Goals for Session - Kettering Health Network · CIPA PGIP INCENTIVE/ADMINISTRATIVE PAYMENTS TO PHYSICIANS AND. Deep Dive into MIPS Beth Hickerson and Angela Hale Quality Improvement

PHA/KPP Kettering Health Network:

“A Deep Dive on the Quality Category of MIPS”

Dr. Troy Tyner, D.O.

April 6,2017

2Value Driven. Health Care. Solutions.

Goals for Session

• CMS Grant Update for PHA Members

• Overview of our PHA/KPP goals

• Ensure You Pay NO Penalties

• Overview of MIPS

• Update on MIPS and Data Submission

• Ensure you know your practice scores

• Ensure You Pay NO Penalties

PHA CMS Grant Status


Clinicians: 496 involved

Successes:

• 300 site interactions in Q1 2017 with practices

• Practices made strong progress

• Several practices that would have failed to submit PQRS in

2016 were able to successfully meet requirements.

• All practices have taken the minimum required steps to avoid

the MIPS penalty.

• Opportunities:

• Practices using Epic Ambulatory EHR report difficulty getting

quality reports, determining reportable measures, and

access to understanding Epic reporting requirements and

capabilities.

PCP Phase Scores

Phase 1 (Action Plan)

• Set Aims – 23

• Phase 2

• Use Data to Drive Care – 106

• Phase 3

• Achieve Progress on Aims – 19

Phase 4

• Achieve Benchmark Status – 0

Phase 5

• Thrive as a Business in Pay-for-Value Approached – 0

PHA/KPP 2017 Goal

Drive 100% that desire

to Phase 3

Specialist Phase Scores from PAT

Phase 1 (Action Plan)

• Set Aims – 51

Phase 2

• Use Data to Drive Care – 413

Phase 3

• Achieve Progress on Aims – 3

Phase 4

• Achieve Benchmark Status – 0

Phase 5

• Thrive as a Business in Pay-for-Value Approached – 0

PHA/KPP 2017 Goal

Drive 100% that desire

to Phase 3

Medical Advantage Group

Experienced team brings years of

success and knowledge in areas that

align with the requirements of MIPS

Medical Advantage Group’s

experience has resulted in:

– 196,445 gaps closed from end of 2014

to Nov. 2016. From 45% to 69% in

gaps closured.

– 176 PCMH practices

– Increased PMPM earning to our

physicians. In 1 contract alone,

increase of $9.15 PMPM in 2 years.

– PCPs earned > $1,900,000 and

specialists earned $1,800,000 in

value-based incentive payments


$5.36

$11.80

$14.51

$0.00$1.00$2.00$3.00$4.00$5.00$6.00$7.00$8.00$9.00

$10.00$11.00$12.00$13.00$14.00$15.00$16.00$17.00$18.00

Total 2014 Total 2015 Total 2016

CIPA PGIP INCENTIVE/ADMINISTRATIVE

PAYMENTS TO PHYSICIANS AND

Deep Dive into MIPS

Beth Hickerson and Angela Hale

Quality Improvement Advisors

PHA Physicians

April 6, 2017

Value Driven. Health Care. Solutions.

MIPS SUMMARY

Acronyms and Basics

Medicare Access and CHIP Reauthorization Act of 2015

(MACRA)


Supported by organized medicine

– Repealed the Sustainable Growth

Rate (SGR) methodology

– Passed with over 90 percent

support in both the House and

Senate; bi-partisan legislation

Created Quality Payment

Program which moves Medicare

into value-based payments

Quality Payment Program (QPP)

January 1, 2019 – physicians enter the APM track or the MIPS track

For the first few years, majority of clinicians in MIPS


Quality Payment Program

(QPP)

Merit-based Incentive

Payment System (MIPS)

Alternative Payment Model

(APM)

Advanced APM MIPS APM

Acronym Reference


MIPS Payment Adjustments

Final score of 0-100

calculated for each eligible

clinician/group based on

performance in four categories

Final score compared against

threshold to determine

payment adjustment to MPFS

First MIPS performance year-

2017

First MIPS payment year-2019


Threshold

4x% 5x% 7x% 9x%

-4x% -5x% -7x% -9x%

2019 2020 2021 2022

Example of MIPS Negative Adjustment


MPFS

Reimbursement

2017 data/

2019 payment

2018 data/

2020 payment

2019 data/ 2021

payment

2020 data/

2022 payment

Maximum Loss 4% 5% 7% 9%

$50,000 $2,000 $2,500 $3,500 $4,500

$100,000 $4,000 $5,000 $7,000 $9,000

$400,000 $16,000 $20,000 $28,000 $36,000

Example of MIPS Positive Adjustment

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MPFS

Reimbursement

2017 data/

2019 payment

2018 data/

2020 payment

2019 data/

2021 payment

2020 data/

2022 payment

Plus or Minus 4% 5% 7% 9%

Bonus 10% 10% 10% 10% 10%

$50,000 $7,000 $7,500 $8,500 $9,500

$100,000 $14,000 $15,000 $17,000 $19,000

$400,000 $56,000 $60,000 $68,000 $76,000


MIPS Final Score for 2017 Performance Year


Final Score Payment Adjustment

≥70 points – Positive adjustment

– Eligible for exceptional performance bonus – minimum of

additional 0.5%

4-69 points – Positive adjustment

– Not eligible for exceptional performance bonus

3 points – Neutral payment adjustment

0 points – Negative payment adjustment of -4%

– 0 points = does not participate

MIPS Category Weights Over Time

:


Quality

Advancing Care

Information

Improvement

Activities Cost

Replaces PQRS Replaces MU New (PCMH) Replaces VBM

2017 60% 25% 15% 0%

2018 50% 25% 15% 10%

2019+ 30% 25% 15% 30%

MIPS Eligible Providers

Years 1 and 2 Medicare Part

B clinicians:

Physicians MD, DO

Podiatrists

Optometrists

Chiropractors

Dentists

Physician Assistants

Nurse Practitioners

Clinical Nurse Specialists

Certified Registered Nurse

Anesthetists

Year 3+ Medicare Part B

clinicians:

Occupational Therapists

Physical Therapists

Speech Therapists

Audiologists

Nurse Midwives

Clinical Social Workers

Dietitians


MIPS Exempt Providers

3 groups of clinicians:


First year of

Medicare Part B

participation

Below low patient

volume threshold

Certain

participants in

ADVANCED

Alternative

Payment Models100 or fewer Part B patients

OR billing no more than

$30k/year

NOTE: MIPS does not apply to hospitals or facilities

Pick Your Pace Options

Three options to participate in MIPS in 2017:


Don’t submit

Three Ways to Avoid the Penalty in 2017


1Quality

Measure

1Improvement

Activity

5Required Advancing Care

Information

Measures

OR OR

Physician Compare Website

Shows MIPS composite

scores and individual

performance category

scores

Patients can see health

care providers rated on a

scale of 0 to 100 and

how physician compares

to peers nationally


REPORTING OPTIONS AND METHODS

Understanding How to Report

Reporting Options

Individual – defined as a single NPI tied to a single TIN

– May protect incentive potential for high-performing

providers

– May be easier if you have NPIs not required to report

Group – multiple NPIs that share a common TIN

– May ease administrative burden

– Beneficial if you have some providers with reporting

obstacles

– Register only if using CMS web interface or CAHPS for

MIPS

Note: Reporting option applies for all four categories; NPIs must report for

each TIN separately


Reporting Methods

Claims

EHR

Registry

Qualified Clinical Data Registry

CMS Web Interface

CAHPS for MIPS Survey

Note: You may only report via one method per category


Reporting Methods (cont.)

Claims

– Add modifier codes to your Medicare claims

– Can be added manually by billers or automatically by

EHR or billing software

EHR

– Directly submit a QRDA III file through the CMS portal

– Register with your EHR to submit on your behalf

as/through a Data Submission Vendor (DSV)

– This category does not include EHRs who submit via

registry



Registry

– Entity that collects data and submits to CMS

– Clinical data can be extracted from EHR or manually

entered via registry web form

– Claims data can be submitted via registry

Qualified Clinical Data Registry (QCDR)

– CMS-approved entity that collects medical and/or clinical

data for the purpose of patient disease tracking to foster

improvement in quality of care

– Usually includes specialty measures not on the general

MIPS measures list

– Clinical data can be extracted from EHR or manually

entered



CMS Web Interface (GPRO)

– Groups of 25 or more

– Populate data (manually or electronically) and report all

GPRO measures on 248 identified attributed patients

– Must register by June 30, 2017

CAHPS for MIPS

– Survey of patients administered and submitted by

approved vendor

– Counts as one of six required measures

– Must submit remaining five measures via other method

– Earn extra bonus points


Data Completeness Rule

Claims – 50% of all Medicare Part B patients

EHR, Registry, QCDR – 50% of all patients

GPRO – all patients assigned, up to 248


Reporting Methods


QUALITY CATEGORY

Requirements and Scoring

Quality Reporting Requirements

Report six measures, including

at least one outcome or high

priority measure

Select from full list of 291

MIPS measures

Or select from a set of

specialty specific measures


3-10 points per measure

based on performance

against a benchmark

60 possible points

Bonus points for high-priority

and EHR reporting

60Points

Measure Choices


https://qpp.cms.gov/measures/quality

https://qpp.cms.gov/measures/quality

Selecting Measures

1. Decide on your reporting method – Claims, EHR,

Registry, QCDR

– Reporting via EHR is easiest but may limit choice of

measures

2. Compile list of all available measures for your chosen

method

3. Narrow your list to include only applicable measures

– Specialty/scope of practice

– Patient population

– Data collection limitations


Selecting Measures (cont.)

4. Calculate your estimated MIPS points per measure

https://qpp.cms.gov/resources/education

“2017 Quality Benchmarks”


Measure_NameSubmission

MethodDecile 3 Decile 4 Decile 5 Decile 6 Decile 7 Decile 8 Decile 9 Decile 10

Pneumonia Vaccination

Status for Older AdultsClaims

39.78 -

51.32

51.33 -

61.67

61.68 -

70.47

70.48 -

77.77

77.78 -

84.49

84.50 -

91.99

92.00 -

99.06>= 99.07


Status for Older AdultsEHR

14.13 -

23.25

23.26 -

33.02

33.03 -

43.58

43.59 -

53.96

53.97 -

63.60

63.61 -

74.54

74.55 -

85.52>= 85.53


Status for Older AdultsRegistry/QCDR

12.24 -

24.02

24.03 -

36.34

36.35 -

48.51

48.52 -

58.95

58.96 -

68.05

68.06 -

77.77

77.78 -

90.19>= 90.20

https://qpp.cms.gov/resources/education

Quality Scoring Basics

Each measure earns between 3 to 10 points

Minimum 20 cases for a measure to earn performance

points above the minimum

Some measures may have a maximum < 10

Reporting additional outcome and high priority

measures yields bonus points

Measures reported via “electronic end-to-end” method

earn 1 bonus point


Quality Scoring Tips

If you submit > six measures, CMS will use the highest

scoring six for your base score

Measures submitted but not scored are still eligible for

bonus points

Groups with 16 or more providers and 200+ eligible

cases will have All-Cause Hospital Readmission


Quality Category Score


ADVANCING CARE INFORMATION CATEGORY


ACI Basics


– Security risk analysis

– e-Prescribing

– Provide patient access

– Send summary of care

– Request/accept summary of

care

– 5 percent per measure

for public health/clinical

data registry reporting

– 10 percent for

improvement activity

alignment

– Submit nine measures

for 90 days for

performance credit

Required base

score (50)

Performance

score (up to 90)

Bonus score

(up to 15)

50 90 15

Choosing Your Objectives/Measures List

https://qpp.cms.gov/measures/aci


https://qpp.cms.gov/measures/aci

2017 Transition Objectives and Measures

Core

1. Security Risk Analysis

2. e-Prescribing

3. Provide Patient Access

4. Health Information

Exchange

Performance

1. Provide Patient Access

2. Health Information

Exchange

3. View, Download, or

Transmit (VDT)

4. Patient-Specific Education

5. Secure Messaging

6. Medication Reconciliation

7. Immunization Registry

Reporting


Performance Measure Scoring


Performance Rates for Each Measure

1-10% = 1

11-20% = 2

21-30% = 3

31-40% = 4

41-50% = 5

51-60% = 6

61-70% = 7

71-80% = 8

81-90% = 9

91-100% = 10

ACI Category Score


ACI Scoring Tips

Start improving your performance measure scores

above previous MU thresholds

– Provide Patient Access

– Health Information Exchange

– Patient Specific Education

– Medication Reconciliation

Consider implementing an Improvement Activity using

your EHR to get 10 bonus points

Consider reporting to a specialized registry or public

health department for 5% bonus


IMPROVEMENT ACTIVITIES CATEGORY


Improvement Activities Basics

Attest to completing up to four

activities at least 90 days

during the year

Rural, health professional

shortage area (HPSA), or

group practices with 15 or

fewer clinicians attest to only

two activities

Eligible clinicians choose from

92 activities in nine categories


1. Expanded

Practice

Access

2. Population

Management

3. Care

Coordination

4. Beneficiary

Engagement

5. Patient

Safety and

Practice

Assessment

6. Participation

in an APM

7. Achieving

Health Equity

8. Integrating

Behavioral and

Mental Health

9. Emergency

Preparedness

and Response

Examples of Improvement Activities


After hours

access to care

Same day

appointments

Extended

office hours

Test tracking

system

Improvement Activities Scoring

40 points needed to maximize this category

Medium-weighted activities worth 10 points

High-weighted activities worth 20 points

Points doubled for rural, HPSA, or small group

practices (15 or fewer providers)

Full credit for clinicians in CPC+, in a PCMH, or in

similar specialist practice

– PCMH certifications for MIPS include: a national program,

a regional or state program, a private payer, or other body

that certifies at least 500 practices

Participation in Transforming Clinical Practice Initiative

is a high-weighted activity


Selecting Improvement Activities

https://qpp.cms.gov/measures/ia


https://qpp.cms.gov/measures/ia

COST CATEGORY


Cost Basics

In 2017, cost does not impact MIPS score

Clinicians are not required to submit cost data to CMS

– CMS assesses clinicians based on Medicare claims data

CMS compares resources used to treat similar care

episodes and clinical condition groups across practices

Cost measures adjusted for geographic payment rates

and beneficiary risk factors

Find previous cost information for your practice in your

2015 Annual Quality Resource and Use Report

(QRUR)


24

Questions?

Beth [email protected]

Angela [email protected]


Documents

Goals for Session - Kettering Health Network · CIPA PGIP INCENTIVE/ADMINISTRATIVE PAYMENTS TO PHYSICIANS AND. Deep Dive into MIPS Beth Hickerson and Angela Hale Quality Improvement