cms transforming clinical practices initiative and · performance category: quality measures (60%)...
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CMS Transforming Clinical Practices Initiative and The Southern New England Practice Transformation Network
MIPS 2017- Quality Measure Selection For Optometrists4/11/17 and 4/13/17
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• Brief overview of the MIPS program
• Reporting options and data submission methods for MIPS
• Quality measure selection options for Optometrists
• Data Submission Quality Measure Scoring Comparison
Agenda
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MIPS Overview: 2017 Transition Year
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1) What is MIPS?
• There are 4 Performance Categories: Quality, Cost, Improvement Activities, Advancing Care Information
2) How do I determine if I am eligible?
• Are you a Medicare Part B clinician who bills more than $30,000 AND provides care for more than 100 Medicare Part B patients a year?
• Are you newly enrolled in Medicare?
• Are you significantly participating in Advanced APMs?
Adapted From: CMS. “The Merit-based Incentive Program.” November 2016. PowerPoint presentation
3) How can I participate?
• Pick Your Pace
MIPS Overview: 2017 Transition Year
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Adapted from: CMS. “The Merit-based Incentive Program.” November 2016. PowerPoint presentation
Don’t Participate
Do not report any data
Receive -4% payment adjustment
Test Pace
Report a minimum of 1 quality measure OR 1
improvement activity OR the base score advancing care
information measures for any time period
Receive a neutral or small payment adjustment
Partial Year
Report more than 1 quality measure AND up to 4
improvement activities ANDmore than the base score
advancing care information measures for 90 days
Receive a small positive payment adjustment
Full Year
Report a minimum of 6 quality measures AND up to 4 improvement activities AND
more than the base score advancing care information measures for the full year
Receive a modest payment adjustment
Data Submission Methods for 2017 Transition Year
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Individual Group
Qualified Clinical Data Registry (QCDR)Qualified RegistryEHRClaims
QCDRQualified RegistryEHRAdministrative ClaimsCMS Web Interface (group of 25 or more)CAHPS for MIPS Survey
AttestationQCDRQualified RegistryEHR Vendor
AttestationQCDRQualified RegistryEHR VendorCMS Web Interface
AttestationQCDRQualified RegistryEHR Vendor
AttestationQCDRQualified RegistryEHR Vendor
Source: CMS. “The Merit-based Incentive Program.” November 2016. PowerPoint presentation
• Requirements
– Choose up to 6 of 271 quality measures including:
• 1 outcome quality measure
OR
• If an appropriate outcome measure is not available, at least 1 high priority quality measure
– Report on at least 50% of patient data
• QCDR, EHR, Qualified Registry: all payers
• Claims: only Medicare Part B patients
– Minimum case volume is 20 cases
Performance Category: Quality Measures
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Source: https://qpp.cms.gov/measures/quality
• Explore the CMS Shopping Cart
– https://qpp.cms.gov/measures/quality
– Filter by:• High Priority Measures
• Data Submission Method
• Specialty Specific Measure Sets
Performance Category: Quality Measures
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Source: https://qpp.cms.gov/
Measure NameMeasure
IDMeasure
TypeHigh Priority
(Y/N)92 Codes
(Y/N)Topped
Out (Y/N)
Controlling High Blood Pressure 236 Outcome Y N N
Diabetes: Eye Exam 117 Process N Y N
Primary Open-Angle Glaucoma (POAG): Optic Nerve Evaluation 12 Process N Y N
Diabetic Retinopathy: Communication with the Physician Managing Ongoing Diabetes Care 19 Process Y Y N
Diabetic Retinopathy: Documentation of Presence or Absence of Macular Edema and Level of Severity of Retinopathy
18 Process N Y N
Documentation of Current Medications in the Medical Record 130 Process Y Y Y
Preventive Care and Screening: Tobacco Use: Screening and Cessation Intervention 226 Process N Y N
Preventive Care and Screening: Screening for High Blood Pressure and Follow-Up Documented 317 Process N Y N
Preventive Care and Screening: Influenza Immunization 110 Process N N N
Preventive Care and Screening: Body Mass Index (BMI) Screening and Follow-Up Plan 128 Process N N N
Pneumococcal Vaccination Status for Older Adults 111 Process N N N
Closing the Referral Loop: Receipt of Specialist Report 374 Process Y Y N
Quality Measures: EHR Reporting
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Measure NameMeasure
IDMeasure
Type
High Priority
(Y/N)
92 Codes (Y/N)
Topped Out (Y/N)
Primary Open-Angle Glaucoma (POAG): Reduction of Intraocular Pressure (IOP) by 15% OR Documentation of a Plan of Care 141 Outcome Y Y Y
Controlling High Blood Pressure 236 Outcome Y N N
Diabetes: Hemoglobin A1C Poor Control 1 Outcome Y N N
Diabetes: Eye Exam 117 Process N Y Y
Primary Open-Angle Glaucoma (POAG): Optic Nerve Evaluation 12 Process N Y Y
Age-Related Macular Degeneration (AMD): Dilated Macular Examination 14 Process N Y N
Age-Related Macular Degeneration (AMD): Counseling on Antioxidant Supplement 140 Process N Y N
Diabetic Retinopathy: Communication with the Physician Managing Ongoing Diabetes Care 19 Process Y Y N
Diabetic Retinopathy: Documentation of Presence or Absence of Macular Edema and Level of Severity of Retinopathy 18 Process N
Documentation of Current Medications in the Medical Record 130 Process Y Y Y
Preventive Care and Screening: Tobacco Use: Screening and Cessation Intervention 226 Process N Y N
Tobacco Use and Help with Quitting Among Adolescents 402 Process N Y N
Preventive Care and Screening: Screening for High Blood Pressure and Follow-Up Documented 317 Process N Y N
Preventive Care and Screening: Influenza Immunization 110 Process N N N
Preventive Care and Screening: Body Mass Index (BMI) Screening and Follow-Up Plan 128 Process N N N
Preventive Care and Screening: Unhealthy Alcohol Use: Screening & Brief Counseling 431 Process N N
Pneumococcal Vaccination Status for Older Adults 111 Process N N N
Care Plan 47 Process Y N N
Closing the Referral Loop: Receipt of Specialist Report 374 Process Y
Quality Measures: Qualified Registry/QCDR Reporting
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Measure NameMeasure
IDMeasure
TypeHigh Priority
(Y/N)92 Codes
(Y/N)Topped
Out (Y/N)
Primary Open-Angle Glaucoma (POAG): Reduction of Intraocular Pressure (IOP) by 15% OR Documentation of a Plan of Care
141 Outcome Y Y Y
Controlling High Blood Pressure 236 Outcome Y N N
Diabetes: Eye Exam 117 Process N Y Y
Primary Open-Angle Glaucoma (POAG): Optic Nerve Evaluation 12 Process N Y Y
Age-Related Macular Degeneration (AMD): Dilated Macular Examination 14 Process N Y Y
Age-Related Macular Degeneration (AMD): Counseling on Antioxidant Supplement 140 Process N Y Y
Diabetic Retinopathy: Communication with the Physician Managing Ongoing Diabetes Care 19 Process Y Y Y
Documentation of Current Medications in the Medical Record 130 Process Y Y Y
Preventive Care and Screening: Tobacco Use: Screening and Cessation Intervention 226 Process N Y Y
Preventive Care and Screening: Screening for High Blood Pressure and Follow-Up Documented 317 Process N Y N
Preventive Care and Screening: Influenza Immunization 110 Process N N N
Preventive Care and Screening: Body Mass Index (BMI) Screening and Follow-Up Plan 128 Process N N N
Pneumococcal Vaccination Status for Older Adults 111 Process N N N
Care Plan 47 Process Y N N
Quality Measures: Claims Reporting
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• Do you have experience submitting quality measures for another CMS program? If so what measures? How have you reported?
• Have you contacted your EHR vendor to determine which measures they will support for MIPS?
• Have you contacted your Qualified Registry or QCDR to determine which measures they will support?
• Where in the patient chart is the relevant data and information collected? How is it organized? Can you retrieve it?
Additional Considerations for Quality Measures
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Quality Measures: Scoring Overview
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Scoring
Reporting Method
Measure Selection
Performance Category: Quality Measures (60%)
• Not submitting performance data for a measure will receive 0 points
• If no benchmark exists or case volume is not met – measure will receive 3 points
• Clinicians receive 3 to 10 points on each quality measure based on performance against benchmarks– Must also have sufficient case volume (≥
20) AND
– Data completeness met (50% of possible data submitted)
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Adapted from: CMS. “The Merit-based Incentive Program.” November 2016. PowerPoint presentation
Performance Category: Quality Measures (60%)
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Source: CMS. “2017 Quality Benchmarks.” December 29, 2016.
• Benchmarks presented in deciles, points awarded within each decile
• Separate benchmarks for the different data submission methods
Decile Number of Points Assigned for 2017 MIPS Performance Period
Below Decile 3Decile 3Decile 4Decile 5Decile 6Decile 7Decile 8Decile 9
Decile 10
3 points3 – 3.9 points4 – 4.9 points5 – 5.9 points6 – 6.9 points7 – 7.9 points8 – 8.9 points9 – 9.9 points
10 points
Topped out measures: performance rates historically have been high and may be scored differently in future years.
Example performance score = 91%
• Bonus points are available for either of the following:
1. Submitting an additional high-priority measure
o 2 points for each additional outcome and patient experience measure
o 1 point for each additional high-priority measure
2. Using CEHRT to submit measures to registries or CMS
o 1 point for submitting electronically end-to-end
Performance Category: Quality Measures (60%)
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Adapted from: CMS. “The Merit-based Incentive Program.” November 2016. PowerPoint presentation
Measure NameOutcomeMeasure
(Y/N)
High Priority
(Y/N)
Case Minimum Met
(Y/N)
Practice Performance(EXAMPLE)
Points Based on Performance
(Qualified Registry/QCDR)
Points Based on Performance
(EHR)
Points Based on Performance
(Claims)
Controlling High Blood Pressure Y Y Y 71% 6 7 5
Diabetes: Eye Exam N N Y 87% 3 4 3
Preventive Care and Screening: Tobacco Use: Screening and Cessation
InterventionN N Y 90% 5 5 3
Diabetic Retinopathy: Communication with the Physician Managing Ongoing
Diabetes CareN Y Y 45% 3 5 3
Primary Open-Angle Glaucoma (POAG):Optic Nerve Evaluation
N N Y 95% 3 7 3
Documentation of Current Medications in the Medical Record
N Y Y 99% 6 8 4
Bonus Points for High Priority 2 2 2
Bonus Points for CEHRT 6 6 N/A
Total Points 34 44 23
Data Submission Comparison – Quality Measure Scoring
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Data Submission Method
Total Points Based On
PerformanceQuality Performance Category Score Calculation
Quality Performance Category Score
Category Weight
Final Quality Performance
Category Score
Qualified Registry/QCDR 34
(Points earned on required 6 quality measures) + (bonus points)Maximum number of points*
(26+2+6)/60 = 56.7 points
60%
34.0 points
EHR 44 (36+2+6)/60 = 73.3 points 44.0 points
Claims 23 (21+2)/60 = 38.3 points 23.0 points
Data Submission Comparison – Quality Measure Scoring
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*Maximum number of points= # of required measures x 10
• The quality measure lists provided in this presentation are meant to guide your practice through the selection process
• MIPS-eligible clinicians must select 6 quality measures
• There are different data submission methods for quality
• You must submit all quality measures through the same submission method
• Initiate contact with your chosen submission vendor for guidance on what measures can be reported
• Your submission method has the potential to impact your Quality score
• Review the CMS benchmarks as well as “topped out” status of measures to ensure the best potential for maximum points
Key Takeaways
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Next Steps
• Download Quality Measure Specifications AND Quality Measure Benchmarks for selected measures on https://qpp.cms.gov/resources/education
• For more information on the other performance categories (Advancing Care Information and Improvement Activities) please watch our previous webinars
– MIPS 2017 - Overview
– MIPS 2017 - Selecting Performance Category Measures and Reporting Requirements
– MIPS 2017 - Scoring: Explanation and Estimation
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