Preparing Your Practice for MIPS Success...2017/09/06 · Category scores are used to determine...

Preparing Your Practice for MIPS Success:Selecting and Reporting on Quality Measures

Value Driven. Health Care. Solutions.

MACRA Jumpstart – Maximizing Performance in MIPS!

2Value Driven. Health Care. Solutions.

At the close of our presentation you

should have a better understanding

of what clinical quality measures

are, their specifications, how to

report, and more about MIPS

quality category scoring. We will

also share free CMS Resources for

MIPS support:

– QPP Resource Center– www.qppresourcecenter.com

– Medical Advantage Group’s

MACRA Jumpstart– www.medicaladvantagegroup.com/macra

jumpstart/

http://www.qppresourcecenter.com/

http://www.medicaladvantagegroup.com/macrajumpstart/

Need to Catch Up?


If today is your first webinar with

us and you need to catch up, visit

our MACRA Jumpstart Website:

– www.medicaladvantagegroup.com

/macrajumpstart/

We have a library of past MACRA

Jumpstart Webinars, and many

other resources to help you get

off to a successful start:

– June 21 – Using Free CMS

Resources for MIPS Success

– July 12 – Preparing Your Small

Practice for MIPS Success

– Aug. 14 – Maximizing

Performance in MIPS


MIPS at a Glance

Each provider is evaluated on individual or group

performance in 4 categories

Category scores are used to determine MIPS Final

Score between 1-100 points



2017 Category Weights

Pick Your Pace in 2017


No

Participation

Minimum

Participation

Partial

Participation

Full

Participation

• Report

nothing

• -4% penalty

• Report

1 Quality measureor

1 Improvement

Activityor

4/5 Required

Advancing Care

Information

measures

• 0% adjustment

• Report more

than minimum

in any category

for at least 90

days

• Small incentive

possible

• Report all

categories for at

least 90 days

(preferably one

full year)

• Up to 4%

incentive

• Possible bonus if

≥ 70 points

Test Pace: Three Ways to Avoid the Penalty in 2017


1Quality

Measure

1Improvement

Activity

4/5Required Advancing Care

Information

Measures

OR OR

Quality Overview

Requirements

Report 6 measures

Include at least 1 outcome

or high priority measure

Choose from 291 generally

approved MIPS measures


Scoring

60 possible category

points

3-10 points per measure

based on performance

against a benchmark

Up to 12 bonus points

available

60Points

Quality Measure Choices


https://qpp.cms.gov/mips/quality-measures

https://qpp.cms.gov/mips/quality-measures

What is in a Quality Measure?

Where do Quality Measures come from and what are they for?

CQM vs. eCQM

Quality Measure talking points:


Measure Description

Numerator Denominator

Inverse Measures

Exclusions Exceptions

ScoringMeasurement

Period

What is in a Quality Measure? (contd.)


How Can You Report?

Participation type Submission Type

Individual Part B Claims

Individual or Group QCDR, Qualified Registry or EHR

Group (25 E.C.’s or larger) CMS Web Interface


Data Completeness Standards for 2017


Individual: Part B Claims Reporting


G8598: Aspirin or

antiplatelet therapy

used --Performance

met

Understanding Benchmarks

Benchmark – standard based on historical data

2017 Quality benchmarks set from 2015 PQRS data

– Mean/Average determined

– Performance scores distributed along a decile range

Download “2017 Quality Benchmarks" at

https://qpp.cms.gov/about/resource-library


Measure NameSubmission

MethodDecile 3 Decile 4 Decile 5 Decile 6 Decile 7 Decile 8 Decile 9 Decile 10

Pneumonia Vaccination

Status for Older AdultsClaims

39.78 -

51.32

51.33 -

61.67

61.68 -

70.47

70.48 -

77.77

77.78 -

84.49

84.50 -

91.99

92.00 -

99.06>= 99.07


Status for Older AdultsEHR

14.13 -

23.25

23.26 -

33.02

33.03 -

43.58

43.59 -

53.96

53.97 -

63.60

63.61 -

74.54

74.55 -

85.52>= 85.53


Status for Older AdultsRegistry/QCDR

12.24 -

24.02

24.03 -

36.34

36.35 -

48.51

48.52 -

58.95

58.96 -

68.05

68.06 -

77.77

77.78 -

90.19>= 90.20


Absolute vs Relative Performance Scoring

Dr. Jones is choosing between two Quality measures to

report.

– Documentation of Current Medications = 97.0%

– Influenza Immunization = 75.0%

Dr. Jones checks the benchmark scoring for these 2

measures to estimate how many points he will earn

Dr. Jones will earn 3 more points using the Influenza

Immunization measure, even though he has a lower

performance %


Measure Name Decile 3 Decile 4 Decile 5 Decile 6 Decile 7 Decile 8 Decile 9 Decile 10 Topped Out

Documentation of Current

Medications in the Medical

Record

61.27 -

82.11

82.12 -

91.71

91.72 -

96.86

96.87 -

99.30

99.31 -

99.99 -- -- 100 Yes

Preventive Care and

Screening: Influenza

Immunization

11.57 -

21.39

21.40 -

31.39

31.40 -

41.31

41.32 -

51.13

51.14 -

62.04

62.05 -

74.27

74.28 -

91.83 >= 91.84 No

Quality Category Bonus Points

Additional High-priority or Outcome measures

– High-priority = 1 point per measure

– Outcome = 2 points per measure

– Up to 6 points maximum

“End-to-end” Electronic reporting

– From point of service through to CMS

– EHR

– Registry or QCDR if data extracted electronically

– 1 point per measure, up to 6 points maximum


Review Your Measure Specifications

Remember: measure specs include

– Numerator and denominator details

– Exclusion and Exception criteria

– Measure Rationale (Quality)

– Additional Information (ACI)

Quality Measure Specs for Claims and Registryhttps://qpp.cms.gov/docs/QPP_quality_measure_specifications.zip

eCQM Measure Specshttps://ecqi.healthit.gov/eligible-professional-eligible-clinician-ecqms

ACI Measure Specshttps://qpp.cms.gov/docs/QPP_Advancing_Care_Information_Measure_S

pecifications.zip

https://qpp.cms.gov/docs/QPP_quality_measure_specifications.zip

https://ecqi.healthit.gov/eligible-professional-eligible-clinician-ecqms

https://qpp.cms.gov/docs/QPP_Advancing_Care_Information_Measure_Specifications.zip

Selecting Measures

1. Decide on your reporting method and vendor

2. Obtain list of all measures available through chosen

method and vendor

3. Narrow your list to include only applicable measures

– Specialty/scope of practice

– Patient population

– Data collection limitations

– Measure Specifications

4. Print a 2017 year-to-date Quality report from your

vendor


Selecting Measures (cont.)

5. Download the “2017 Quality Benchmarks” file from


6. Estimate your MIPS points per measure using the “2017

Quality Benchmarks

7. Choose your highest 6 scoring measures to report



Quality Reporting Tips

Can report more than 6 measures

– CMS will automatically choose highest scoring 6 for

Quality category score

Minimum 20 cases for required to earn performance

points above the minimum

Additional high-priority and outcome measures not

included in category score still earn bonus points

2018 Quality scoring likely to include points for

improvement – must submit measure in 2017 to qualify


Quality Category Score


Each

measure

earns 3-10

points

End-to-

End

bonus

points

High-

priority

and

Outcome

bonus

points

TOTAL

POINTS

EARNED

Step 1

Step 2

TOTAL

POINTS

EARNED

60 Points

QUALITY

CATEGORY

SCORE

(capped

at 60)

60

(Total

Possible

Points)

Next Webinar – Oct. 12


Visit Medical Advantage Group’s

MACRA Jumpstart Page:

– www.medicaladvantagegroup.com/mac

rajumpstart/

Register for our Oct. 12 webinar:

– MACRA Jumpstart: MIPS

Advancing Care Information 101 – This will be a primer on ACI for MIPS

View our other upcoming webinars:

– Nov. 9 – QPP Final Rule for 2018


Value Driven. Health Care. Solutions.

Thank You!

Preparing Your Practice for MIPS Success...2017/09/06 · Category scores are used to determine...

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