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MACRA/Quality Payment Program/MIPS
Participation without an EHR August 2017
In Partnership with Alliant Quality
Michele Stanek, MHS South Carolina Office of Rural Health Center for Practice Transformation
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Transformation
• Changes in Healthcare Delivery System
• Changes in Payment Systems
• Changes in Culture
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MACRA/QPP Medicare Access and CHIP Reauthorization Act of 2015
• New framework of physician reimbursement –
rewards better care (value) rather than more care (volume)
• Repeals and replaces sustainable growth rate (SGR) • Primarily still based on fee-for-service architecture • Consolidates Medicare quality programs
– Meaningful Use – Physician Quality Reporting System (Quality) – Value Based Payment Modifier Program (Cost)
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Quality Payment Program
Medicare Physician Reimbursement MIPS (Merit-Based Incentive Program): • Based on fee-for-service • Performance score based on
“value” • FFS payment adjusted based on
performance score APMs (Alternate Payment Models): • Moves to population-based and
episode-based payment • Requires shared two-sided risk • Incentives for organizations to
move towards APMs (bonus)
QPP
MIPS
MIPS
APM
APM
Source: https://www.cms.gov/Medicare/Quality-Initiatives-Patient-Assessment-Instruments/Value-Based-Programs/MACRA-MIPS-and-APMs/MACRA-LAN-PPT.pdf
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Merit-Based Incentive Program
Each physician or eligible professional or group will receive a composite performance score: 0-100; score will determine reimbursement
Quality
60%
Improvement
Activities
15%
Cost
0%
Advancing
Clinical
Information
25%
Final Score
(0-100)
Source: https://www.cms.gov/Medicare/Quality-Initiatives-Patient-Assessment-Instruments/Value-Based-Programs/MACRA-MIPS-and-APMs/MACRA-LAN-PPT.pdf
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MIPS • Quality: 6 performance measures (1 outcome/high value) or
one specialty-specific or subspecialty-specific measure set (PQRS)
• ACI: 5 required measures of EHR functionality & how well you are using EHR/HIT/HIE); optional measures that provide bonus points (MU)
• Cost: Claims-based; total per capita cost per attributed beneficiary & Medicare spending per beneficiary; 30% CPS by 2019/2021 (VM)
• IA: high and medium weighted activities; PCMH recognition maximum points; must complete 4 medium or 2 high-weighted activities; small practices 1 high or 2 medium; activity that involves CERHT gets bonus score
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MIPS
Source: https://www.cms.gov/Medicare/Quality-Initiatives-Patient-Assessment-Instruments/Value-Based-Programs/MACRA-MIPS-and-APMs/MACRA-LAN-PPT.pdf
Transitional Year:
Threshold 3 points; > 70
points eligible for bonus
adjustments
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Pick Your Pace Measurement Year 2017; Payment Year 2019
Source: https://www.cms.gov/Medicare/Quality-Initiatives-Patient-Assessment-Instruments/Value-Based-Programs/MACRA-MIPS-and-APMs/MACRA-LAN-PPT.pdf
2017 data must be submitted by March 2018
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Pick Your Pace Testing QPP to Avoid Negative Adjustement
Source: https://www.cms.gov/Medicare/Quality-Initiatives-Patient-Assessment-Instruments/Value-Based-Programs/MACRA-MIPS-and-APMs/MIPS-ACI-and-IA-presentation.pdf
✔ ✔ ✖
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Clinical Quality
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Clinical Quality
• Must select and report on 6 clinical quality measures from list of 271 measures - https://qpp.cms.gov/mips/quality-measures
• 1 of 6 measures must be an outcome measure; if an outcome measure is not available that is applicable to your specialty you can select another high priority measures
• Data completeness: must report on at least 50% of all Medicare Part B patients
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Quality Measures
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Selecting Measures
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Selecting Measures
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Selecting Measures
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Selecting Measures
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Reporting
Report as an Individual Reporting by group
• Report by NPI tied to single TIN
• Reporting through EHR, Registry or QCDR and claims
• Set of clinicians whose NPIs are tied to a shared TIN
• Submit group level data through CMS web interface or an electronic health record, registry, or a qualified clinical data registry
• Option for solo or small practices to create virtual group for MIPS reporting
Source: https://www.cms.gov/Medicare/Quality-Initiatives-Patient-Assessment-Instruments/Value-Based-Programs/MACRA-MIPS-and-APMs/MACRA-LAN-PPT.pdf
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Reporting
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Registry Reporting
Source: qpp.cms.gov
• Explore listing of approved registries - https://qpp.cms.gov/about/resource-library
• Many specialty societies have an approved registry
• Different methods to interact with registry
• Must meet data completeness standard of 50% of all eligible Medicare Part B patients; must include at least 20 patients
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Registry Reporting
Source: https://qpp.cms.gov/about/resource-library
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Claims Reporting
Source: qpp.cms.gov
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Claims Reporting
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Claims Reporting
• Codes that ensure patient is part of denominator and numerator
• Denominator: CPT or HCPCS – Codes to eliminate patient from
denominator if they meet exclusion
• Numerator: Mostly CPT II and modifier codes – CPT II are tracking codes – Paired with cost of $0.00 or $0.01
• Submit 1 patient using codes to “Test Program”
• To partial or fully participate must have a case minimum of 20 patients and must report on 50% of all Medicare Part B patients
Source: https://qpp.cms.gov/about/resource-library
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Claims Reporting
Source: https://qpp.cms.gov/about/resource-library
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Scoring
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Scoring
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Improvement Activity
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Practice Improvement Activities • Practices must attest to the completion of
approved practice improvement activities for a minimum of 90 days – 92 approved practice improvement activities
– Activities rated as either high and medium activities
• Must complete 4 medium or 2 high-weighted activities;
• Small practices must complete 1 high or 2 medium activities – 15 or fewer clinicians attached to one Tax ID #
– Rural or health professional shortage area
– Non-patient facing specialties
Source: https://www.cms.gov/Medicare/Quality-Initiatives-Patient-Assessment-Instruments/Value-Based-Programs/MACRA-MIPS-and-APMs/MIPS-ACI-and-IA-presentation.pdf
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Practice Improvement Activities
• PCMH or PCSP recognition maximum points • Groups qualifying for specials scoring as an MIPS APM
(MSSP Track 1, Oncology Care Model…) have no additional PI reporting requirement; receive maximum points
• Groups participating in other APM will get automatic half credit
• Activities that involves CERHT gets bonus score • Total Points available 40 points
– Medium Activity = 10 points – High Activity = 20 points
• Small, rural, or non-patient facing clinicians – 40 points – Medium = 20 points – High = 40 points
Source: https://www.cms.gov/Medicare/Quality-Initiatives-Patient-Assessment-Instruments/Value-Based-Programs/MACRA-MIPS-and-APMs/MIPS-ACI-and-IA-presentation.pdf
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Reporting
• Report through attestation through CMS portal – not yet available
• Must be able to provide documentation on selected improvement activities
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Practice Improvement Activities
Source: https://qpp.cms.gov/measures/ia
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Practice Improvement Activities
Source: https://qpp.cms.gov/measures/ia
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ACI: Reweighting
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Reweighting
• Hardship Exemption: To have ACI category to be reweighted to 0%, ECs/groups must meet the following: – Insufficient Internet Connectivity – Extreme or Uncontrolled Circumstances – Lack of control over the Availability of CEHRT Must submit application to CMS
• Automatic Reweighting: To qualify for automatic reweighting: – Hospital-based MIPS clinician – PA – NP – CNS – CRNA – Clinician who lack face-to-face interactions with patients ACI Category will be reweighted at 0% with the 25% assigned to the Clinical Quality Category
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QUESTIONS?