Measure What Matters MIPS Registry Reporting
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1 Measure What Matters MIPS Registry Reporting
2 Introduction and Disclosure Spencer Heaton M.D., M.B.A ArborMetrix Chief Medical Officer The ASIPP National Interventional Pain Management Qualified Clinical Data Registry (NIPM-QCDR) is operated by ArborMetrix
3 Agenda 1. MACRA/MIPS Overview 2. MIPS Reporting Options 3. National Interventional Pain Management Qualified Clinical Data Registry (NIPM-QCDR) CMS-approved ASIPP Quality Measures 5. Next Steps
4 Medicare Access and CHIP Reauthorization Act of 2015 (MACRA) Quality Payment Program PQRS Meaningful Use Value-Based Payment Modifier Merit Based Incentive Payment System (MIPS) or Alternative Payment Models (APMs)
5 MIPS Reporting Categories and Weights Quality 60% Improvement Activities 15% Advancing Care Info 25% Cost 0% MIPS Score = Quality + ACI + IA + Cost
6 Quality Measure Scoring Per Measure Minimum Quality Points Performance Based Quality Points Outcome or Patient Experience Measures High Priority Measures Range of Quality Points Performance Points 3-10 Bonus Points 0-3 *Maximum quality points across 6 measures = 60
7 Improvement Activity Requirements High-weighted (14 activities) Medium-weighted (78 activities) *Practices with < 15 clinicians only need to attest to 2 total activities ** Complete activity list available at:
8 MIPS Payment Adjustments (2017 performance adjusts 2019 payments) MIPS Score Medicare Part B Payment Adjustment > 70 points Positive payment adjustment + exceptional performance bonus 4-69 points Positive payment adjustment 3 points No payment adjustment 0 points -4% payment adjustment *Payment adjustments are budget neutral
9 MIPS Adjustment Schedule
10 Public Reporting of MIPS Performance
11 MIPS Eligibility 2017 Physicians PAs NPs CRNAs CNSs >100 Medicare Part B patients AND >$30,000 Medicare Part B allowed charges
12 2017 Transition Year Options Test Participation (3 points) 1 Quality Measure 1 IA or or 4-5 Required ACI Measures No penalty Partial Participation (4-69 points) 90 days of MIPS participation Small positive adjustment Full Participation (4-100 points) Full year of MIPS participation Modest positive adjustment
13 CMS Registry Options for MIPS Reporting Qualified Registry (QR) 271 MIPS measures 0 non-mips measures Qualified Clinical Data Registry (QCDR) 271 MIPS measures 30 non-mips specialty measures 2017 No IPM Measures IPM Measures
14 What is the NIPM-QCDR? MIPS Quality Reporting tool custom-built by ASIPP for interventional pain physicians Report on clinical decisions and actions relevant to IPM Meet CMS MIPS requirements for Quality and Improvement Activities Earn credit toward Advancing Care Information Receive real-time feedback to help optimize quality performance Improve the quality of patient care in IPM
15 NIPM Measures ASIPP Measures MIPS Measures Total Options Must report at least 6 total measures Can report on all measures Top 6 measures will be scored for MIPS
16 Excessive Use Measures Avoiding excessive use of epidural injections in managing chronic pain originating in the lumbosacral spine > 5 treatments in year one or > 4 treatments in subsequent years Multilevel or bilateral injections on the same day are considered one treatment CPT Codes: 62322, 62323, 64483, 64484
17 Excessive Use Measures Avoiding excessive use of epidural injections in managing chronic pain originating in the cervical/thoracic spine > 5 treatments in year one or > 4 treatments in subsequent years Multilevel or bilateral injections on the same day are considered one treatment CPT Codes: 62320, 62321, 64479, 64480
18 Excessive Use Measures Avoiding excessive use of therapeutic facet joint interventions in managing chronic lumbosacral spinal pain > 4 facet joint injection treatments or > 2 facet joint RFA treatments per year Bilateral treatments performed unilaterally on separate days are considered one treatment Multilevel treatments are considered one treatment CPT Codes: 64493, 64494, 64495, 64635, 64636, (IPM03)
19 Excessive Use Measures Avoiding excessive use of therapeutic facet joint interventions in managing chronic cervical/thoracic spinal pain > 4 facet joint injection treatments or > 2 facet joint RFA treatments per year Bilateral treatments performed unilaterally on separate days are considered one treatment Multilevel treatments are considered one treatment CPT Codes: 64490, 64491, 64492, 64633, 64634, (IPM03)
20 Patient Selection Measures Appropriate patient selection for diagnostic facet joint procedures (all spine regions) 3 months of moderate/severe pain; functional impairment; unresponsive to NSAIDs or PT; axial pain separate from radiculopathy or neurogenic claudication; absence of fracture, tumor, etc. that would explain the pain; documented assessment CPT Codes: 64490, 64491, 64492, 64493, 64494, 64495, (IPM04, IPM05)
21 Patient Selection Measures Appropriate patient selection for trial spinal cord stimulation Failed conservative therapies; no active substance abuse; proper patient education and risk/benefit discussion; appropriate psychological testing CPT Code: 63650, (IPM06)
22 Patient Selection Measures Appropriate patient selection for use of epidural injections in managing pain originating in the sacral, lumbar, thoracic or cervical spine Radiculopathy or neurogenic claudication; radiology supported discogenic or post-surgery pain; moderate/severe pain with functional impairment; failure of 4 weeks of conservative care (unless inability to work or control severe pain, or prior successful ESI for similar pain); x-ray to rule out red flag conditions CPT Codes: 62320, 62321, 62322, 62323, 64479, 64480, 64483, 64484, (IPM07)
23 Patient Safety Measures Rate of caudal and interlaminar epidural injections without dural puncture Percentage of patients undergoing epidural injections with a caudal approach or lumbar, thoracic or cervical interlaminar approach without a dural puncture CPT Codes: 62320, 62321, 62322, 62323, (IPM13) ICD-10 Code: G97.41 [accidental dural puncture during a procedure]
24 Patient Safety Measures Shared decision making regarding anticoagulant and antithrombotic use in the setting of caudal or interlaminar epidural injections Documentation of appropriate discussion, risk/benefit analysis, and shared decision making regarding continuation or discontinuation of their anticoagulation or antithrombotic regimen CPT Codes: 62320, 62321, 62322, 62323, (IPM09, IPM10, IPM11, IPM12) ICD-10 Codes: G79.01 [chronic anticoagulant]; G79.02 [chronic antithrombotic]
25 How to Get Started with NIPM-QCDR 1. Visit 2. Complete the web-based form 2017 Participation Fees Per Clinician ASIPP member rate Non-member rate Eligible clinician/physician $500 $750 Eligible clinician/non-physician $400 $650
26 Access the system Administrator for your practice User accounts for each provider Training and on-boarding provided
27 Submit Data Multiple approaches Directly upload a file with encounter data and codes to the QCDR Manually enter the data EMR configuration / integration
28 Select Measures / Improvement Activities Track any of 53 quality measures Make your selection with each clinician s profile Attest to any CMS-approved Improvement Activities
29 Track Performance Interactive, real-time analytics and reports Intuitive, web-based, HIPAA-compliant interface Clinical depth with drill-down to patientlevel details
30 Questions? Visit
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