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Quality Payment Program Y4: Planning for Success

The information contained in this presentation is for general information purposes only. The information is provided by UK HealthCare’s Kentucky Regional Extension Center and while we endeavor to keep the information up to date and correct, we make no representations or warranties of any kind, express or implied, about the completeness, accuracy, reliability, suitability or availability with respect to content.

UK’s Kentucky REC is a trusted advisor and partner to healthcare organizations, supplying expert guidance to maximize quality, outcomes and financial performance.

To date, the Kentucky REC’s activities include:

• Assisting more than 5,000 individual providers across Kentucky, including primary care providers and specialists

• Helping more than 95% of the Federally Qualified Health Centers (FQHCs) and Rural Health Clinics (RHCs) within Kentucky

• Working with more than 1/2 of all Kentucky hospitals

• Supporting practices and health systems across the Commonwealth with practice transformation and preparation for value based payment

Physician Services

1. Promoting Interoperability (MU) & Mock Audit

2. HIPAA SRA, Project Management & Vulnerability Scanning

3. Patient Centered Medical Home (PCMH) Consulting

4. Patient Centered Specialty Practice (PCSP) Consulting

5. Value Based Payment & MACRA Support

6. Quality Improvement Support

7. Telehealth Services

Hospital Services

1. Promoting Interoperability (Meaningful Use)

2. HIPAA Security Analysis & Project Management

3. Hospital Quality Improvement Support

Kentucky REC Description

Kentucky Regional Extension Center Services

MIPS Y4 Program Essentials

MIPS Category Planning

Additional Reminders

Objectives

QPP Y4: QPP Clinician Eligibility

Merit-Based Incentive Payment System(MIPS)

$90KPart B

200 Medicare Patients

200 PFS

Advanced Alternative Payment Models(APMs)

Advanced APM

Participant 50%

Payment35%

Medicare Patients

QPP Track Eligibility Requirements

Eligible Clinician Types: Physician, PA, NP, CNS, CRNA, PT, OT, Qualified Speech-Language Pathologist, Qualified Audiologist, Clinical Psychologist, Registered Dietitian or Nutrition Professional

OR

QPP Y4: MIPS Thresholds

0 Points =Full 9% Penalty

45 Points Minimum

Threshold =No Penalty, No Reward

Between 46-84 Points =

No Penalty

85+ = Exceptional Performance

Split $500M Pool

Year 5 Minimum Threshold = 60 Points

QPP Y4: MIPS Overview

Program Year

Payment Year

Quality ImprovementActivities

Promoting Interoperability

CostAdjustment

Factor+ / -

2020(Y4) 2022 45% 15% 25% 15% 9%

Reporting Timeframes

365-Days

90-Day Minimum

90-Day Minimum

365-Days

Applied During

Payment Year

Must Submit by March 31st, 2021

QPP Y4: Reporting Options

Individual

Under an NPI number & TIN

where they reassign benefits

Group

> 2 clinicians (NPIs) who

have reassigned their billing rights to a single TIN

As an APM Entity

Virtual Group

Combination of > 2 TINs

assigned to > 1 individual MIPS ECs, or to > 1

groups consisting of <10 ECs with > 1

MIPS EC

Quality:6 Measures Required except for: CMS Web Interface report 10 quality measures

At least 1 Outcome measure

7th Measure based on claims for large groups

IA:40 points raw score required• Combination of

medium & highly weighted activities

• 50% ECs must participate in same activity

• 50% of the locations under the TIN are Certified PCMH/PCSP

Cost:Score is based on Medicare claims, including:Measure 1: Medicare Spending per Beneficiary (MSPB)

Measure 2: Total per capita costs (TPCC) for all attributed beneficiaries

18 Episode-Based Measures

QPP Y4: Reporting Categories: Basics

PI:100 points raw score required

• 4 Objectives, 5 Measures

Scoring:• Performance

Score• Bonus

2015 CEHRT Required

Year 4: Minimum Threshold = 45 Points; 9% Risk

QPP Y4: Quality Planning & Action Steps

Choose Submission Method(s)

Analyze 2019 Quality Performance

Review 2020 Decile Scoring

Pick Quality Measures & Study Measure Specifications

Validate Reporting

Integrate Improvement Methodology

QPP Y4: Quality Example

Analyze Previous Quality Performance Data

QPP Y4: Quality Example

Study Measure Specifications & Integrate Improvement Methodologies

QPP Y4: IA Planning & Action Steps

Determine Special Statuses

Decide 50% NPI Population (Group Only)

Select IAs

Choose Timeframe

Collect Evidence

QPP Y4: IA Example

Determine Special Status&

Select IAs

QPP Y4: PI Planning & Action Steps

Choose Submission Method(s)

Determine Special Status, Hardship & Bonus Possibilities

Study Measure Specifications

Validate Reporting

Clinician Documentation Training

QPP Y4: PI Example

Determine Special Status&

Study Measure Specs

QPP Y4: Cost Planning & Action Steps

Review Measure Specifications

Familiarize Measure Attribution Methodology

Analyze Past Cost Performance

Confirm Coding/Billing Practices

Consider Relevant QI Improvement Processes

QPP Y4: Cost Example

Review Specs & Attribution&

Confirm Coding Practices

QPP Y4: ResourcesPlanning• Y3 Performance Data – QPP Portal

• https://qpp.cms.gov/login• Eligibility & Special Status– QPP Website

• https://qpp.cms.gov/participation-lookup• Quality & Cost Measure Specs., Scoring, Imp. Activities, Data

Validation & Hardship Exceptions – QPP Resource Library• https://qpp.cms.gov/about/resource-library

Action• Kentucky Health Information Exchange (KHIE)

• https://khie.ky.gov/cwkhie/Pages/getstarted.aspx• QI Methodologies

• PDSA, Lean, Six Sigma, etc.

Additional Reminders

QPP Y4: CMS TimelineSn

apsh

ots CMS provides

a Minimum of Two Snapshots Throughout the Performance Year –1: April2: December

Legi

slat

ive

Upd

ates Notice for Proposed Rule Making(NPRM) – Late AugustQPP Final Rule – Early November Pe

rform

ance

Fee

dbac

k Typically Released in June – July Following Performance Period

QPP Y4: Planning for SuccessQ1

• Check Eligibility

• Determine Quality Measures • Map & Track

• Establish Submission Level & Method(s)

Q2

• Audit for Data Accuracy

• Plan Improvement Activities• Capture

Documentation

• Check Eligibility• Capture

Documentation from w/in QPP Portal

• Review Feedback Reports

Q3

• Review NPRM Proposals• Place Comments

• Check Quality & PI Reports

• Capture IA Documentation

• Review Feedback Reports

Q4

• Review QPP Final Rule Changes

• Final Eligibility Check

• Attestation Prep

• Documentation to Retain

QPP Y4: It’s that Time!

QPP Y4: Questions

Value-Based Payment Support Services

QPP SURS Technical Assistance:Free, high-level resources for organizations with 15 or fewer eligible clinicians as they navigate the Quality Payment Program. The Resource Center include: straightforward, self-directed resources and tools, up-to-date materials, and access to expert Quality Improvement Advisors. Sign up: www.qppresourcecenter.com

VBP Individualized Assistance: 12 months of planning and transformation support tailored to meet specific client needs and support success in value-based payment. This includes current state analysis, recommendations for action, collaborative goal setting and project planning, education, strategic decision support and ongoing advisory services.

Advanced APM Support:Ongoing support, research, work plan development and application support for transition to advanced alternative payment models (APM).

Like us on Facebook: facebook.com/KentuckyREC

Follow us on Twitter: @KentuckyREC

Follow us on LinkedIn: linkedin.com/company/kentucky-rec

Check out our Website: www.kentuckyrec.com• Call us: 859-323-3090• Email us: kyrec@uky.edu

Connect with Kentucky REC!