Kentucky Regional Extension Center Services

1. Quality Payment ProgramRobin Huffman & Kelly Fountain The information contained in this presentation is for general information purposes only. The information is provided by UK HealthCare’s Kentucky Regional Extension Center and while we endeavor to keep the information up to date and correct, we make no representations or warranties of any kind, express or implied, about the completeness, accuracy, reliability, suitability or availability with respect to content.

2. Kentucky Regional Extension Center Services Kentucky REC Description To date, the Kentucky REC’s activities include: • Helping bring over $100 million incentive dollars to providers throughout the Commonwealth • Assisting more than 3,400 individual providers across Kentucky, including primary care providers and specialists • Helping more than 95% of the Federally Qualified Health Centers (FQHCs) and Rural Health Clinics (RHCs) within Kentucky • Working with more than 1/3 of all Kentucky hospitals • Supporting dozens of practices and multiple health systems with practice transformation and preparation for value based payment REC Service Lines UK’s Kentucky REC is a trusted advisor and partner to healthcare organizations, supplying expert guidance to maximize quality, outcomes and financial performance. Physician Services • Meaningful Use & Mock Audit • HIPAA Security Risk Analysis & Project Management • Patient Centered Medical Home (PCMH) Consulting • Patient Centered Specialty Practice (PCSP) Consulting • Value Based Payment & MACRASupport • Hospital Services • Meaningful Use • HIPAA Security Analysis • ElectronicQuality Reporting Support

3. Objectives

4. MACRA: Quality Payment Program Merit-based Incentive Payment System Alternative Payment Models

5. New 2017 Reporting Options

6. Recommended QPP Options Never Submitted PQRS/MU MIPS Option 1: Test the QPP MIPS Option 2: Participate for Partial Year Limited Success with Submitting PQRS/MU MIPS Option 3: Participate for Full Year Successfully Submitted PQRS/MU Option 4: Participate in APM

7. Eligible Clinicians Clinicians billing more than $30,000 a year in Medicare Part B allowed charges and providing care for more than 100 Medicare patients a year. These clinicians include: BILLING >$30,000 AND >100 Physician Assistants Physicians Nurse Practitioners Clinical Nurse Specialists CRNA

8. Whois Exemptfrom MIPS? Clinicians who are

9. Eligibilityfor CliniciansinSpecificFacilities • RuralHealth Clinics(RHC)andFederallyQualifiedHealthCenters (FQHC) • EligiblecliniciansbillingundertheRHC orFQHCpaymentmethodologiesare notsubject to theMIPSpaymentadjustment. • However…. • Eligiblecliniciansin aRHC orFQHCbillingunderthe PhysicianFeeSchedule (PFS)arerequiredtoparticipateinMIPSandaresubject to apayment adjustment.

10. Eligibility Examples: Provider A: Provider B:

11. NPI Lookup • Quick Checks: • Go to: www.qpp.cms.gov • Type in every provider’s NPI. • Scroll down to confirm eligibility at Individual and TIN level. • Remember that a provider can be eligible multiple times. • When in doubt report at least a test!

12. Example 1: 123456789

13. Example 1: Dr. Jane Doe

14. If YouAre Exempt… • You maychoosetovoluntarilysubmitqualitydatatoCMS toprepare forfutureparticipation,butyou willnotqualifyfor apayment adjustment based on your2017performance. • Thiswillhelpyou hitthe groundrunningwhenyou are eligiblefor • payment adjustments infutureyears.

15. Special Considerations

16. Eligibilityfor Non-PatientFacingClinicians • Non-patientfacing cliniciansareeligibleto participateinMIPSaslongasthey exceedthelow-volumethreshold,arenotnewlyenrolled,and arenotaQualifyingAPMParticipant (QP)or PartialQPthat elects notto reportdatato MIPS. • Thenon-patient facingMIPS-eligibleclinicianthresholdfor individual MIPS-eligible cliniciansis< 100 patient facing encountersina designatedperiod. • Agroupisnon-patient facing if>75%of NPIsbillingunderthe group’s TINduringa performanceperiodarelabeledasnon-patient facing. • There aremore flexiblereportingrequirementsfor non-patient facingclinicians.

17. MIPS Track

18. MIPS: 2017 Reporting Categories Quality: Improvement Activities: ACI: Cost: • PY 2017= 15% • Full points for: • Certified PCMH/PCSP • Medical Home Model • MIPS - APMS • APMS • 40 points raw score required • PY 2017 = 0% • Score is based off of Medicare claims, including: • Measure 1: Spending per Beneficiary (MSPB) • Measure 2: Total costs per capita for all attributed beneficiaries • CMS is testing new condition measures • PY 2017 = 25% • Replaces Medicare EHR Incentive Program • Flexible Scoring: • Base Score • Performance Score • Bonus • Reweighting for certain EC’s • Hardship(s) • PY 2017 = 60% • 6 Measures are reported, except for: • Groups using CMS web interface report 15 quality measures • MIPS – APMS report via CMS web interface • 1 outcome or High Priority measure • 7th Measure based off of claims for large groups

19. MIPS: 2017 Reporting Categories Quality: ACI: Cost: IA: • Reporting Range: • At least 90 days in program year No reporting required. However validation of QRUR data recommended Reporting Range: 90-365 days • Reporting Range: • 90-365 days Must Submit by March 31st 2018

20. Year 1 Thresholds Already Set

21. Individual vs. Group Reporting Options

22. Submission Methods Advancing Care Information

23. Bonus Points Opportunities • Report an additional high priority measure for 1 point • Report an additional outcome measure for 2 bonus points • Use of End to End Electronic Submission for 1 bonus point • Total Quality Score= (Points earned on required # measures + Bonus points)/ Total weight • End to End Electronic Submission for 1 point • Report additional public health and clinical data registries beyond the Immunization Registry Reporting measure will result in a 5-point bonus to the raw score. • Total ACI = (Base Score + Performance Score + Bonus) x 0.25 = Category Score • IA CEHRT- Reporting “yes” to the completion of at least 1 of the specified Improvement Activities using CEHRT will result in a 10-point bonus in ACI raw score. Use Appendix B of the final rule and report at least 90 days during the reporting period. Improvement Activities Advancing Care Information Quality

24. APM & MIPS APM Track

25. APM and MIPS APM Track • Alternative Payment Model (APM) is a payment approach that gives added incentive payments to provide high-quality and cost-efficient care. APMs can apply to a specific clinical condition, a care episode, or a population. • Advanced APMs are a subset of APMs, and let practices earn more for taking on some risk related to their patients' outcomes. You may earn a 5% incentive payment by going further in improving patient care and taking on risk through an Advanced APM.

26. MIPS APMS

27. Advanced Alternative Payment Models Advanced APM participants are eligible for 5% bonus payment.But, only some APMsarerisk-bearingMedicarepayment models that qualify for this bonus payment. • Next Generation ACO Model • MedicareSharedSavingsProgram – Tracks 2 & 3 • Comprehensive Primary Care Plus (CPC+) • Comprehensive ESRD Care Model • Oncology Care Model Two-Sided Risk Arrangement (in 2018) • Cardiac & CJR Episode Model (in 2018) In new MACRA Final Rule, Advanced APMsinclude: MACRAdoes not changehowanyparticularAPM rewards value. APMparticipantswhoarenot“Qualifying Providers”(QPs) willreceivefavorablescoringunder MIPS.

28. Qualifying APM Participants • Almost 100% of eligible clinicians in the following Advanced APMs will be Qualifying APM Participants (QP) based on performance year 2017 - meaning that they will be eligible to receive a 5% APM Incentive Payment in 2019. An unauthenticated QP determination status lookup QP Lookup Tool is available for eligible clinicians to review. • There are approximately 75,000 NPIs included in this initial QP analysis. This assessment was completed using Medicare claims with dates of service between January 1, 2017 and March 31, 2017 that were processed between January 1, 2017 and June 30, 2017 and APM participation lists as of March 31, 2017. • https://data.cms.gov/qplookup

29. Next Steps

30. Questions

31. Value-Based Payment Support Services • QPP SURS Technical Assistance:Free, high-level assistance for organizations with 15 or fewer eligible clinicians as they navigate the Quality Payment Program. The Resource Center include: straightforward, self-directed resources and tools, up-to-date materials, and access to expert Quality Improvement Advisors. Sign up: www.qppresourcecenter.com • VBP Individualized Assistance: 12 months of planning and transformation support tailored to meet specific client needs and support success in value-based payment. This includes current state analysis, recommendations for action, collaborative goal setting and project planning, education, strategic decision support and ongoing advisory services. • Advanced APM Support (coming in 2018):Ongoing support, research, work plan development and application support for transition to advanced alternative payment models (APM).

32. Our Partnership with KPCA • VBP Individualized Assistance: 12 months of planning and transformation support tailored to meet specific client needs and support success in value-based payment. This includes current state analysis, recommendations for action, collaborative goal setting and project planning, education, strategic decision support and ongoing advisory services. • Designated Practice Transformation Advisor • Currently engaged with 24 practices across Kentucky • Next cohort –early 2018

33. Connect with Kentucky REC! Follow us on Twitter: @KentuckyREC Like us on Facebook: facebook.com/KentuckyREC Follow us on LinkedIn: linkedin.com/company/kentucky-rec Check out our Website: www.kentuckyrec.com Call us: 859-323-3090 Email us: kyrec@uky.edu