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Taming the MIPS Monster

Learn about MACRA, QPP, MIPS, and APM, important things to know about MIPS, a focus on 2017 reporting, case studies, and recommendations.

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Taming the MIPS Monster

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  1. Taming the MIPS Monster Wednesday, December 7, 2016 3-4 pm MST * 1-2 pm AKST * 12-1 pm HAST Presented by: Sharon Phelps, BSN Sarah Leake, MBA,CPEHR HTS, a department of Mountain-Pacific Quality Health Foundation

  2. Welcome!!! • Thank you for spending your valuable time with us today! • You can put questions in the chat box or wait for open microphone time at the end. • A link to both presentation slides and recording on our website will be sent to attendees following the webinar today. • Your feedback is greatly appreciated and can be provided via the post-webinar survey.

  3. Closed Captioning • Closed captioning will appear under today’s presentation. To see more lines of captioned text, click the small arrow below.

  4. Health Technology Services (HTS) is a department of Mountain-Pacific Quality Health (MP). M-P is the QIN/QIO for MT/WY/AK/HI. • We can help to: • Simplify and streamline quality reporting requirements • Stay current on changing regulations for Meaningful Use, PQRS, MACRA, etc. • Simplify HIPAA compliance • Advance and leverage your EHR usage to advance care delivery • Enhance patient engagement and satisfaction • Improve health outcomes to maximize value based performance payments

  5. Disclaimer

  6. Session Presenters • Sarah Leake • Sharon Phelps Sarah Leake, MBA, CPEHRHealth Technology and Quality Consultant HTS, Mountain-Pacific Quality Health Sharon Phelps, RN, BSN, CPHIMS, CHTS-CP Senior Account Manager Mountain-Pacific Quality Health

  7. Goals for today! • What is MACRA, QPP, MIPS and APM? • Important things to Know about MIPS • A Focus on 2017 Reporting • A Look at some Case Studies • Recommendations • This webinar will not be explaining the APM option.

  8. What is MACRA, QPP, MIPS and APM?

  9. Let’s look at Some Acronyms • MACRA - Medicare Access and CHIP Reauthorization Act of 2015 • QPP – Quality Payment Program • MIPS - Merit Incentive Payment System • APM – Alternative Payment Model • Advanced APM (like CPC+), MIPS-APM

  10. The Program Illustrated

  11. More on Quality Payment Program • What Does the Quality Payment Program Do? • Creates Medicare payment methods that promote quality over volume by: • Repealing SGR formula • Creating two tracks: • Merit-based Incentive Payment System (MIPS) • Advanced Alternative Payment Models (Advanced APMs) • Streamlining legacy programs • Providing 5% incentive to Advanced APM participants • Establishing PTAC, the Physician-focused Payment Model Technical Advisory Committee

  12. Comparison with Legacy Programs

  13. One Page on APMs • APM – Alternative Payment Model • Advanced APM • MIPS-APM • Qualified Advanced APM • Clinicians must receive enough of their Medicare payments or see enough of their Medicare patients through an Advanced APM to qualify for incentive pay and not participate in the MIPS track • MIPS APM

  14. Important Things to Know about MIPS

  15. Important Dates PQRS/MU • Jan 1 -Dec 31, 2016 - last date for collecting data in Legacy programs • Reporting between Feb 28 – March 30, 2017 depending upon reporting program and method • 2018 – Payment adjusted based on Legacy Program QPP • Start collecting data for QPP from Jan 1, 2017 or later depending upon “Pace Picked” • June 30, 2017 - Register only if reporting Group Web Interface • March 31, 2018 - Last day to report 2017 data

  16. Eligible Clinicians • Medicare Part B clinicians billing more than $30,000 and providing care to more than 100 Medicare patients per year - • Physicians • Physician Assistants • Nurse Practitioners • Clinical Nurse Specialists • Certified Registered Nurse Anesthetists • Voluntary option for all other clinicians but not included in transition year Clinicians will be contacted by CMS in December 2016 to notify if they are Eligible for MIPS? Web Page will also be available to check on eligibility (per CMS)

  17. Who is Exempt? Clinicians who: • Are newly enrolled in Medicare • Meet the threshold • < or equal to $30,000 in Medicare charges OR • < or equal to 100 Medicare patients • Are recognized by CMS as participating in an Advanced APM • MIPS doesn’t apply to hospital-based or facility-based payment programs

  18. Reporting Methods * If clinicians participate as a group, they are assessed as group across all 4 MIPS performance categories . 1. Individual – under an NPI number and TIN where they reassign benefits 2. As a Group • 2 or more clinicians(NPIs)who have reassigned their billing rights to a single TIN* • As a MIPS APM entity

  19. A Focus on 2017 Reporting

  20. MIPS Categories & Weightsfor 2017 NOTE: These are defaults weights - the weights can adjust in certain circumstances

  21. “Pick Your Pace”

  22. Reporting Categories

  23. Points & Adjustments • Score 0 • Full negative 4% payment adjustment in 2019 • Score 3 - 70 • No negative adjustment, possibly small positive adjustment • Score 70 – 100 • No negative adjustment, small positive adjustment PLUS high bonus adjustment

  24. Determining Your 2017 Plan • Avoid the Penalty • Easier to meet in 2017 than in 2016 • Multiple options • Achieve a Positive Adjustment • Look at quality measure benchmarks to aid in measure selection • Report for 90 days or longer • Shoot for the High Performance Bonus!!

  25. Checklist • Step 1 – determine your eligibility (low volume threshold) tbd on a CMS website • Step 2 – determine if reporting by individual or group • Step 3 – determine what is realistic for you to report to avoid a penalty -What is the simplest thing to report? -What quality measures are you familiar with and working on? -Have you been attesting to Meaningful Use? -Do your current improvement activities include an activity from the Improvement Activity list? • Step 4 – review your chosen item(s) to determine a start date • Step 5 – assemble your team for QPP planning

  26. A Look at some Case Studies

  27. Case Study #1 • Specialty practice with 12 providers • Bills $800,000 in Medicare Part B allowed charges per year • Has met Meaningful Use for Medicare for 3 years • Has not reported PQRS • Vendor is building a quality measure dashboard but it’s not ready yet

  28. Case Study #1 • Determine eligibility /low volume threshold • Given the volume of Part B charges, it is likely few of the 12 providers will be low volume providers • Determine if reporting by individual or group • Individual reporting would require more manhours to perform and to track/trend results • Consider individual if selected providers with high Part B volume are also high performing on quality measures • Determine what is realistic for you to report to avoid a penalty • What is the simplest thing to report? (MU due to familiarity) • What is the your clinic quality plan? • Start date – monitor throughout the year to determine best 90 day period • Team planning • Review quality measure performance • Select Improvement Activity

  29. Case Study #2 • Critical Access Hospital with Rural Health Clinic • Minimal Part B billing in RHC • $75,000 in Part B allowed charges in ER across 2 permanent providers and 5 locums • Has met Meaningful Use in hospital and in RHC • Has reported PQRS for ER providers as a group

  30. Case Study #2 • Determine eligibility /low volume threshold • Given the volume of Part B charges, it is likely all of the providers could be low volume providers • (Hint – check the 2015 PQRS Feedback reports for a quick glance) • Determine which locums may be returning • Determine if reporting by individual or group • Individual reporting could result in only 1 – 2 providers that are eligible and do not meet low volume threshold • Determine what is realistic for you to report to avoid a penalty • What is the simplest thing to report? (MU or PQRS due to familiarity) • Start date – monitor throughout the year to determine best 90 day period • Team planning • Review quality measure performance • Select Improvement Activity

  31. Case Study #3 • Solo practitioner • $50,000 in Part B allowed charges in 2015 • Does not have a certified EHR • Has not attested to Meaningful Use • Has reported PQRS using claims submission

  32. Case Study #3 • Determine eligibility /low volume threshold • Given the volume of Part B charges in 2015, this provider will not meet the exclusion criteria • Determine if reporting by individual or group • Only individual reporting applicable • Determine what is realistic for you to report to avoid a penalty • What is the simplest thing to report? A given quality measure using claims? • Start date – as the claims process is already being done, continue throughout 2017. Ensure coding is correct for correct data collection. • Team planning • Investigate using a certified EHR in 2018 • Review quality measure performance • Select Improvement Activity

  33. Your “Case” Questions

  34. Recommendations

  35. Planning Recommendations • Report, attest, or submit to existing Quality & Incentive programs for 2016 • Review your 2015 Annual QRUR and supporting documents to discover: • Quality measures results lower than the benchmark • Cost results higher than your peer group • Start a quality improvement process to improve your quality measure scores: • Consider using an approved improvement activity • Use accepted clinical guidelines • HTS eCQI toolkit has resources to assist • eClinical Quality Improvement (eCQI) Resources

  36. Quality Payment Program Link • Quality Payment Program CMS Site - Program Information, Education and Tools, Explore Measures

  37. Webinars & Links MACRA/MIPS/QPP Upcoming Webinars • 2016 Meaningful Use End of Year ReviewThursday, Dec 8, 20161-2 pm MST * 11-12 pm AKST * 10-11 am HASTRegister Now!

  38. Please complete the survey and thank you for your time today!

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