PTO Training - Resource Hub | Practice Innovation Program...

PTO TrainingJuly 27, 2017 9:00 am

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PTO TrainingJuly 27, 2017 9:00 am

Agenda

9:00 – 9:05: Welcome and Announcements – Kellyn Pearson9:05 – 9:50: Presentation and discussion;

Quality Payment Program Reporting: Using Registries & Qualified Clinical Data Registries (QCDRs) to Maximize Success; Lance Mueller, Manager of Healthcare Quality for the American Medical Association (AMA)9:50 – 10:00: Future PTO Trainings

Clinical Data Registries and QPPOverview

© 2017 American Medical Association. All rights reserved.

Welcome and Introduction

• This presentation will provide a high-

level overview of:

• Clinical Data Registries

• MACRA / QPP

• MIPS reporting via registries

• Qualified Clinical Data Registries

(QCDRs)

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Clinical Data Registries

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What is a Clinical Data Registry

• Registries are databases designed to capture rich, clinical data that matter to

health care practitioners, providers and patients.

• Collect uniform clinical data for specific patient populations for predetermined purposes

• Increasingly capture structured data electronically from multiple EHRs

• Usually focus on patient populations defined by a specific disease or condition,

procedure, medical device or drug

• Are normally created for specific purposes such as quality improvement, payment,

research and many others

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What registries are not

• EHRs

• Billing systems

• Health Information Exchanges

(HIEs)

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Registry information flow – looks like PDSA

Physician documents patient care

EHR

Registry

Provider performance

report

Provider reviews report

Patients can enter their own data into some registries

How can I improve my

performance?

Report to External Stakeholders


Registries provide

value to many

different kinds of

organizations

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Registries

Federal, state

government

Hospitals & health

systems

Physician practices

Health plans and

employers

Researchers

Consumers & public


What are registries used for and by whom…

Supporting the performance

measurement enterprise:

Quality improvement

Value-based payment

Benchmarking

Research

Many other purposes

10

Rates of major and minor complications have decreased for National Anesthesia Clinical Outcomes Registry (NACOR) participants.


Resources for Further Learning

National Quality Registry Network (NQRN)

Registry inventory

“What is a registry?” handout

Registry vendor assessment

CMS - Qualified Clinical Data Registry program information

AHRQ - Registries user’s guide

Other networks of registries: NAACCR, ICHOM, ICOR, MDEpiNet, many others

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MACRA – QPP – MIPS

and Registries

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Some general observations

• MACRA is complex

• More than a “replacement for the SGR”

• Many of the “new” requirements are revisions to the current FFS program

• Impacts of previous law not universally experienced, understood, or in full effect

• One goal of MACRA was to simplify administrative processes for physicians

• Compared to recent past framework, there are significant improvements

• MACRA and ACA dynamics are often confused

• More work remains

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MACRA established two Medicare paths for physicians

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• MACRA was designed to offer

physicians a choice between two

payment pathways:

• A modified fee-for-service model

(MIPS)

• New payment models that reduce

costs of care and/or support high-value

services not typically covered under

the Medicare fee schedule (APMs)

• In the beginning, most are expected to

participate in MIPS

• CMS named the physician payment

system created by MACRA the Quality

Payment Program (QPP)

MIPS

APMs


MACRA: New vs Re-Organized

• New

• Bonus opportunities (APMs & MIPS)

• Greater support for physicians that want

to pursue new models

• Improvement Activities

• Re-organized

• PQRS, MU and VBM

• Penalties reduced in absolute terms &

through partial credit

• Reduce net administrative burdens

• Greater flexibility for physicians

• Low score in one area can be made up

by high score in other components

• No more double jeopardy for failing

PQRS (think VBM)

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Check MIPS Eligibility

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• Enter a national provider identifier (NPI) into CMS’ tool to determine if you should participate in MIPS in 2017.

• Exemptions include • Low-volume providers• 1st year in Medicare• Advance APM participants• Additional exemptions

https://qpp.cms.gov/learn/eligibility

Pick Your Pace: 2017 transitional performance reporting options

• Report some data at any point in CY 2017 to demonstrate capability

• 1 quality measure, or 1 improvement activity, or 4/ 5 required ACI measures

• No minimum reporting period

• No negative adjustment in 2019

MIPS Testing

• Submit partial MIPS data for at least 90 consecutive days

• 1+ quality measure, or 1+ improvement activities, or 4/ 5 required ACI measures


• Potential for some positive adjustment ( < 4%) in 2019

Partial MIPS reporting

• Meet all reporting requirements for at least 90 consecutive days


• Maximum opportunity for positive 2019 adjustment ( < 4%)

• Exceptional performers eligible for additional positive adjustment (up to 10%)

Full MIPS reporting

• No MIPS reporting requirements (APMs have their own reporting requirements)

• Eligible for 5% advanced APM participation incentive in 2019

Advanced APM participation

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2017 MIPS Components

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MIPS aims:

Align 3 current independent programs

Add 4th component to promote

improvement and innovation

Provide more flexibility and choice of

measures

Retain a fee-for-service payment option

Clinicians exempt from MIPS:

First year of Part B participation

Medicare allowed charges < $30K or < 100

patients

Advanced APM participants

AMA’s Payment Model Evaluator

• Educate

• Provides resources to learn about

QPP, MIPS, and advanced APMs

• Assess

• A short, 8-10 question survey

• Implement

• Recommendation on participating in

QPP via MIPS or advanced APM with

specific educational resources

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What’s Next? Use the AMA MIPS Action Plan

• The MIPS Action Plan lays out the 10

key steps needed to successfully

implement MIPS for 2017.

• Intended for physicians who plan to

participate in MIPS and not as part of

an advanced APM.

• MIPS Action Plan PDF, 214.17 KB

• MIPS Action Plan Supplementary

FAQ PDF, 300.78 KB

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https://www.ama-assn.org/sites/default/files/media-browser/public/physicians/macra/AMA-QPP-Action-Plan.pdf

https://www.ama-assn.org/sites/default/files/media-browser/public/physicians/macra/AMA-QPP-FAQ.pdf


MIPS 10 Step Action Plan

• STEP 1 Determine whether MIPS Applies to You

• STEP 2 Review Available Performance Categories

• STEP 3 ‘Pick Your Pace’ for MIPS Participation

• STEP 4 Review your Data

• STEP 5 Decide whether to Report as an Individual or a Group

• STEP 6 Identify your Reporting Mechanism

• STEP 7 Perform a Security Risk Analysis

• STEP 8 Report for at Least 90 Days* [CMS DEADLINE: OCT. 2, 2017]

• STEP 9 Complete MIPS performance [CMS DEADLINE: DEC. 31, 2017]

• STEP 10 Submit 2017 MIPS Data

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Selecting Measures:

Quality, ACI, and IAs

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Select a Specialty Measure Set• Allergy/Immunology

• Anesthesiology

• Cardiology

• Dermatology

• Diagnostic Radiology

• Electrophysiology Cardiac Specialist

• Emergency Medicine

• Gastroenterology

• General Oncology

• General Practice/Family Medicine

• General Surgery

• Hospitalists

• Internal Medicine

• Interventional Radiology

• Mental/Behavioral Health

• Neurology

• Obstetrics/Gynecology

• Ophthalmology

• Orthopedic Surgery

• Otolaryngology

• Pathology

• Pediatrics

• Physical Medicine

• Plastic Surgery

• Preventive Medicine

• Radiation Oncology

• Rheumatology

• Thoracic Surgery

• Urology

• Vascular Surgery

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Additional Points on Selecting Quality Measures

• Many other initiatives – State

Innovation Model, Evidence Now,

Million Hearts, etc. have quality

measures which align with the MIPS

Quality Measures.

• Utilize these measures for both

programs to reduce the burden of

quality measure data collection.

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ACI performance category scoring:

required measures (50% score)

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Bonus Points are available for registry reporting…

• MIPS eligible clinicians can earn bonus percentage points by doing the following:

• Reporting “yes” to 1 or more additional public health and clinical data registries

beyond the Immunization

• Registry Reporting measure will result in a 5% bonus.

• Reporting “yes” to the completion of at least 1 of the specified Improvement

Activities using CEHRT will result in a 10% bonus.

• See Appendix B for the list of Improvement Activities that may be completed using

certified EHR technology to qualify for the bonus.

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Select Improvement Activities

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Take advantage of educational opportunities

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www.stepsforward.org

Completion of select STEPS Forward™ modules meets eligibility criteria for Improvement Activity category credit

http://www.stepsforward.org/

TCPI Participation counts as an Improvement Activity

• Participation in the CMS

Transforming Clinical Practice

Initiative.

• ACTIVITY ID

• IA_CC_4

• SUBCATEGORY NAME

• Care Coordination

• ACTIVITY WEIGHTING

• High

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Select measures which apply across the MIPS performance

categories

• Quality – Controlling High Blood

Pressure

• IA – Chronic care and preventative

care management for empaneled

patients

• ACI – Public Health Registry Reporting

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Getting the data to CMS


Registries

• Practices will need to work with a 3rd

party to help collect and report their data to CMS.

• The 3rd party vendor can help practices setup interfaces between the practice’s IT systems and the registry.

• The 3rd party intermediary provides feedback reports so physicians and practice administrators can monitor progress throughout the year.

• Lastly, the 3rd party intermediary will submit your data to CMS so you can get credit for participating in the Quality Payment Program via MIPS.

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Participating with a registry – 2 sets of activity

• Activities within your group / practice

• Consider your practice model, # of

providers, admin support,

billing/claims processing, practice

setting, patient population, and IT

systems

• Activities with your registry

• Initial setup, periodic reporting of data

to registry, feedback reports,

regulatory reporting (MACRA/QPP)

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Preparing for registry reporting

• Identify the data and define data collection process(es)

• Engage external players who have the data you need

• Billing/Claims, EMR, Quality

• Educate your providers

• Review quality measures

• Support go-live or launch

• Assess Results

• Validate the vendor feedback reports

• Feedback reports should be reviewed on a regular basis with providers

• Be able to answer – “Why are we doing this?”

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Using a Qualified Registry for MIPS Data Submission

• A qualified registry is a CMS-approved entity that

collects clinical data from MIPS eligible clinicians (both

individual and groups) and submits it to CMS on their

behalf for purposes of MIPS.

• Qualified Registries are run by medical special

societies, TCPI organizations (both PTNs and SANs),

commercial vendors (HIT and Quality), and other

quality-improvement focused organizations

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Benefits of a Qualified Registry

• Report on the 3 performance

categories – Quality, Improvement

Activities, and Advancing Care

Information

• Required to provide feedback reports

to participants

• Existing interfaces with local systems

• Claims, EHR, Quality

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Benefits of partnering with a QCDR

• All the benefits of a registry

• Plus

• QCDRs often make available quality

measures that are more meaningful

for participants

• These count as part of the 6 quality

measures

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Disadvantages of reporting via a registry – both QR & QCDR

• Setup time

• Getting data from local systems

• Participation Cost

• Member vs Non-member

• Administration Cost

• Time spent by office staff

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Key Points and the Future


More small practice accommodations

• “Pick your pace” transition for 2017: CMS estimates 90% of eligible clinicians in

groups < 10 will get zero or positive adjustments

• Fewer Improvement Activities required: 1 high or 2 medium = full credit

• Example: TCPI participation is a High-weighted activity (full ACI credit for small practices)

• $100 million in grants for technical assistance to small practices via QIOs and

regional health improvement collaboratives (QPP-SURS)

• Future rulemaking to address virtual groups, allowing solo and small practices to

combine resources to jointly participate in QPP

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Things to Remember

• Practices can avoid the penalty by “Testing” their systems and reporting on 1

measure for 1 patient via the claims reporting method

• https://www.ama-assn.org/qpp-reporting

• Practices who have participated in PQRS reporting previously and are still

reporting the Quality Data Codes (G-code, CPT II) on their claims to CMS, may

already be well on their way to successful reporting.

• The best opportunity for reporting, and potentially receiving an incentive, is to

partner with a registry to help with your reporting. Start with the medical specialty

society to see what their solution is or who they recommend.

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https://www.ama-assn.org/qpp-reporting


What’s Next? Use the AMA MIPS Action Plan

• The MIPS Action Plan lays out the 10 key steps needed to successfully implement MIPS for 2017. It is intended for physicians who plan to participate in MIPS and not as part of an advanced APM. For more detailed information regarding each step of the Action Plan, refer to the MIPS Action Plan Supplementary FAQ.

• DOWNLOADS

• MIPS Action Plan PDF, 214.17 KB

• MIPS Action Plan Supplementary FAQ PDF, 300.78 KB

• https://www.ama-assn.org/practice-management/understanding-medicare-s-merit-based-incentive-payment-system-mips

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https://www.ama-assn.org/sites/default/files/media-browser/public/physicians/macra/AMA-QPP-Action-Plan.pdf

https://www.ama-assn.org/sites/default/files/media-browser/public/physicians/macra/AMA-QPP-FAQ.pdf

https://www.ama-assn.org/practice-management/understanding-medicare-s-merit-based-incentive-payment-system-mips


Future

• MACRA and the QPP are here to stay but evolving.

• They are not part of the ACA.

• The 2018 proposed rule is in comment period.

• Last year, the proposed rule received over 3000 comments.

• The 2017 final rule contained many changes from the proposed rule.

• CMS is looking at new Alternative Payment Models and possibly designating some

existing payment models as APMs

• Use this year to setup reporting through a registry to be ready for full-year reporting

in 2018.

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Things to Remember

• CMS Resources – QPP.CMS.GOV

• 2017 is transition year – Pick Your Pace – Do something!

• Partial Credit – Make up points in another category – No double jeopardy

• QPP is here to stay and evolving – 2018 will look a little different than 2017

• Use a QCDR or Qualified Registry to get your data to CMS and to help you score

higher on your measures – especially Quality and IAs

• AMA has MACRA resources to help - https://www.ama-assn.org/MACRA

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https://www.ama-assn.org/practice-management/medicare-payment-delivery-changes

Where to find help?


QPP Educational Resource Library

• Links to official information to help you prepare for success in the Quality Payment

Program.

• Many of the CMS QPP docs are here --- https://qpp.cms.gov/resources/education

• CMS Webinars and Educational Programs are here:

https://www.cms.gov/Medicare/Quality-Initiatives-Patient-Assessment-

Instruments/Value-Based-Programs/MACRA-MIPS-and-APMs/Quality-Payment-

Program-Events.html

• MIPS Data Validation criteria provides information about IAs and documenting

activity - https://qpp.cms.gov/docs/QPP_MIPS_Data_Validation_Criteria.zip

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https://qpp.cms.gov/resources/education

https://www.cms.gov/Medicare/Quality-Initiatives-Patient-Assessment-Instruments/Value-Based-Programs/MACRA-MIPS-and-APMs/Quality-Payment-Program-Events.html

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


Where Can I Go for Help?

• Visit QPP.CMS.GOV

• Call 1-866-288-8292 (TTY users should call 1-877-715-6222) or email [email protected]

• For local assistance, contact one of the CMS-approved organizations that can help:

• Practice Transformation Networks (PTNs) are organizations designed to support clinician practices in quality

improvement strategies.

• For more information or to get connected to a PTN, contact [email protected]

• Quality Innovation Network (QIN)-Quality Improvement Organizations (QIOs) are regionalized organizations dedicated to

improving health quality at the community level.

• To find your QIN-QIO, please visit http:// qioprogram.org/

• The Small, Underserved, and Rural Support initiative provides direct, customized support to small practices.

• Email [email protected] for general information or help getting connected

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Technical Assistance for clinicians from CMS

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AMA MACRA Resources

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Questions and Contact

Lance Mueller,

Manager, Healthcare Quality

AMA

• [email protected]

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mailto:[email protected]

Announcement:

• Fall Collaborative Learning Sessions- Registration info in CHES Newsletter• ENSW Sept 8th – Denver

• TCPi Oct 4th – Denver

• SIM Nov 3 – Denver

• Western Slope SIM/TCPi TBD

• Aug 16-17 SIM PTO Training registration open• Aug 16 Lowery Center 10 am to 4 pm

• Aug 17 Anschutz Campus 9 am to 3:30 pm (Bring your laptop for live SPLIT training)

Future PTO Trainings

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August 2017

• 8/8 – TCPi PTO Touchbase

• 8/10 – SIM Office Hours

• 8/16-17 – SIM PTO Training

• 8/16 – MGMA Practice Webinar-- Payers Prepare for Value Based Contracts, Payer Panel

• 8/17 – Learning Features Call – CANCELLED DUE TO PTO TRAINING

• 8/22 -- Colorado QPP Coalition Office Hours webinar

• 8/23 – PTO Training- Opiod Project

University Practice Innovation Team Contact Information

CQMs – [email protected]

e-Learning – [email protected] or [email protected]

Learning Community - [email protected]

Practice Transformation – [email protected]

Qualtrics/Data Related -- [email protected]

SIM – [email protected]

SIM Invoicing – [email protected]

SPLIT/Data Related – [email protected]

TCPi - [email protected]

TCPi Project Manager - [email protected]

TCPI Faculty -- [email protected] 55













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