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Quality Payment Program Year 4:

Quality Deep DiveThe information contained in this presentation is for general information purposes only. The information is provided by UK HealthCare’s Kentucky Regional Extension Center and while we endeavor to keep the information up to date and correct, we make no representations or warranties of any kind, express or implied, about the completeness, accuracy, reliability, suitability or availability with respect to content.

UK’s Kentucky REC is a trusted advisor and partner to healthcare organizations, supplying expert guidance to maximize quality, outcomes and financial performance.

To date, the Kentucky REC’s activities include:

• Assisting more than 5,000 individual providers across Kentucky, including primary care providers and specialists

• Helping more than 95% of the Federally Qualified Health Centers (FQHCs) and Rural Health Clinics (RHCs) within Kentucky

• Working with more than 1/2 of all Kentucky hospitals

• Supporting practices and health systems across the Commonwealth with practice transformation and preparation for value based payment

Physician Services

1. Promoting Interoperability (MU) & Mock Audit

2. HIPAA SRA, Project Management & Vulnerability Scanning

3. Patient Centered Medical Home (PCMH) Consulting

4. Patient Centered Specialty Practice (PCSP) Consulting

5. Value Based Payment & MACRA Support

6. Quality Improvement Support

7. Telehealth Services

Hospital Services

1. Promoting Interoperability (Meaningful Use)

2. HIPAA Security Analysis & Project Management

3. Hospital Quality Improvement Support

Kentucky REC Description

Kentucky Regional Extension Center Services

Rebecca CheathamQIA

Robin CurnelQIA

Brent DoomQIA

Your REC Advisors & Presenters

Year 4 Merit-Based Incentive Payment System (MIPS) Basics

Year 4 Quality Category Deep Dive

Next Steps

Objectives

QPP Program TracksBy law, MACRA requires CMS to implement an incentive program, referred to as the

Quality Payment Program, which provides two participation tracks for clinicians:

Quality Payment Program (QPP)

MIPS Merit-based Incentive

Payment System

MIPS ECs are subject to a performance-based payment

adjustment through MIPS

Advanced APMsAdvanced Alternative

Payment Models

QPs may earn an incentive payment for participating in

one of these models

Polling Question #1

What are your performance goals for the Quality Payment Program for 2020?

Enter your answer into the polling window on the

right side of your screen

2020 Merit-Based Incentive Payment System (MIPS) Basics

MIPS Clinician Eligibility

Merit-Based Incentive Payment System (MIPS)

$90KPart B Billing

200 Medicare Patients

200 Covered Services

under PFS

QPP Track Eligibility RequirementsEligible Clinician Types:Physicians (including Doctors of

Medicine, Osteopathy, Dental Surgery, Dental Medicine, Podiatric Medicine,

and Optometry), Osteopathic Practitioners, Chiropractors, PA, NP,

CNS, CRNA, PT, OT, Qualified Speech-Language Pathologist, Qualified Audiologist, Clinical

Psychologist, Registered Dietitian or Nutrition Professional

MIPS Thresholds

0 - 44 Points

MinimumPerformance

Threshold

45 Points

46 - 84 Points

Exceptional Performance

Threshold

+85Points

– Payment Adjustment Avoid Penalty Potential +

Adjustment+ Payment Adjustment

NEW for 2020–/+ 9%

Adjustment Factor!!!

MIPS Overview

Must Submit by March 31st, 2021

Quality

PromotingInteroperability

Improvement Activities

Cost

2020 PROGRAM

YEAR&

2022 PAYMENT

YEAR

CAT

EGO

RY

WEI

GH

T

15%

25%

45%

15%

REP

OR

TIN

G

TIM

EFR

AMES

365 Days

365Days

90 Days

90 Days

Reporting OptionsIn

divi

dual • Under an NPI

number & TIN where they reassign benefits

Gro

up • > 2 clinicians (NPIs) who have reassigned their billing rights to a single TIN

• As an APM Entity

Virt

ual G

roup • Combination

of > 2 TINs assigned to > 1 individual MIPS ECs, or to > 1 groups consisting of <10 ECs with > 1 MIPS EC

How many Eligible Clinicians (ECs) are at your practice?

Polling Question #2

Enter your answer into the polling window on the

right side of your screen

Year 4 Quality Category

Quality Overview

Historical Context:Formally known as PQRS (2011-2018), the Quality Category covers the quality of care delivered based on performance measures best-suited for your organization/practice.Basic Requirements:Submit at least 6 Quality Measures w/ > 1 outcome or high priority measure12-Month Performance Period70% Data CompletenessScoring: Measure achievement points are earned based on a measure’s performance in comparison to a benchmark, exclusive of bonus points. Decile scoring range is based on national performance dependent on method of submission. Program Year Weight Multiple Submissions Collection Types Level of Reporting2019 45% Yes eCQMs, MIPS CQMs, QCDR, Claims, CAHPS

for MIPS SurveyGroup AND/OR Individual

2020 45% Yes eCQMs, MIPS CQMs, QCDR, Claims, CAHPS for MIPS Survey

Group AND/OR Individual

2021 TBD TBD eCQMs, MIPS CQMs, QCDR, Claims, CAHPS for MIPS Survey, MVP(s), TBD

Group, Individual, AND/OR MVP(s)

Web Interface

Web Interface Bonus Opportunities

CAHPS for MIPS Survey

• Exempt from topped out measures

• Reporting deadline extended to March 31st

• No bonus points awarded for additional high priority measure

• No bonus points awarded for end-to-end submission

• Adjustment to Denominator if practice does not meet the minimum threshold for survey (reduced by 10)

Web Interface

Multiple Collection Types Considerations

Possible Advantages

Additional Measure(s)

Flexibility

Mix & Match

Potential Challenges

Workflow(s)

Cost

Uncertainty

QPP Y4: Changes to Quality

Final Score:• 45% for 2020• TBD for 2021 • 30% for 2022 & Beyond

Measures

• Adding:• 3 New Measures• 7 New Specialty Measure Sets• Add 1 New Measure to the

CMS Web Interface Set• Added Claims-Based Measure

for PY21 • Removing:

• 42 Measures• Altering:

• 83 Significantly for 2020+• 1 Retroactive Change for

2019+

Requirements

• Increase of Data Completeness Requirement to 70%

• Scoring:• Flat percentage benchmarks

Controlling High Blood Pressure & A1C Poor Control• This only applicable for

Part B Claims & MIPS CQM Measure Submissions

What is Data Completeness?

Data Completeness

Cherry Picking:Using data selection criteria to misrepresent a clinician or group’s performance for a performance period results in data that is not true, accurate, or complete

What Not To Do

CMS will assign zero points for any measure that does not meet data completeness requirements for the quality performance category. Small practices will continue to receive 3 points

Score ImpactClaims:• 70% sample of

Medicare Part B patients for the performance period

QCDR, MIPS CQMs, & eCQMs:• 70% sample of

clinician's or group's patients across all payers for the performance period

MIPS Requirements

Public Reporting

Quality measures will not be publicly reported for the first two years in use, starting with Performance Year 2

Providers & Organizations have the opportunity to view data before it gets publicly published on Physician Compare

Category Flexibilities

Bonus Points• Additional

High Priority Measures

• End-to-End Reporting

3 Point Floor for Scoring

Improvement Scoring

Reweighting Opportunities

Small Practice Specific Flexibilities

Claims reporting still available

Minimum of 1 measure reported is required to get the bonus• Non Small MUST

submit all 6 to get base Quality score

Data completeness threshold not met= still

gets 3 points rather than the 0 if 70 % is

not met

Quality Category Flexibilities

Quality85%

IA15%

No Cost &

No PI

Quality60%

IA15%

PI25%

No Cost

Quality70%

Cost 15%

IA15%

No PI

Reweighting Opportunities

Quality45%

Cost 15%

IA15%

PI25%

2020 Weights

2020 MIPS Category Weights w/o Any

Reweighting

3 Most Common Reweighting Scenarios

Polling Question #3

Enter your answer into the polling window on the

right side of your screen

How are you collecting data for Quality for the 2020 Program Year?

Next Steps

Select Measures Each Year

Measures are updated each year so make sure you review and select your measures

appropriately

Pull Specification Sheets

Do this each year & keep with

documentation of submission & eligibility

Use these Specification Sheets

Assure your are accurately tracking your numerator &

denominator populations for each

measure

Pull Your DataTrack your data

regularly to be able to make improvements throughout the year

Next Steps

Put in Process Flow

Verify Documentation

Method

Pull Specification

Sheet

Pull Decile Scoring

Benchmarks

Verify Internal Workflows

Measure Deep Dive

Process Workflows• Verify all reporting mechanisms align• Validate denominators• Confirm data across all programs to

measure impacts• Ensure consistency across clinical

workflows

Submission Workflows

Submission Methods• Determine Workflow(s) for Submission:

• Vendor & Submitter Timelines• Cost• Verification Process• Your Responsibilities

• Establish a Monitoring Process:• Ongoing monitoring, adjust workflows as necessary• Ensure annual verification of workflows and eligibility • Determine monitoring process for each

measure/submission method• Evaluate potential impact on final score

eCQI Resource Center:https://ecqi.healthit.gov/eligible-professional/eligible-clinician-ecqms?field_year_value=1

CMS Resource Library:https://qpp.cms.gov/about/resource-

library

Quality Resource Locations

45 Points Threshold; 60 for Year 5

50% IA

85 Points to be Exceptional Performer

Expanded Cost Measures; defined at measure level

MVPs 2021; Mandatory 2022

QCDR PushRemoval of IA’s PDMP

Quality Measures adjustments and removal70% Data ValidationNo Weight shifts

QPP Y4: Top 10 Final Rule Impacts

Polling Question #4

Was today’s content helpful and what other content would you like to

see?

Enter your answer into the polling window on the

right side of your screen

QPP Y4: Questions

In the midst of COVID-19, Kentucky REC is here for

you!

Here are resources for your information:• https://ukhealthcare.uky.edu/about/questions-

answers-covid-19-coronavirus• https://chfs.ky.gov/agencies/dph/pages/covid19.aspx

COVID-19 Update

Upcoming QPP Webinars

QPP Y4: MIPS APM

4.30.20

QPP Y4: Cost

5.21.20

Client Only