2018 QUALITY PERFORMANCE CATEGORY WEBINAR

Transcription

1 2018 QUALITY PERFORMANCE CATEGORY WEBINAR

2 Disclaimers This presentatin was prepared as a tl t assist prviders and is nt intended t grant rights r impse bligatins. Althugh every reasnable effrt has been made t assure the accuracy f the infrmatin within these pages, the ultimate respnsibility fr the crrect submissin f claims and respnse t any remittance advice lies with the prvider f services. This publicatin is a general summary that explains certain aspects f the Medicare Prgram, but is nt a legal dcument. The fficial Medicare Prgram prvisins are cntained in the relevant laws, regulatins, and rulings. Medicare plicy changes frequently, and links t the surce dcuments have been prvided within the dcument fr yur reference. The Centers fr Medicare & Medicaid Services (CMS) emplyees, agents, and staff make n representatin, warranty, r guarantee that this cmpilatin f Medicare infrmatin is errr-free and will bear n respnsibility r liability fr the results r cnsequences f the use f this guide. 2

3 Tpics Overview f the Quality Payment Prgram Merit-based Incentive Payment System (MIPS) Year 2 Requirements Overview f the Quality Perfrmance Categry Quality Perfrmance Categry Requirements Hw t Submit Quality Data Quality Perfrmance Categry Scring Help and Supprt 3

4 Quality Payment Prgram MIPS and Advanced APMs The Medicare Access and CHIP Reauthrizatin Act f 2015 (MACRA) requires CMS by law t implement an incentive prgram, referred t as the Quality Payment Prgram, that prvides fr tw participatin tracks: MIPS Advanced APMs The Merit-based Incentive Payment System (MIPS) If yu are a MIPS eligible clinician, yu will be subject t a perfrmance-based payment adjustment thrugh MIPS. OR Advanced Alternative Payment Mdels (Advanced APMs) If yu decide t take part in an Advanced APM, yu may earn a Medicare incentive payment fr sufficiently participating in an innvative payment mdel. 4

5 MERIT-BASED INCENTIVE PAYMENT SYSTEM (MIPS) 5

6 Merit-based Incentive Payment System (MIPS) Quick Overview Cmbined legacy prgrams int a single, imprved prgram. Physician Quality Reprting System (PQRS) Value-Based Payment Mdifier (VM) MIPS Medicare EHR Incentive Prgram (EHR) fr Eligible Prfessinals 6

7 Merit-based Incentive Payment System (MIPS) Quick Overview MIPS Perfrmance Categries fr Year 2 (2018) Quality + Cst + Imprvement Activities + Prmting Interperability = 100 Pssible Final Scre Pints Cmprised f fur perfrmance categries in S what? The pints frm each perfrmance categry are added tgether t give yu a MIPS Final Scre. The MIPS Final Scre is cmpared t the MIPS perfrmance threshld t determine if yu receive a psitive, negative, r neutral payment adjustment. Nte: Starting in 2018, the Advancing Care Infrmatin perfrmance categry was renamed the Prmting Interperability perfrmance categry. 7

8 MIPS YEAR 2 (2018) Participatin Basics 8

9 MIPS Year 2 (2018) Wh is Included? N change in the types f clinicians eligible t participate in MIPS eligible clinicians include: Physicians Physician Assistants Nurse Practitiners Clinical Nurse Specialists Certified Registered Nurse Anesthetists 9

10 MIPS Year 2 (2018) Wh is Included? Change t the Lw-Vlume Threshld fr Includes MIPS eligible clinicians billing mre than $90,000 a year in allwed charges fr cvered prfessinal services under the Medicare PFS AND furnishing cvered prfessinal services t mre than 200 Medicare beneficiaries a year. Transitin Year 1 (2017) Final Year 2 (2018) Final BILLING >$30,000 AND >100 BILLING >$90,000 AND >200 Vluntary reprting remains an ptin fr thse clinicians wh are exempt frm MIPS. Clinicians wh submit data vluntarily will nt receive a payment adjustment. 10

11 MIPS Year 2 (2018) Wh is Exempt? N change in basic exemptin criteria.* Advanced APMs Newly-enrlled in Medicare Enrlled in Medicare fr the first time during the perfrmance perid (exempt until fllwing perfrmance year) Belw the lw-vlume threshld Allwed charges fr cvered prfessinal services under the Medicare PFS less than r equal t $90,000 a year OR Furnish services t 200 r fewer Medicare Part B patients a year Significantly participating in Advanced APMs Receive 25% f their Medicare payments OR See 20% f their Medicare patients thrugh an Advanced APM *Only Change t Lw-vlume Threshld 11

12 MIPS Year 2 (2018) Perfrmance Perid Change: Increase t Perfrmance Perid Transitin Year 1 (2017) Final Year 2 (2018) Final Perfrmance Categry Minimum Perfrmance Perid Perfrmance Categry Minimum Perfrmance Perid Quality Cst 90-days minimum; full year (12 mnths) was an ptin Nt included. 12-mnths fr feedback nly. Quality Cst 12-mnths 12-mnths Imprvement Activities 90-days Imprvement Activities 90-days 90-days 90-days Advancing Care Infrmatin Prmting Interperability 12

13 MIPS Year 2 (2018) Timeline fr Year 2 Perfrmance perid submit Feedback available adjustment 2018 Perfrmance Year March 31, 2019 Data Submissin Feedback January 1, 2020 Payment Adjustment Perfrmance perid pens January 1, Clses December 31, Clinicians care fr patients and recrd data during the year. Deadline fr submitting data is March 31, Clinicians are encuraged t submit data early. CMS prvides perfrmance feedback after the data is submitted. Clinicians will receive feedback befre the start f the payment year. MIPS payment adjustments are prspectively applied t each claim beginning January 1,

14 QUALITY PERFORMANCE CATEGORY IN

15 Why Fcus n Quality? What are Quality measures? Quality measures are tls that help us t: Measure health care prcesses, utcmes, and patient experiences f their care Link utcmes that relate t ne r mre f these quality gals fr health care that s effective, safe, efficient, patient-centered, equitable, and timely Quality Perfrmance Categry measures: If yu re a MIPS eligible clinician, yu can chse frm: Mre than 270 MIPS quality measures fr the 2018 perfrmance perid Qualified Clinical Data Registry (QCDR) measures develped by QCDRs (utside f the MIPS quality measure set), if yu re reprting thrugh a QCDR 15

16 Quality Measures Quality Measure Classificatins: Prcess measures: shw what dctrs and ther clinicians d t maintain r imprve the health f healthy peple r thse diagnsed with a given cnditin r disease Outcme measures: shw hw a patient ultimately des in respnse t a treatment fr a particular cnditin High Pririty measures include these measure categries: Outcme Apprpriate Use Patient Experience Patient Safety Efficiency Measures Care Crdinatin 16

17 2018 Quality Perfrmance Categry Requirements Quality cmprises 50% f yur MIPS final scre in 2018 T participate, yu must: Submit cllected data fr at least 6 measures fr the 12 mnth perfrmance perid (January 1 December 31, 2018) One f these measures shuld be an utcme measure OR a high-pririty measure, if yu have n applicable utcme measure Yu may als select specialty-specific set f measures (e.g., cardilgy, dentistry, emergency medicine, general surgery) TIP: T review the 2018 Quality measures, including the specialty sets, visit the Explre Measures sectin f the Quality Payment Prgram website: 17

18 2018 Quality Perfrmance Categry Requirements CMS Web Interface Submissin Grups and Virtual Grups with 25 r mre clinicians participating in MIPS, wh are registered and chse t submit data using the CMS Web Interface, must reprt all 15 required quality measures fr the full year (January 1 - December 31, 2018). Bnus Pints Quality measure bnus pints can be earned in the fllwing ways: Submissin f 2 r mre utcme r high pririty quality measures (bnus will nt be awarded fr the first utcme r high pririty quality measure) Submissin using End-t-End Electrnic Reprting, with quality data directly reprted frm an EHR t a qualified registry, QCDR, r via CMS Web Interface 18

19 QUALITY PERFORMANCE CATEGORY SCORING 19

20 Quality Requirements Recap Yu pick 6 f 270+ available measures t reprt 1 f the 6 measures must be: Outcme measure, OR High-pririty measure (if n utcme measures are applicable) The CAHPS fr MIPS Survey measure can cunt fr 1 f the 6 measures (patient experience measure r 1 high pririty measure) Instead f picking 6 measures frm the MIPS measures list, yu can chse t reprt: Specific specialty measure set CMS Web Interface measures (15 quality measures) 6 QCDR measures (must include 1 utcme measure [if available] r 1 high pririty measure if an utcme measure is nt available) All-Cause Readmissin measure applies t grups r virtual grups with 16 r mre clinicians wh meet 200 patient case minimum; this measure is calculated by CMS 20

21 Quality Perfrmance Categry Scring Yu ll receive 3 t 10 pints n each quality measure based n perfrmance against benchmarks Failure t submit perfrmance data fr a measure means yu ll receive 0 pints Yu ll receive bnus pints if yu: Submit mre utcme r high pririty measures Use end-t-end electrnic reprting Bnus pints are capped at 10% f ttal pints available fr the Quality perfrmance categry TIP: Yu have the chance t raise yur 2018 Quality categry scre based n the rate f imprvement frm yur Quality categry scre in

22 Quality Perfrmance Categry Scring Quality measures that d nt: Have a benchmark r d nt meet the case minimum (e.g., denminatr f 20) will receive 3 pints Meet data cmpleteness requirements (60% in 2018) will receive 1 pint instead f 3 pints Exceptin: Small practices cnsisting f 15 r fewer eligible clinicians wuld receive 3 pints. Nte: Each data submissin mechanism requires a minimum amunt f data t meet data cmpleteness requirement. 22

23 Quality Benchmarks What are benchmarks? The 2018 Quality benchmarks, fr qualified registries, QCDRs, claims, and EHR submissin mechanisms, are based n data that was reprted via the Physician Quality Reprting System (PQRS) in 2016, tw years befre the perfrmance perid Fr 2017 CAHPS fr MIPS survey measure, the benchmarks were based n tw sets f surveys: 2015 CAHPS fr PQRS and CAHPS fr Accuntable Care Organizatins (ACOs) 2018 CAHPS fr MIPS survey measure benchmarks haven t been established yet since we re using a revised survey, but will be available fr each summary survey measure (SSM) This means we ll calculate benchmarks based n 2018 perfrmance data Fr the CMS Web Interface quality measures, benchmarks are the same as thse used fr the Medicare Shared Savings Prgram 23

24 Quality Benchmarks Mre Abut Benchmarks Separate benchmarks fr different reprting mechanisms EHR, QCDR/registries, claims, CMS Web Interface, administrative claim measures, and CAHPS fr MIPS All reprters (individuals and grups regardless f specialty r practice size) are cmbined int ne benchmark Need at least 20 reprters that meet the fllwing criteria: Meet r exceeds the minimum case vlume (has enugh data t reliably measured) Meets r exceeds data cmpleteness criteria Has perfrmance greater than 0 percent Why this matters? Nt all measures will have a benchmark. If there is n benchmark, then a clinician nly receives 3 pints. 24

25 Quality Benchmarks Hw are benchmarks cnverted t pints? Each measure yu submit is assessed against its submissin mechanism specific benchmark t see hw many pints are earned based n yur quality perfrmance Each quality measure is cnverted int a 10-pint scring system Except fr the 6 tpped-ut MIPS quality measures finalized with a 7-pint scale Perfrmance is typically brken dwn int 10 deciles, with each decile having a value between 3 and 10 pints We cmpare yur perfrmance n a quality measure t the perfrmance levels in the natinal deciles The pints yu earn are based n the decile range that matches yur perfrmance level 25

26 Quality Perfrmance Categry Scring Tpped ut measures capped at 7 pints fr Periperative Care: Selectin f Prphylactic Antibitic-First r Secnd Generatin Cephalsprin. (Quality Measure ID: 21) 2. Melanma: Overutilizatin f Imaging Studies in Melanma. (Quality Measure ID: 224) 3. Periperative Care: Venus Thrmbemblism (VTE) Prphylaxis (When Indicated in ALL Patients). (Quality Measure ID: 23) 4. Image Cnfirmatin f Successful Excisin f Image-Lcalized Breast Lesin. (Quality Measure ID: 262) 5. Optimizing Patient Expsure t Inizing Radiatin: Utilizatin f a Standardized Nmenclature fr Cmputerized Tmgraphy (CT) Imaging Descriptin. (Quality Measure ID: 359) 6. Chrnic Obstructive Pulmnary Disease (COPD): Inhaled Brnchdilatr Therapy. (Quality Measure ID: 52) 26

27 Quality Perfrmance Categry Scring There are 130 available pints if yu submit yur data via the CMS Web Interface and administer the CAHPS fr MIPS Survey There is a validatin prcess fr quality measures that are cllected thrugh claims and/r registry if yu dn t have 6 applicable quality measures 27

28 Reweighting the Quality Perfrmance Categry If yu dn t submit data fr the Quality perfrmance categry because there are n quality measures available t yu, yu wn t earn any pints in this categry, and the Imprvement Activities and Prmting Interperability wuld be reweighted t 45%. Reweighting the Quality Categry in Quality Cst Imprvement Activities Prmting Interperability 0% 10% 45% 45% Nte: We anticipate that reweighting f the Quality perfrmance categry wuld rarely ccur because there are quality measures applicable and available fr mst clinicians. 28

29 Measuring Bnus Pints What is the end-t-end reprting bnus? 1 bnus pint per measure fr reprting yur quality data directly frm yur EHR t a Qualified Registry, QCDR, r via the CMS Web Interface What is the bnus fr submitting additinal utcme/high pririty measures? 1 bnus pint fr each additinal high pririty measure 2 bnus pints fr each additinal utcme and patient experience measure. Nte: Bnus pints will be added t yur grup/virtual Grup s Quality perfrmance categry achievement pints (thse earned based n perfrmance) 29

30 Imprvement Scring Hw d we evaluate eligibility fr imprvement scring? Yu ll be evaluated fr imprvement scring in 2018 when yu: Have a Quality perfrmance categry achievement scre based n reprted measures fr the last perfrmance perid (2017 transitin year) and the current perfrmance perid (2018). Participate fully in the Quality perfrmance categry fr the current perfrmance perid (submit 6 measures/specialty measure set with at least 1 utcme/high pririty measure OR submit as many measures as were available and applicable; all measures must meet data cmpleteness requirements). Submit data under the same identifier fr the 2 perfrmance perids, r if we can cmpare the data submitted fr the 2 perfrmance perids. 30

31 Imprvement Scring Imprvement scring is calculated by: Cmparing the quality achievement percentage pints (thse earned by measures based n perfrmance) frm the previus perid t the quality achievement percentage pints in the current perid. Measure bnus pints are nt included in imprvement scring. 31

32 Imprvement Scring Example In the 2018 perfrmance perid, a MIPS eligible clinician submitted 6 measures via Certified Electrnic Heath Recrd Technlgy (CEHRT). She earned 33 measure achievement pints and 6 measure bnus pints fr end-t-end electrnic reprting. In the transitin year (2017), the same MIPS eligible clinician earned 25 measure achievement pints and 2 measure bnus pints fr reprting an additinal utcme measure Quality perfrmance categry achievement percent scre = 42% 25 achievement pints 60 pssible pints Excludes the 2 bnus pints 2018 Quality perfrmance categry achievement percent scre = 55% 33 achievement pints 60 pssible pints Excludes the 6 bnus pints The increase in Quality perfrmance categry achievement percent scre frm prir perfrmance perid t current perfrmance perid = 13% (55% - 42%) The imprvement percent scre = 3.1% (13% 42%) x 10%) If CMS can t cmpare data between tw perfrmance perids, r there is n imprvement, the imprvement scre will be 0%. The imprvement percent scre cannt be negative 32

33 Imprvement Scring T accunt fr transitin year plicies that allwed clinicians t test their participatin, MIPS eligible clinicians with a 2017 Quality perfrmance categry achievement percent scre belw 30% will be scred fr imprvement based n a 30% achievement percent scre, which is the lwest scre a MIPS eligible clinician can achieve with cmplete reprting in year 1. This plicy allws us t scre a MIPS eligible clinician n imprvement and still accunt fr differences in participatin levels between the tw years. Please nte that the imprvement percent scre cannt be negative and is capped at 10%. 33

34 Calculating the Quality Perfrmance Scre Quality calculatin updated t include imprvement scre 34

35 Quality Scring Example Cntinuing frm previus example: The MIPS eligible clinician submitted 6 measures fr the 2018 perfrmance year via CEHRT. She earned 33 measure achievement pints and 6 measure bnus pints fr end-t-end electrnic reprting. Her imprvement percent scre is 3.1%. Quality perfrmance categry percent scre = 68.1% (33 achievement pints + 6 bnus pints) (60 ttal available achievement pints) = 65% 65% (fr submitted measures) + 3.1% (imprvement percent scre) = 68.1% The Quality perfrmance categry percent scre (68.1) is then multiplied by the weight f the Quality categry (50%) t determine the number f pints cntributing t the final scre (34.05 pints).

36 PREPARING FOR QUALITY IN

37 Hw t Prepare fr Quality 1. Check if yu re eligible fr MIPS. Yu can use the QPP Participatin Status Tl at qpp.cms.gv 2. Chse yur measures. There are mre than 270 MIPS quality measures available fr reprting. Additinal measures (knwn as QCDR measures) may be available if yu chse t wrk with a QCDR. Utilizing thse ptins, yu can find the measures that wrk best fr yu, yur grup, r Virtual Grup. Use the Explre Measures tl t review quality measures fr

38 Hw t Prepare fr Quality 3. Lk at the current measure specificatins that are aligned with the measures yu chse. Measure specificatins describe each measure and utline their elements. Each measure has its wn specificatins. See the 2018 QPP Resurce library n CMS.gv t view quality measure specificatins. 4. Cllect yur data. Yu shuld start data cllectin n January 1, 2018 t meet data cmpleteness requirements and make it mre likely t earn a higher psitive payment adjustment. 5. Submit yur 2018 data. The data submissin perid is between January 1, 2019 and April 2, If yu re submitting quality data via claims, yur claims need t be prcessed via MACs by March 1, There will be an 8-week submissin perid between January 2 and March 31, 2019 fr the CMS Web Interface. Yu can sign int the Quality Payment Prgram website ( t review yur data thrughut this perid. Yu ll just need Enterprise Identity Management (EIDM) credentials, and an apprpriate user rle. If yu dn t have ne, yu can create ne here: 38

39 HELP AND SUPPORT 39

40 Quality Perfrmance Categry Resurces Visit the Quality Payment Prgram Website: Quality Measures Requirements Explre Quality Measures Check ut the resurces in the 2018 Resurce Library n CMS.gv, including: Quality Perfrmance Categry Fact Sheet Quality measure specificatins fr claims and registry measures Quality measure specificatins supprting dcuments Quality Benchmarks CMS Web Interface measures and supprting dcuments 30-day All-Cause Hspital Readmissin Measure Patient facing encunter cdes QCDR Measure Specificatins Quality Perfrmance Categry fact sheet 40

41 Technical Assistance Available Resurces CMS has free resurces and rganizatins n the grund t prvide help t eligible clinicians included in the Quality Payment Prgram: T learn mre, g t: 41

42 Cmments due September 10 When and Where t Submit Cmments See prpsed rule fr infrmatin n submitting cmments by clse f 60-day cmment perid n September 10 (When cmmenting refer t file cde CMS P) Instructins fr submitting cmments can be fund in prpsed rule; FAX transmissins will nt be accepted Yu must fficially submit yur cmments in ne f fllwing ways: electrnically thrugh Regulatins.gv by regular mail by express r vernight mail by hand r curier 42

43 Q&A SESSION 43

44 Q&A Sessin T ask a questin, please dial: If prmpted, use passcde: Press *1 t be added t the questin queue. Yu may als submit questins via the chat bx. Speakers will answer as many questins as time allws. 44

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