powerpoint presentation · 2019. 9. 5. · title: powerpoint presentation author: jackie...

MIPS Cost Category and Feedback ReportsFebruary 8, 2019

Presented by

Jackie Rogers, Director- Quality Reporting Engagement Group

Kate Elam, MIPS Senior Consultant

Disclaimer

▪ Information presented is done solely for informational and educational

purposes

▪ Information should not be relied upon for purposes of regulatory

compliance or as a guarantee for increased revenues or practice

successes or failures

▪ Information provided herein does not constitute and should not

substitute for legal advice; Practice should consult with Practice’s own

legal and regulatory counsel regarding all applicable legal and

regulatory requirements

02/06/2019 CONFIDENTIAL2

02/06/20193

Performance Thresholds

Minimum points needed to avoid a downward adjustment

2019

Performance Thresholds

Minimum points needed to earn an Exceptional Performer Bonus

2019

MIPS Exceptional Performers

▪962 QREG Eligible Clinicians scored over 70 Points- 99.4%

▪48 QREG Eligible Clinicians scored 100 Points (Perfect Score)- 4.9%

▪6 QREG Eligible Clinicians scored under 70 Points- 0.6%

▪QREG Eligible Clinicians Average Score utilizing our full MIPS Services - 89.8 out of 100 points

▪QREG Eligible Clinicians Average Score utilizing our MIPS Alternative Service (ACI/IA categories only)- 48.25out of 50 points

Note: For 2017 and 2018, 70 points or more put Eligible Clinicians into the ‘Exceptional Performer’ category for MIPS reporting. This makes Clinicians eligible to receive from additional bonus pool of $500M for all those clinicians who were in this category.

MIPS – 2019

How data is submitted to the Quality Payment Program (QPP)

Cost Category Overview

Cost Category

▪ Bipartisan Budget Act 2018:

- 30% in first post-transition year (2022)

- May vary through 2021(10-30%)

▪ 2019 Finalized at 15%

- Anticipate Cost category to increase

by 5% each year


QUALITY – 45%

PI – 25%IA – 15%

COST –

15%

Cost Category

▪ CMS uses Medicare claims data to calculate cost measure

performance

▪ Payment standardization

- Regional differences in labor costs and practice expenses

- Differences in the relative price of inputs in local markets where a service is provided

- Extra payments from Medicare in medically under-served regions

- Policy-driven payment adjustments such as those for teaching hospitals

▪ Benchmarks are established each year AFTER performance period

ends

- 2019 benchmarks will be determined based on 2019 claims data

- Benchmarks are same for all clinicians nationally


Cost Category

▪ LOW COST = HIGH SCORES

▪ Scoring

- Practices who report as a group are scored on Cost as a group

- Practices who report as individuals are scored on Cost individually

- Will receive feedback for individuals, where applicable, even if the practice reported as a group

▪ 10 points per measure

▪ Only scored on measures that meet or exceed the case minimum

▪ Episode-based measures are not scored for 2018 or 2019 performance, but may be scored starting in 2020

- Feedback is provided if you meet the case minimum for any episode-based measure


Total Per Capita Cost


▪ The TPCC measure includes all Part A and Part B costs for an

attributed Medicare patient

▪ Cost = Medicare allowed charges

▪ Includes all of the Part A and B charges billed by any clinician or facility

during the performance period

- The total per capita cost of the patient is NOT just what your practice billed

▪ Each patient is attributed to one NPI-TIN


TPCC


▪ Attribution

- STEP 1: Patient is attributed to whichever PCP, NP, PA, or CNS provided the

most primary care services

- STEP 2: If the patient did not receive a primary care service from any PCP,

NP, PA, or CNS during the year, then the patient is attributed

- “Most” meaning allowed $

▪ Patients are NOT attributed to specialists if they have seen a PCP

during the year

▪ NPs, PAs, or CNSs who bill “incident to” do not fall under Step 1

▪ Case minimum: 20 patients


TPCC


▪ Primary Care Services

- E&M services

- Initial Medicare visits

- Annual wellness visits


TPCC


▪ Cost adjustments

- Annualized cost

>Adjusts cost based on Medicare new enrollee status or if patient died during the

year

>

- Risk-adjusted costs

>79 Hierarchical Condition Category (HCC) indicators from a beneficiary’s claims

during the 90-day period before the start of the episode

>End stage renal disease (ESRD) status

- Specialty adjusted cost


TPCC

Medicare Spending Per Beneficiary


▪ The MSPB measure includes all Medicare Part A and Part B claims

surrounding a patient’s hospital inpatient stay, including 3 days prior to

admission through 30 days post-discharge

▪ Attribution: Each MSPB episode is attributed to the TIN-NPI

responsible for the plurality of Part B Physician/Supplier services

during the episode

▪ Case minimum: 35 episodes


MSPB


▪ Risk adjustment

- 79 Hierarchical Condition Category (HCC) indicators from a beneficiary’s claims during the 90-day

period before the start of the episode

- Recent long-term care status

- End stage renal disease (ESRD) status

- The Medicare Severity Diagnosis-Related Group (MS-DRG) code of the index hospital admission


MSPB

Episode-Based Measures

Episode-Based Measures

▪ Elective Outpatient Percutaneous Coronary Intervention (PCI)

▪ Knee Arthroplasty

▪ Revascularization for Lower Extremity Chronic Critical Limb Ischemia

▪ Routine Cataract Removal with Intraocular Lens (IOL) Implantation

▪ Screening/Surveillance Colonoscopy


▪ Intracranial Hemorrhage or Cerebral Infarction

▪ Simple Pneumonia with Hospitalization

▪ ST-Elevation Myocardial Infarction (STEMI) with Percutaneous Coronary Intervention (PCI)

Procedural MeasuresAcute Inpatient Medical

Condition Measures

Feedback Only in 2018/2019

Case Minimum: 10 Case Minimum: 20

Feedback Reports

HARP User Access

▪ https://qpp.cms.gov

- MIPS submission

- Program requirements and resources

- Eligibility lookup

- Feedback reports

▪ Previously managed under Enterprise Identity Management (EIDM)

▪ Security Official or practice representative connects to the practice Tax

ID number

▪ Step-by-step walkthrough of account creation for first time users:

https://www.youtube.com/watch?v=4xGkWvPa33E


https://qpp.cms.gov/


What’s in a Feedback Report

▪ You receive MIPS feedback on all categories for which you submit

data

▪ You receive Cost data on measures for which you meet the case

minimum

- If you only met the case minimum for TPCC, but not MSPB, you only receive

feedback on TPCC

▪ Patient details are not included

- CMS has stated the are planning to provide these details in future

feedback—possibly 2018?


2017 Feedback available now in QPP portal


TPCC Feedback


Items & Services


In relation to TPCC

MSPB Feedback


Where can I go if I need help?

Quality Reporting Engagement Group- QREG

Resources

▪ QPP/MIPS Resources:

- https://qpp.cms.gov/

- https://qpp.cms.gov/about/resource-library

- https://qpp.cms.gov/participation-lookup

- https://www.youtube.com/watch?v=4xGkWvPa33E

- [email protected]

▪ QPP Help Desk: 1-866-288-8292


https://qpp.cms.gov/

https://qpp.cms.gov/about/resource-library

https://qpp.cms.gov/participation-lookup


mailto:[email protected]

powerpoint presentation · 2019. 9. 5. · title: powerpoint presentation author: jackie...

Documents