MIPS Deep Dive
-
Upload
athenahealth -
Category
Healthcare
-
view
415 -
download
0
Transcript of MIPS Deep Dive
![Page 1: MIPS Deep Dive](https://reader036.fdocuments.in/reader036/viewer/2022081421/5878dca91a28ab917a8b74b9/html5/thumbnails/1.jpg)
This event is live as of XYZ
MIPS Deep DiveAlexis Isabelle
Senior Manager Quality Performance
![Page 2: MIPS Deep Dive](https://reader036.fdocuments.in/reader036/viewer/2022081421/5878dca91a28ab917a8b74b9/html5/thumbnails/2.jpg)
2
![Page 3: MIPS Deep Dive](https://reader036.fdocuments.in/reader036/viewer/2022081421/5878dca91a28ab917a8b74b9/html5/thumbnails/3.jpg)
Source: CMS, “2013 Annual Report of the Boards of Trustees of the Federal Hospital Insuranceand Federal Supplementary Medical Insurance Trust Funds,” May 31, 2013, available at:http://downloads.cms.gov/files/TR2013.pdf;
Projected Medicare Fee-for-service Payment Cuts per the ACA
2014 2015 2016 2017 2018 2019 2020
Projected number of Medicare beneficiaries
54M 56M 57M 59M 61M 63M 64M
-14B -21B -25B -32B -42B -53B -64B
Source: CMS, “2013 Annual Report of the Boards of Trustees of the Federal Hospital Insuranceand Federal Supplementary Medical Insurance Trust Funds,” May 31, 2013, available at: http://downloads.cms.gov/files/TR2013.pdf
![Page 4: MIPS Deep Dive](https://reader036.fdocuments.in/reader036/viewer/2022081421/5878dca91a28ab917a8b74b9/html5/thumbnails/4.jpg)
FFS versus FFV
Eliminates incentive to increase volume Eliminates incentive to provide high-cost services over equally effective low-cost servicesQuality-based incentives Shared risk Emphasizes the role of primary care providers Encourages coordination of care
Fees billed per units of serviceIncome maximized through volumeNo penalty for poor quality Providers lose money if they reduce unnecessary services
Volume
Driven Health
Care
Value-
BasedHealth
Care Co
stQualit
y
Fee-for-service Value-based payments
![Page 5: MIPS Deep Dive](https://reader036.fdocuments.in/reader036/viewer/2022081421/5878dca91a28ab917a8b74b9/html5/thumbnails/5.jpg)
• Medicare Access and CHIP Reauthorization Act (MACRA) signed into law April 16th, 2015
• Repealed the flawed sustainable growth rate (SGR) formula
• Extends Children’s Health Insurance Program (CHIP) for two years
• New two-track Medicare physician payment system emphasizing value-based payment models
Landmark legislation alters howMedicare reimburses physicians
![Page 6: MIPS Deep Dive](https://reader036.fdocuments.in/reader036/viewer/2022081421/5878dca91a28ab917a8b74b9/html5/thumbnails/6.jpg)
6
![Page 7: MIPS Deep Dive](https://reader036.fdocuments.in/reader036/viewer/2022081421/5878dca91a28ab917a8b74b9/html5/thumbnails/7.jpg)
APMACIAPM Entity
Eligible Clinician
MIPS
QPAdvanced APM
CPIAQPPPartial
QPCPS
PQRS
CPIA
MU
VM
MACRA
CHIP
ACI
![Page 8: MIPS Deep Dive](https://reader036.fdocuments.in/reader036/viewer/2022081421/5878dca91a28ab917a8b74b9/html5/thumbnails/8.jpg)
8
QPP
APMMIPS Merit-based Incentive
Payment Systemcombination of MU, PQRs, VM, and new CPIA
Alternative Payment Model
Quality Payment Programthe overarching name that covers MIPS and APM tracks
CPS MIPS composite performance score
![Page 9: MIPS Deep Dive](https://reader036.fdocuments.in/reader036/viewer/2022081421/5878dca91a28ab917a8b74b9/html5/thumbnails/9.jpg)
MIPS Deep Dive
![Page 10: MIPS Deep Dive](https://reader036.fdocuments.in/reader036/viewer/2022081421/5878dca91a28ab917a8b74b9/html5/thumbnails/10.jpg)
10
MU PQRS VMMIPSMerit-Based Incentive Payment
System
Consolidates three existing programs, adds in additional performance category
APMAlternative Payment Models
Incentive payments available to qualified and eligible APM
1
2
![Page 11: MIPS Deep Dive](https://reader036.fdocuments.in/reader036/viewer/2022081421/5878dca91a28ab917a8b74b9/html5/thumbnails/11.jpg)
11
MIPS Eligibility – Years 1 and 2
• Physicians (MD/DO and DMD/DDS)• PAs• NPs• Clinical nurse specialists• CRNs• Anesthetists• Groups (defined by TIN) that include
such clinicians
![Page 12: MIPS Deep Dive](https://reader036.fdocuments.in/reader036/viewer/2022081421/5878dca91a28ab917a8b74b9/html5/thumbnails/12.jpg)
12
MIPS Eligibility – Years 3+
• Physical or occupational therapists• Speech-language pathologists,• Audiologists,• Nurse midwives• Clinical social workers• Clinical psychologists• Dietitians/Nutritional professionals
![Page 13: MIPS Deep Dive](https://reader036.fdocuments.in/reader036/viewer/2022081421/5878dca91a28ab917a8b74b9/html5/thumbnails/13.jpg)
Everyone reports MIPS
in 2017.
![Page 14: MIPS Deep Dive](https://reader036.fdocuments.in/reader036/viewer/2022081421/5878dca91a28ab917a8b74b9/html5/thumbnails/14.jpg)
14
Three clinician groups not subject to MIPS
ExclusionsECs can volunteer to reporting but won’t receive any money
Has not submitted claims under any
group prior to performance
period
Qualifyingparticipants (QPs)
Partial qualifying participants who opt not to report
MIPS
<$10k in Medicare billing
AND≤ 100 Part B
enrolled beneficiaries
Newly enrolled Medicare clinicians
APM participantsLow threshold
NOTE: MIPS does not apply to hospitals or facilities
![Page 15: MIPS Deep Dive](https://reader036.fdocuments.in/reader036/viewer/2022081421/5878dca91a28ab917a8b74b9/html5/thumbnails/15.jpg)
Four performance categories
![Page 16: MIPS Deep Dive](https://reader036.fdocuments.in/reader036/viewer/2022081421/5878dca91a28ab917a8b74b9/html5/thumbnails/16.jpg)
16
Category weight varies over time
2019 2020 2021+
25 25 25
15 15 1510 15 30
50 45 30
Four Categories That Determine MIPS Score Relative Weight Over Time
Quality
Resource UseClinical practice
improvement activities (CPIA)
Advancing Care Information (ACI)
![Page 17: MIPS Deep Dive](https://reader036.fdocuments.in/reader036/viewer/2022081421/5878dca91a28ab917a8b74b9/html5/thumbnails/17.jpg)
Quality1
![Page 18: MIPS Deep Dive](https://reader036.fdocuments.in/reader036/viewer/2022081421/5878dca91a28ab917a8b74b9/html5/thumbnails/18.jpg)
18
Quality(currently PQRS)
1• 6 measure selection• 1 cross-cutting measure and 1 outcome
measure, or another high priority measure if outcome is unavailable
• Select from individual measures or a specialty measure set
• Population measures automatically calculated
• Providers and groups measured and graded against the performance of their peers
![Page 19: MIPS Deep Dive](https://reader036.fdocuments.in/reader036/viewer/2022081421/5878dca91a28ab917a8b74b9/html5/thumbnails/19.jpg)
ACI(Advancing Care
Information) 2
![Page 20: MIPS Deep Dive](https://reader036.fdocuments.in/reader036/viewer/2022081421/5878dca91a28ab917a8b74b9/html5/thumbnails/20.jpg)
20
Advancing Care Information(currently EHR Incentive or MU)
2• Scoring based on key measures of patient
engagement and information exchange• Flexible scoring for all measures to promote
care coordination for better patient outcomes
• Points are awarded based on performance; only the highest performers will be able to earn full credit
![Page 21: MIPS Deep Dive](https://reader036.fdocuments.in/reader036/viewer/2022081421/5878dca91a28ab917a8b74b9/html5/thumbnails/21.jpg)
CPIA(Clinical practice
improvement activities)3
![Page 22: MIPS Deep Dive](https://reader036.fdocuments.in/reader036/viewer/2022081421/5878dca91a28ab917a8b74b9/html5/thumbnails/22.jpg)
22
Clinical practiceimprovement activities
3New category
• Minimum selection of one CPIA activity (from 90+ proposed activities) with additional credit for more activities
• Full credit for patient-centered medical home (PCMH)
• Minimum of half credit for APM participation• Activities are weighted as High or Medium
weight with corresponding points
![Page 23: MIPS Deep Dive](https://reader036.fdocuments.in/reader036/viewer/2022081421/5878dca91a28ab917a8b74b9/html5/thumbnails/23.jpg)
Resource Use4
![Page 24: MIPS Deep Dive](https://reader036.fdocuments.in/reader036/viewer/2022081421/5878dca91a28ab917a8b74b9/html5/thumbnails/24.jpg)
24
Resource Use(currently VM)
4• Medicare claims; no reporting• Minimum thresholds of 20 patients/cases• Adjusted for geographic payment, beneficiary risk factors
Total per capita cost measure (part A+B across VM chronic conditions for COPD, CHF, CAD, DM) as seen in VM with slight modification• Expanded list of primary care services to include TCM, CCM• Excluded SNF
MSPB measure as seen in VM with slight modifications
Episode-based measures (41 across specialties)*
1
2
3
![Page 25: MIPS Deep Dive](https://reader036.fdocuments.in/reader036/viewer/2022081421/5878dca91a28ab917a8b74b9/html5/thumbnails/25.jpg)
MIPS has different set of “rules” and scoring going forward
Weighting of Cost & Quality categories will change over time with Quality declining and Cost increasing (from 10% to 30% by 2019)
Source: CMS
25
Category Weight(Year 1) Scoring
Quality 50%
• Each measure 1-10 points compared to historical benchmark
• 0 points for a measure that is not reported• Bonus for reporting outcomes, patient experience,
appropriate use, patient safety and EHR reporting• Measures are averaged to get a score for the category
Advancing Care
Information (ACI)
25%
• Base score of 50 percentage points achieved by reporting at least one use case for each available measure
• Performance score of up to 80 percentage points• Public Health Reporting bonus point• Total cap of 100 percentage points available
Clinical practice
improvement activities
(CPIA)
15%• Each activity worth 10 points; double weight for “high”
value activities; sum of activity points compared to a target
Resource Use 10% • Similar to quality
![Page 26: MIPS Deep Dive](https://reader036.fdocuments.in/reader036/viewer/2022081421/5878dca91a28ab917a8b74b9/html5/thumbnails/26.jpg)
Composite performance score calculation
26
A single MIPS composite performance score will factor in performance in 4 weighted performance
categories on a 0-100 point scale
Quality Resource UseCPIAACI
MIPS Composite Performance Score (CPS)
![Page 27: MIPS Deep Dive](https://reader036.fdocuments.in/reader036/viewer/2022081421/5878dca91a28ab917a8b74b9/html5/thumbnails/27.jpg)
Payment adjustment scale has more complexity, less middle ground
27
Demonstrative onlyMIPS Budget-neutral program, 2019 payment based on 2017 performanceCPS Threshold has not yet been releasedCMS estimates only 0.3% of providers will have a score exactly equal to the CPS threshold
Provider payment adjustmentBased on distance from CPS Threshold score
(Example) CPS Threshold -
60Lowest
quartile or non
reporters get flat
4% downward adjustmen
t0 10 20 30 40 50 60 70 80 90 100
14
12
10
8
6
4
2
0
-2
-4
-6
All providers with <60 CPS receives
downward adjustment
All providers with
>60 CPS receive an upward adjustment
Payment Adjustment (%) Payment Adjustment (%) (high performers)
![Page 28: MIPS Deep Dive](https://reader036.fdocuments.in/reader036/viewer/2022081421/5878dca91a28ab917a8b74b9/html5/thumbnails/28.jpg)
-1% +1%
Payment adjustment will increase over time
28
30%
20%
10%
0%
-10%
Paym
ent A
djus
tmen
t
-4%4%
12%
2019
-5%
5%
15%
2020
-7%
7%
21%
2021
-9%
9%
27%
2022
High performers eligible
for additional incentive
Budget neutrality adjustment: Scaling factor up to 3x may be applied to upward adjustment to ensure payout pool equals penalty pool
Non-reporting
groups given lowest score
![Page 29: MIPS Deep Dive](https://reader036.fdocuments.in/reader036/viewer/2022081421/5878dca91a28ab917a8b74b9/html5/thumbnails/29.jpg)
Preparing for 2017
![Page 30: MIPS Deep Dive](https://reader036.fdocuments.in/reader036/viewer/2022081421/5878dca91a28ab917a8b74b9/html5/thumbnails/30.jpg)
30
2019
Fast timeline for clinicians to follow
MACRA Implementation Timeline
2016 2017 20182019
TodayFinal Rule
Released
Providers may not be certain which track they
will fall into when reporting in 2017
Not much time for many
providers to get
involved in QPP
Performance period
Providers notified of track
assignmentPayment
adjustment
Based on
Merit Based Incentive Payment
System (MIPS)
Advanced Alternative Payment
Models (APM)
Preparing Performing Reporting Payment
StartsJanuary 1st, 2017
Source: CMS
![Page 31: MIPS Deep Dive](https://reader036.fdocuments.in/reader036/viewer/2022081421/5878dca91a28ab917a8b74b9/html5/thumbnails/31.jpg)
Payment adjustments vary with differentsizes of clinician groups
31
Solo 2-9 10-24 25-99 100 or more Overall0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
100%
87.00%69.90%
59.40%44.90%
18.30%
45.50%
12.90%29.80%
40.30%54.50%
81.30%
54.10%
CMS Estimated Penalties and Bonuses in 2017,By Practice Size
Percent likely to be penalized Percent likely to receive bonus
![Page 32: MIPS Deep Dive](https://reader036.fdocuments.in/reader036/viewer/2022081421/5878dca91a28ab917a8b74b9/html5/thumbnails/32.jpg)
32
Historically, our clients perform better.
Meaningful Use Stage 2 attestation
% of HCPs avoidingPQRS penalties in 2015
NATIONAL AVERAGE
60%ATHENAHEALTH
CLIENTS
93.6%NATIONAL AVERAGE
33%ATHENAHEALTH
CLIENTS
98.2%MU and PQRS Client
Guarantee
![Page 33: MIPS Deep Dive](https://reader036.fdocuments.in/reader036/viewer/2022081421/5878dca91a28ab917a8b74b9/html5/thumbnails/33.jpg)
33
Currently estimating our clients’ performance in real-time
![Page 34: MIPS Deep Dive](https://reader036.fdocuments.in/reader036/viewer/2022081421/5878dca91a28ab917a8b74b9/html5/thumbnails/34.jpg)
athenaNet provider performance on Meaningful Use Stage 2 measure: Use Secure Electronic Messaging
NETWORK WIDE CHANGES:1. NEW FUNCTION: Now easier for practices to
register patients to the patient portal.2. FUNCTION UPDATE: Now easier for providers
to send patients secure messages through the patient portal.
100%
90%
80%
70%
OCT. 2014 NOV. 2014 DEC. 2014
![Page 35: MIPS Deep Dive](https://reader036.fdocuments.in/reader036/viewer/2022081421/5878dca91a28ab917a8b74b9/html5/thumbnails/35.jpg)
35
We will take on your busy work
![Page 36: MIPS Deep Dive](https://reader036.fdocuments.in/reader036/viewer/2022081421/5878dca91a28ab917a8b74b9/html5/thumbnails/36.jpg)
36
We will make sense of the 200 measures and choose which are right for
you
![Page 37: MIPS Deep Dive](https://reader036.fdocuments.in/reader036/viewer/2022081421/5878dca91a28ab917a8b74b9/html5/thumbnails/37.jpg)
37
![Page 38: MIPS Deep Dive](https://reader036.fdocuments.in/reader036/viewer/2022081421/5878dca91a28ab917a8b74b9/html5/thumbnails/38.jpg)
Thank You
![Page 39: MIPS Deep Dive](https://reader036.fdocuments.in/reader036/viewer/2022081421/5878dca91a28ab917a8b74b9/html5/thumbnails/39.jpg)
Glossary of Terms
![Page 40: MIPS Deep Dive](https://reader036.fdocuments.in/reader036/viewer/2022081421/5878dca91a28ab917a8b74b9/html5/thumbnails/40.jpg)
ACI
Advanced APM
APM
Advanced Care Information, formerly known as Meaningful Use
Alternative Payment Model
Alternative Payment Model which CMS has designated “eligible”
![Page 41: MIPS Deep Dive](https://reader036.fdocuments.in/reader036/viewer/2022081421/5878dca91a28ab917a8b74b9/html5/thumbnails/41.jpg)
APM Entity
CPS
CPIA
EC
The TIN(s) participating in an APM or Advanced APM
Clinical Practice Improvement Activities
MIPS composite performance score
Eligible Clinician, the new definition of professionals who fall under this category under MACRA
![Page 42: MIPS Deep Dive](https://reader036.fdocuments.in/reader036/viewer/2022081421/5878dca91a28ab917a8b74b9/html5/thumbnails/42.jpg)
MIPS
QPP
QP
Partial QP
Merit Based Incentive Payment System, the combination of MU, PQRS, VM and new CPIA
Qualifying APM Participant
Quality Payment Program, the overarching name that covers MIPS and APM tracks
Partial Qualifying APM participants