Understanding Your QRUR Meghan Donohue and Mary Franzen Qualis Health Dec. 9, 2015.
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Transcript of Understanding Your QRUR Meghan Donohue and Mary Franzen Qualis Health Dec. 9, 2015.
Understanding Your QRUR
Meghan Donohue and Mary FranzenQualis Health
Dec. 9, 2015
2
Qualis Health • A leading national population health
management organization• The Medicare Quality Innovation Network - Quality
Improvement Organization (QIN-QIO) for Idaho and Washington
The QIO Program • One of the largest federal programs dedicated to
improving health quality at the local level
3
Housekeeping Items
• Please chat questions to “All Participants.” We will be answering questions as we go and at the end of the presentation.
• If you have downloaded your QRUR, you might want to refer to it during the presentation.
4
Save the DatePublic Health Reporting for Meaningful Use in WA:
How to Meet 2015 RequirementsJanuary 12, 2016
12 – 1 pm PTRegister here
Speakers to include:
Travis Kushner, MPAPublic Health Data Exchange Program Coordinator,Office of the State Health Officer
Topics will include:
• Technical requirements to submit MU Objective 10: Public Health Reporting, including immunization registry reporting, syndromic surveillance reporting, and specialized registry reporting.
• Process for submitting data in WA and options available to EPs in 2015.
5
Save the DateIt’s not too late!
Options for 2015 PQRS ReportingJanuary 26, 2016
11:30-12:30 PT / 12:30-1:30 MTRegister here
Speakers to include:
Kelley Carnwath, MPH, CPHITQuality Improvement PrincipalQualis Health
Mary Franzen, MPHQuality Improvement Consultant Qualis Health
Topics will include:
• 2015 PQRS reporting requirements• The financial risks and rewards of PQRS
participation• Submission options for individual and group
PQRS reporting• The future direction of value-based Medicare
payments
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PANELISTS
Today’s SpeakersMODERATOR
Kelley Carnwath, MPH, CPHITQuality Improvement PrincipalQualis [email protected]
Meghan DonohueClinical Outcomes AnalystQualis [email protected]
Mary Franzen, MPHQuality Improvement ConsultantQualis [email protected]
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Objectives
By the end of today’s presentation, you will be able to:
• Better understand the Value Modifier program
• Interpret data in your QRUR• Identify opportunities for quality
improvement
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MACRA
MIPS
PQRS
VM
MU
APM
ACO
SHIP
MACRA, MIPS, and Modifiers…Oh My!
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Who is subject to the Value Modifier?
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Say Hello to Group X
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Say Hello to Group X’s QRUR
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Why should Group X look at their QRUR?
Groups can use QRURs and available drill-down reports through PQRS to:
• Verify EPs were correctly assigned to group’s TIN
• Compare their performance to others nationwide
• Validate the assigned beneficiaries and the basis for attribution
• Understand which beneficiaries are driving performance on cost and quality measures
• Identify beneficiaries in need of greater care coordination
• Explore provider-specific quality reporting to pinpoint improvement opportunities
• Raise awareness of cost and quality concerns
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Overall Performance
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Impact of Performance on Reimbursement
AF represents an adjustment factor to ensure the program remains budget-neutral.
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Attributed Beneficiaries
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Fewer Benes Than You Were Expecting?
Beneficiaries may be attributed elsewhere if:• Bulk of primary care services in your TIN provided by NPs or PAs• CMS does not have accurate provider/specialty information for TIN• Primary care services are not accurately coded and billed
Beneficiaries are not attributed to any medical group if:• They were enrolled in only Part A or only Part B for any portion of the
year• They were enrolled in Part C for any portion of the year• They resided outside the United States for any portion of the year• They had no allowable Medicare charges for primary care services for
the year
Supplemental Exhibits list both the providers in your TIN and the patients assigned to your TIN. It is important to validate
the accuracy of these lists in case CMS made a mistake.
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Overview of Quality Domain
Note: Standardized score calculated as
(Group Score – National Mean)_________________________(National Standard Deviation)
All measures are weighted equally within each domain and all domains are weighted equally within the average domain score
Quality Domain
Number of Quality Measures Included in Composite Score
Standardized Performance Score (Quality Tier Designation)
Quality Composite Score 16 -0.13
Effective Clinical Care 11 -0.80
Person and Caregiver-Centered Experience and Outcomes 0 ---
Community/Population Health 1 -0.13
Patient Safety 1 -0.22
Communication and Care Coordination 3 -0.31
Efficiency and Cost Reduction 0 ---
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Sample Performance ChartMeasure
Reference Measure Name
Your TIN’s
Eligible Cases
Your TIN’s Performance
Rate Benchmark
Benchmark -1 Standard Deviation
Benchmark +1 Standard
DeviationStandardized
Score
Included in
Domain Score?
111 Preventive Care and Screening: Pneumococcal Vaccination for Older Adults
774 89.78% 45.42% 14.41% 76.42% 1.43 Yes
- Diabetes Mellitus (DM): Composite (All or Nothing Scoring)
867 55.09% 25.50% 12.96% 37.43% 2.36 Yes
204 Ischemic Vascular Disease (IVD): Use of Aspirin or Another Antithrombotic
389 58.55% 70.56% 46.12% 95.00% -0.49 Yes
236 Hypertension (HTN): Controlling High Blood Pressure
437 82.43% 73.99% 54.77% 93.22% 0.44 Yes
- Coronary Artery Disease (CAD): Composite (All or Nothing Screening)
328 43.01% 68.09% 53.61% 82.56% -1.73 Yes
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Required Care Coordination MeasuresPerformance
CategoryMeasure
Reference Measure Name
Your TIN’s
Eligible Cases
Your TIN’s Performance
Rate Benchmark
Benchmark -1 Standard Deviation
Benchmark +1
Standard Deviation
Standardized Score
Included in
Domain Score?
Hospitalization Rate per 1,000 Beneficiaries for Ambulatory Care-Sensitive Conditions
CMS-1 Acute Conditions Composite 8,076 7.00 7.53 1.81 13.24 0.09 Yes
-
Bacterial Pneumonia 8,076 1.02 11.20 1.76 20.63 --- No
Urinary Tract Infection 8,076 9.37 7.25 0.00 15.08 --- No
Dehydration 8,076 10.62 4.10 0.00 8.58 --- No
CMS-2 Chronic Conditions Composite 3,495 40.73 50.43 26.19 74.66 0.40 Yes
-
Diabetes (composite of 4 indicators)
2,465 2.48 18.07 0.00 38.07 --- No
Chronic Obstructive Pulmonary Disease (COPD) or Asthma
947 36.87 70.23 25.43 115.03 --- No
Heart Failure 1,206 136.94 99.75 48.72 150.77 --- No
Hospital Readmissions CMS-3 All-Cause Hospital
Readmissions 1,597 16.45% 15.94% 14.55% 17.34% -0.37 Yes
Supplemental Exhibits offer additional patient-level detail on these measures and can be used to identify potential quality
improvement opportunities.
20
Two Hospitalization
Measures
Hospitalizations for benes attributed through claims quality and per capita cost measures
Hospitalizations for benes attributed through Medicare Spending per Beneficiary
measure
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Cost Measures: All Practices
All measures are risk-adjusted using beneficiary HCC scores, price standardized to remove geographic variation in labor costs, and specialty-adjusted based on group composition.
Measure Definition Attribution Methodology
Domain One
Medicare Spending per Beneficiary
Total Part A and Part B Costs for 3 days before, during, and 30 days after inpatient episode
TINs providing the most Part B inpatient services as measured through allowable charges
Per Capita Costs All Part A and Part B Costs
1. Primary care physicians providing the most primary care services
2. Non-primary care physicians providing the most primary care services
Domain Two
Per Capita Costs for Beneficiaries with Specific Conditions
Same as above; only includes individuals with COPD, CAD, HF, Diabetes (Four Separate Measures)
Same as above
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Overview of Cost Domain
Note: Standardized score calculated as
(Group Score – National Mean)_________________________(National Standard Deviation)
Cost DomainNumber of Cost
Measures Included in Composite Score
Standardized Performance Score (Cost Tier Designation)
Cost Composite Score 6 -0.28 (Average)
Per Capita Costs for All Attributed Beneficiaries 2 0.54
Per Capita Costs for Beneficiaries with Specific Conditions 4 -0.85
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Sample Cost TableCost
DomainCost
Measures
Your TIN’s Eligible
Cases or Episodes
Your TIN’s Per Capita
or Per Episode Costs
BenchmarkBenchmark -1 Standard Deviation
Benchmark +1 Standard
DeviationStandardized
Score
Included in
Domain Score?
Per Capita Costs for All Attributed Beneficiaries
Per Capita Costs for All Attributed Beneficiaries
8,076 $9,998 $10,907 $8,066 $13,749 -0.32 Yes
Medicare Spending per Beneficiary
1,597 $22,712 $20,475 $18,877 $22,073 1.40 Yes
Per Capita Costs for Beneficiaries with Specific Conditions
Diabetes 2,465 9,329 $15,826 $11,466 $20,185 -1.49 Yes
Chronic Obstructive Pulmonary Disease (COPD
947 $12,760 $24,854 $17,524 $32,185 -1.65 Yes
Coronary Artery Disease (CAD)
932 $15,020 $18,234 $13,132 $23,336 -0.63 Yes
Heart Failure 1,206 $32,836 $28,033 $19,606 $36,460 0.57 Yes
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Framework for Risk-Adjustment
25
Overview of HCC Risk Adjustment
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Sample Patient HCC Determination
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Determining Patient Risk Scores
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Expected Costs for Individual PatientsMultipliers are constants for each beneficiary demographic group.
Note: Community risk scores are based on diagnoses from the previous calendar year as shown on the previous slide. New Enrollee Risk Scores are based solely on beneficiary demographic factors such as
age, disability, income, and institutionalization status and used only when there are fewer than 12 months of Part B coverage.
29
Aggregating Provider Expected Costs
Dr. Smith had actual costs of approximately $16,000 per patient, but those costs
translated to $4,665 when risk-adjusted
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Cost drill-down: 201Download your Supplemental Exhibits
Rank order attributed beneficiaries by cost. You will notice that about 10% of patients incur about 50% of costs and that 20% of patients incur about 80% of costs.
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Cost drill-down: 201(Continued)Most Expensive 20% Least Expensive 80%
Patient Profile
• Many chronic conditions; likely seeing multiple specialists
• Over age 85 or under age 65
• Significant post-acute needs
• One-two chronic conditions
• Little to no inpatient utilization
Quality Improvement Opportunities
• Improved care coordination and chronic disease management
• Increased hospice referrals
• Decreased use of low-value services such as unnecessary scans
• Same-day appointment access to avoid ED use
What’s Next?
33
Review QRUR Before December 16, 2015
• If you have any questions regarding the status of your 2014 PQRS reporting or are concerned about potentially receiving the PQRS negative payment adjustment in 2016, please do not hesitate to submit an informal review request.
• All informal review requests must be submitted electronically via the Quality Reporting Communication Support Page (CSP) which is available now through December 16, 2015 at 11:59 p.m. Eastern Time.
34
Use the information in your QRUR
• Guide your 2015 PQRS submission• Upcoming Webinar on 2015 PQRS reporting on
Jan. 26, 2016
• Identify areas for improvement
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Sample Performance ChartMeasure
Reference Measure Name
Your TIN’s
Eligible Cases
Your TIN’s Performance
Rate Benchmark
Benchmark -1 Standard Deviation
Benchmark +1 Standard
DeviationStandardized
Score
Included in
Domain Score?
111 Preventive Care and Screening: Pneumococcal Vaccination for Older Adults
774 89.78% 45.42% 14.41% 76.42% 1.43 Yes
- Diabetes Mellitus (DM): Composite (All or Nothing Scoring)
867 55.09% 25.50% 12.96% 37.43% 2.36 Yes
204 Ischemic Vascular Disease (IVD): Use of Aspirin or Another Antithrombotic
389 58.55% 70.56% 46.12% 95.00% -0.49 Yes
236 Hypertension (HTN): Controlling High Blood Pressure
437 82.43% 73.99% 54.77% 93.22% 0.44 Yes
- Coronary Artery Disease (CAD): Composite (All or Nothing Screening)
328 43.01% 68.09% 53.61% 82.56% -1.73 Yes
36
Sample Performance ChartMeasure
Reference Measure Name
Your TIN’s
Eligible Cases
Your TIN’s Performance
Rate Benchmark
Benchmark -1 Standard Deviation
Benchmark +1 Standard
DeviationStandardized
Score
Included in
Domain Score?
111 Preventive Care and Screening: Pneumococcal Vaccination for Older Adults
774 89.78% 45.42% 14.41% 76.42% 1.43 Yes
- Diabetes Mellitus (DM): Composite (All or Nothing Scoring)
867 55.09% 25.50% 12.96% 37.43% 2.36 Yes
204 Ischemic Vascular Disease (IVD): Use of Aspirin or Another Antithrombotic
389 58.55% 70.56% 46.12% 95.00% -0.49 Yes
236 Hypertension (HTN): Controlling High Blood Pressure
437 82.43% 73.99% 54.77% 93.22% 0.44 Yes
- Coronary Artery Disease (CAD): Composite (All or Nothing Screening)
328 43.01% 68.09% 53.61% 82.56% -1.73 Yes
37
Areas for Improvement
• Cardiac care and adult immunization• CMS has identified cardiac care and adult
immunization as areas of special focus• Prevent more serious, more costly conditions in the future
• Qualis Health has specific programs for practices to improve in these areas
• 2015 PQRS reporting will require cross-cutting measures• Includes some cardiac and adult immunization measures
38
Areas for ImprovementABCS measuresA – Aspirin for IVD PQRS # 204
B – Blood Pressure Control PQRS # 236
C – Cholesterol PQRS # 316
S – Smoking Cessation PQRS # 226
Adult immunization measures
Preventive care and screening: influenza immunization
PQRS # 110
Pneumonia vaccination status in older adults PQRS # 111
Included in cross-cutting measures for 2015 PQRS reporting
39
Model for Improvement
• Choose one measure or one area of improvement• Ask three fundamental questions
• What are we trying to accomplish?
• How will we know if that change is an improvement?
• What changes can we make that will result in that improvement?
• Develop an aim statement• State the aim clearly
• Use numerical goals (“75% of our Medicare Part B patients”)
• State the timeframe and site of work (“by Feb. 29 at our downtown clinic”)
40
Plan-Do-Study-Act
• Plan – Define your goals and decide what you will do to try to reach them.
• Do – Implement the change on a small scale.
• Study – What did you learn? • Act – Change the plan as
necessary, or adopt, to meet your goals.
41
Helpful CMS Resources
2014 QRUR
https://www.cms.gov/Medicare/Medicare-Fee-for-Service-Payment/PhysicianFeedbackProgram/2014-QRUR.html
How to Obtain a QRUR
https://www.cms.gov/Medicare/Medicare-Fee-for-Service-Payment/PhysicianFeedbackProgram/Obtain-2013-QRUR.html
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Q & A
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For survey: https://www.surveymonkey.com/r/SZXRCF8
For more information: www.Medicare.QualisHealth.org
This material was prepared by Qualis Health, the Medicare Quality Innovation Network - Quality Improvement Organization (QIN-QIO) for Idaho and Washington, under contract with the Centers for Medicare & Medicaid Services (CMS), an agency of the U.S. Department of Health and Human Services.
The contents presented do not necessarily reflect CMS policy. ID/WA-HITC-QH-2047-12-15
ContactKelley Carnwath
Quality Improvement [email protected]
206.288.2574
Meghan Donohue Clinical Outcomes [email protected]
206.288.2440
Mary Franzen Quality Improvement Consultant