2019 QPP Measures for Pathologists Diana Cardona, MD, FCAP February 12, 2019

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1 2019 QPP Measures for Pathologists Diana Cardona, MD, FCAP February 12, 2019

2 Welcome Diana Cardona, MD, FCAP Chair, Measures & Performance Assessment Subcommittee

3 Today Overview of MIPS 2019 Quality Category Changes for 2019 Quality Payment Measures Overview Quality Category Requirements and Scoring Pathology Specialty Measures Set 2019 Quality Reporting Scenarios 3

4 Quality Payment Program Overview QPP Quality MIPS Improvement Activities Promoting Interoperability Cost Advanced APMs 4

2019 MIPS Performance Year Quality Payment Measures: 85% of Final Score Improvement Activities: 15% of Final Score IA 15% Minimum score: 30 points o If you do not score at least 30 points

Quality 85% Exceptional performance bonus: 75 points o Clinicians whose MIPS final score is 75 points or above are eligible to receive additional incentive payments from a pool of $500

5 2019 MIPS Performance Year Quality Payment Measures: 85% of Final Score Improvement Activities: 15% of Final Score IA 15% Minimum score: 30 points o If you do not score at least 30 points in 2019, you are subject to a penalty. Quality 85% Exceptional performance bonus: 75 points o Clinicians whose MIPS final score is 75 points or above are eligible to receive additional incentive payments from a pool of $500 million for exceptional performance. Exceptional Performance Bonus Performance Threshold 30 0 MIPS Final Score points Payment Adjustment 7% - 0.1% negative MIPS Final Score points Payment Adjustment 0% positive MIPS Final Score points Payment Adjustment 0% positive + Exceptional Performance Bonus % 100 5

6 2019 Quality Category Changes for Large Practices (16+ eligible pathologists) Claims Individual NOT AVAILABLE QR Individual and/or group Individual and/or group QCDR Individual and/or group Individual and/or group # of mechanisms 1 for all measures Multiple (If the same measure is submitted via multiple collection types, the one with the greatest number of measure achievement points will be selected for scoring) IMPORTANT UPDATE FOR 2019 Large Practices Starting January 1, 2019, the claims/ your billing company submission mechanism is NOT available to clinicians in a practice of 16 or more eligible clinicians, whether participating as an individual or a group. 6

7 2019 Quality Category Changes for Small Practices ( 15 eligible pathologists) Claims Individual Individual and/or group QR Individual and/or group Individual and/or group QCDR Individual and/or group Individual and/or group # of mechanisms 1 for all measures Multiple (If the same measure is submitted via multiple collection types, the one with the greatest number of measure achievement points will be selected for scoring) IMPORTANT UPDATE FOR 2019 Small Practices Starting January 1, 2019, the claims/ your billing company submission mechanism can only be submitted by clinicians in a small practice (15 or fewer eligible clinicians), whether participating individually or as a group. There is still a small practice bonus for 2019, and it has increased to six points, however, it is now added to the quality category score instead of the overall MIPS score. 7

8 2019 Quality Payment Measure Changes Extremely Topped-out Measures removed from MIPS: o Breast Cancer Resection Reporting o Colon Cancer Resection Reporting o Quantitative IHC Evaluation of HER2 Testing in Breast Cancer Patients Several Topped-out Measures assigned a 7-point cap benchmark The Pathologist Quality Registry updates: o 21 QCDR measures added to the Registry o 2 MIPS CQMs added Biopsy Follow-up Basal Cell Carcinoma (BCC)/Squamous Cell Carcinoma (SCC): Biopsy Reporting Time 8

9 Quality Category Requirements o Report a minimum of 6 measures One must be an outcome or high priority measure o OR report on the complete Pathology Specialty Measure Set o 12 month reporting period (January 1 December 31, 2019) o 60% data completeness o 20 case minimum per measure 9

10 Quality Payment Measures Overview QPP Measures o Medicare Part B Claims Measures and MIPS Clinical Quality Measures (MIPS CQMs) MIPS CQMs were previously called Registry Measures o Publicly available o Comprise the 2018 Pathology Specialty Measure Set Specialty measure sets can be reported as an alternative to selecting 6 quality payment measures out of all possible quality payment measures It is not a requirement for pathologists to report on the pathology specialty measure set; however, these are measures the majority of pathologists and/or groups should be able to report Qualified Clinical Data Registry (QCDR) Measures o Proprietary to QCDR o Only reported through QCDR o New measures added annually 10

Quality Payment Measures Overview continued High-priority measures o Outcome o Appropriate use o Patient experience o Patient safety o Efficiency o Care

11 Quality Payment Measures Overview continued High-priority measures o Outcome o Appropriate use o Patient experience o Patient safety o Efficiency o Care coordination Topped-out measures (QPP only) o Overall performance is very high Topped-out (95 100%) Extremely topped-out (98 100%) o Little room for improvement 11

12 Quality Payment Measure Scoring Measure value Max Points Measure 10 With benchmark 7 Topped-out 3 Without benchmark Submitting below 20 case minimum Points Practice Size 3 Large Practice (16+ pathologists) 3 Small practice ( 15 pathologists) Submitting less than 60% data completeness Points Practice Size 1 Large Practice (16+ pathologists) 3 Small practice ( 15 pathologists) 12

13 Bonus Points Additional outcome or high-priority measures o 2 points Outcome o 1 point High-priority o To qualify for this bonus, the measure: Must meet the required case minimum (20 cases) Must meet the required data completeness criteria (60%) Must have performance rate > 0% Does not have to be one of the top six measures scored for the Quality category points The first [required] outcome or high-priority measure is not eligible for bonus points The bonus points are capped at 6 points, which is 10% of the total possible points 13

14 MIPS CQM Benchmarks and Points Measure Name Measure ID Submission Method Benchmark Average Decile_3 Decile_10 TOPPED OUT Barrett's Esophagus 249 Claims Y Yes 7 Barrett's Esophagus 249 Registry/QCDR Y Yes 7 Radical Prostatectomy Pathology Reporting 250 Claims Y Yes 10 Radical Prostatectomy Pathology Reporting 250 Registry/QCDR Y Yes 7 Lung Cancer Reporting (Biopsy/Cytology Specimens) 395 Claims Y Yes 7 Lung Cancer Reporting (Biopsy/Cytology Specimens) 395 Registry/QCDR Y Yes 7 Lung Cancer Reporting (Resection Specimens) 396 Claims N Lung Cancer Reporting (Resection Specimens) 396 Registry/QCDR Y Yes 10 Melanoma Reporting 397 Claims Y Yes 7 Melanoma Reporting 397 Registry/QCDR Y 89.5 Biopsy Follow-Up 265 Registry/QCDR Y 81.8 Basal Cell Carcinoma (BCC)/Squamous Cell Carcinoma (SCC): Biopsy Reporting Time - Pathologist to Clinician 440 Registry/QCDR Y 92.2 Max Points Yes Yes Yes 10 14

15 Quality Category Score Calculation Total Measure Points Earned Measure Bonus Points Small Practice Bonus (6 points) 85% 60 points (50 points if reporting Pathology Measures Set) 15

16 2019 Quality Measures Landscape: QPP Measures Measure Submission Mechanism Max Points Claims Registry Claims Registry 249: Barrett s Esophagus Reporting X X : Radical Prostatectomy Reporting X X : Lung Cancer (biopsy/cytology)* X X : Lung Cancer (resection)* X X : Melanoma Reporting* X X : Biopsy Follow-Up* -- X : BCC/SCC Reporting* -- X *High Priority Measures 16

17 2019 Quality Measures Landscape: QCDR Measures Updated Measures for 2019 Turnaround Time (TAT) Biopsies* Cancer Protocol Elements and Turnaround Time for Carcinoma and Carcinosarcoma of the Endometrium* Cancer Protocol Elements and Turnaround Time for Carcinoma of the Intrahepatic Bile Ducts* Cancer Protocol Elements and Turnaround Time for Carcinoma of the Pancreas* Cancer Protocol Elements and Turnaround Time for Carcinoma of the Pancreas* Cancer Protocol Elements and Turnaround Time for Invasive Carcinoma of Renal Tubular Origin* Helicobacter pylori Status and Turnaround Time* Measures with no Changes for 2019 Turnaround Time (TAT) Troponin* Turnaround Time (TAT) Lactate* *High Priority Measures 17

18 2019 Quality Measures Landscape: QCDR Measures New Measures for 2019 HER2 Tumor Evaluation and Repeat Evaluation in Patients with Breast Carcinoma* HER2 Tumor Evaluation and Repeat Evaluation in Patients with Gastroesophageal Adenocarcinoma* Appropriate Formalin Fixation Time (6 72 hours) of Breast Cancer Specimens Blood Laboratory Samples for Potassium Determination with Hemolysis Drawn in the Emergency Department** EGFR Testing in Patients with NSCLC* ROS 1 Testing in Patients with NSCLC* ALK Testing to in Patients with NSCLC* BRAF Testing in Patients with Metastatic Colorectal Adenocarcinoma* MMR or MSI Testing in Patients with Primary or Metastatic Colorectal Carcinoma* FLT3-ITD Testing to in Patients with Acute Myeloid Leukemia* High Risk HPV Testing and p16 Scoring in Surgical Specimens for Patients with OPSCC* High Risk HPV Testing in Cytopathology Specimens for Patients with OPSCC* *High Priority Measures 18

19 Pathology Specialty Measure Set Clinicians and groups can choose to submit a specialty measure set o In doing so, they must submit data on at least 6 measures within that set; or if the set contains fewer than 6 measures, the clinician or group should submit each measure in the set 2019 is the first year the Pathology Measure Set contains < 6 measures o Can submit the 5 measures of the Pathology Specialty Measure Set through the Qualified Registry or Medicare Part B Claims (small practices only) o In this instance, the Quality Category will be scored out of 50 points, rather than 60 points 19

20 Pathology Specialty Measures Set continued Measure Submission Mechanism Max Points Claims Registry Claims Registry 249: Barrett s Esophagus Reporting X X : Radical Prostatectomy Reporting X X : Lung Cancer (biopsy/cytology)* X X : Lung Cancer (resection)* X X : Melanoma Reporting* X X 7 7 *High Priority Measures 20

21 2019 Quality Category Summary Claims-based Reporting phasing out o Only small practices o Removing topped-out claims-based measures Scoring changes o Fewer measures worth 10 points o CMS raised the minimum performance and exceptional performance bonus thresholds Available measures o Pathology Specialty Measures Set less than 6 measures o Fewer QPP measures o 21 QCDR measures 21

22 The CAP MIPS Resources Visit cap.org/advocacy for MIPS tools and resources 2019 Updates Coming Soon o Making Sense of CMS s Quality Payment Program (Video) o MIPS Checklist for Pathologists o MIPS FAQs o MIPS Financial Impact Calculator o Understanding Your MIPS Reporting Options o Pathology-specific Quality Measures o 2019 Improvement Activities for Pathologists Read STATLINE 22

23 Questions? us at 23

MIPS Reporting Deep Dive: Which Path is Right for Your Practice?

MIPS Reporting Deep Dive: Which Path is Right for Your Practice? Emily E. Volk, MD, MBA, FCAP Chair, QCDR Ad Hoc Committee Stephanie Peditto Director of Quality at the College of American Pathologists