Topics to be covered Do I have to participate in MACRA/MIPS/QPP? Choices for participation Timelines What is changing with QPP
I have no relevant financial relationships to disclose. Participant engagement http://drkolsun.participoll.com I am awake for this presentation A Yes B No C I m not sure A B 1 vote at Drkolsun.participoll.com
MACRA is not ACA Medicare Access and CHIP Reauthorization Act of 2015 2015 House 392-37, Senate 92-8 Repealed the SGR (Sustainable Growth Rate) Reinforced with Bipartisan Budget Act of 2018
Acronym Analysis Medicare Access and CHIP Reauthorization Act Quality Payment Program Merit based Incentive Payment System Alternative Payment Model
Up to the end of 2016 2017 and beyond Physician Quality Reporting System M erit Value Based Payment Modifier I ncentive P ayment S ystem Meaningful Use
MIPS 2017 Are you participating in the following in 2018? A - MIPS/QPP B - APM C I don t know D I didn t participate E I m Excluded A B C D E 0
Qpp.cms.gov
Joby Kolsun Joby Kolsun
Joby Kolsun Joby Kolsun
Have you reviewed feedback? A - Yes B -No C I didn t know I could do that A B C 0
2017 Feedback
2017 Performance Review
How does this affect my Payment? RVU Value Medicare Physician Fee Schedule Conversion Factor QPP Adjustment Factor
Based on 2017 MIPS score 2019 Payment Adjustments 2.1 2 1.9 1.8 1.7 1.6 1.5 1.4 1.3 1.2 1.1 1 0.9 0.8 0.7 0.6 0.5 0.4 0.3 0.2 0.1 0-0.1-0.2-0.3-0.4-0.5-0.6-0.7-0.8-0.9-1 -1.1-1.2-1.3-1.4-1.5-1.6-1.7-1.8-1.9-2 -2.1-2.2-2.3-2.4-2.5-2.6-2.7-2.8-2.9-3 -3.1-3.2-3.3-3.4-3.5-3.6-3.7-3.8-3.9-4 70 Points 3 Points ** BUDGET NEUTRAL ** 10 20 30 40 50 60 70 80 90 100
You are Here Performance Year 2017 2018 2019 2020 2021 2022 Payment Year 2019 2020 2021 2022 2023 2024 QPP 4 5 7 9 9 9-4 -5-7 -9-9 -9 Gross Revenue $1,500,000 $20,000 $25,000 $35,000 $45,000 $45,000 $45,000 Medicare Revenue $500,000 -$20,000 -$25,000 -$35,000 -$45,000 -$45,000 -$45,000
What was your 2017 adjustment? A Negative Adjustment B Zero points C Positive D Exceptional performance level A B C D 0
Performance Changes
Times are a changing Performance 2016 2017 2018 Program PQRS Transition QPP Payment 2018 2019 2020 Are you ready for 2019? A Yes B- No C I m not sure A B C 0
CMS 2018 changes Objective is to move more providers into APMs Increasing exemption criteria Exempt providers can opt out to have data publically reported on Physician Compare Topped out measure being removed
Cost Category Total Per Capita Cost measure all Medicare Part A and Part B costs during the MIPS performance period. 25 case minimum Medicare Spending Per Beneficiary measure An MSPB episode includes all Medicare Part A and Part B claims during the episode, specifically claims with a start date between three days before a hospital admission (the index admission for the episode) through 30 days after hospital discharge. 35 case minimum
QPP Minimum Requirements Year 2017 2018 Part B $30,000 $90,000 Allowed Charges Beneficiaries 100 200
The easy days are over 2017 2018 2019 Quality 90 days 1 year 1 year Cost 1 year 1 year Improvement 90 days 90 days 90 days Interoperability 90 days 90 days 90 days
All quality measures are not the same American College of Physicians (ACP) Performance Measurement Committee (PMC) developed criteria to assess the validity of performance measures Valid 37% Uncertain Validity 28% Not valid 35% https://www.nejm.org/doi/full/10.1056/nejmp1802595
Quality Measure list https://www.cms.gov/medicare/quality-payment-program/resource-library/2018-quality-benchmarks.zip
Quality Measure list Type process, claims, registry Standard deviation Average Decile rankings Topped out https://www.cms.gov/medicare/quality-payment-program/resource-library/2018-quality-benchmarks.zip
Virtual Group Reporting A virtual group is a combination of two or more TINs consisting of the following: Solo practitioners who are MIPS eligible (a solo practitioner is defined as the only clinician in a practice); and/or Groups that have 10 or fewer clinicians (at least one clinician within the group must be MIPS eligible). A group is considered to be an entire single TIN. https://qpp.cms.gov/mips/individual-or-group-participation
Exemptions 2018 Promoting Interoperability Hardship Exception Overview 25% Promoting Interoperability score moves to Quality category Special Status Clinicians Qualified individuals will be automatically reweighted Extreme And Uncontrollable Circumstances Exception Overview rare events (highly unlikely to occur in a given year) entirely outside your control and the facility in which you practice https://qpp.cms.gov/mips/exception-applications?py=2018#
Quality 2018 require 6 measures with full year reporting 2014 CEHRT and ACI transition measure still allowed but bonus for using the more difficult 2015 CEHRT only Some measures are capped out at 7 points. CMS will phase out topped out measures Topped out Variation by reporting method Claims 70%, Registry 45%, EHR 10%. Improve documentation HCC to reduce impact of complex patients on cost.
QPP Video showing how to submit data https://www.youtube.com/watch?v=q0cvke6fnrg&t=56s