MIPS FOR PPRNET MEMBERS A PRIMER AND WHAT YOUR PRACTICE NEEDS TO KNOW
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1 MIPS FOR PPRNET MEMBERS A PRIMER AND WHAT YOUR PRACTICE NEEDS TO KNOW August 25, 2017 Ruth Jenkins, PhD Andrea Wessell, PharmD
2 GOALS Demystify the MIPS process Explain how scores will be determined and work through an example Demonstrate PPRNet tools that can be used to enable quality improvement Provide a MIPS encyclopedia reference
3 AGENDA Topic Slide Quality Payment Program 4 Merit-based Incentive Payment System Payment Adjustments 8 MIPS 2017 Performance Categories 10 Quality 12 Improvement Activities 23 Advancing Care Information 25 Scoring Example 43 PPRNet MIPS Tools & Solution 52 Next Steps 55 Physician Compare 58
4 QUALITY PAYMENT PROGRAM (QPP) The Medicare Access and CHIP Reauthorization Act of 2015 (MACRA) streamlined several payment programs Physician Quality Reporting System (PQRS), Medicare Meaningful Use (MU), and Value-Based Payment Modifiers (VM) Rewards Medicare Part B clinicians via a performancebased payment system QPP includes two paths: Merit-based Incentive Payment System (MIPS) Advanced Alternative Payment Models (APMs)
5 HOW THE QPP WILL CHANGE MEDICARE PAYMENTS
6 WHO IS EXEMPT FROM MIPS? Enrolled in Medicare for the first time Below the Low-volume Threshold* Bill <= $30,000 in Medicare Part B charges OR Provide care for <= 100 Part B-enrolled Medicare beneficiaries Participating in Advanced APM Check your Participation Status: *You can elect to participate even if exempt Enter your NPI: PPRNet qpp.cms.gov/participation-lookup 2017
7 WHY REPORT? Avoid automatic -4% payment adjustment in 2019 Earn points toward neutral or positive adjustment in 2019
8 2019 PAYMENT ADJUSTMENTS Final Score Payment Adjustment >70 points Positive adjustment Eligible for exceptional performance bonus minimum of additional points Positive adjustment Not eligible for exceptional performance bonus 3 points Neutral payment adjustment 0 points Negative payment adjustment of -4% 0 points = does not participate
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10 MIPS 2017 PERFORMANCE Cost Category=0% for 2017
11 PPRNET S QCDR SUBMISSION ROLE Approved by CMS as a Qualified Clinical Data Registry (QCDR) since 2015 QCDR is a type of submission mechanism PPRNet is approved to submit all 3 MIPS categories: 18 Quality Measures Improvement Activities Advancing Care Information (even if you submit your Quality data through another mechanism)
12 2017 MIPS - QUALITY PPRNet is approved for 18 Quality Measures Submit minimum of 6 measures (one must be an outcome measure) Receive 3 to 10 points on each quality measure based on performance against benchmarks Bonus points for additional outcome (2) and highpriority measures (1) (Max of 6 bonus points) Bonus points for end-to-end reporting (6 points) Maximum score of 60 points
13 PPRNET MIPS BENCHMARK REFERENCE
14 2017 MIPS SCORING FOR QUALITY Maximum score cannot exceed 100% *Maximum number of points = # of required measures x 10
15 2017 MIPS PPRNET QUALITY MEASURES 3 Outcome Measures Diabetes: Hemoglobin A1c (HbA1c) Poor Control (>9%) Controlling High Blood Pressure Treatment of Hypokalemia
16 2017 MIPS PPRNET QUALITY MEASURES 5 High Priority Additional Measures Appropriate Treatment for Adults with Upper Respiratory Infection Use of Benzodiazepines in the Elderly NSAID or Cox 2 Inhibitor Use in Patients with Heart Failure, Hypertension, or Chronic Kidney Disease Monitoring Serum Creatinine Avoiding Use of CNS Depressants in Patients on Long- Term Opioids
17 2017 MIPS PPRNET QUALITY MEASURES 10 Additional Measures Screening for Type 2 Diabetes Antiplatelet Medication for High Risk Patients Atrial Fibrillation/Atrial Flutter: Chronic Anticoagulation Rx Scrn for albuminuria in pts at risk for CKD (DM and/or HTN) Chronic Kidney Disease (CKD): egfr Monitoring Chronic Kidney Disease (CKD): Hemoglobin Monitoring Breast Cancer Screening Colorectal Cancer Screening Pneumococcal Vaccination Status for Older Adults Zoster (Shingles) Vaccination
18 QUALITY SCORING EXAMPLE 1 OUTCOME MEASURES Measure Pract Perf Decile Range Decile Pts Bonus Pts Treatment of Hypokalemia 98.3% Diabetes: HgbA1c Poor control 48.0% Controlling High Blood Pressure 28.7% < Highest Outcome Measure* *
19 QUALITY SCORING EXAMPLE 1 ADDITIONAL HIGH PRIORITY MEASURES Measure Pract Perf Decile Range Decile Pts Bonus Pts Appropriate Treatment for Adults with Upper Respiratory Infection 100% na Use of Benzodiazepines in the Elderly 100% na NSAID or Cox 2 Inhibitor Use in Patients 92.0% with Heart Failure, Hypertension, or Chronic Kidney Disease Monitoring Serum Creatinine 51.3% < Avoiding Use of CNS Depressants in Patients on Long-Term Opioids % new
20 QUALITY SCORING EXAMPLE 1 ADDITIONAL MEASURES Measure Pract Perf Decile Range Decile Pts Screening for Type 2 Diabetes 74.0% na Antiplatelet Medication for High Risk Patients AFib and AFlutter: Chronic Anticoagulation Rx Screening for albuminuria in pats at risk for CKD (DM and/or HTN) Chronic Kidney Disease (CKD): egfr Monitoring Chronic Kidney Disease (CKD): Hemoglobin Monitoring 19.8% % % na % < %
21 QUALITY SCORING EXAMPLE 1 ADDITIONAL MEASURES Measure Pract Perf Decile Range Decile Pts Breast Cancer Screening 8.8% <3 3 Colorectal Cancer Screening 24.6% Pneumonia Vaccination in Older Adults 23.7% Zoster (Shingles) Vaccination 12.8%
22 QUALITY SCORING EXAMPLE 1 QUALITY POINTS TOTAL Measure Pract Perf Pts O/HP Treatment of Hypokalemia 98.3% 7.8 O/HP NSAID or Cox 2 Inhibitor Use in Patients with Heart 92.0% 9.6 HP Failure, Hypertension, or Chronic Kidney Disease Diabetes: HgbA1c Poor control 48.0% 5.3 O/HP Colorectal Cancer Screening 24.6% 4.3 AFib and AFlutter: Chronic Anticoagulation Rx 42.9% 4.2 Pneumonia Vaccination in Older Adults 23.7% 3.8 Point Sum 35 O/HP Bonus 6 End-to-end electronic reporting Bonus 6 Grand Total-Quality 47 * Highest Outcome Measure Receive Quality Score = 47% *
23 2017 MIPS IMPROVEMENT ACTIVITIES Select from 92 activities Maximum score of 40 points Special rule for MIPS eligible clinicians in practices with <= 15 clinicians 1 high-weighted activity (40 points) OR 2 medium-weighted activities (20 points each)
24 2017 MIPS IMPROVEMENT ACTIVITIES USE OF QCDR Feedback reports that incorporate population health Population Management Subcategory High weight Participating with PPRNet QCDR awards the full 40 IA points Receive Maximum Improvement Activities Score = 15%
25 MIPS 2017 PERFORMANCE Cost Category=0% for 2017
26 2017 MIPS ADVANCING CARE INFORMATION 25% of Final Score in 2017 Promotes use of certified EHR technology Replaces Medicare EHR Incentive Program A.K.A. Medicare Meaningful Use If you participated in MU, you are already familiar with the measures from your EHR See me at help desk today at 2:30 for detailed calculation
27 2017 MIPS ADVANCING CARE INFORMATION Maximum score of 155%, capped at 100% Must fulfill Base score to receive any points
28 2017 MIPS SCORING FOR ADVANCING CARE INFORMATION
29 2017 MIPS ADVANCING CARE INFORMATION Two measure set reporting options, depends on CEHRT version We will use the 2014 CEHRT option for our example
30 2017 MIPS ADVANCING CARE INFORMATION 2017 ACI Transition Objectives and Measures Majority of PPRNet uses 2014 CEHRT Edition Includes 11 Measures 4 Core (Base) Measures 5 Optional Performance Measures 2 Options for Registry Reporting (5% Bonus) Additional 10% ACI Performance Bonus for specific Improvement Activities
31 2017 MIPS ADVANCING CARE INFORMATION 4 CORE (BASE) MEASURES Required! 2017 ACI Transition Objectives and Measures Electronic Prescribing Health Information Electronic Exchange Provide Patient Electronic Access Security Risk Analysis to maintain PHI
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33 2017 MIPS ADVANCING CARE INFORMATION PERFORMANCE MEASURES 2017 ACI Transition Objectives and Measures Base Measures Health Information Electronic Exchange Provide Patient Electronic Access Optional Measures Immunization Registry Reporting Medication Reconciliation Patient-Specific Education Materials Secure Messaging: Provider to Patient View, Download, or Transmit (VDT)
34 2017 MIPS PERFORMANCE SCORING FOR ADVANCING CARE INFORMATION
35 2017 MIPS PERFORMANCE SCORING FOR ADVANCING CARE INFORMATION
36 2017 MIPS ADVANCING CARE INFORMATION BONUS SCORE 2017 ACI Transition Objectives and Measures 2 Options for Registry Reporting (+5%) Bonus Specialized Registry Reporting (PPRNet counts) OR Syndromic Surveillance Reporting Bonus for Specific Improvement Activities (+10%) (Perform any one of the activities)
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38 2017 MIPS ADVANCING CARE INFORMATION
39 SCORING EXAMPLE: ADVANCING CARE INFORMATION BASE SCORE Measure Practice Performance % Points Electronic Prescribing 30/ * Health Information Electronic Exchange 650/750 87% 18% (worth 20%) * Provide Patient Electronic Access 250/750 33% 8% (worth 20%) Security Risk Analysis to maintain PHI Yes Met the Core (Base) Requirement Base Score 50%
40 SCORING EXAMPLE: ADVANCING CARE INFORMATION PERFORMANCE SCORE Measure Practice Performance % Points * Health Information Electronic Exchange 650/750 87% 18% (worth 20%) * Provide Patient Electronic Access 250/750 33% 8% (worth 20%) Immunization Registry Reporting Did Not Report Medication Reconciliation 250/750 33% 4% Patient-Specific Education Materials Did Not Report Secure Messaging: Provider to Patient 100/750 13% 2% View, Download, or Transmit (VDT) 475/750 63% 7% Performance Score 39%
41 SCORING EXAMPLE: ADVANCING CARE INFORMATION BONUS SCORE Measure Practice Performance % Points Specialized Registry Reporting Yes 5 Syndromic Surveillance Reporting Yes --- Specific Improvement Activity No 0 Bonus Score 5%
42 2017 MIPS SCORING FOR ADVANCING CARE INFORMATION 50% 39% 5% = 94% Receive 94% of 25 points ACI = 23.5 points
43 MIPS Final Score Quality Improvement Activities Advancing Care Information
44 SCORING EXAMPLE FINAL SCORE = Max
45 QUALITY SCORING EXAMPLE 1 QUALITY POINTS TOTAL Measure Pract Perf Pts O/HP Treatment of Hypokalemia 98.3% 7.8 O/HP NSAID or Cox 2 Inhibitor Use in Patients with Heart 92.0% 9.6 HP Failure, Hypertension, or Chronic Kidney Disease Diabetes: HgbA1c Poor control 48.0% 5.3 O/HP Colorectal Cancer Screening 24.6% 4.3 AFib and AFlutter: Chronic Anticoagulation Rx 42.9% 4.2 Pneumonia Vaccination in Older Adults 23.7% 3.8 Highest Outcome Measure Point Sum 35 O/HP Bonus 6 End-to-end electronic reporting Bonus 6 Grand Total-Quality 47 Receive Quality Score = 47% * *
46 SCORING EXAMPLE IMPROVEMENT ACTIVITIES Measure Practice Performance Points IA_PM_7: Use of a QCDR for feedback reports that incorporate population health Meets 15 Receive Maximum Improvement Activities Score = 15%
47 2017 MIPS SCORING FOR ADVANCING CARE INFORMATION 50% 39% 5% = 94% Receive 94% of 25 points ACI = 23.5 points Score = 23.5%
48 SCORING EXAMPLE TOTAL Performance Category Points Quality 47 Improvement Activities 15 Advancing Care Information 23.5 TOTAL 85.5 Remember Goal is to exceed 70 points
49 2019 PAYMENT ADJUSTMENTS Final Score Payment Adjustment >70 points Positive adjustment Eligible for exceptional performance bonus minimum of additional points Positive adjustment Not eligible for exceptional performance bonus 3 points Neutral payment adjustment 0 points Negative payment adjustment of -4% 0 points = does not participate
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51 POSSIBLE PAYMENT ADJUSTMENT Medicare Payment* Estimated Adjustment -4% 3% 4.5% 7% 12% $36,091 $1,444 $1,083 $1,624 $2,526 $4,331 $47,804 $1,912 $1,434 $2,151 $3,346 $5,737 $71,966 $2,878 $2,159 $3,238 $5,038 $8,636 $82,261 $3,290 $2,468 $3,702 $5,758 $9,871 $170,412 $6,816 $5,112 $7,669 $11,929 $20,449 $221,386 $8,855 $6,642 $9,962 $15,497 $26,566 $445,087 $17,803 $13,353 $20,029 $31,156 $53,410 *Actual PPRNet Practice Payments for 2015
52 PPRNET 2017 MIPS SOLUTION MIPS data submission to CMS for 2017 Receive feedback performance reports after each data upload during the year. 70 clinical quality primary care measures Practice and provider level performance Peer benchmarking Patient-level registry that makes the feedback actionable
53 PPRNET FEEDBACK REPORTS MIPS MEASURES
54 PPRNET FEEDBACK REPORTS MIPS MEASURES
55 NEXT STEPS TO PPRNET MIPS SOLUTION Register with PPRNet by October 31 Upload Summary of Care documents in ccda format from a certified EHR to PPRNet at least four times in Use PPRNet reports and tools to improve quality Provide information to PPRNet for Improvement Activities and Advancing Care Information categories Conduct a chart audit in early 2018 to verify data accuracy
56 CHART AUDIT DETAILS PPRNet provides list of 25 patients/provider that are eligible for multiple measures Open each patient s EHR chart and verify that the data on the list are accurate and complete Document data verification on list provided and submit to PPRNet
57 IMPROVEMENT ACTIVITIES & ADVANCING CARE INFORMATION Complete a Redcap questionnaire form with the data you request PPRNet to submit for you These measures will be combined with the quality measure data and uploaded to CMS as one submission Watch for notices of deadlines for dates to complete the form
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60 SUMMARY PPRNet MIPS Solution can help maximize your Medicare payments for 2019 and beyond PPRNet can report Quality, Improvement Activities, and Advancing Care Information Further information in Saturday s presentation Friday afternoon 2:30 help desk
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62 QUALITY SCORING EXAMPLE 2
63 QUALITY SCORING EXAMPLE 2 OUTCOME MEASURES Measure Pract Perf Decile Range Decile Pts Bonus Pts Diabetes: HgbA1c Poor control 18.8% Controlling High Blood Pressure 57.2% Treatment of Hypokalemia 97.8%
64 QUALITY SCORING EXAMPLE 2 ADDITIONAL HIGH PRIORITY MEASURES Measure Pract Perf Decile Range Decile Pts Bonus Pts Appropriate Treatment for Adults with Upper Respiratory Infection 97.6% na Use of Benzodiazepines in the Elderly 100% na NSAID or Cox 2 Inhibitor Use in Patients 87.6% with Heart Failure, Hypertension, or Chronic Kidney Disease Monitoring Serum Creatinine 86.6% Avoiding Use of CNS Depressants in Patients on Long-Term Opioids % new
65 QUALITY SCORING EXAMPLE 2 ADDITIONAL MEASURES Measure Pract Perf Decile Range Decile Pts Screening for Type 2 Diabetes 83.9% na Antiplatelet Medication for High Risk Patients AFib and AFlutter: Chronic Anticoagulation Rx Screening for albuminuria in pats at risk for CKD (DM and/or HTN) Chronic Kidney Disease (CKD): egfr Monitoring Chronic Kidney Disease (CKD): Hemoglobin Monitoring 65.2% % % na % %
66 QUALITY SCORING EXAMPLE 2 ADDITIONAL MEASURES Measure Pract Perf Decile Range Decile Pts Breast Cancer Screening 9.8% <3 3 Colorectal Cancer Screening 44.8% Pneumonia Vaccination in Older Adults 70.8% Zoster (Shingles) Vaccination 23.3%
67 QUALITY SCORING EXAMPLE 2 QUALITY POINTS TOTAL Measure Pract Perf Pts O/HP Diabetes: HgbA1c Poor control 18.8% 8.6 O/HP Chronic Kidney Disease (CKD): egfr Monitoring 85.5% 9.2 Antiplatelet Medication for High Risk Patients 65.2% 9.0 Pneumonia Vaccination in Older Adults 70.8% 8.2 Treatment of Hypokalemia 97.8% 7.4 O/HP NSAID or Cox 2 Inhibitor in Pats with HF, HTN or CKD 87.6% 6.2 HP Highest Outcome Measure Point Sum 48.6 O/HP Bonus 6 End-to-end electronic reporting Bonus 6 Grand Total-Quality 60.6 Receive Maximum Quality Score = 60% * * 60.6/60 =101%
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