AAPM (Advanced Alternate Payment Model)

b. EHR Incentive/Meaningful Use – for Medicaid-eligible providers▪ Modified Stage 2 (applicable for 2017 only)▪ Stage 3

3. Set functional exclusions for the selected provider for the indicated yeara. EPCS (Electronically Prescribe Controlled Substances)b. Immunization Registry Reportingc. Syndromic Surveillance Data Reportingd. Specialized Data Registry Reportinge. NAMCS (National Ambulatory Medical Care Survey) Reporting

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Applicable for MU & QPP/MIPS ACI

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Measures Setup

1. The Quality Measures apply for all programs (QPP and MU)Note: This tab will be populated for all providers regardless of the program selected.

a. The Claim Based measures are applicable only for QPP MIPSb. The EHR Based measures are applicable to QPP AAPM and MU, all stages

2. The ACI Measures apply for QPP/MIPS onlyNote: Measures are defined in 3 sub-categories: Base, Performance, & Bonus.

3. The Improved Activities apply for QPP/MIPS onlyNote: Select activities qualify for ACI Bonus points also.

4. The Meaningful Use tab applies only for Meaningful Use Core Objectives, all stagesNote: For required CQM, please see Quality Measures EHR Based tab.

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Each layer within the accordion may be collapsed by clicking or

expanded by clicking

Quality Measures 1. The Reporting Period will be completed for attestation/data submission (Jan. 2018)2. The 2 tabs are based upon the data submission method (Claims or EHR)

• Minimum of 6 measures must be selected• All measures must be from the same data submission method

3. Use Search By/Filter By options to locate measures by Type, Priority, or SpecialtyNote: Specify criteria then click the Go button.

4. The Measures Details will display all measures within the search/filter criteria entered above, including: Quality ID, Name, Type, High Priority status, applicable Specialties, and an Info link to view the measure specifications/definition.

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Quality Measures (cont’d)1. Select the check box for each measure to be reported (a √ will display: )

Note: At least 6 measures should be selected under either tab (but not both).2. At least 1 measure must be Type: Outcome or relevant High Priority: Yes.3. Click Info to view the applicable measure’s definition and requirements.

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Viewing Measure Specifications ( )1. Example of a Claim-based measure, which includes required QDC Codes2. Example of an EHR-based measure and the requirements of clinical documentation

The format/content of this icon will vary for each measure. The

requirements is what determines where in PrognoCIS the data is

captured.

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ACI Measures 1. The Reporting Period will be completed for attestation/data submission (Jan. 2018)2. Use Search By/Filter By options to locate measures by Base status or Weight.

Note: Specify criteria then click the Go button.3. The Measures Details will display all measures within the search/filter criteria entered

above, including the Measure ID and Name as well as whether or not it is Required for the Base Score and its Performance/Bonus Weight.

4. A single list includes all 3 sub-categories: Base, Performance, and Bonus.Note: Some measures apply across multiple categories (i.e.: Base/Performance).• All Base measures will be pre-selected and identified as Required for Base: Yes• Performance measures will display a Performance Score Weight %

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ACI Measures (cont’d)

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1. Select the check box for each measure to be reported (a √ will display: ).Note: All Base measures are pre-selected and cannot be deselected ( ).

2. If reporting at least 1 of the 18 EHR-based Improvement Activities, you must select measure ACI_IACEHRT_1 to receive credit for the bonus points (see IA category below).

3. A Performance Score Weight > 0 indicates either Performance or Bonus measure.

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Improvement Activities1. The Reporting Period will be completed for attestation/data submission (Jan. 2018)2. Use Search By/Filter By options to locate activities by Weight or Related to ACI Bonus.

Note: By default, all 92 activities defined by CMS are listed for all categories.3. The Activity Details section will display (a) all activities within the search/filter criteria

entered above, including the Activity ID, Name, Sub Category, Weightage and whether or not it is Related to ACI Measures (i.e.: 1 of the 18 IAs that qualify for ACI Bonus).

4. Click to view the activity’s definitions and requirements.

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Improvement Activities (cont’d)

*Activity Weightage:• Medium = 10 points• High = 20 points

1. Select the check box for each activity to be reported (a √ will display: ).Note: Select any number of activities worth at least 40 points*.

2. When selecting activities for ACI bonus, be sure to select ACI_IACEHRT_1 above also.

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Viewing Activity Specifications ( )• Clicking the Info icon ( ) for any activity invokes that activity’s specifications as to

what is required within the practice to attest Yes.

IA that does not require data to be captured within EHR. It is a

requirement outside of PrognoCIS.

1 of the 18 Improvement Activities that also qualify as ACI Bonus when the data is captured within CEHRT.

Meaningful Use Core Objectives• All objectives for the selected Stage should be selected unless you are excluded.

See Appendix B for Core Objectives

• Select the check box for each applicable measure• The required Core Objectives will be pre-selected for the stage

indicated above for the selected Provider.

QPP/Meaningful UseReports

MU/QPP Reports Reports MU/QPP Reports• Classification: 2017 – QPP-MIPS

• Classification: 2017 – MU

Reports MIPS-Quality-Claim Report

See Appendix A – QPP MIPS Weightage/Scoring

QPP/MU Reports (cont’d)

1. Able to generate for multiple Providers at once (tooltip will list all selected names)

2. Patient level filters available 3. Additional filters for QRDA only*

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*Measure-specific Problems per selected

demographics

QPP/MU Reports in PrognoCIS (cont’d)• Classification: Quality-EHR-eCQM-QRDA1

• Classification: Quality-EHR-eCQM-QRDA3

Patient-level details for each specific eCQM measure

Cumulative/Summary reports for all applicable

measures

QRDA1 Import

• User Role requires Read Access

• Settings Configuration Clinic QRDA1 Import• Patients will be matched by First & Last Name, Gender, DOB, & Provider NPI.

MIPS Quality Claim Based• Reports MIPS-Quality-Claims Report • Encounter TOC Quality Measures

Note: Formerly labeled as PQRS. G-Code column relabeled as QDC (Quality Data Code) as required on the claim when applicable.

MIPS Quality Claim Based (cont’d)• Encounter TOC Assessment eCQM button

1. Encounter-level values for the current/selected encounter (Numerator/Denominator)

2. System-level values for the current Attending Provider’s Overall % for that one measure

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Appendix A – QPP MIPSWeightage / Scoring

Performance Category Weights• The weights assigned to each category are based on 1 to 100 points• The overall MIPS score is a number of points calculated by the individual scores of

each category and weighted to final score of 100 (or 100%)

The following example uses random points based on partial participation minimums.

Quality Category Scoring• Counts for 60% of overall MIPS score• CMS-defined Performance Benchmarks classified into “deciles”• Benchmarks are specific to the data submission method and are based

on 2015 PQRS reporting data• EC will earn from 3 to 10 points per measure (not counting bonus points)

based upon performance % within the applicable decile assigned

Example 1:

• EC reports required data and gets a performance score of 5.25%

• This falls in the 1st decile, which is worth 3 points

Example 2:

• EC reports required data and gets a performance score of 78.25%

• This falls in the 10th decile, which is worth 10 points

Quality Category Scoring – Example

The Points

• Measure 1 = 10 pts(Outcome measure)

• Measure 2 = 6 pts• Measure 3 = 8 pts• Measure 4 = 9 pts• Measure 5 = 10 pts• Measure 6 = 10 pts• Measure 7 = 1 pt

The Score

• 53 + 1 points

• 60 maximum÷

• A minimum of 3 points will be given for any amount of data submitted per measure• The more data submitted, the higher potential points to be earned• Bonus points are earned by submitting additional measures (beyond the 6 required)

=

Quality =90 points

Improvement Activities Category Scoring• Counts for 15% of overall MIPS score• Report up to 40 points to receive full credit for this category• 92 activities defined under 9 categories

• Each activity is weighted as Medium or High• Medium = 10 points• High = 20 points

Improvement Activities Scoring – Example

• Report 3 activities• Weightage:

• Medium 2 x 10 pts = 20 pts• High 1 x 20 pts = 20 pts

Example 1

• Report 2 activities• Weightage:

• High 2 x 20 pts = 40 pts

Example 2

The Score

• 40 points

• 40 maximum

• 100 possible

÷

x

Example 1 Points• IA 1 = 10 pts• IA 2 = 10 pts• IA 3 = 20 pts

• Counts for 15% of overall MIPS score• Report activities that equal up to 40 points

Note: 18 of these also qualify towards ACI Bonus points (see ACI Scoring Example below).

=

Improvement Activities Scoring – Example (cont’d)

IA =100 points

Advancing Care Information Category Scoring• Counts for 25% of overall MIPS score• Score is calculated across 3 sub-categories worth maximum 155 points

• Base score = 50 pointsNote: All 5 of these measures are mandatory, or no credit will beissued to the EC for this category at all.

• Performance score = 90 points • Bonus score = 15 points

• 5 points for reporting 1 Public Health Reporting measuresNote: The bonus points apply regardless of one, two, or all three PHR measures being fulfilled.

• 10 points for reporting any of the specific 18 Improvement Activities within CEHRT

ACI Base Scoring – Example

The Points

• 5 Base measures count as a whole; no point value is assessed to measures individually

• EC must attest Yes to the 1st

measure (Security Risk Analysis)• Numerator must be at least 1 or

more for the other four measures

up to50 points

• EC must fulfill the requirements of all five Base Score measures• If requirements are not met, EC will get a 0 for overall ACI score*

*The ScoreACI Base =50 points

ACI Performance Scoring – Example

• Base 3/Perf 1 = 10 pts• Base 4/Perf 2 = 10 pts• Base 5/Perf 3 = 10 pts• Perf 3 = 10 pts • Perf 4 = 7 pts • Perf 5 = 8 pts • Perf 6 = 8 pts • Perf 7 = 10 pts• Perf 8 = 7 pts• Perf 9 = 10 pts

The ScoreACI Performance

= 90 points

The Points*

*Each measure is worth from 1 up to 10 points based on benchmarks set by CMS.

ACI Performance Scoring – Example (cont’d)• CMS has established Performance Rates for each measure • Most measures are worth a maximum of 10 percentage points• Based on numerator/denominator submitted, 1% = 1 performance point• The Immunization Registry Reporting measure is actually a Yes/No rather

than a numerator/denominator result; thus, EC gets either 10 or 0 points.Note: This measure will also qualify towards Bonus points.

up to90 points

• Numerator/Denominator = 90/100• Performance Rate = 90%• ACI Performance Score = 9 points

Performance Rate per MeasureExample:

ACI Bonus Scoring – Example

The Points

• The Immunization Registry ReportingPerformance measure also counts as a Bonus measure worth 5 points^Note: Whether you do only the 1, or if you do 2 or all 3 PHR measures, it is only worth 5 Bonus Points.

up to15 points

The Score^ACI Bonus =

5 points

• Attesting Yes to 1 or more of the Public Health Reporting measures^ yields the EC a 5% Bonus

• Attesting Yes to the completion of at least 1 or more of the specific 18 Improvement Activities using CEHRT results in a 10% Bonus

The Score

• Base – 50 points

• Performance – 90 points

• Bonus = 5 points

Total ACI =145 points

+

+

Maximum Allowed ACI = 100 points

Advancing Care Information Scoring – The Total

=

MIPS Composite Score• The Final MIPS Score is calculated by combining the individual scores from all categories

Quality 54 points(90 points x 60%)

IA 15 points(40 points x 15%)

ACI 25 points(100 points x 25%)

+

+

=

IA100 x 15% = 15

ACI100 x 25% = 25

Quality90 x 60% = 54 + +

MIPS score =

94 points

MIPS Composite Score (cont’d)• The Final MIPS Score determines the level of payment adjustment in 2019 for the EC• Scores of 70 points or more allow for additional bonus incentive• In our example, the score of 94 points qualifies for a positive adjustment + bonus

potential due to participation beyond minimal requirements

Test/MinimalParticipation No

Participation

PartialParticipation

FullParticipation

MIPS score =

94 points

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