Benchmarking, MIPS and Arcade Games: Using Benchmarks in Quality. David Smith, MBA HIT Project Manager

Transcription

1 Benchmarking, MIPS and Arcade Games: Using Benchmarks in Quality David Smith, MBA HIT Project Manager

2 HealthInsight Quality Innovation Network (QIN) Quality Improvement Organization (QIO) CMS Quality Strategy: Eliminating disparities Strengthening infrastructure and data systems Enabling innovation Fostering learning organizations 2 Source: Quality Improvement Organizations About QIN-QIOs, QIO Program Fact Sheet. Accessed March 20, 2017: qioprogram.org/about/why-cms-has-qios

3 We want to hear from you! Type questions into the Chat at any time during this presentation 3

4 Expert Presenter David Smith HIT Project Manager HealthInsight Oregon 4

5 Caution Benchmarks are not necessarily a great indicator of improvement. Sustainability and overall improvement should be considered. If you re experiencing a reduction in quality with your rate of change or delta on a regular basis, it can be a bad indicator. However, using benchmarks can help to compare and set goals. Recommend using balance measures in your work to determine appropriateness.

6 MIPS Application MIPS Requirement: Six measures to be submitted in MIPS Up to 10 points per quality measure for performance in each decile If you score within a decile, you get that many points Automatic three points for just submitting (assuming you re in the third decile, despite the fact that you may or may not be performing at that level) PQRS from 2016 results were used in the deciled benchmarks file, which will tell you how many points you can get for your performance

7 Common Misconceptions s what they aren t and what they are: The decile could be anywhere on the spectrum from x+0 percent to x-100 percent. A quality measure reporting at 45 percent is not necessarily in the fourth decile. 45 percent could be in the third decile or the eighth decile depending on the performance of others.

8 Examples of Scoring in MIPS Within 3rd decile: 3+ points toward MIPS quality Within 1st decile: 3+ points toward MIPS quality Within 4th decile: 4+ points toward MIPS quality Within 5th decile: 5+ points toward MIPS quality Within 8th decile: 8+ points toward MIPS quality Within 2th decile: 3+ points toward MIPS quality

9 Example: Poor Control of A1C 1. Using Claims submitted method, how many points for 15%? Measure_Name Measure _ID Diabetes: Hemoglobin A1c Poor Control 1 Diabetes: Hemoglobin A1c Poor Control 1 Diabetes: Hemoglobin A1c Poor Control 1 Submission_ Method Claims EHR Registry/QCD R Measure_ Type Outcome Outcome Outcome Benchm ark Y Y Y Using EHR method, how many points for 20%? 3. Using Registry method, how many points for 15%? Topped Out <= No No <= No Topped Out Claims <= No EHR No Registry/QCDR <= No

10 Space Invaders

11 Cost s Coming to MIPS Coming to MIPS in 2019 Reports from 2017 will show scoring methodology Costs will utilize Episode Groups s will be created based on episode groups Assigned episode groups based on? 1 point for 10 measures, up to 10 points per measure

12 Strategies for Quality Get accurate data - you may not be getting full credit for your work. Focus on low-performing decile areas to help patient care (which may also help costs). Find measures where you re on the edge - make improvements. Implement an overall quality strategy.

13 Strategies for Quality (continued) Consider where your quality is at - where do you want to be? Where could you be? Use quality improvement (QI) methods including: goal setting, teamwork, PDSA, RCA, and FMEA (for new methods, strategies). Start with a list of patients.

14 Cardiac Considerations: Aspirin Ischemic Vascular Disease (IVD): Use of Aspirin or Another Antithrombotic [Measure ID 204] Process Measure Submission_ Method Topped Out Claims No EHR >= No Registry/ QCDR No

15 Cardiac Considerations: Blood Pressure Controlling High Blood Pressure [Measure ID 236] Process Measure Submission _Method Topped Out Claims >= No EHR >= No Registry/ QCDR >= No

16 Cardiac Considerations: Blood Pressure Hypertension: Improvement in Blood Pressure [Measure ID 373] Outcome Measure Submission _Method Topped Out EHR >= No Registry/ QCDR >= 10 No

17 Poll Who of you out there has a blood pressure treatment protocol commonly used in your clinic? Will you share it with us?

18 Cardiac Considerations: Cholesterol Ischemic Vascular Disease (IVD): Complete Lipid Profile and LDL-C Control (<100 mg/dl) [Measure ID 241] Process Measure Submission _Method Topped Out EHR >= No Registry/ QCDR >= No

19 Cardiac Considerations: Smoking Preventive Care and Screening: Tobacco Use: Screening and Cessation Intervention [Measure ID 226] Process Measure Submission _Method Claims EHR Registry/ QCDR Topp ed Out Yes >= No No

20 Episode Group Measures: Sample Projection Based on Final Rule Table 25 Example of Using Benchmarks for One Sample Measure To Assign Points Average cost Possible points Benchmark 1 $100,000 or more Benchmark 2 $75,893-$99, Benchmark 3 $69,003-$75, Benchmark 4 $56,009-$69, Benchmark 5 $50,300-$56, Benchmark 6 $34,544-$50, Benchmark 7 $27,900-$34, Benchmark 8 $21,656-$27, Benchmark 9 $15,001-$21, Benchmark 10 $1,000-$15, Note: The numbers provided in this table are for illustrative purposes only. MIPS Final Rule:

21 Cardiac BP Episode Groups: in your QRUR Check out median spend on some of these measure groups! Heart failure Atrial fibrillation Coronary artery disease Chest pain Diabetes Draft list of MACRA Episode Groups and Trigger Codes: Initiatives-Patient-Assessment-Instruments/Value-Based-Programs/MACRA-MIPS-and-APMs/MACRA- Feedback.html

22 Resources Benchmarks File for 2017 MIPS: Draft list of MACRA Episode Groups and Trigger Codes: Assessment-Instruments/Value-Based-Programs/MACRA- MIPS-and-APMs/MACRA-Feedback.html MIPS Final Rule: /medicare-program-merit-based-incentivepayment-system-mips-and-alternative-payment-model-apm

23 Questions? David H. Smith, MBA Rebekah Bally, MPH

24 Thank You! Please complete post-webinar survey Next webinar: Using Community Health Workers and Patient Navigators to Support Clinical Community Partnerships and Patient Engagement July 19, :30-1:30 p.m. MT/11:30 a.m.-12:30 p.m. PT This material was prepared by HealthInsight, the Medicare Quality Innovation Network Quality Improvement Organization for Nevada, New Mexico, Oregon and Utah, under contract with the Centers for Medicare & Medicaid Services (CMS), an agency of the U.S. Department of Health and Human Services. The contents presented do not necessarily reflect CMS policy. 11SOW-B