administrative burden: legislative and regulatory advocacy to improve physician wellness - wolfe
TRANSCRIPT
Quality Payment Program
CMS UpdateAddressing Administrative Burden
Ashby Wolfe MD MPP MPHChief Medical Officer Region IX
Centers for Medicare and Medicaid Services
Presentation to the American Academy of Family PhysiciansState Legislative Conference
November 3 2017
Quality Payment Program
This presentation was prepared as a tool to assist providers and is not intended to grant rights or impose obligations Although every reasonable effort has been made to assure the accuracy of the information within these pages the ultimate responsibility for the correct submission of claims and response to any remittance advice lies with the provider of services
This publication is a general summary that explains certain aspects of the Medicare Program but is not a legal document The official Medicare Program provisions are contained in the relevant laws regulations and rulings Medicare policy changes frequently and links to the source documents have been provided within the document for your reference
The Centers for Medicare amp Medicaid Services (CMS) employees agents and staff make no representation warranty or guarantee that this compilation of Medicare information is error-free and will bear no responsibility or liability for the results or consequences of the use of this guide
Disclaimer
Quality Payment Program
bull Overview of CMS Priorities
bull Recent Updates
- Regulatory activities to address administrative burdenbull Fee Schedules and Prospective Payment System rules
- Measure alignment efforts
- Updates to the Innovation Center
- MACRA
bull Regulatory Reform Initiative
Objectives for today
Quality Payment Program
CMS OFFICES
Quality Payment ProgramKey CMS Priorities in health system transformation
1 Empower patients and clinicians to make decisions about their health care
2 Usher in a new era of state flexibility and local leadership
3 Support innovative approaches to improve quality accessibility and affordability
4 Improve the CMS customer experience
Quality Payment Program
bull Provides greater potential for payment system modernization
bull Sought public comment on reducing administrative burdens for providing patient care including visits care management and telehealth services
bull Takes steps to better align incentives and provide clinicians with a smoother transition to the new Merit-based Incentive Payment System under the Quality Payment Program (QPP)
bull Makes additional proposals to implement the Center for Medicare and Medicaid Innovationrsquos Medicare Diabetes Prevention Program expanded model starting in 2018
6
PROPOSED 2018 Medicare Physician Fee SchedulePublished July 13 2017
For a fact sheet on the proposed rule please visit httpswwwcmsgovNewsroomMediaReleaseDatabaseFact-sheets2017-Fact-Sheet-items2017-07-13-2html
Quality Payment Program
bull Medicare Telehealth Services - we are proposing to add several codes to the list of telehealth services including
- HCPCS code G0296 (visit to determine low dose computed tomography eligibility)
- CPT code 90785 (Interactive Complexity)
- CPT codes 96160 and 96161 (Health Risk Assessment)
- HCPCS code G0506 (Care Planning for Chronic Care Management) and
- CPT codes 90839 and 90840 (Psychotherapy for Crisis)
bull Improvement of Payment Rates for Office-based Behavioral Health Services
- CMS is proposing an improvement in the way rates are set that would increase payment by better recognizing overhead expenses for office-based face-to-face visits
bull Evaluation and Management Comment Solicitation
- CMS sought comment from stakeholders on specific changes we should undertake to update the guidelines to reduce the associated burden and to better align EM coding and documentation with the current practice of medicine
7
PROPOSED 2018 Medicare Physician Fee SchedulePublished July 13 2017
httpswwwcmsgovNewsroomMediaReleaseDatabaseFact-sheets2017-Fact-Sheet-items2017-07-13-2html
Quality Payment Program
bull Changes to the Medicare and Medicaid EHR Incentive Programs
bull For 2018 CMS is finalizing the modification to the EHR reporting periods for new and returning participants attesting to CMS or their state Medicaid agency from the full year to a minimum of any continuous 90-day period during the calendar year
bull Additional changes
- Created a new exception from the Medicare payment adjustments for clinicians eligible hospitals and CAHs that demonstrate through an application process that compliance is not possible because their EHR technology has been decertified
- Finalized an exception to the 2017 and 2018 Medicare payment adjustments for ambulatory surgical center (ASC)-based clinicians (those who furnish 75 percent or more of their covered professional services in an ASC using Place of Service (POS) code 24)
- Allow healthcare providers to use either 2014 Edition CEHRT 2015 Edition CEHRT or a combinationof 2014 Edition and 2015 Edition CEHRT for the reporting period in 2018
8
2018 Inpatient Prospective Payment System IPPS andLong Term Care Hospital PPS Final Rule
Published August 2 2017
For a fact sheet on the final rule please visit httpswwwcmsgovNewsroomMediaReleaseDatabaseFact-sheets2017-Fact-
Sheet-items2017-08-02html
Quality Payment Program
bull Proposing to change the payment rate for certain Medicare Part B drugs purchased by hospitals through the 340B program
- Requests comment on how CMS can best implement the proposal to pass savings on to beneficiaries and providers and to allow seniors to save money on their drug costs
bull The proposed rule also includes a provision that would alleviate some of the burdens rural hospitals experience in recruiting physicians by placing a two-year moratorium on the direct supervision requirement currently in place at rural hospitals and critical access hospitals
bull Request for Information on Flexibilities and Efficiencies
- Solicited feedback on positive solutions to better achieve transparency flexibility program simplification and innovation
- This will inform the discussion on future regulatory action related to outpatient services performed at hospitals and services performed at ambulatory surgical centers
9
PROPOSED 2018 Outpatient Prospective Payment System andAmbulatory Surgical Center Payment System
Published July 13 2017
For a fact sheet on the proposed rule please visit httpswwwcmsgovNewsroomMediaReleaseDatabaseFact-sheets2017-Fact-Sheet-
items2017-07-13html
Quality Payment Program
Measure Alignment Efforts
bull CMS Draft Quality Measure Development Plan- Highlight known measurement gaps and develop strategy to address these
- Promote harmonization and alignment across programs care settings and payers
- Assist in prioritizing development and refinement of measures
- Annual updates to the plan
bull Core Measures Sets released in 2016 new PEDIATRIC measure set released 2017- ACOs Patient Centered Medical Homes (PCMH) and Primary Care
- Cardiology
- Gastroenterology
- HIV and Hepatitis C
- Medical Oncology
- Obstetrics and Gynecology
- Orthopedics
- Pediatrics
httpswwwcmsgovMedicareQuality-Initiatives-Patient-Assessment-InstrumentsQualityMeasuresCore-Measureshtml
Quality Payment ProgramThe CMS Innovation Center was created by the Affordable Care Act to develop test and implement new payment and delivery models
ldquoThe purpose of the [Center] is to test innovative payment and service delivery
models to reduce program expenditureshellipwhile preserving or enhancing
the quality of care furnished to individuals under such titlesrdquo
Section 3021 of Affordable Care Act
Three scenarios for success1 Quality improves cost neutral2 Quality neutral cost reduced3 Quality improves cost reduced (best case)If a model meets one of these three criteria and other statutory prerequisites the statute allows the Secretary to expand the duration and scope of a model through rulemaking
Quality Payment Program
Innovation Center Models
Variety of models and initiatives currently being tested across several categories
- Accountable Care
- Episode-based Payment Initiatives
- Primary Care Transformation
- Medicaid and CHIP Population focus
- Initiatives Focused on the Medicare-Medicaid Enrollees (ldquoDual-Eligiblesrdquo)
- Initiatives to Accelerate the Development and Testing of New Payment and Service Delivery Models
- Initiatives to Speed the Adoption of Best Practices
Quality Payment ProgramCMS has engaged the health care delivery system and invested in innovation across the country
Models run at the state levelSites where innovation models are being tested
Source CMS Innovation Center website July 2017
Quality Payment Program
14
Quality Payment Program
15
Quality Payment Program
THE
MEDICARE ACCESS amp CHIP REAUTHORIZATION ACT
OF 2015
Quality Payment Program
MACRA Goals
Through MACRA HHS aims to
bull Offer multiple pathways with varying levels of risk and reward for providers to tie more of their payments to value
bull Over time expand the opportunities for a broad range of providers to participate in APMs
bull Minimize additional reporting burdens for APM participants
bull Promote understanding of each physicianrsquos or practitionerrsquos status with respect to MIPS andor APMs
bull Support multi-payer initiatives and the development of APMs in Medicaid Medicare Advantage and other payer arrangements
Quality Payment Program
The Quality Payment Program
The Quality Payment Program policy will
bull Reform Medicare Part B payments for more than 600000 clinicians
bull Improve care across the entire health care delivery system
Clinicians have two tracks to choose from
5
Quality Payment Program
Test
bull Submit some data after January 1 2017
bull Neutral payment adjustment
Partial Year
bull Report for 90-day period after January 1 2017
bull Neutral or positive payment adjustment
19
Pick Your Pace for Participation for the Transition Year
Full Year
bull Fully participate starting January 1 2017
bull Positive payment adjustment
MIPS
Not participating in the Quality Payment Program for the Transition Year will result in a negative 4 payment adjustment
Participate in an Advanced Alternative
Payment Model
bull Some practices may choose to participate in an Advanced Alternative Payment Model in 2017
Note Clinicians do not need to tell CMS which option they intend to
pursue
Quality Payment Program
Website httpsqppcmsgov
Quality Payment Program
Technical Support Available to CliniciansIntegrated Technical Assistance Program
- Full-service expert help
bull Quality Payment Program Service Center
bull Quality Innovation NetworkQuality Improvement Organizations
bull Quality Payment Program mdash Small Underserved and Rural Support
bull Transforming Clinical Practice Initiative
bull APM Learning Networks
- Self-service
bull QPP Online Portal
21
All support is FREE to clinicians
httpsqppcmsgoveducation
Quality Payment Program
QPP Technical Assistance
bull Technical Assistance organizations can help you- Understand the general requirements of the Quality Payment Program
- Review the information included in your Clinician Participation Letter andor help you use the MIPS Participation Look-up Tool to determine if you are included in the program
- Choose whether you will participate individually or as a part of a group
- Pick a participation pace for the 2017 transition year
- Identify appropriate MIPS measures and Improvement Activities based on your patients and practice structure
bull Map your current efforts to appropriate MIPS measures and Improvement Activities
- Determine a suitable submission mechanism(s) to report your data create a strategy for capturing data and guide you through the submission process
- Understand the MIPS scoring structure
- Analyze your performance data and trends
- Prepare to transition into an Alternative Payment Model (APM) or Advanced APMs
22
What program-specific services are available
Quality Payment Program
QPP Technical Assistance
bull Technical Assistance organizations can help you- Assess your practicersquos overall readiness for the Quality Payment Program
- Implement change management and strategic planning
- Redesign your practice workflow
- Optimize your current Health Information Technology (HIT) or begin integrating new forms of technology into your practice and select resources that meet your patientrsquos needs
- Form partnerships with other practices local stakeholders regional initiatives etc
- Participate in a quality improvement initiative if interested
23
What practice-specific services are available
Quality Payment Program
Quality Payment ProgramHow to get help
Two-minute QPP primer httpsyoutube96djML-m2Wo
Quality Payment Program
25httpswwwcmsgovNewsroomMediaReleaseDatabasePress-
releases2017-Press-releases-items2017-10-30html
Quality Payment Program
26
TwitterHashtaghttpstwittercomhashtagpatientsoverpaperworkref_src=twsrc5Egoogle7Ctwcamp5Eserp7Ctwgr5Ehashtag
Quality Payment Program
Thank you
27
Ashby Wolfe MD MPP MPH
Chief Medical Officer Region IX
Centers for Medicare and Medicaid Services
ashbywolfe1cmshhsgov
ResourceshttpswwwcmsgovResearch-Statistics-Data-and-SystemsMonitoring-
ProgramsMedicare-FFS-Compliance-ProgramsReducingProviderBurdenhtml
httpsqppcmsgov
httpswwwcmsgovNewsroomMediaReleaseDatabasePress-releases2017-Press-releases-items2017-10-30html
- Slide Number 1
- Disclaimer
- Objectives for today
- CMS OFFICES
- Slide Number 5
- Slide Number 6
- Slide Number 7
- Slide Number 8
- Slide Number 9
- Measure Alignment Efforts
- The CMS Innovation Center was created by the Affordable Care Act to develop test and implement new payment and delivery models
- Innovation Center Models
- CMS has engaged the health care delivery system and invested in innovation across the country
- Slide Number 14
- Slide Number 15
- Slide Number 16
- MACRA Goals
- The Quality Payment Program
- Pick Your Pace for Participation for the Transition Year
- Website httpsqppcmsgov
- Technical Support Available to Clinicians
- QPP Technical Assistance
- QPP Technical Assistance
- Slide Number 24
- Slide Number 25
- Slide Number 26
- Thank you
-
Quality Payment Program
This presentation was prepared as a tool to assist providers and is not intended to grant rights or impose obligations Although every reasonable effort has been made to assure the accuracy of the information within these pages the ultimate responsibility for the correct submission of claims and response to any remittance advice lies with the provider of services
This publication is a general summary that explains certain aspects of the Medicare Program but is not a legal document The official Medicare Program provisions are contained in the relevant laws regulations and rulings Medicare policy changes frequently and links to the source documents have been provided within the document for your reference
The Centers for Medicare amp Medicaid Services (CMS) employees agents and staff make no representation warranty or guarantee that this compilation of Medicare information is error-free and will bear no responsibility or liability for the results or consequences of the use of this guide
Disclaimer
Quality Payment Program
bull Overview of CMS Priorities
bull Recent Updates
- Regulatory activities to address administrative burdenbull Fee Schedules and Prospective Payment System rules
- Measure alignment efforts
- Updates to the Innovation Center
- MACRA
bull Regulatory Reform Initiative
Objectives for today
Quality Payment Program
CMS OFFICES
Quality Payment ProgramKey CMS Priorities in health system transformation
1 Empower patients and clinicians to make decisions about their health care
2 Usher in a new era of state flexibility and local leadership
3 Support innovative approaches to improve quality accessibility and affordability
4 Improve the CMS customer experience
Quality Payment Program
bull Provides greater potential for payment system modernization
bull Sought public comment on reducing administrative burdens for providing patient care including visits care management and telehealth services
bull Takes steps to better align incentives and provide clinicians with a smoother transition to the new Merit-based Incentive Payment System under the Quality Payment Program (QPP)
bull Makes additional proposals to implement the Center for Medicare and Medicaid Innovationrsquos Medicare Diabetes Prevention Program expanded model starting in 2018
6
PROPOSED 2018 Medicare Physician Fee SchedulePublished July 13 2017
For a fact sheet on the proposed rule please visit httpswwwcmsgovNewsroomMediaReleaseDatabaseFact-sheets2017-Fact-Sheet-items2017-07-13-2html
Quality Payment Program
bull Medicare Telehealth Services - we are proposing to add several codes to the list of telehealth services including
- HCPCS code G0296 (visit to determine low dose computed tomography eligibility)
- CPT code 90785 (Interactive Complexity)
- CPT codes 96160 and 96161 (Health Risk Assessment)
- HCPCS code G0506 (Care Planning for Chronic Care Management) and
- CPT codes 90839 and 90840 (Psychotherapy for Crisis)
bull Improvement of Payment Rates for Office-based Behavioral Health Services
- CMS is proposing an improvement in the way rates are set that would increase payment by better recognizing overhead expenses for office-based face-to-face visits
bull Evaluation and Management Comment Solicitation
- CMS sought comment from stakeholders on specific changes we should undertake to update the guidelines to reduce the associated burden and to better align EM coding and documentation with the current practice of medicine
7
PROPOSED 2018 Medicare Physician Fee SchedulePublished July 13 2017
httpswwwcmsgovNewsroomMediaReleaseDatabaseFact-sheets2017-Fact-Sheet-items2017-07-13-2html
Quality Payment Program
bull Changes to the Medicare and Medicaid EHR Incentive Programs
bull For 2018 CMS is finalizing the modification to the EHR reporting periods for new and returning participants attesting to CMS or their state Medicaid agency from the full year to a minimum of any continuous 90-day period during the calendar year
bull Additional changes
- Created a new exception from the Medicare payment adjustments for clinicians eligible hospitals and CAHs that demonstrate through an application process that compliance is not possible because their EHR technology has been decertified
- Finalized an exception to the 2017 and 2018 Medicare payment adjustments for ambulatory surgical center (ASC)-based clinicians (those who furnish 75 percent or more of their covered professional services in an ASC using Place of Service (POS) code 24)
- Allow healthcare providers to use either 2014 Edition CEHRT 2015 Edition CEHRT or a combinationof 2014 Edition and 2015 Edition CEHRT for the reporting period in 2018
8
2018 Inpatient Prospective Payment System IPPS andLong Term Care Hospital PPS Final Rule
Published August 2 2017
For a fact sheet on the final rule please visit httpswwwcmsgovNewsroomMediaReleaseDatabaseFact-sheets2017-Fact-
Sheet-items2017-08-02html
Quality Payment Program
bull Proposing to change the payment rate for certain Medicare Part B drugs purchased by hospitals through the 340B program
- Requests comment on how CMS can best implement the proposal to pass savings on to beneficiaries and providers and to allow seniors to save money on their drug costs
bull The proposed rule also includes a provision that would alleviate some of the burdens rural hospitals experience in recruiting physicians by placing a two-year moratorium on the direct supervision requirement currently in place at rural hospitals and critical access hospitals
bull Request for Information on Flexibilities and Efficiencies
- Solicited feedback on positive solutions to better achieve transparency flexibility program simplification and innovation
- This will inform the discussion on future regulatory action related to outpatient services performed at hospitals and services performed at ambulatory surgical centers
9
PROPOSED 2018 Outpatient Prospective Payment System andAmbulatory Surgical Center Payment System
Published July 13 2017
For a fact sheet on the proposed rule please visit httpswwwcmsgovNewsroomMediaReleaseDatabaseFact-sheets2017-Fact-Sheet-
items2017-07-13html
Quality Payment Program
Measure Alignment Efforts
bull CMS Draft Quality Measure Development Plan- Highlight known measurement gaps and develop strategy to address these
- Promote harmonization and alignment across programs care settings and payers
- Assist in prioritizing development and refinement of measures
- Annual updates to the plan
bull Core Measures Sets released in 2016 new PEDIATRIC measure set released 2017- ACOs Patient Centered Medical Homes (PCMH) and Primary Care
- Cardiology
- Gastroenterology
- HIV and Hepatitis C
- Medical Oncology
- Obstetrics and Gynecology
- Orthopedics
- Pediatrics
httpswwwcmsgovMedicareQuality-Initiatives-Patient-Assessment-InstrumentsQualityMeasuresCore-Measureshtml
Quality Payment ProgramThe CMS Innovation Center was created by the Affordable Care Act to develop test and implement new payment and delivery models
ldquoThe purpose of the [Center] is to test innovative payment and service delivery
models to reduce program expenditureshellipwhile preserving or enhancing
the quality of care furnished to individuals under such titlesrdquo
Section 3021 of Affordable Care Act
Three scenarios for success1 Quality improves cost neutral2 Quality neutral cost reduced3 Quality improves cost reduced (best case)If a model meets one of these three criteria and other statutory prerequisites the statute allows the Secretary to expand the duration and scope of a model through rulemaking
Quality Payment Program
Innovation Center Models
Variety of models and initiatives currently being tested across several categories
- Accountable Care
- Episode-based Payment Initiatives
- Primary Care Transformation
- Medicaid and CHIP Population focus
- Initiatives Focused on the Medicare-Medicaid Enrollees (ldquoDual-Eligiblesrdquo)
- Initiatives to Accelerate the Development and Testing of New Payment and Service Delivery Models
- Initiatives to Speed the Adoption of Best Practices
Quality Payment ProgramCMS has engaged the health care delivery system and invested in innovation across the country
Models run at the state levelSites where innovation models are being tested
Source CMS Innovation Center website July 2017
Quality Payment Program
14
Quality Payment Program
15
Quality Payment Program
THE
MEDICARE ACCESS amp CHIP REAUTHORIZATION ACT
OF 2015
Quality Payment Program
MACRA Goals
Through MACRA HHS aims to
bull Offer multiple pathways with varying levels of risk and reward for providers to tie more of their payments to value
bull Over time expand the opportunities for a broad range of providers to participate in APMs
bull Minimize additional reporting burdens for APM participants
bull Promote understanding of each physicianrsquos or practitionerrsquos status with respect to MIPS andor APMs
bull Support multi-payer initiatives and the development of APMs in Medicaid Medicare Advantage and other payer arrangements
Quality Payment Program
The Quality Payment Program
The Quality Payment Program policy will
bull Reform Medicare Part B payments for more than 600000 clinicians
bull Improve care across the entire health care delivery system
Clinicians have two tracks to choose from
5
Quality Payment Program
Test
bull Submit some data after January 1 2017
bull Neutral payment adjustment
Partial Year
bull Report for 90-day period after January 1 2017
bull Neutral or positive payment adjustment
19
Pick Your Pace for Participation for the Transition Year
Full Year
bull Fully participate starting January 1 2017
bull Positive payment adjustment
MIPS
Not participating in the Quality Payment Program for the Transition Year will result in a negative 4 payment adjustment
Participate in an Advanced Alternative
Payment Model
bull Some practices may choose to participate in an Advanced Alternative Payment Model in 2017
Note Clinicians do not need to tell CMS which option they intend to
pursue
Quality Payment Program
Website httpsqppcmsgov
Quality Payment Program
Technical Support Available to CliniciansIntegrated Technical Assistance Program
- Full-service expert help
bull Quality Payment Program Service Center
bull Quality Innovation NetworkQuality Improvement Organizations
bull Quality Payment Program mdash Small Underserved and Rural Support
bull Transforming Clinical Practice Initiative
bull APM Learning Networks
- Self-service
bull QPP Online Portal
21
All support is FREE to clinicians
httpsqppcmsgoveducation
Quality Payment Program
QPP Technical Assistance
bull Technical Assistance organizations can help you- Understand the general requirements of the Quality Payment Program
- Review the information included in your Clinician Participation Letter andor help you use the MIPS Participation Look-up Tool to determine if you are included in the program
- Choose whether you will participate individually or as a part of a group
- Pick a participation pace for the 2017 transition year
- Identify appropriate MIPS measures and Improvement Activities based on your patients and practice structure
bull Map your current efforts to appropriate MIPS measures and Improvement Activities
- Determine a suitable submission mechanism(s) to report your data create a strategy for capturing data and guide you through the submission process
- Understand the MIPS scoring structure
- Analyze your performance data and trends
- Prepare to transition into an Alternative Payment Model (APM) or Advanced APMs
22
What program-specific services are available
Quality Payment Program
QPP Technical Assistance
bull Technical Assistance organizations can help you- Assess your practicersquos overall readiness for the Quality Payment Program
- Implement change management and strategic planning
- Redesign your practice workflow
- Optimize your current Health Information Technology (HIT) or begin integrating new forms of technology into your practice and select resources that meet your patientrsquos needs
- Form partnerships with other practices local stakeholders regional initiatives etc
- Participate in a quality improvement initiative if interested
23
What practice-specific services are available
Quality Payment Program
Quality Payment ProgramHow to get help
Two-minute QPP primer httpsyoutube96djML-m2Wo
Quality Payment Program
25httpswwwcmsgovNewsroomMediaReleaseDatabasePress-
releases2017-Press-releases-items2017-10-30html
Quality Payment Program
26
TwitterHashtaghttpstwittercomhashtagpatientsoverpaperworkref_src=twsrc5Egoogle7Ctwcamp5Eserp7Ctwgr5Ehashtag
Quality Payment Program
Thank you
27
Ashby Wolfe MD MPP MPH
Chief Medical Officer Region IX
Centers for Medicare and Medicaid Services
ashbywolfe1cmshhsgov
ResourceshttpswwwcmsgovResearch-Statistics-Data-and-SystemsMonitoring-
ProgramsMedicare-FFS-Compliance-ProgramsReducingProviderBurdenhtml
httpsqppcmsgov
httpswwwcmsgovNewsroomMediaReleaseDatabasePress-releases2017-Press-releases-items2017-10-30html
- Slide Number 1
- Disclaimer
- Objectives for today
- CMS OFFICES
- Slide Number 5
- Slide Number 6
- Slide Number 7
- Slide Number 8
- Slide Number 9
- Measure Alignment Efforts
- The CMS Innovation Center was created by the Affordable Care Act to develop test and implement new payment and delivery models
- Innovation Center Models
- CMS has engaged the health care delivery system and invested in innovation across the country
- Slide Number 14
- Slide Number 15
- Slide Number 16
- MACRA Goals
- The Quality Payment Program
- Pick Your Pace for Participation for the Transition Year
- Website httpsqppcmsgov
- Technical Support Available to Clinicians
- QPP Technical Assistance
- QPP Technical Assistance
- Slide Number 24
- Slide Number 25
- Slide Number 26
- Thank you
-
Quality Payment Program
bull Overview of CMS Priorities
bull Recent Updates
- Regulatory activities to address administrative burdenbull Fee Schedules and Prospective Payment System rules
- Measure alignment efforts
- Updates to the Innovation Center
- MACRA
bull Regulatory Reform Initiative
Objectives for today
Quality Payment Program
CMS OFFICES
Quality Payment ProgramKey CMS Priorities in health system transformation
1 Empower patients and clinicians to make decisions about their health care
2 Usher in a new era of state flexibility and local leadership
3 Support innovative approaches to improve quality accessibility and affordability
4 Improve the CMS customer experience
Quality Payment Program
bull Provides greater potential for payment system modernization
bull Sought public comment on reducing administrative burdens for providing patient care including visits care management and telehealth services
bull Takes steps to better align incentives and provide clinicians with a smoother transition to the new Merit-based Incentive Payment System under the Quality Payment Program (QPP)
bull Makes additional proposals to implement the Center for Medicare and Medicaid Innovationrsquos Medicare Diabetes Prevention Program expanded model starting in 2018
6
PROPOSED 2018 Medicare Physician Fee SchedulePublished July 13 2017
For a fact sheet on the proposed rule please visit httpswwwcmsgovNewsroomMediaReleaseDatabaseFact-sheets2017-Fact-Sheet-items2017-07-13-2html
Quality Payment Program
bull Medicare Telehealth Services - we are proposing to add several codes to the list of telehealth services including
- HCPCS code G0296 (visit to determine low dose computed tomography eligibility)
- CPT code 90785 (Interactive Complexity)
- CPT codes 96160 and 96161 (Health Risk Assessment)
- HCPCS code G0506 (Care Planning for Chronic Care Management) and
- CPT codes 90839 and 90840 (Psychotherapy for Crisis)
bull Improvement of Payment Rates for Office-based Behavioral Health Services
- CMS is proposing an improvement in the way rates are set that would increase payment by better recognizing overhead expenses for office-based face-to-face visits
bull Evaluation and Management Comment Solicitation
- CMS sought comment from stakeholders on specific changes we should undertake to update the guidelines to reduce the associated burden and to better align EM coding and documentation with the current practice of medicine
7
PROPOSED 2018 Medicare Physician Fee SchedulePublished July 13 2017
httpswwwcmsgovNewsroomMediaReleaseDatabaseFact-sheets2017-Fact-Sheet-items2017-07-13-2html
Quality Payment Program
bull Changes to the Medicare and Medicaid EHR Incentive Programs
bull For 2018 CMS is finalizing the modification to the EHR reporting periods for new and returning participants attesting to CMS or their state Medicaid agency from the full year to a minimum of any continuous 90-day period during the calendar year
bull Additional changes
- Created a new exception from the Medicare payment adjustments for clinicians eligible hospitals and CAHs that demonstrate through an application process that compliance is not possible because their EHR technology has been decertified
- Finalized an exception to the 2017 and 2018 Medicare payment adjustments for ambulatory surgical center (ASC)-based clinicians (those who furnish 75 percent or more of their covered professional services in an ASC using Place of Service (POS) code 24)
- Allow healthcare providers to use either 2014 Edition CEHRT 2015 Edition CEHRT or a combinationof 2014 Edition and 2015 Edition CEHRT for the reporting period in 2018
8
2018 Inpatient Prospective Payment System IPPS andLong Term Care Hospital PPS Final Rule
Published August 2 2017
For a fact sheet on the final rule please visit httpswwwcmsgovNewsroomMediaReleaseDatabaseFact-sheets2017-Fact-
Sheet-items2017-08-02html
Quality Payment Program
bull Proposing to change the payment rate for certain Medicare Part B drugs purchased by hospitals through the 340B program
- Requests comment on how CMS can best implement the proposal to pass savings on to beneficiaries and providers and to allow seniors to save money on their drug costs
bull The proposed rule also includes a provision that would alleviate some of the burdens rural hospitals experience in recruiting physicians by placing a two-year moratorium on the direct supervision requirement currently in place at rural hospitals and critical access hospitals
bull Request for Information on Flexibilities and Efficiencies
- Solicited feedback on positive solutions to better achieve transparency flexibility program simplification and innovation
- This will inform the discussion on future regulatory action related to outpatient services performed at hospitals and services performed at ambulatory surgical centers
9
PROPOSED 2018 Outpatient Prospective Payment System andAmbulatory Surgical Center Payment System
Published July 13 2017
For a fact sheet on the proposed rule please visit httpswwwcmsgovNewsroomMediaReleaseDatabaseFact-sheets2017-Fact-Sheet-
items2017-07-13html
Quality Payment Program
Measure Alignment Efforts
bull CMS Draft Quality Measure Development Plan- Highlight known measurement gaps and develop strategy to address these
- Promote harmonization and alignment across programs care settings and payers
- Assist in prioritizing development and refinement of measures
- Annual updates to the plan
bull Core Measures Sets released in 2016 new PEDIATRIC measure set released 2017- ACOs Patient Centered Medical Homes (PCMH) and Primary Care
- Cardiology
- Gastroenterology
- HIV and Hepatitis C
- Medical Oncology
- Obstetrics and Gynecology
- Orthopedics
- Pediatrics
httpswwwcmsgovMedicareQuality-Initiatives-Patient-Assessment-InstrumentsQualityMeasuresCore-Measureshtml
Quality Payment ProgramThe CMS Innovation Center was created by the Affordable Care Act to develop test and implement new payment and delivery models
ldquoThe purpose of the [Center] is to test innovative payment and service delivery
models to reduce program expenditureshellipwhile preserving or enhancing
the quality of care furnished to individuals under such titlesrdquo
Section 3021 of Affordable Care Act
Three scenarios for success1 Quality improves cost neutral2 Quality neutral cost reduced3 Quality improves cost reduced (best case)If a model meets one of these three criteria and other statutory prerequisites the statute allows the Secretary to expand the duration and scope of a model through rulemaking
Quality Payment Program
Innovation Center Models
Variety of models and initiatives currently being tested across several categories
- Accountable Care
- Episode-based Payment Initiatives
- Primary Care Transformation
- Medicaid and CHIP Population focus
- Initiatives Focused on the Medicare-Medicaid Enrollees (ldquoDual-Eligiblesrdquo)
- Initiatives to Accelerate the Development and Testing of New Payment and Service Delivery Models
- Initiatives to Speed the Adoption of Best Practices
Quality Payment ProgramCMS has engaged the health care delivery system and invested in innovation across the country
Models run at the state levelSites where innovation models are being tested
Source CMS Innovation Center website July 2017
Quality Payment Program
14
Quality Payment Program
15
Quality Payment Program
THE
MEDICARE ACCESS amp CHIP REAUTHORIZATION ACT
OF 2015
Quality Payment Program
MACRA Goals
Through MACRA HHS aims to
bull Offer multiple pathways with varying levels of risk and reward for providers to tie more of their payments to value
bull Over time expand the opportunities for a broad range of providers to participate in APMs
bull Minimize additional reporting burdens for APM participants
bull Promote understanding of each physicianrsquos or practitionerrsquos status with respect to MIPS andor APMs
bull Support multi-payer initiatives and the development of APMs in Medicaid Medicare Advantage and other payer arrangements
Quality Payment Program
The Quality Payment Program
The Quality Payment Program policy will
bull Reform Medicare Part B payments for more than 600000 clinicians
bull Improve care across the entire health care delivery system
Clinicians have two tracks to choose from
5
Quality Payment Program
Test
bull Submit some data after January 1 2017
bull Neutral payment adjustment
Partial Year
bull Report for 90-day period after January 1 2017
bull Neutral or positive payment adjustment
19
Pick Your Pace for Participation for the Transition Year
Full Year
bull Fully participate starting January 1 2017
bull Positive payment adjustment
MIPS
Not participating in the Quality Payment Program for the Transition Year will result in a negative 4 payment adjustment
Participate in an Advanced Alternative
Payment Model
bull Some practices may choose to participate in an Advanced Alternative Payment Model in 2017
Note Clinicians do not need to tell CMS which option they intend to
pursue
Quality Payment Program
Website httpsqppcmsgov
Quality Payment Program
Technical Support Available to CliniciansIntegrated Technical Assistance Program
- Full-service expert help
bull Quality Payment Program Service Center
bull Quality Innovation NetworkQuality Improvement Organizations
bull Quality Payment Program mdash Small Underserved and Rural Support
bull Transforming Clinical Practice Initiative
bull APM Learning Networks
- Self-service
bull QPP Online Portal
21
All support is FREE to clinicians
httpsqppcmsgoveducation
Quality Payment Program
QPP Technical Assistance
bull Technical Assistance organizations can help you- Understand the general requirements of the Quality Payment Program
- Review the information included in your Clinician Participation Letter andor help you use the MIPS Participation Look-up Tool to determine if you are included in the program
- Choose whether you will participate individually or as a part of a group
- Pick a participation pace for the 2017 transition year
- Identify appropriate MIPS measures and Improvement Activities based on your patients and practice structure
bull Map your current efforts to appropriate MIPS measures and Improvement Activities
- Determine a suitable submission mechanism(s) to report your data create a strategy for capturing data and guide you through the submission process
- Understand the MIPS scoring structure
- Analyze your performance data and trends
- Prepare to transition into an Alternative Payment Model (APM) or Advanced APMs
22
What program-specific services are available
Quality Payment Program
QPP Technical Assistance
bull Technical Assistance organizations can help you- Assess your practicersquos overall readiness for the Quality Payment Program
- Implement change management and strategic planning
- Redesign your practice workflow
- Optimize your current Health Information Technology (HIT) or begin integrating new forms of technology into your practice and select resources that meet your patientrsquos needs
- Form partnerships with other practices local stakeholders regional initiatives etc
- Participate in a quality improvement initiative if interested
23
What practice-specific services are available
Quality Payment Program
Quality Payment ProgramHow to get help
Two-minute QPP primer httpsyoutube96djML-m2Wo
Quality Payment Program
25httpswwwcmsgovNewsroomMediaReleaseDatabasePress-
releases2017-Press-releases-items2017-10-30html
Quality Payment Program
26
TwitterHashtaghttpstwittercomhashtagpatientsoverpaperworkref_src=twsrc5Egoogle7Ctwcamp5Eserp7Ctwgr5Ehashtag
Quality Payment Program
Thank you
27
Ashby Wolfe MD MPP MPH
Chief Medical Officer Region IX
Centers for Medicare and Medicaid Services
ashbywolfe1cmshhsgov
ResourceshttpswwwcmsgovResearch-Statistics-Data-and-SystemsMonitoring-
ProgramsMedicare-FFS-Compliance-ProgramsReducingProviderBurdenhtml
httpsqppcmsgov
httpswwwcmsgovNewsroomMediaReleaseDatabasePress-releases2017-Press-releases-items2017-10-30html
- Slide Number 1
- Disclaimer
- Objectives for today
- CMS OFFICES
- Slide Number 5
- Slide Number 6
- Slide Number 7
- Slide Number 8
- Slide Number 9
- Measure Alignment Efforts
- The CMS Innovation Center was created by the Affordable Care Act to develop test and implement new payment and delivery models
- Innovation Center Models
- CMS has engaged the health care delivery system and invested in innovation across the country
- Slide Number 14
- Slide Number 15
- Slide Number 16
- MACRA Goals
- The Quality Payment Program
- Pick Your Pace for Participation for the Transition Year
- Website httpsqppcmsgov
- Technical Support Available to Clinicians
- QPP Technical Assistance
- QPP Technical Assistance
- Slide Number 24
- Slide Number 25
- Slide Number 26
- Thank you
-
Quality Payment Program
CMS OFFICES
Quality Payment ProgramKey CMS Priorities in health system transformation
1 Empower patients and clinicians to make decisions about their health care
2 Usher in a new era of state flexibility and local leadership
3 Support innovative approaches to improve quality accessibility and affordability
4 Improve the CMS customer experience
Quality Payment Program
bull Provides greater potential for payment system modernization
bull Sought public comment on reducing administrative burdens for providing patient care including visits care management and telehealth services
bull Takes steps to better align incentives and provide clinicians with a smoother transition to the new Merit-based Incentive Payment System under the Quality Payment Program (QPP)
bull Makes additional proposals to implement the Center for Medicare and Medicaid Innovationrsquos Medicare Diabetes Prevention Program expanded model starting in 2018
6
PROPOSED 2018 Medicare Physician Fee SchedulePublished July 13 2017
For a fact sheet on the proposed rule please visit httpswwwcmsgovNewsroomMediaReleaseDatabaseFact-sheets2017-Fact-Sheet-items2017-07-13-2html
Quality Payment Program
bull Medicare Telehealth Services - we are proposing to add several codes to the list of telehealth services including
- HCPCS code G0296 (visit to determine low dose computed tomography eligibility)
- CPT code 90785 (Interactive Complexity)
- CPT codes 96160 and 96161 (Health Risk Assessment)
- HCPCS code G0506 (Care Planning for Chronic Care Management) and
- CPT codes 90839 and 90840 (Psychotherapy for Crisis)
bull Improvement of Payment Rates for Office-based Behavioral Health Services
- CMS is proposing an improvement in the way rates are set that would increase payment by better recognizing overhead expenses for office-based face-to-face visits
bull Evaluation and Management Comment Solicitation
- CMS sought comment from stakeholders on specific changes we should undertake to update the guidelines to reduce the associated burden and to better align EM coding and documentation with the current practice of medicine
7
PROPOSED 2018 Medicare Physician Fee SchedulePublished July 13 2017
httpswwwcmsgovNewsroomMediaReleaseDatabaseFact-sheets2017-Fact-Sheet-items2017-07-13-2html
Quality Payment Program
bull Changes to the Medicare and Medicaid EHR Incentive Programs
bull For 2018 CMS is finalizing the modification to the EHR reporting periods for new and returning participants attesting to CMS or their state Medicaid agency from the full year to a minimum of any continuous 90-day period during the calendar year
bull Additional changes
- Created a new exception from the Medicare payment adjustments for clinicians eligible hospitals and CAHs that demonstrate through an application process that compliance is not possible because their EHR technology has been decertified
- Finalized an exception to the 2017 and 2018 Medicare payment adjustments for ambulatory surgical center (ASC)-based clinicians (those who furnish 75 percent or more of their covered professional services in an ASC using Place of Service (POS) code 24)
- Allow healthcare providers to use either 2014 Edition CEHRT 2015 Edition CEHRT or a combinationof 2014 Edition and 2015 Edition CEHRT for the reporting period in 2018
8
2018 Inpatient Prospective Payment System IPPS andLong Term Care Hospital PPS Final Rule
Published August 2 2017
For a fact sheet on the final rule please visit httpswwwcmsgovNewsroomMediaReleaseDatabaseFact-sheets2017-Fact-
Sheet-items2017-08-02html
Quality Payment Program
bull Proposing to change the payment rate for certain Medicare Part B drugs purchased by hospitals through the 340B program
- Requests comment on how CMS can best implement the proposal to pass savings on to beneficiaries and providers and to allow seniors to save money on their drug costs
bull The proposed rule also includes a provision that would alleviate some of the burdens rural hospitals experience in recruiting physicians by placing a two-year moratorium on the direct supervision requirement currently in place at rural hospitals and critical access hospitals
bull Request for Information on Flexibilities and Efficiencies
- Solicited feedback on positive solutions to better achieve transparency flexibility program simplification and innovation
- This will inform the discussion on future regulatory action related to outpatient services performed at hospitals and services performed at ambulatory surgical centers
9
PROPOSED 2018 Outpatient Prospective Payment System andAmbulatory Surgical Center Payment System
Published July 13 2017
For a fact sheet on the proposed rule please visit httpswwwcmsgovNewsroomMediaReleaseDatabaseFact-sheets2017-Fact-Sheet-
items2017-07-13html
Quality Payment Program
Measure Alignment Efforts
bull CMS Draft Quality Measure Development Plan- Highlight known measurement gaps and develop strategy to address these
- Promote harmonization and alignment across programs care settings and payers
- Assist in prioritizing development and refinement of measures
- Annual updates to the plan
bull Core Measures Sets released in 2016 new PEDIATRIC measure set released 2017- ACOs Patient Centered Medical Homes (PCMH) and Primary Care
- Cardiology
- Gastroenterology
- HIV and Hepatitis C
- Medical Oncology
- Obstetrics and Gynecology
- Orthopedics
- Pediatrics
httpswwwcmsgovMedicareQuality-Initiatives-Patient-Assessment-InstrumentsQualityMeasuresCore-Measureshtml
Quality Payment ProgramThe CMS Innovation Center was created by the Affordable Care Act to develop test and implement new payment and delivery models
ldquoThe purpose of the [Center] is to test innovative payment and service delivery
models to reduce program expenditureshellipwhile preserving or enhancing
the quality of care furnished to individuals under such titlesrdquo
Section 3021 of Affordable Care Act
Three scenarios for success1 Quality improves cost neutral2 Quality neutral cost reduced3 Quality improves cost reduced (best case)If a model meets one of these three criteria and other statutory prerequisites the statute allows the Secretary to expand the duration and scope of a model through rulemaking
Quality Payment Program
Innovation Center Models
Variety of models and initiatives currently being tested across several categories
- Accountable Care
- Episode-based Payment Initiatives
- Primary Care Transformation
- Medicaid and CHIP Population focus
- Initiatives Focused on the Medicare-Medicaid Enrollees (ldquoDual-Eligiblesrdquo)
- Initiatives to Accelerate the Development and Testing of New Payment and Service Delivery Models
- Initiatives to Speed the Adoption of Best Practices
Quality Payment ProgramCMS has engaged the health care delivery system and invested in innovation across the country
Models run at the state levelSites where innovation models are being tested
Source CMS Innovation Center website July 2017
Quality Payment Program
14
Quality Payment Program
15
Quality Payment Program
THE
MEDICARE ACCESS amp CHIP REAUTHORIZATION ACT
OF 2015
Quality Payment Program
MACRA Goals
Through MACRA HHS aims to
bull Offer multiple pathways with varying levels of risk and reward for providers to tie more of their payments to value
bull Over time expand the opportunities for a broad range of providers to participate in APMs
bull Minimize additional reporting burdens for APM participants
bull Promote understanding of each physicianrsquos or practitionerrsquos status with respect to MIPS andor APMs
bull Support multi-payer initiatives and the development of APMs in Medicaid Medicare Advantage and other payer arrangements
Quality Payment Program
The Quality Payment Program
The Quality Payment Program policy will
bull Reform Medicare Part B payments for more than 600000 clinicians
bull Improve care across the entire health care delivery system
Clinicians have two tracks to choose from
5
Quality Payment Program
Test
bull Submit some data after January 1 2017
bull Neutral payment adjustment
Partial Year
bull Report for 90-day period after January 1 2017
bull Neutral or positive payment adjustment
19
Pick Your Pace for Participation for the Transition Year
Full Year
bull Fully participate starting January 1 2017
bull Positive payment adjustment
MIPS
Not participating in the Quality Payment Program for the Transition Year will result in a negative 4 payment adjustment
Participate in an Advanced Alternative
Payment Model
bull Some practices may choose to participate in an Advanced Alternative Payment Model in 2017
Note Clinicians do not need to tell CMS which option they intend to
pursue
Quality Payment Program
Website httpsqppcmsgov
Quality Payment Program
Technical Support Available to CliniciansIntegrated Technical Assistance Program
- Full-service expert help
bull Quality Payment Program Service Center
bull Quality Innovation NetworkQuality Improvement Organizations
bull Quality Payment Program mdash Small Underserved and Rural Support
bull Transforming Clinical Practice Initiative
bull APM Learning Networks
- Self-service
bull QPP Online Portal
21
All support is FREE to clinicians
httpsqppcmsgoveducation
Quality Payment Program
QPP Technical Assistance
bull Technical Assistance organizations can help you- Understand the general requirements of the Quality Payment Program
- Review the information included in your Clinician Participation Letter andor help you use the MIPS Participation Look-up Tool to determine if you are included in the program
- Choose whether you will participate individually or as a part of a group
- Pick a participation pace for the 2017 transition year
- Identify appropriate MIPS measures and Improvement Activities based on your patients and practice structure
bull Map your current efforts to appropriate MIPS measures and Improvement Activities
- Determine a suitable submission mechanism(s) to report your data create a strategy for capturing data and guide you through the submission process
- Understand the MIPS scoring structure
- Analyze your performance data and trends
- Prepare to transition into an Alternative Payment Model (APM) or Advanced APMs
22
What program-specific services are available
Quality Payment Program
QPP Technical Assistance
bull Technical Assistance organizations can help you- Assess your practicersquos overall readiness for the Quality Payment Program
- Implement change management and strategic planning
- Redesign your practice workflow
- Optimize your current Health Information Technology (HIT) or begin integrating new forms of technology into your practice and select resources that meet your patientrsquos needs
- Form partnerships with other practices local stakeholders regional initiatives etc
- Participate in a quality improvement initiative if interested
23
What practice-specific services are available
Quality Payment Program
Quality Payment ProgramHow to get help
Two-minute QPP primer httpsyoutube96djML-m2Wo
Quality Payment Program
25httpswwwcmsgovNewsroomMediaReleaseDatabasePress-
releases2017-Press-releases-items2017-10-30html
Quality Payment Program
26
TwitterHashtaghttpstwittercomhashtagpatientsoverpaperworkref_src=twsrc5Egoogle7Ctwcamp5Eserp7Ctwgr5Ehashtag
Quality Payment Program
Thank you
27
Ashby Wolfe MD MPP MPH
Chief Medical Officer Region IX
Centers for Medicare and Medicaid Services
ashbywolfe1cmshhsgov
ResourceshttpswwwcmsgovResearch-Statistics-Data-and-SystemsMonitoring-
ProgramsMedicare-FFS-Compliance-ProgramsReducingProviderBurdenhtml
httpsqppcmsgov
httpswwwcmsgovNewsroomMediaReleaseDatabasePress-releases2017-Press-releases-items2017-10-30html
- Slide Number 1
- Disclaimer
- Objectives for today
- CMS OFFICES
- Slide Number 5
- Slide Number 6
- Slide Number 7
- Slide Number 8
- Slide Number 9
- Measure Alignment Efforts
- The CMS Innovation Center was created by the Affordable Care Act to develop test and implement new payment and delivery models
- Innovation Center Models
- CMS has engaged the health care delivery system and invested in innovation across the country
- Slide Number 14
- Slide Number 15
- Slide Number 16
- MACRA Goals
- The Quality Payment Program
- Pick Your Pace for Participation for the Transition Year
- Website httpsqppcmsgov
- Technical Support Available to Clinicians
- QPP Technical Assistance
- QPP Technical Assistance
- Slide Number 24
- Slide Number 25
- Slide Number 26
- Thank you
-
Quality Payment ProgramKey CMS Priorities in health system transformation
1 Empower patients and clinicians to make decisions about their health care
2 Usher in a new era of state flexibility and local leadership
3 Support innovative approaches to improve quality accessibility and affordability
4 Improve the CMS customer experience
Quality Payment Program
bull Provides greater potential for payment system modernization
bull Sought public comment on reducing administrative burdens for providing patient care including visits care management and telehealth services
bull Takes steps to better align incentives and provide clinicians with a smoother transition to the new Merit-based Incentive Payment System under the Quality Payment Program (QPP)
bull Makes additional proposals to implement the Center for Medicare and Medicaid Innovationrsquos Medicare Diabetes Prevention Program expanded model starting in 2018
6
PROPOSED 2018 Medicare Physician Fee SchedulePublished July 13 2017
For a fact sheet on the proposed rule please visit httpswwwcmsgovNewsroomMediaReleaseDatabaseFact-sheets2017-Fact-Sheet-items2017-07-13-2html
Quality Payment Program
bull Medicare Telehealth Services - we are proposing to add several codes to the list of telehealth services including
- HCPCS code G0296 (visit to determine low dose computed tomography eligibility)
- CPT code 90785 (Interactive Complexity)
- CPT codes 96160 and 96161 (Health Risk Assessment)
- HCPCS code G0506 (Care Planning for Chronic Care Management) and
- CPT codes 90839 and 90840 (Psychotherapy for Crisis)
bull Improvement of Payment Rates for Office-based Behavioral Health Services
- CMS is proposing an improvement in the way rates are set that would increase payment by better recognizing overhead expenses for office-based face-to-face visits
bull Evaluation and Management Comment Solicitation
- CMS sought comment from stakeholders on specific changes we should undertake to update the guidelines to reduce the associated burden and to better align EM coding and documentation with the current practice of medicine
7
PROPOSED 2018 Medicare Physician Fee SchedulePublished July 13 2017
httpswwwcmsgovNewsroomMediaReleaseDatabaseFact-sheets2017-Fact-Sheet-items2017-07-13-2html
Quality Payment Program
bull Changes to the Medicare and Medicaid EHR Incentive Programs
bull For 2018 CMS is finalizing the modification to the EHR reporting periods for new and returning participants attesting to CMS or their state Medicaid agency from the full year to a minimum of any continuous 90-day period during the calendar year
bull Additional changes
- Created a new exception from the Medicare payment adjustments for clinicians eligible hospitals and CAHs that demonstrate through an application process that compliance is not possible because their EHR technology has been decertified
- Finalized an exception to the 2017 and 2018 Medicare payment adjustments for ambulatory surgical center (ASC)-based clinicians (those who furnish 75 percent or more of their covered professional services in an ASC using Place of Service (POS) code 24)
- Allow healthcare providers to use either 2014 Edition CEHRT 2015 Edition CEHRT or a combinationof 2014 Edition and 2015 Edition CEHRT for the reporting period in 2018
8
2018 Inpatient Prospective Payment System IPPS andLong Term Care Hospital PPS Final Rule
Published August 2 2017
For a fact sheet on the final rule please visit httpswwwcmsgovNewsroomMediaReleaseDatabaseFact-sheets2017-Fact-
Sheet-items2017-08-02html
Quality Payment Program
bull Proposing to change the payment rate for certain Medicare Part B drugs purchased by hospitals through the 340B program
- Requests comment on how CMS can best implement the proposal to pass savings on to beneficiaries and providers and to allow seniors to save money on their drug costs
bull The proposed rule also includes a provision that would alleviate some of the burdens rural hospitals experience in recruiting physicians by placing a two-year moratorium on the direct supervision requirement currently in place at rural hospitals and critical access hospitals
bull Request for Information on Flexibilities and Efficiencies
- Solicited feedback on positive solutions to better achieve transparency flexibility program simplification and innovation
- This will inform the discussion on future regulatory action related to outpatient services performed at hospitals and services performed at ambulatory surgical centers
9
PROPOSED 2018 Outpatient Prospective Payment System andAmbulatory Surgical Center Payment System
Published July 13 2017
For a fact sheet on the proposed rule please visit httpswwwcmsgovNewsroomMediaReleaseDatabaseFact-sheets2017-Fact-Sheet-
items2017-07-13html
Quality Payment Program
Measure Alignment Efforts
bull CMS Draft Quality Measure Development Plan- Highlight known measurement gaps and develop strategy to address these
- Promote harmonization and alignment across programs care settings and payers
- Assist in prioritizing development and refinement of measures
- Annual updates to the plan
bull Core Measures Sets released in 2016 new PEDIATRIC measure set released 2017- ACOs Patient Centered Medical Homes (PCMH) and Primary Care
- Cardiology
- Gastroenterology
- HIV and Hepatitis C
- Medical Oncology
- Obstetrics and Gynecology
- Orthopedics
- Pediatrics
httpswwwcmsgovMedicareQuality-Initiatives-Patient-Assessment-InstrumentsQualityMeasuresCore-Measureshtml
Quality Payment ProgramThe CMS Innovation Center was created by the Affordable Care Act to develop test and implement new payment and delivery models
ldquoThe purpose of the [Center] is to test innovative payment and service delivery
models to reduce program expenditureshellipwhile preserving or enhancing
the quality of care furnished to individuals under such titlesrdquo
Section 3021 of Affordable Care Act
Three scenarios for success1 Quality improves cost neutral2 Quality neutral cost reduced3 Quality improves cost reduced (best case)If a model meets one of these three criteria and other statutory prerequisites the statute allows the Secretary to expand the duration and scope of a model through rulemaking
Quality Payment Program
Innovation Center Models
Variety of models and initiatives currently being tested across several categories
- Accountable Care
- Episode-based Payment Initiatives
- Primary Care Transformation
- Medicaid and CHIP Population focus
- Initiatives Focused on the Medicare-Medicaid Enrollees (ldquoDual-Eligiblesrdquo)
- Initiatives to Accelerate the Development and Testing of New Payment and Service Delivery Models
- Initiatives to Speed the Adoption of Best Practices
Quality Payment ProgramCMS has engaged the health care delivery system and invested in innovation across the country
Models run at the state levelSites where innovation models are being tested
Source CMS Innovation Center website July 2017
Quality Payment Program
14
Quality Payment Program
15
Quality Payment Program
THE
MEDICARE ACCESS amp CHIP REAUTHORIZATION ACT
OF 2015
Quality Payment Program
MACRA Goals
Through MACRA HHS aims to
bull Offer multiple pathways with varying levels of risk and reward for providers to tie more of their payments to value
bull Over time expand the opportunities for a broad range of providers to participate in APMs
bull Minimize additional reporting burdens for APM participants
bull Promote understanding of each physicianrsquos or practitionerrsquos status with respect to MIPS andor APMs
bull Support multi-payer initiatives and the development of APMs in Medicaid Medicare Advantage and other payer arrangements
Quality Payment Program
The Quality Payment Program
The Quality Payment Program policy will
bull Reform Medicare Part B payments for more than 600000 clinicians
bull Improve care across the entire health care delivery system
Clinicians have two tracks to choose from
5
Quality Payment Program
Test
bull Submit some data after January 1 2017
bull Neutral payment adjustment
Partial Year
bull Report for 90-day period after January 1 2017
bull Neutral or positive payment adjustment
19
Pick Your Pace for Participation for the Transition Year
Full Year
bull Fully participate starting January 1 2017
bull Positive payment adjustment
MIPS
Not participating in the Quality Payment Program for the Transition Year will result in a negative 4 payment adjustment
Participate in an Advanced Alternative
Payment Model
bull Some practices may choose to participate in an Advanced Alternative Payment Model in 2017
Note Clinicians do not need to tell CMS which option they intend to
pursue
Quality Payment Program
Website httpsqppcmsgov
Quality Payment Program
Technical Support Available to CliniciansIntegrated Technical Assistance Program
- Full-service expert help
bull Quality Payment Program Service Center
bull Quality Innovation NetworkQuality Improvement Organizations
bull Quality Payment Program mdash Small Underserved and Rural Support
bull Transforming Clinical Practice Initiative
bull APM Learning Networks
- Self-service
bull QPP Online Portal
21
All support is FREE to clinicians
httpsqppcmsgoveducation
Quality Payment Program
QPP Technical Assistance
bull Technical Assistance organizations can help you- Understand the general requirements of the Quality Payment Program
- Review the information included in your Clinician Participation Letter andor help you use the MIPS Participation Look-up Tool to determine if you are included in the program
- Choose whether you will participate individually or as a part of a group
- Pick a participation pace for the 2017 transition year
- Identify appropriate MIPS measures and Improvement Activities based on your patients and practice structure
bull Map your current efforts to appropriate MIPS measures and Improvement Activities
- Determine a suitable submission mechanism(s) to report your data create a strategy for capturing data and guide you through the submission process
- Understand the MIPS scoring structure
- Analyze your performance data and trends
- Prepare to transition into an Alternative Payment Model (APM) or Advanced APMs
22
What program-specific services are available
Quality Payment Program
QPP Technical Assistance
bull Technical Assistance organizations can help you- Assess your practicersquos overall readiness for the Quality Payment Program
- Implement change management and strategic planning
- Redesign your practice workflow
- Optimize your current Health Information Technology (HIT) or begin integrating new forms of technology into your practice and select resources that meet your patientrsquos needs
- Form partnerships with other practices local stakeholders regional initiatives etc
- Participate in a quality improvement initiative if interested
23
What practice-specific services are available
Quality Payment Program
Quality Payment ProgramHow to get help
Two-minute QPP primer httpsyoutube96djML-m2Wo
Quality Payment Program
25httpswwwcmsgovNewsroomMediaReleaseDatabasePress-
releases2017-Press-releases-items2017-10-30html
Quality Payment Program
26
TwitterHashtaghttpstwittercomhashtagpatientsoverpaperworkref_src=twsrc5Egoogle7Ctwcamp5Eserp7Ctwgr5Ehashtag
Quality Payment Program
Thank you
27
Ashby Wolfe MD MPP MPH
Chief Medical Officer Region IX
Centers for Medicare and Medicaid Services
ashbywolfe1cmshhsgov
ResourceshttpswwwcmsgovResearch-Statistics-Data-and-SystemsMonitoring-
ProgramsMedicare-FFS-Compliance-ProgramsReducingProviderBurdenhtml
httpsqppcmsgov
httpswwwcmsgovNewsroomMediaReleaseDatabasePress-releases2017-Press-releases-items2017-10-30html
- Slide Number 1
- Disclaimer
- Objectives for today
- CMS OFFICES
- Slide Number 5
- Slide Number 6
- Slide Number 7
- Slide Number 8
- Slide Number 9
- Measure Alignment Efforts
- The CMS Innovation Center was created by the Affordable Care Act to develop test and implement new payment and delivery models
- Innovation Center Models
- CMS has engaged the health care delivery system and invested in innovation across the country
- Slide Number 14
- Slide Number 15
- Slide Number 16
- MACRA Goals
- The Quality Payment Program
- Pick Your Pace for Participation for the Transition Year
- Website httpsqppcmsgov
- Technical Support Available to Clinicians
- QPP Technical Assistance
- QPP Technical Assistance
- Slide Number 24
- Slide Number 25
- Slide Number 26
- Thank you
-
Quality Payment Program
bull Provides greater potential for payment system modernization
bull Sought public comment on reducing administrative burdens for providing patient care including visits care management and telehealth services
bull Takes steps to better align incentives and provide clinicians with a smoother transition to the new Merit-based Incentive Payment System under the Quality Payment Program (QPP)
bull Makes additional proposals to implement the Center for Medicare and Medicaid Innovationrsquos Medicare Diabetes Prevention Program expanded model starting in 2018
6
PROPOSED 2018 Medicare Physician Fee SchedulePublished July 13 2017
For a fact sheet on the proposed rule please visit httpswwwcmsgovNewsroomMediaReleaseDatabaseFact-sheets2017-Fact-Sheet-items2017-07-13-2html
Quality Payment Program
bull Medicare Telehealth Services - we are proposing to add several codes to the list of telehealth services including
- HCPCS code G0296 (visit to determine low dose computed tomography eligibility)
- CPT code 90785 (Interactive Complexity)
- CPT codes 96160 and 96161 (Health Risk Assessment)
- HCPCS code G0506 (Care Planning for Chronic Care Management) and
- CPT codes 90839 and 90840 (Psychotherapy for Crisis)
bull Improvement of Payment Rates for Office-based Behavioral Health Services
- CMS is proposing an improvement in the way rates are set that would increase payment by better recognizing overhead expenses for office-based face-to-face visits
bull Evaluation and Management Comment Solicitation
- CMS sought comment from stakeholders on specific changes we should undertake to update the guidelines to reduce the associated burden and to better align EM coding and documentation with the current practice of medicine
7
PROPOSED 2018 Medicare Physician Fee SchedulePublished July 13 2017
httpswwwcmsgovNewsroomMediaReleaseDatabaseFact-sheets2017-Fact-Sheet-items2017-07-13-2html
Quality Payment Program
bull Changes to the Medicare and Medicaid EHR Incentive Programs
bull For 2018 CMS is finalizing the modification to the EHR reporting periods for new and returning participants attesting to CMS or their state Medicaid agency from the full year to a minimum of any continuous 90-day period during the calendar year
bull Additional changes
- Created a new exception from the Medicare payment adjustments for clinicians eligible hospitals and CAHs that demonstrate through an application process that compliance is not possible because their EHR technology has been decertified
- Finalized an exception to the 2017 and 2018 Medicare payment adjustments for ambulatory surgical center (ASC)-based clinicians (those who furnish 75 percent or more of their covered professional services in an ASC using Place of Service (POS) code 24)
- Allow healthcare providers to use either 2014 Edition CEHRT 2015 Edition CEHRT or a combinationof 2014 Edition and 2015 Edition CEHRT for the reporting period in 2018
8
2018 Inpatient Prospective Payment System IPPS andLong Term Care Hospital PPS Final Rule
Published August 2 2017
For a fact sheet on the final rule please visit httpswwwcmsgovNewsroomMediaReleaseDatabaseFact-sheets2017-Fact-
Sheet-items2017-08-02html
Quality Payment Program
bull Proposing to change the payment rate for certain Medicare Part B drugs purchased by hospitals through the 340B program
- Requests comment on how CMS can best implement the proposal to pass savings on to beneficiaries and providers and to allow seniors to save money on their drug costs
bull The proposed rule also includes a provision that would alleviate some of the burdens rural hospitals experience in recruiting physicians by placing a two-year moratorium on the direct supervision requirement currently in place at rural hospitals and critical access hospitals
bull Request for Information on Flexibilities and Efficiencies
- Solicited feedback on positive solutions to better achieve transparency flexibility program simplification and innovation
- This will inform the discussion on future regulatory action related to outpatient services performed at hospitals and services performed at ambulatory surgical centers
9
PROPOSED 2018 Outpatient Prospective Payment System andAmbulatory Surgical Center Payment System
Published July 13 2017
For a fact sheet on the proposed rule please visit httpswwwcmsgovNewsroomMediaReleaseDatabaseFact-sheets2017-Fact-Sheet-
items2017-07-13html
Quality Payment Program
Measure Alignment Efforts
bull CMS Draft Quality Measure Development Plan- Highlight known measurement gaps and develop strategy to address these
- Promote harmonization and alignment across programs care settings and payers
- Assist in prioritizing development and refinement of measures
- Annual updates to the plan
bull Core Measures Sets released in 2016 new PEDIATRIC measure set released 2017- ACOs Patient Centered Medical Homes (PCMH) and Primary Care
- Cardiology
- Gastroenterology
- HIV and Hepatitis C
- Medical Oncology
- Obstetrics and Gynecology
- Orthopedics
- Pediatrics
httpswwwcmsgovMedicareQuality-Initiatives-Patient-Assessment-InstrumentsQualityMeasuresCore-Measureshtml
Quality Payment ProgramThe CMS Innovation Center was created by the Affordable Care Act to develop test and implement new payment and delivery models
ldquoThe purpose of the [Center] is to test innovative payment and service delivery
models to reduce program expenditureshellipwhile preserving or enhancing
the quality of care furnished to individuals under such titlesrdquo
Section 3021 of Affordable Care Act
Three scenarios for success1 Quality improves cost neutral2 Quality neutral cost reduced3 Quality improves cost reduced (best case)If a model meets one of these three criteria and other statutory prerequisites the statute allows the Secretary to expand the duration and scope of a model through rulemaking
Quality Payment Program
Innovation Center Models
Variety of models and initiatives currently being tested across several categories
- Accountable Care
- Episode-based Payment Initiatives
- Primary Care Transformation
- Medicaid and CHIP Population focus
- Initiatives Focused on the Medicare-Medicaid Enrollees (ldquoDual-Eligiblesrdquo)
- Initiatives to Accelerate the Development and Testing of New Payment and Service Delivery Models
- Initiatives to Speed the Adoption of Best Practices
Quality Payment ProgramCMS has engaged the health care delivery system and invested in innovation across the country
Models run at the state levelSites where innovation models are being tested
Source CMS Innovation Center website July 2017
Quality Payment Program
14
Quality Payment Program
15
Quality Payment Program
THE
MEDICARE ACCESS amp CHIP REAUTHORIZATION ACT
OF 2015
Quality Payment Program
MACRA Goals
Through MACRA HHS aims to
bull Offer multiple pathways with varying levels of risk and reward for providers to tie more of their payments to value
bull Over time expand the opportunities for a broad range of providers to participate in APMs
bull Minimize additional reporting burdens for APM participants
bull Promote understanding of each physicianrsquos or practitionerrsquos status with respect to MIPS andor APMs
bull Support multi-payer initiatives and the development of APMs in Medicaid Medicare Advantage and other payer arrangements
Quality Payment Program
The Quality Payment Program
The Quality Payment Program policy will
bull Reform Medicare Part B payments for more than 600000 clinicians
bull Improve care across the entire health care delivery system
Clinicians have two tracks to choose from
5
Quality Payment Program
Test
bull Submit some data after January 1 2017
bull Neutral payment adjustment
Partial Year
bull Report for 90-day period after January 1 2017
bull Neutral or positive payment adjustment
19
Pick Your Pace for Participation for the Transition Year
Full Year
bull Fully participate starting January 1 2017
bull Positive payment adjustment
MIPS
Not participating in the Quality Payment Program for the Transition Year will result in a negative 4 payment adjustment
Participate in an Advanced Alternative
Payment Model
bull Some practices may choose to participate in an Advanced Alternative Payment Model in 2017
Note Clinicians do not need to tell CMS which option they intend to
pursue
Quality Payment Program
Website httpsqppcmsgov
Quality Payment Program
Technical Support Available to CliniciansIntegrated Technical Assistance Program
- Full-service expert help
bull Quality Payment Program Service Center
bull Quality Innovation NetworkQuality Improvement Organizations
bull Quality Payment Program mdash Small Underserved and Rural Support
bull Transforming Clinical Practice Initiative
bull APM Learning Networks
- Self-service
bull QPP Online Portal
21
All support is FREE to clinicians
httpsqppcmsgoveducation
Quality Payment Program
QPP Technical Assistance
bull Technical Assistance organizations can help you- Understand the general requirements of the Quality Payment Program
- Review the information included in your Clinician Participation Letter andor help you use the MIPS Participation Look-up Tool to determine if you are included in the program
- Choose whether you will participate individually or as a part of a group
- Pick a participation pace for the 2017 transition year
- Identify appropriate MIPS measures and Improvement Activities based on your patients and practice structure
bull Map your current efforts to appropriate MIPS measures and Improvement Activities
- Determine a suitable submission mechanism(s) to report your data create a strategy for capturing data and guide you through the submission process
- Understand the MIPS scoring structure
- Analyze your performance data and trends
- Prepare to transition into an Alternative Payment Model (APM) or Advanced APMs
22
What program-specific services are available
Quality Payment Program
QPP Technical Assistance
bull Technical Assistance organizations can help you- Assess your practicersquos overall readiness for the Quality Payment Program
- Implement change management and strategic planning
- Redesign your practice workflow
- Optimize your current Health Information Technology (HIT) or begin integrating new forms of technology into your practice and select resources that meet your patientrsquos needs
- Form partnerships with other practices local stakeholders regional initiatives etc
- Participate in a quality improvement initiative if interested
23
What practice-specific services are available
Quality Payment Program
Quality Payment ProgramHow to get help
Two-minute QPP primer httpsyoutube96djML-m2Wo
Quality Payment Program
25httpswwwcmsgovNewsroomMediaReleaseDatabasePress-
releases2017-Press-releases-items2017-10-30html
Quality Payment Program
26
TwitterHashtaghttpstwittercomhashtagpatientsoverpaperworkref_src=twsrc5Egoogle7Ctwcamp5Eserp7Ctwgr5Ehashtag
Quality Payment Program
Thank you
27
Ashby Wolfe MD MPP MPH
Chief Medical Officer Region IX
Centers for Medicare and Medicaid Services
ashbywolfe1cmshhsgov
ResourceshttpswwwcmsgovResearch-Statistics-Data-and-SystemsMonitoring-
ProgramsMedicare-FFS-Compliance-ProgramsReducingProviderBurdenhtml
httpsqppcmsgov
httpswwwcmsgovNewsroomMediaReleaseDatabasePress-releases2017-Press-releases-items2017-10-30html
- Slide Number 1
- Disclaimer
- Objectives for today
- CMS OFFICES
- Slide Number 5
- Slide Number 6
- Slide Number 7
- Slide Number 8
- Slide Number 9
- Measure Alignment Efforts
- The CMS Innovation Center was created by the Affordable Care Act to develop test and implement new payment and delivery models
- Innovation Center Models
- CMS has engaged the health care delivery system and invested in innovation across the country
- Slide Number 14
- Slide Number 15
- Slide Number 16
- MACRA Goals
- The Quality Payment Program
- Pick Your Pace for Participation for the Transition Year
- Website httpsqppcmsgov
- Technical Support Available to Clinicians
- QPP Technical Assistance
- QPP Technical Assistance
- Slide Number 24
- Slide Number 25
- Slide Number 26
- Thank you
-
Quality Payment Program
bull Medicare Telehealth Services - we are proposing to add several codes to the list of telehealth services including
- HCPCS code G0296 (visit to determine low dose computed tomography eligibility)
- CPT code 90785 (Interactive Complexity)
- CPT codes 96160 and 96161 (Health Risk Assessment)
- HCPCS code G0506 (Care Planning for Chronic Care Management) and
- CPT codes 90839 and 90840 (Psychotherapy for Crisis)
bull Improvement of Payment Rates for Office-based Behavioral Health Services
- CMS is proposing an improvement in the way rates are set that would increase payment by better recognizing overhead expenses for office-based face-to-face visits
bull Evaluation and Management Comment Solicitation
- CMS sought comment from stakeholders on specific changes we should undertake to update the guidelines to reduce the associated burden and to better align EM coding and documentation with the current practice of medicine
7
PROPOSED 2018 Medicare Physician Fee SchedulePublished July 13 2017
httpswwwcmsgovNewsroomMediaReleaseDatabaseFact-sheets2017-Fact-Sheet-items2017-07-13-2html
Quality Payment Program
bull Changes to the Medicare and Medicaid EHR Incentive Programs
bull For 2018 CMS is finalizing the modification to the EHR reporting periods for new and returning participants attesting to CMS or their state Medicaid agency from the full year to a minimum of any continuous 90-day period during the calendar year
bull Additional changes
- Created a new exception from the Medicare payment adjustments for clinicians eligible hospitals and CAHs that demonstrate through an application process that compliance is not possible because their EHR technology has been decertified
- Finalized an exception to the 2017 and 2018 Medicare payment adjustments for ambulatory surgical center (ASC)-based clinicians (those who furnish 75 percent or more of their covered professional services in an ASC using Place of Service (POS) code 24)
- Allow healthcare providers to use either 2014 Edition CEHRT 2015 Edition CEHRT or a combinationof 2014 Edition and 2015 Edition CEHRT for the reporting period in 2018
8
2018 Inpatient Prospective Payment System IPPS andLong Term Care Hospital PPS Final Rule
Published August 2 2017
For a fact sheet on the final rule please visit httpswwwcmsgovNewsroomMediaReleaseDatabaseFact-sheets2017-Fact-
Sheet-items2017-08-02html
Quality Payment Program
bull Proposing to change the payment rate for certain Medicare Part B drugs purchased by hospitals through the 340B program
- Requests comment on how CMS can best implement the proposal to pass savings on to beneficiaries and providers and to allow seniors to save money on their drug costs
bull The proposed rule also includes a provision that would alleviate some of the burdens rural hospitals experience in recruiting physicians by placing a two-year moratorium on the direct supervision requirement currently in place at rural hospitals and critical access hospitals
bull Request for Information on Flexibilities and Efficiencies
- Solicited feedback on positive solutions to better achieve transparency flexibility program simplification and innovation
- This will inform the discussion on future regulatory action related to outpatient services performed at hospitals and services performed at ambulatory surgical centers
9
PROPOSED 2018 Outpatient Prospective Payment System andAmbulatory Surgical Center Payment System
Published July 13 2017
For a fact sheet on the proposed rule please visit httpswwwcmsgovNewsroomMediaReleaseDatabaseFact-sheets2017-Fact-Sheet-
items2017-07-13html
Quality Payment Program
Measure Alignment Efforts
bull CMS Draft Quality Measure Development Plan- Highlight known measurement gaps and develop strategy to address these
- Promote harmonization and alignment across programs care settings and payers
- Assist in prioritizing development and refinement of measures
- Annual updates to the plan
bull Core Measures Sets released in 2016 new PEDIATRIC measure set released 2017- ACOs Patient Centered Medical Homes (PCMH) and Primary Care
- Cardiology
- Gastroenterology
- HIV and Hepatitis C
- Medical Oncology
- Obstetrics and Gynecology
- Orthopedics
- Pediatrics
httpswwwcmsgovMedicareQuality-Initiatives-Patient-Assessment-InstrumentsQualityMeasuresCore-Measureshtml
Quality Payment ProgramThe CMS Innovation Center was created by the Affordable Care Act to develop test and implement new payment and delivery models
ldquoThe purpose of the [Center] is to test innovative payment and service delivery
models to reduce program expenditureshellipwhile preserving or enhancing
the quality of care furnished to individuals under such titlesrdquo
Section 3021 of Affordable Care Act
Three scenarios for success1 Quality improves cost neutral2 Quality neutral cost reduced3 Quality improves cost reduced (best case)If a model meets one of these three criteria and other statutory prerequisites the statute allows the Secretary to expand the duration and scope of a model through rulemaking
Quality Payment Program
Innovation Center Models
Variety of models and initiatives currently being tested across several categories
- Accountable Care
- Episode-based Payment Initiatives
- Primary Care Transformation
- Medicaid and CHIP Population focus
- Initiatives Focused on the Medicare-Medicaid Enrollees (ldquoDual-Eligiblesrdquo)
- Initiatives to Accelerate the Development and Testing of New Payment and Service Delivery Models
- Initiatives to Speed the Adoption of Best Practices
Quality Payment ProgramCMS has engaged the health care delivery system and invested in innovation across the country
Models run at the state levelSites where innovation models are being tested
Source CMS Innovation Center website July 2017
Quality Payment Program
14
Quality Payment Program
15
Quality Payment Program
THE
MEDICARE ACCESS amp CHIP REAUTHORIZATION ACT
OF 2015
Quality Payment Program
MACRA Goals
Through MACRA HHS aims to
bull Offer multiple pathways with varying levels of risk and reward for providers to tie more of their payments to value
bull Over time expand the opportunities for a broad range of providers to participate in APMs
bull Minimize additional reporting burdens for APM participants
bull Promote understanding of each physicianrsquos or practitionerrsquos status with respect to MIPS andor APMs
bull Support multi-payer initiatives and the development of APMs in Medicaid Medicare Advantage and other payer arrangements
Quality Payment Program
The Quality Payment Program
The Quality Payment Program policy will
bull Reform Medicare Part B payments for more than 600000 clinicians
bull Improve care across the entire health care delivery system
Clinicians have two tracks to choose from
5
Quality Payment Program
Test
bull Submit some data after January 1 2017
bull Neutral payment adjustment
Partial Year
bull Report for 90-day period after January 1 2017
bull Neutral or positive payment adjustment
19
Pick Your Pace for Participation for the Transition Year
Full Year
bull Fully participate starting January 1 2017
bull Positive payment adjustment
MIPS
Not participating in the Quality Payment Program for the Transition Year will result in a negative 4 payment adjustment
Participate in an Advanced Alternative
Payment Model
bull Some practices may choose to participate in an Advanced Alternative Payment Model in 2017
Note Clinicians do not need to tell CMS which option they intend to
pursue
Quality Payment Program
Website httpsqppcmsgov
Quality Payment Program
Technical Support Available to CliniciansIntegrated Technical Assistance Program
- Full-service expert help
bull Quality Payment Program Service Center
bull Quality Innovation NetworkQuality Improvement Organizations
bull Quality Payment Program mdash Small Underserved and Rural Support
bull Transforming Clinical Practice Initiative
bull APM Learning Networks
- Self-service
bull QPP Online Portal
21
All support is FREE to clinicians
httpsqppcmsgoveducation
Quality Payment Program
QPP Technical Assistance
bull Technical Assistance organizations can help you- Understand the general requirements of the Quality Payment Program
- Review the information included in your Clinician Participation Letter andor help you use the MIPS Participation Look-up Tool to determine if you are included in the program
- Choose whether you will participate individually or as a part of a group
- Pick a participation pace for the 2017 transition year
- Identify appropriate MIPS measures and Improvement Activities based on your patients and practice structure
bull Map your current efforts to appropriate MIPS measures and Improvement Activities
- Determine a suitable submission mechanism(s) to report your data create a strategy for capturing data and guide you through the submission process
- Understand the MIPS scoring structure
- Analyze your performance data and trends
- Prepare to transition into an Alternative Payment Model (APM) or Advanced APMs
22
What program-specific services are available
Quality Payment Program
QPP Technical Assistance
bull Technical Assistance organizations can help you- Assess your practicersquos overall readiness for the Quality Payment Program
- Implement change management and strategic planning
- Redesign your practice workflow
- Optimize your current Health Information Technology (HIT) or begin integrating new forms of technology into your practice and select resources that meet your patientrsquos needs
- Form partnerships with other practices local stakeholders regional initiatives etc
- Participate in a quality improvement initiative if interested
23
What practice-specific services are available
Quality Payment Program
Quality Payment ProgramHow to get help
Two-minute QPP primer httpsyoutube96djML-m2Wo
Quality Payment Program
25httpswwwcmsgovNewsroomMediaReleaseDatabasePress-
releases2017-Press-releases-items2017-10-30html
Quality Payment Program
26
TwitterHashtaghttpstwittercomhashtagpatientsoverpaperworkref_src=twsrc5Egoogle7Ctwcamp5Eserp7Ctwgr5Ehashtag
Quality Payment Program
Thank you
27
Ashby Wolfe MD MPP MPH
Chief Medical Officer Region IX
Centers for Medicare and Medicaid Services
ashbywolfe1cmshhsgov
ResourceshttpswwwcmsgovResearch-Statistics-Data-and-SystemsMonitoring-
ProgramsMedicare-FFS-Compliance-ProgramsReducingProviderBurdenhtml
httpsqppcmsgov
httpswwwcmsgovNewsroomMediaReleaseDatabasePress-releases2017-Press-releases-items2017-10-30html
- Slide Number 1
- Disclaimer
- Objectives for today
- CMS OFFICES
- Slide Number 5
- Slide Number 6
- Slide Number 7
- Slide Number 8
- Slide Number 9
- Measure Alignment Efforts
- The CMS Innovation Center was created by the Affordable Care Act to develop test and implement new payment and delivery models
- Innovation Center Models
- CMS has engaged the health care delivery system and invested in innovation across the country
- Slide Number 14
- Slide Number 15
- Slide Number 16
- MACRA Goals
- The Quality Payment Program
- Pick Your Pace for Participation for the Transition Year
- Website httpsqppcmsgov
- Technical Support Available to Clinicians
- QPP Technical Assistance
- QPP Technical Assistance
- Slide Number 24
- Slide Number 25
- Slide Number 26
- Thank you
-
Quality Payment Program
bull Changes to the Medicare and Medicaid EHR Incentive Programs
bull For 2018 CMS is finalizing the modification to the EHR reporting periods for new and returning participants attesting to CMS or their state Medicaid agency from the full year to a minimum of any continuous 90-day period during the calendar year
bull Additional changes
- Created a new exception from the Medicare payment adjustments for clinicians eligible hospitals and CAHs that demonstrate through an application process that compliance is not possible because their EHR technology has been decertified
- Finalized an exception to the 2017 and 2018 Medicare payment adjustments for ambulatory surgical center (ASC)-based clinicians (those who furnish 75 percent or more of their covered professional services in an ASC using Place of Service (POS) code 24)
- Allow healthcare providers to use either 2014 Edition CEHRT 2015 Edition CEHRT or a combinationof 2014 Edition and 2015 Edition CEHRT for the reporting period in 2018
8
2018 Inpatient Prospective Payment System IPPS andLong Term Care Hospital PPS Final Rule
Published August 2 2017
For a fact sheet on the final rule please visit httpswwwcmsgovNewsroomMediaReleaseDatabaseFact-sheets2017-Fact-
Sheet-items2017-08-02html
Quality Payment Program
bull Proposing to change the payment rate for certain Medicare Part B drugs purchased by hospitals through the 340B program
- Requests comment on how CMS can best implement the proposal to pass savings on to beneficiaries and providers and to allow seniors to save money on their drug costs
bull The proposed rule also includes a provision that would alleviate some of the burdens rural hospitals experience in recruiting physicians by placing a two-year moratorium on the direct supervision requirement currently in place at rural hospitals and critical access hospitals
bull Request for Information on Flexibilities and Efficiencies
- Solicited feedback on positive solutions to better achieve transparency flexibility program simplification and innovation
- This will inform the discussion on future regulatory action related to outpatient services performed at hospitals and services performed at ambulatory surgical centers
9
PROPOSED 2018 Outpatient Prospective Payment System andAmbulatory Surgical Center Payment System
Published July 13 2017
For a fact sheet on the proposed rule please visit httpswwwcmsgovNewsroomMediaReleaseDatabaseFact-sheets2017-Fact-Sheet-
items2017-07-13html
Quality Payment Program
Measure Alignment Efforts
bull CMS Draft Quality Measure Development Plan- Highlight known measurement gaps and develop strategy to address these
- Promote harmonization and alignment across programs care settings and payers
- Assist in prioritizing development and refinement of measures
- Annual updates to the plan
bull Core Measures Sets released in 2016 new PEDIATRIC measure set released 2017- ACOs Patient Centered Medical Homes (PCMH) and Primary Care
- Cardiology
- Gastroenterology
- HIV and Hepatitis C
- Medical Oncology
- Obstetrics and Gynecology
- Orthopedics
- Pediatrics
httpswwwcmsgovMedicareQuality-Initiatives-Patient-Assessment-InstrumentsQualityMeasuresCore-Measureshtml
Quality Payment ProgramThe CMS Innovation Center was created by the Affordable Care Act to develop test and implement new payment and delivery models
ldquoThe purpose of the [Center] is to test innovative payment and service delivery
models to reduce program expenditureshellipwhile preserving or enhancing
the quality of care furnished to individuals under such titlesrdquo
Section 3021 of Affordable Care Act
Three scenarios for success1 Quality improves cost neutral2 Quality neutral cost reduced3 Quality improves cost reduced (best case)If a model meets one of these three criteria and other statutory prerequisites the statute allows the Secretary to expand the duration and scope of a model through rulemaking
Quality Payment Program
Innovation Center Models
Variety of models and initiatives currently being tested across several categories
- Accountable Care
- Episode-based Payment Initiatives
- Primary Care Transformation
- Medicaid and CHIP Population focus
- Initiatives Focused on the Medicare-Medicaid Enrollees (ldquoDual-Eligiblesrdquo)
- Initiatives to Accelerate the Development and Testing of New Payment and Service Delivery Models
- Initiatives to Speed the Adoption of Best Practices
Quality Payment ProgramCMS has engaged the health care delivery system and invested in innovation across the country
Models run at the state levelSites where innovation models are being tested
Source CMS Innovation Center website July 2017
Quality Payment Program
14
Quality Payment Program
15
Quality Payment Program
THE
MEDICARE ACCESS amp CHIP REAUTHORIZATION ACT
OF 2015
Quality Payment Program
MACRA Goals
Through MACRA HHS aims to
bull Offer multiple pathways with varying levels of risk and reward for providers to tie more of their payments to value
bull Over time expand the opportunities for a broad range of providers to participate in APMs
bull Minimize additional reporting burdens for APM participants
bull Promote understanding of each physicianrsquos or practitionerrsquos status with respect to MIPS andor APMs
bull Support multi-payer initiatives and the development of APMs in Medicaid Medicare Advantage and other payer arrangements
Quality Payment Program
The Quality Payment Program
The Quality Payment Program policy will
bull Reform Medicare Part B payments for more than 600000 clinicians
bull Improve care across the entire health care delivery system
Clinicians have two tracks to choose from
5
Quality Payment Program
Test
bull Submit some data after January 1 2017
bull Neutral payment adjustment
Partial Year
bull Report for 90-day period after January 1 2017
bull Neutral or positive payment adjustment
19
Pick Your Pace for Participation for the Transition Year
Full Year
bull Fully participate starting January 1 2017
bull Positive payment adjustment
MIPS
Not participating in the Quality Payment Program for the Transition Year will result in a negative 4 payment adjustment
Participate in an Advanced Alternative
Payment Model
bull Some practices may choose to participate in an Advanced Alternative Payment Model in 2017
Note Clinicians do not need to tell CMS which option they intend to
pursue
Quality Payment Program
Website httpsqppcmsgov
Quality Payment Program
Technical Support Available to CliniciansIntegrated Technical Assistance Program
- Full-service expert help
bull Quality Payment Program Service Center
bull Quality Innovation NetworkQuality Improvement Organizations
bull Quality Payment Program mdash Small Underserved and Rural Support
bull Transforming Clinical Practice Initiative
bull APM Learning Networks
- Self-service
bull QPP Online Portal
21
All support is FREE to clinicians
httpsqppcmsgoveducation
Quality Payment Program
QPP Technical Assistance
bull Technical Assistance organizations can help you- Understand the general requirements of the Quality Payment Program
- Review the information included in your Clinician Participation Letter andor help you use the MIPS Participation Look-up Tool to determine if you are included in the program
- Choose whether you will participate individually or as a part of a group
- Pick a participation pace for the 2017 transition year
- Identify appropriate MIPS measures and Improvement Activities based on your patients and practice structure
bull Map your current efforts to appropriate MIPS measures and Improvement Activities
- Determine a suitable submission mechanism(s) to report your data create a strategy for capturing data and guide you through the submission process
- Understand the MIPS scoring structure
- Analyze your performance data and trends
- Prepare to transition into an Alternative Payment Model (APM) or Advanced APMs
22
What program-specific services are available
Quality Payment Program
QPP Technical Assistance
bull Technical Assistance organizations can help you- Assess your practicersquos overall readiness for the Quality Payment Program
- Implement change management and strategic planning
- Redesign your practice workflow
- Optimize your current Health Information Technology (HIT) or begin integrating new forms of technology into your practice and select resources that meet your patientrsquos needs
- Form partnerships with other practices local stakeholders regional initiatives etc
- Participate in a quality improvement initiative if interested
23
What practice-specific services are available
Quality Payment Program
Quality Payment ProgramHow to get help
Two-minute QPP primer httpsyoutube96djML-m2Wo
Quality Payment Program
25httpswwwcmsgovNewsroomMediaReleaseDatabasePress-
releases2017-Press-releases-items2017-10-30html
Quality Payment Program
26
TwitterHashtaghttpstwittercomhashtagpatientsoverpaperworkref_src=twsrc5Egoogle7Ctwcamp5Eserp7Ctwgr5Ehashtag
Quality Payment Program
Thank you
27
Ashby Wolfe MD MPP MPH
Chief Medical Officer Region IX
Centers for Medicare and Medicaid Services
ashbywolfe1cmshhsgov
ResourceshttpswwwcmsgovResearch-Statistics-Data-and-SystemsMonitoring-
ProgramsMedicare-FFS-Compliance-ProgramsReducingProviderBurdenhtml
httpsqppcmsgov
httpswwwcmsgovNewsroomMediaReleaseDatabasePress-releases2017-Press-releases-items2017-10-30html
- Slide Number 1
- Disclaimer
- Objectives for today
- CMS OFFICES
- Slide Number 5
- Slide Number 6
- Slide Number 7
- Slide Number 8
- Slide Number 9
- Measure Alignment Efforts
- The CMS Innovation Center was created by the Affordable Care Act to develop test and implement new payment and delivery models
- Innovation Center Models
- CMS has engaged the health care delivery system and invested in innovation across the country
- Slide Number 14
- Slide Number 15
- Slide Number 16
- MACRA Goals
- The Quality Payment Program
- Pick Your Pace for Participation for the Transition Year
- Website httpsqppcmsgov
- Technical Support Available to Clinicians
- QPP Technical Assistance
- QPP Technical Assistance
- Slide Number 24
- Slide Number 25
- Slide Number 26
- Thank you
-
Quality Payment Program
bull Proposing to change the payment rate for certain Medicare Part B drugs purchased by hospitals through the 340B program
- Requests comment on how CMS can best implement the proposal to pass savings on to beneficiaries and providers and to allow seniors to save money on their drug costs
bull The proposed rule also includes a provision that would alleviate some of the burdens rural hospitals experience in recruiting physicians by placing a two-year moratorium on the direct supervision requirement currently in place at rural hospitals and critical access hospitals
bull Request for Information on Flexibilities and Efficiencies
- Solicited feedback on positive solutions to better achieve transparency flexibility program simplification and innovation
- This will inform the discussion on future regulatory action related to outpatient services performed at hospitals and services performed at ambulatory surgical centers
9
PROPOSED 2018 Outpatient Prospective Payment System andAmbulatory Surgical Center Payment System
Published July 13 2017
For a fact sheet on the proposed rule please visit httpswwwcmsgovNewsroomMediaReleaseDatabaseFact-sheets2017-Fact-Sheet-
items2017-07-13html
Quality Payment Program
Measure Alignment Efforts
bull CMS Draft Quality Measure Development Plan- Highlight known measurement gaps and develop strategy to address these
- Promote harmonization and alignment across programs care settings and payers
- Assist in prioritizing development and refinement of measures
- Annual updates to the plan
bull Core Measures Sets released in 2016 new PEDIATRIC measure set released 2017- ACOs Patient Centered Medical Homes (PCMH) and Primary Care
- Cardiology
- Gastroenterology
- HIV and Hepatitis C
- Medical Oncology
- Obstetrics and Gynecology
- Orthopedics
- Pediatrics
httpswwwcmsgovMedicareQuality-Initiatives-Patient-Assessment-InstrumentsQualityMeasuresCore-Measureshtml
Quality Payment ProgramThe CMS Innovation Center was created by the Affordable Care Act to develop test and implement new payment and delivery models
ldquoThe purpose of the [Center] is to test innovative payment and service delivery
models to reduce program expenditureshellipwhile preserving or enhancing
the quality of care furnished to individuals under such titlesrdquo
Section 3021 of Affordable Care Act
Three scenarios for success1 Quality improves cost neutral2 Quality neutral cost reduced3 Quality improves cost reduced (best case)If a model meets one of these three criteria and other statutory prerequisites the statute allows the Secretary to expand the duration and scope of a model through rulemaking
Quality Payment Program
Innovation Center Models
Variety of models and initiatives currently being tested across several categories
- Accountable Care
- Episode-based Payment Initiatives
- Primary Care Transformation
- Medicaid and CHIP Population focus
- Initiatives Focused on the Medicare-Medicaid Enrollees (ldquoDual-Eligiblesrdquo)
- Initiatives to Accelerate the Development and Testing of New Payment and Service Delivery Models
- Initiatives to Speed the Adoption of Best Practices
Quality Payment ProgramCMS has engaged the health care delivery system and invested in innovation across the country
Models run at the state levelSites where innovation models are being tested
Source CMS Innovation Center website July 2017
Quality Payment Program
14
Quality Payment Program
15
Quality Payment Program
THE
MEDICARE ACCESS amp CHIP REAUTHORIZATION ACT
OF 2015
Quality Payment Program
MACRA Goals
Through MACRA HHS aims to
bull Offer multiple pathways with varying levels of risk and reward for providers to tie more of their payments to value
bull Over time expand the opportunities for a broad range of providers to participate in APMs
bull Minimize additional reporting burdens for APM participants
bull Promote understanding of each physicianrsquos or practitionerrsquos status with respect to MIPS andor APMs
bull Support multi-payer initiatives and the development of APMs in Medicaid Medicare Advantage and other payer arrangements
Quality Payment Program
The Quality Payment Program
The Quality Payment Program policy will
bull Reform Medicare Part B payments for more than 600000 clinicians
bull Improve care across the entire health care delivery system
Clinicians have two tracks to choose from
5
Quality Payment Program
Test
bull Submit some data after January 1 2017
bull Neutral payment adjustment
Partial Year
bull Report for 90-day period after January 1 2017
bull Neutral or positive payment adjustment
19
Pick Your Pace for Participation for the Transition Year
Full Year
bull Fully participate starting January 1 2017
bull Positive payment adjustment
MIPS
Not participating in the Quality Payment Program for the Transition Year will result in a negative 4 payment adjustment
Participate in an Advanced Alternative
Payment Model
bull Some practices may choose to participate in an Advanced Alternative Payment Model in 2017
Note Clinicians do not need to tell CMS which option they intend to
pursue
Quality Payment Program
Website httpsqppcmsgov
Quality Payment Program
Technical Support Available to CliniciansIntegrated Technical Assistance Program
- Full-service expert help
bull Quality Payment Program Service Center
bull Quality Innovation NetworkQuality Improvement Organizations
bull Quality Payment Program mdash Small Underserved and Rural Support
bull Transforming Clinical Practice Initiative
bull APM Learning Networks
- Self-service
bull QPP Online Portal
21
All support is FREE to clinicians
httpsqppcmsgoveducation
Quality Payment Program
QPP Technical Assistance
bull Technical Assistance organizations can help you- Understand the general requirements of the Quality Payment Program
- Review the information included in your Clinician Participation Letter andor help you use the MIPS Participation Look-up Tool to determine if you are included in the program
- Choose whether you will participate individually or as a part of a group
- Pick a participation pace for the 2017 transition year
- Identify appropriate MIPS measures and Improvement Activities based on your patients and practice structure
bull Map your current efforts to appropriate MIPS measures and Improvement Activities
- Determine a suitable submission mechanism(s) to report your data create a strategy for capturing data and guide you through the submission process
- Understand the MIPS scoring structure
- Analyze your performance data and trends
- Prepare to transition into an Alternative Payment Model (APM) or Advanced APMs
22
What program-specific services are available
Quality Payment Program
QPP Technical Assistance
bull Technical Assistance organizations can help you- Assess your practicersquos overall readiness for the Quality Payment Program
- Implement change management and strategic planning
- Redesign your practice workflow
- Optimize your current Health Information Technology (HIT) or begin integrating new forms of technology into your practice and select resources that meet your patientrsquos needs
- Form partnerships with other practices local stakeholders regional initiatives etc
- Participate in a quality improvement initiative if interested
23
What practice-specific services are available
Quality Payment Program
Quality Payment ProgramHow to get help
Two-minute QPP primer httpsyoutube96djML-m2Wo
Quality Payment Program
25httpswwwcmsgovNewsroomMediaReleaseDatabasePress-
releases2017-Press-releases-items2017-10-30html
Quality Payment Program
26
TwitterHashtaghttpstwittercomhashtagpatientsoverpaperworkref_src=twsrc5Egoogle7Ctwcamp5Eserp7Ctwgr5Ehashtag
Quality Payment Program
Thank you
27
Ashby Wolfe MD MPP MPH
Chief Medical Officer Region IX
Centers for Medicare and Medicaid Services
ashbywolfe1cmshhsgov
ResourceshttpswwwcmsgovResearch-Statistics-Data-and-SystemsMonitoring-
ProgramsMedicare-FFS-Compliance-ProgramsReducingProviderBurdenhtml
httpsqppcmsgov
httpswwwcmsgovNewsroomMediaReleaseDatabasePress-releases2017-Press-releases-items2017-10-30html
- Slide Number 1
- Disclaimer
- Objectives for today
- CMS OFFICES
- Slide Number 5
- Slide Number 6
- Slide Number 7
- Slide Number 8
- Slide Number 9
- Measure Alignment Efforts
- The CMS Innovation Center was created by the Affordable Care Act to develop test and implement new payment and delivery models
- Innovation Center Models
- CMS has engaged the health care delivery system and invested in innovation across the country
- Slide Number 14
- Slide Number 15
- Slide Number 16
- MACRA Goals
- The Quality Payment Program
- Pick Your Pace for Participation for the Transition Year
- Website httpsqppcmsgov
- Technical Support Available to Clinicians
- QPP Technical Assistance
- QPP Technical Assistance
- Slide Number 24
- Slide Number 25
- Slide Number 26
- Thank you
-
Quality Payment Program
Measure Alignment Efforts
bull CMS Draft Quality Measure Development Plan- Highlight known measurement gaps and develop strategy to address these
- Promote harmonization and alignment across programs care settings and payers
- Assist in prioritizing development and refinement of measures
- Annual updates to the plan
bull Core Measures Sets released in 2016 new PEDIATRIC measure set released 2017- ACOs Patient Centered Medical Homes (PCMH) and Primary Care
- Cardiology
- Gastroenterology
- HIV and Hepatitis C
- Medical Oncology
- Obstetrics and Gynecology
- Orthopedics
- Pediatrics
httpswwwcmsgovMedicareQuality-Initiatives-Patient-Assessment-InstrumentsQualityMeasuresCore-Measureshtml
Quality Payment ProgramThe CMS Innovation Center was created by the Affordable Care Act to develop test and implement new payment and delivery models
ldquoThe purpose of the [Center] is to test innovative payment and service delivery
models to reduce program expenditureshellipwhile preserving or enhancing
the quality of care furnished to individuals under such titlesrdquo
Section 3021 of Affordable Care Act
Three scenarios for success1 Quality improves cost neutral2 Quality neutral cost reduced3 Quality improves cost reduced (best case)If a model meets one of these three criteria and other statutory prerequisites the statute allows the Secretary to expand the duration and scope of a model through rulemaking
Quality Payment Program
Innovation Center Models
Variety of models and initiatives currently being tested across several categories
- Accountable Care
- Episode-based Payment Initiatives
- Primary Care Transformation
- Medicaid and CHIP Population focus
- Initiatives Focused on the Medicare-Medicaid Enrollees (ldquoDual-Eligiblesrdquo)
- Initiatives to Accelerate the Development and Testing of New Payment and Service Delivery Models
- Initiatives to Speed the Adoption of Best Practices
Quality Payment ProgramCMS has engaged the health care delivery system and invested in innovation across the country
Models run at the state levelSites where innovation models are being tested
Source CMS Innovation Center website July 2017
Quality Payment Program
14
Quality Payment Program
15
Quality Payment Program
THE
MEDICARE ACCESS amp CHIP REAUTHORIZATION ACT
OF 2015
Quality Payment Program
MACRA Goals
Through MACRA HHS aims to
bull Offer multiple pathways with varying levels of risk and reward for providers to tie more of their payments to value
bull Over time expand the opportunities for a broad range of providers to participate in APMs
bull Minimize additional reporting burdens for APM participants
bull Promote understanding of each physicianrsquos or practitionerrsquos status with respect to MIPS andor APMs
bull Support multi-payer initiatives and the development of APMs in Medicaid Medicare Advantage and other payer arrangements
Quality Payment Program
The Quality Payment Program
The Quality Payment Program policy will
bull Reform Medicare Part B payments for more than 600000 clinicians
bull Improve care across the entire health care delivery system
Clinicians have two tracks to choose from
5
Quality Payment Program
Test
bull Submit some data after January 1 2017
bull Neutral payment adjustment
Partial Year
bull Report for 90-day period after January 1 2017
bull Neutral or positive payment adjustment
19
Pick Your Pace for Participation for the Transition Year
Full Year
bull Fully participate starting January 1 2017
bull Positive payment adjustment
MIPS
Not participating in the Quality Payment Program for the Transition Year will result in a negative 4 payment adjustment
Participate in an Advanced Alternative
Payment Model
bull Some practices may choose to participate in an Advanced Alternative Payment Model in 2017
Note Clinicians do not need to tell CMS which option they intend to
pursue
Quality Payment Program
Website httpsqppcmsgov
Quality Payment Program
Technical Support Available to CliniciansIntegrated Technical Assistance Program
- Full-service expert help
bull Quality Payment Program Service Center
bull Quality Innovation NetworkQuality Improvement Organizations
bull Quality Payment Program mdash Small Underserved and Rural Support
bull Transforming Clinical Practice Initiative
bull APM Learning Networks
- Self-service
bull QPP Online Portal
21
All support is FREE to clinicians
httpsqppcmsgoveducation
Quality Payment Program
QPP Technical Assistance
bull Technical Assistance organizations can help you- Understand the general requirements of the Quality Payment Program
- Review the information included in your Clinician Participation Letter andor help you use the MIPS Participation Look-up Tool to determine if you are included in the program
- Choose whether you will participate individually or as a part of a group
- Pick a participation pace for the 2017 transition year
- Identify appropriate MIPS measures and Improvement Activities based on your patients and practice structure
bull Map your current efforts to appropriate MIPS measures and Improvement Activities
- Determine a suitable submission mechanism(s) to report your data create a strategy for capturing data and guide you through the submission process
- Understand the MIPS scoring structure
- Analyze your performance data and trends
- Prepare to transition into an Alternative Payment Model (APM) or Advanced APMs
22
What program-specific services are available
Quality Payment Program
QPP Technical Assistance
bull Technical Assistance organizations can help you- Assess your practicersquos overall readiness for the Quality Payment Program
- Implement change management and strategic planning
- Redesign your practice workflow
- Optimize your current Health Information Technology (HIT) or begin integrating new forms of technology into your practice and select resources that meet your patientrsquos needs
- Form partnerships with other practices local stakeholders regional initiatives etc
- Participate in a quality improvement initiative if interested
23
What practice-specific services are available
Quality Payment Program
Quality Payment ProgramHow to get help
Two-minute QPP primer httpsyoutube96djML-m2Wo
Quality Payment Program
25httpswwwcmsgovNewsroomMediaReleaseDatabasePress-
releases2017-Press-releases-items2017-10-30html
Quality Payment Program
26
TwitterHashtaghttpstwittercomhashtagpatientsoverpaperworkref_src=twsrc5Egoogle7Ctwcamp5Eserp7Ctwgr5Ehashtag
Quality Payment Program
Thank you
27
Ashby Wolfe MD MPP MPH
Chief Medical Officer Region IX
Centers for Medicare and Medicaid Services
ashbywolfe1cmshhsgov
ResourceshttpswwwcmsgovResearch-Statistics-Data-and-SystemsMonitoring-
ProgramsMedicare-FFS-Compliance-ProgramsReducingProviderBurdenhtml
httpsqppcmsgov
httpswwwcmsgovNewsroomMediaReleaseDatabasePress-releases2017-Press-releases-items2017-10-30html
- Slide Number 1
- Disclaimer
- Objectives for today
- CMS OFFICES
- Slide Number 5
- Slide Number 6
- Slide Number 7
- Slide Number 8
- Slide Number 9
- Measure Alignment Efforts
- The CMS Innovation Center was created by the Affordable Care Act to develop test and implement new payment and delivery models
- Innovation Center Models
- CMS has engaged the health care delivery system and invested in innovation across the country
- Slide Number 14
- Slide Number 15
- Slide Number 16
- MACRA Goals
- The Quality Payment Program
- Pick Your Pace for Participation for the Transition Year
- Website httpsqppcmsgov
- Technical Support Available to Clinicians
- QPP Technical Assistance
- QPP Technical Assistance
- Slide Number 24
- Slide Number 25
- Slide Number 26
- Thank you
-
Quality Payment ProgramThe CMS Innovation Center was created by the Affordable Care Act to develop test and implement new payment and delivery models
ldquoThe purpose of the [Center] is to test innovative payment and service delivery
models to reduce program expenditureshellipwhile preserving or enhancing
the quality of care furnished to individuals under such titlesrdquo
Section 3021 of Affordable Care Act
Three scenarios for success1 Quality improves cost neutral2 Quality neutral cost reduced3 Quality improves cost reduced (best case)If a model meets one of these three criteria and other statutory prerequisites the statute allows the Secretary to expand the duration and scope of a model through rulemaking
Quality Payment Program
Innovation Center Models
Variety of models and initiatives currently being tested across several categories
- Accountable Care
- Episode-based Payment Initiatives
- Primary Care Transformation
- Medicaid and CHIP Population focus
- Initiatives Focused on the Medicare-Medicaid Enrollees (ldquoDual-Eligiblesrdquo)
- Initiatives to Accelerate the Development and Testing of New Payment and Service Delivery Models
- Initiatives to Speed the Adoption of Best Practices
Quality Payment ProgramCMS has engaged the health care delivery system and invested in innovation across the country
Models run at the state levelSites where innovation models are being tested
Source CMS Innovation Center website July 2017
Quality Payment Program
14
Quality Payment Program
15
Quality Payment Program
THE
MEDICARE ACCESS amp CHIP REAUTHORIZATION ACT
OF 2015
Quality Payment Program
MACRA Goals
Through MACRA HHS aims to
bull Offer multiple pathways with varying levels of risk and reward for providers to tie more of their payments to value
bull Over time expand the opportunities for a broad range of providers to participate in APMs
bull Minimize additional reporting burdens for APM participants
bull Promote understanding of each physicianrsquos or practitionerrsquos status with respect to MIPS andor APMs
bull Support multi-payer initiatives and the development of APMs in Medicaid Medicare Advantage and other payer arrangements
Quality Payment Program
The Quality Payment Program
The Quality Payment Program policy will
bull Reform Medicare Part B payments for more than 600000 clinicians
bull Improve care across the entire health care delivery system
Clinicians have two tracks to choose from
5
Quality Payment Program
Test
bull Submit some data after January 1 2017
bull Neutral payment adjustment
Partial Year
bull Report for 90-day period after January 1 2017
bull Neutral or positive payment adjustment
19
Pick Your Pace for Participation for the Transition Year
Full Year
bull Fully participate starting January 1 2017
bull Positive payment adjustment
MIPS
Not participating in the Quality Payment Program for the Transition Year will result in a negative 4 payment adjustment
Participate in an Advanced Alternative
Payment Model
bull Some practices may choose to participate in an Advanced Alternative Payment Model in 2017
Note Clinicians do not need to tell CMS which option they intend to
pursue
Quality Payment Program
Website httpsqppcmsgov
Quality Payment Program
Technical Support Available to CliniciansIntegrated Technical Assistance Program
- Full-service expert help
bull Quality Payment Program Service Center
bull Quality Innovation NetworkQuality Improvement Organizations
bull Quality Payment Program mdash Small Underserved and Rural Support
bull Transforming Clinical Practice Initiative
bull APM Learning Networks
- Self-service
bull QPP Online Portal
21
All support is FREE to clinicians
httpsqppcmsgoveducation
Quality Payment Program
QPP Technical Assistance
bull Technical Assistance organizations can help you- Understand the general requirements of the Quality Payment Program
- Review the information included in your Clinician Participation Letter andor help you use the MIPS Participation Look-up Tool to determine if you are included in the program
- Choose whether you will participate individually or as a part of a group
- Pick a participation pace for the 2017 transition year
- Identify appropriate MIPS measures and Improvement Activities based on your patients and practice structure
bull Map your current efforts to appropriate MIPS measures and Improvement Activities
- Determine a suitable submission mechanism(s) to report your data create a strategy for capturing data and guide you through the submission process
- Understand the MIPS scoring structure
- Analyze your performance data and trends
- Prepare to transition into an Alternative Payment Model (APM) or Advanced APMs
22
What program-specific services are available
Quality Payment Program
QPP Technical Assistance
bull Technical Assistance organizations can help you- Assess your practicersquos overall readiness for the Quality Payment Program
- Implement change management and strategic planning
- Redesign your practice workflow
- Optimize your current Health Information Technology (HIT) or begin integrating new forms of technology into your practice and select resources that meet your patientrsquos needs
- Form partnerships with other practices local stakeholders regional initiatives etc
- Participate in a quality improvement initiative if interested
23
What practice-specific services are available
Quality Payment Program
Quality Payment ProgramHow to get help
Two-minute QPP primer httpsyoutube96djML-m2Wo
Quality Payment Program
25httpswwwcmsgovNewsroomMediaReleaseDatabasePress-
releases2017-Press-releases-items2017-10-30html
Quality Payment Program
26
TwitterHashtaghttpstwittercomhashtagpatientsoverpaperworkref_src=twsrc5Egoogle7Ctwcamp5Eserp7Ctwgr5Ehashtag
Quality Payment Program
Thank you
27
Ashby Wolfe MD MPP MPH
Chief Medical Officer Region IX
Centers for Medicare and Medicaid Services
ashbywolfe1cmshhsgov
ResourceshttpswwwcmsgovResearch-Statistics-Data-and-SystemsMonitoring-
ProgramsMedicare-FFS-Compliance-ProgramsReducingProviderBurdenhtml
httpsqppcmsgov
httpswwwcmsgovNewsroomMediaReleaseDatabasePress-releases2017-Press-releases-items2017-10-30html
- Slide Number 1
- Disclaimer
- Objectives for today
- CMS OFFICES
- Slide Number 5
- Slide Number 6
- Slide Number 7
- Slide Number 8
- Slide Number 9
- Measure Alignment Efforts
- The CMS Innovation Center was created by the Affordable Care Act to develop test and implement new payment and delivery models
- Innovation Center Models
- CMS has engaged the health care delivery system and invested in innovation across the country
- Slide Number 14
- Slide Number 15
- Slide Number 16
- MACRA Goals
- The Quality Payment Program
- Pick Your Pace for Participation for the Transition Year
- Website httpsqppcmsgov
- Technical Support Available to Clinicians
- QPP Technical Assistance
- QPP Technical Assistance
- Slide Number 24
- Slide Number 25
- Slide Number 26
- Thank you
-
Quality Payment Program
Innovation Center Models
Variety of models and initiatives currently being tested across several categories
- Accountable Care
- Episode-based Payment Initiatives
- Primary Care Transformation
- Medicaid and CHIP Population focus
- Initiatives Focused on the Medicare-Medicaid Enrollees (ldquoDual-Eligiblesrdquo)
- Initiatives to Accelerate the Development and Testing of New Payment and Service Delivery Models
- Initiatives to Speed the Adoption of Best Practices
Quality Payment ProgramCMS has engaged the health care delivery system and invested in innovation across the country
Models run at the state levelSites where innovation models are being tested
Source CMS Innovation Center website July 2017
Quality Payment Program
14
Quality Payment Program
15
Quality Payment Program
THE
MEDICARE ACCESS amp CHIP REAUTHORIZATION ACT
OF 2015
Quality Payment Program
MACRA Goals
Through MACRA HHS aims to
bull Offer multiple pathways with varying levels of risk and reward for providers to tie more of their payments to value
bull Over time expand the opportunities for a broad range of providers to participate in APMs
bull Minimize additional reporting burdens for APM participants
bull Promote understanding of each physicianrsquos or practitionerrsquos status with respect to MIPS andor APMs
bull Support multi-payer initiatives and the development of APMs in Medicaid Medicare Advantage and other payer arrangements
Quality Payment Program
The Quality Payment Program
The Quality Payment Program policy will
bull Reform Medicare Part B payments for more than 600000 clinicians
bull Improve care across the entire health care delivery system
Clinicians have two tracks to choose from
5
Quality Payment Program
Test
bull Submit some data after January 1 2017
bull Neutral payment adjustment
Partial Year
bull Report for 90-day period after January 1 2017
bull Neutral or positive payment adjustment
19
Pick Your Pace for Participation for the Transition Year
Full Year
bull Fully participate starting January 1 2017
bull Positive payment adjustment
MIPS
Not participating in the Quality Payment Program for the Transition Year will result in a negative 4 payment adjustment
Participate in an Advanced Alternative
Payment Model
bull Some practices may choose to participate in an Advanced Alternative Payment Model in 2017
Note Clinicians do not need to tell CMS which option they intend to
pursue
Quality Payment Program
Website httpsqppcmsgov
Quality Payment Program
Technical Support Available to CliniciansIntegrated Technical Assistance Program
- Full-service expert help
bull Quality Payment Program Service Center
bull Quality Innovation NetworkQuality Improvement Organizations
bull Quality Payment Program mdash Small Underserved and Rural Support
bull Transforming Clinical Practice Initiative
bull APM Learning Networks
- Self-service
bull QPP Online Portal
21
All support is FREE to clinicians
httpsqppcmsgoveducation
Quality Payment Program
QPP Technical Assistance
bull Technical Assistance organizations can help you- Understand the general requirements of the Quality Payment Program
- Review the information included in your Clinician Participation Letter andor help you use the MIPS Participation Look-up Tool to determine if you are included in the program
- Choose whether you will participate individually or as a part of a group
- Pick a participation pace for the 2017 transition year
- Identify appropriate MIPS measures and Improvement Activities based on your patients and practice structure
bull Map your current efforts to appropriate MIPS measures and Improvement Activities
- Determine a suitable submission mechanism(s) to report your data create a strategy for capturing data and guide you through the submission process
- Understand the MIPS scoring structure
- Analyze your performance data and trends
- Prepare to transition into an Alternative Payment Model (APM) or Advanced APMs
22
What program-specific services are available
Quality Payment Program
QPP Technical Assistance
bull Technical Assistance organizations can help you- Assess your practicersquos overall readiness for the Quality Payment Program
- Implement change management and strategic planning
- Redesign your practice workflow
- Optimize your current Health Information Technology (HIT) or begin integrating new forms of technology into your practice and select resources that meet your patientrsquos needs
- Form partnerships with other practices local stakeholders regional initiatives etc
- Participate in a quality improvement initiative if interested
23
What practice-specific services are available
Quality Payment Program
Quality Payment ProgramHow to get help
Two-minute QPP primer httpsyoutube96djML-m2Wo
Quality Payment Program
25httpswwwcmsgovNewsroomMediaReleaseDatabasePress-
releases2017-Press-releases-items2017-10-30html
Quality Payment Program
26
TwitterHashtaghttpstwittercomhashtagpatientsoverpaperworkref_src=twsrc5Egoogle7Ctwcamp5Eserp7Ctwgr5Ehashtag
Quality Payment Program
Thank you
27
Ashby Wolfe MD MPP MPH
Chief Medical Officer Region IX
Centers for Medicare and Medicaid Services
ashbywolfe1cmshhsgov
ResourceshttpswwwcmsgovResearch-Statistics-Data-and-SystemsMonitoring-
ProgramsMedicare-FFS-Compliance-ProgramsReducingProviderBurdenhtml
httpsqppcmsgov
httpswwwcmsgovNewsroomMediaReleaseDatabasePress-releases2017-Press-releases-items2017-10-30html
- Slide Number 1
- Disclaimer
- Objectives for today
- CMS OFFICES
- Slide Number 5
- Slide Number 6
- Slide Number 7
- Slide Number 8
- Slide Number 9
- Measure Alignment Efforts
- The CMS Innovation Center was created by the Affordable Care Act to develop test and implement new payment and delivery models
- Innovation Center Models
- CMS has engaged the health care delivery system and invested in innovation across the country
- Slide Number 14
- Slide Number 15
- Slide Number 16
- MACRA Goals
- The Quality Payment Program
- Pick Your Pace for Participation for the Transition Year
- Website httpsqppcmsgov
- Technical Support Available to Clinicians
- QPP Technical Assistance
- QPP Technical Assistance
- Slide Number 24
- Slide Number 25
- Slide Number 26
- Thank you
-
Quality Payment ProgramCMS has engaged the health care delivery system and invested in innovation across the country
Models run at the state levelSites where innovation models are being tested
Source CMS Innovation Center website July 2017
Quality Payment Program
14
Quality Payment Program
15
Quality Payment Program
THE
MEDICARE ACCESS amp CHIP REAUTHORIZATION ACT
OF 2015
Quality Payment Program
MACRA Goals
Through MACRA HHS aims to
bull Offer multiple pathways with varying levels of risk and reward for providers to tie more of their payments to value
bull Over time expand the opportunities for a broad range of providers to participate in APMs
bull Minimize additional reporting burdens for APM participants
bull Promote understanding of each physicianrsquos or practitionerrsquos status with respect to MIPS andor APMs
bull Support multi-payer initiatives and the development of APMs in Medicaid Medicare Advantage and other payer arrangements
Quality Payment Program
The Quality Payment Program
The Quality Payment Program policy will
bull Reform Medicare Part B payments for more than 600000 clinicians
bull Improve care across the entire health care delivery system
Clinicians have two tracks to choose from
5
Quality Payment Program
Test
bull Submit some data after January 1 2017
bull Neutral payment adjustment
Partial Year
bull Report for 90-day period after January 1 2017
bull Neutral or positive payment adjustment
19
Pick Your Pace for Participation for the Transition Year
Full Year
bull Fully participate starting January 1 2017
bull Positive payment adjustment
MIPS
Not participating in the Quality Payment Program for the Transition Year will result in a negative 4 payment adjustment
Participate in an Advanced Alternative
Payment Model
bull Some practices may choose to participate in an Advanced Alternative Payment Model in 2017
Note Clinicians do not need to tell CMS which option they intend to
pursue
Quality Payment Program
Website httpsqppcmsgov
Quality Payment Program
Technical Support Available to CliniciansIntegrated Technical Assistance Program
- Full-service expert help
bull Quality Payment Program Service Center
bull Quality Innovation NetworkQuality Improvement Organizations
bull Quality Payment Program mdash Small Underserved and Rural Support
bull Transforming Clinical Practice Initiative
bull APM Learning Networks
- Self-service
bull QPP Online Portal
21
All support is FREE to clinicians
httpsqppcmsgoveducation
Quality Payment Program
QPP Technical Assistance
bull Technical Assistance organizations can help you- Understand the general requirements of the Quality Payment Program
- Review the information included in your Clinician Participation Letter andor help you use the MIPS Participation Look-up Tool to determine if you are included in the program
- Choose whether you will participate individually or as a part of a group
- Pick a participation pace for the 2017 transition year
- Identify appropriate MIPS measures and Improvement Activities based on your patients and practice structure
bull Map your current efforts to appropriate MIPS measures and Improvement Activities
- Determine a suitable submission mechanism(s) to report your data create a strategy for capturing data and guide you through the submission process
- Understand the MIPS scoring structure
- Analyze your performance data and trends
- Prepare to transition into an Alternative Payment Model (APM) or Advanced APMs
22
What program-specific services are available
Quality Payment Program
QPP Technical Assistance
bull Technical Assistance organizations can help you- Assess your practicersquos overall readiness for the Quality Payment Program
- Implement change management and strategic planning
- Redesign your practice workflow
- Optimize your current Health Information Technology (HIT) or begin integrating new forms of technology into your practice and select resources that meet your patientrsquos needs
- Form partnerships with other practices local stakeholders regional initiatives etc
- Participate in a quality improvement initiative if interested
23
What practice-specific services are available
Quality Payment Program
Quality Payment ProgramHow to get help
Two-minute QPP primer httpsyoutube96djML-m2Wo
Quality Payment Program
25httpswwwcmsgovNewsroomMediaReleaseDatabasePress-
releases2017-Press-releases-items2017-10-30html
Quality Payment Program
26
TwitterHashtaghttpstwittercomhashtagpatientsoverpaperworkref_src=twsrc5Egoogle7Ctwcamp5Eserp7Ctwgr5Ehashtag
Quality Payment Program
Thank you
27
Ashby Wolfe MD MPP MPH
Chief Medical Officer Region IX
Centers for Medicare and Medicaid Services
ashbywolfe1cmshhsgov
ResourceshttpswwwcmsgovResearch-Statistics-Data-and-SystemsMonitoring-
ProgramsMedicare-FFS-Compliance-ProgramsReducingProviderBurdenhtml
httpsqppcmsgov
httpswwwcmsgovNewsroomMediaReleaseDatabasePress-releases2017-Press-releases-items2017-10-30html
- Slide Number 1
- Disclaimer
- Objectives for today
- CMS OFFICES
- Slide Number 5
- Slide Number 6
- Slide Number 7
- Slide Number 8
- Slide Number 9
- Measure Alignment Efforts
- The CMS Innovation Center was created by the Affordable Care Act to develop test and implement new payment and delivery models
- Innovation Center Models
- CMS has engaged the health care delivery system and invested in innovation across the country
- Slide Number 14
- Slide Number 15
- Slide Number 16
- MACRA Goals
- The Quality Payment Program
- Pick Your Pace for Participation for the Transition Year
- Website httpsqppcmsgov
- Technical Support Available to Clinicians
- QPP Technical Assistance
- QPP Technical Assistance
- Slide Number 24
- Slide Number 25
- Slide Number 26
- Thank you
-
Quality Payment Program
14
Quality Payment Program
15
Quality Payment Program
THE
MEDICARE ACCESS amp CHIP REAUTHORIZATION ACT
OF 2015
Quality Payment Program
MACRA Goals
Through MACRA HHS aims to
bull Offer multiple pathways with varying levels of risk and reward for providers to tie more of their payments to value
bull Over time expand the opportunities for a broad range of providers to participate in APMs
bull Minimize additional reporting burdens for APM participants
bull Promote understanding of each physicianrsquos or practitionerrsquos status with respect to MIPS andor APMs
bull Support multi-payer initiatives and the development of APMs in Medicaid Medicare Advantage and other payer arrangements
Quality Payment Program
The Quality Payment Program
The Quality Payment Program policy will
bull Reform Medicare Part B payments for more than 600000 clinicians
bull Improve care across the entire health care delivery system
Clinicians have two tracks to choose from
5
Quality Payment Program
Test
bull Submit some data after January 1 2017
bull Neutral payment adjustment
Partial Year
bull Report for 90-day period after January 1 2017
bull Neutral or positive payment adjustment
19
Pick Your Pace for Participation for the Transition Year
Full Year
bull Fully participate starting January 1 2017
bull Positive payment adjustment
MIPS
Not participating in the Quality Payment Program for the Transition Year will result in a negative 4 payment adjustment
Participate in an Advanced Alternative
Payment Model
bull Some practices may choose to participate in an Advanced Alternative Payment Model in 2017
Note Clinicians do not need to tell CMS which option they intend to
pursue
Quality Payment Program
Website httpsqppcmsgov
Quality Payment Program
Technical Support Available to CliniciansIntegrated Technical Assistance Program
- Full-service expert help
bull Quality Payment Program Service Center
bull Quality Innovation NetworkQuality Improvement Organizations
bull Quality Payment Program mdash Small Underserved and Rural Support
bull Transforming Clinical Practice Initiative
bull APM Learning Networks
- Self-service
bull QPP Online Portal
21
All support is FREE to clinicians
httpsqppcmsgoveducation
Quality Payment Program
QPP Technical Assistance
bull Technical Assistance organizations can help you- Understand the general requirements of the Quality Payment Program
- Review the information included in your Clinician Participation Letter andor help you use the MIPS Participation Look-up Tool to determine if you are included in the program
- Choose whether you will participate individually or as a part of a group
- Pick a participation pace for the 2017 transition year
- Identify appropriate MIPS measures and Improvement Activities based on your patients and practice structure
bull Map your current efforts to appropriate MIPS measures and Improvement Activities
- Determine a suitable submission mechanism(s) to report your data create a strategy for capturing data and guide you through the submission process
- Understand the MIPS scoring structure
- Analyze your performance data and trends
- Prepare to transition into an Alternative Payment Model (APM) or Advanced APMs
22
What program-specific services are available
Quality Payment Program
QPP Technical Assistance
bull Technical Assistance organizations can help you- Assess your practicersquos overall readiness for the Quality Payment Program
- Implement change management and strategic planning
- Redesign your practice workflow
- Optimize your current Health Information Technology (HIT) or begin integrating new forms of technology into your practice and select resources that meet your patientrsquos needs
- Form partnerships with other practices local stakeholders regional initiatives etc
- Participate in a quality improvement initiative if interested
23
What practice-specific services are available
Quality Payment Program
Quality Payment ProgramHow to get help
Two-minute QPP primer httpsyoutube96djML-m2Wo
Quality Payment Program
25httpswwwcmsgovNewsroomMediaReleaseDatabasePress-
releases2017-Press-releases-items2017-10-30html
Quality Payment Program
26
TwitterHashtaghttpstwittercomhashtagpatientsoverpaperworkref_src=twsrc5Egoogle7Ctwcamp5Eserp7Ctwgr5Ehashtag
Quality Payment Program
Thank you
27
Ashby Wolfe MD MPP MPH
Chief Medical Officer Region IX
Centers for Medicare and Medicaid Services
ashbywolfe1cmshhsgov
ResourceshttpswwwcmsgovResearch-Statistics-Data-and-SystemsMonitoring-
ProgramsMedicare-FFS-Compliance-ProgramsReducingProviderBurdenhtml
httpsqppcmsgov
httpswwwcmsgovNewsroomMediaReleaseDatabasePress-releases2017-Press-releases-items2017-10-30html
- Slide Number 1
- Disclaimer
- Objectives for today
- CMS OFFICES
- Slide Number 5
- Slide Number 6
- Slide Number 7
- Slide Number 8
- Slide Number 9
- Measure Alignment Efforts
- The CMS Innovation Center was created by the Affordable Care Act to develop test and implement new payment and delivery models
- Innovation Center Models
- CMS has engaged the health care delivery system and invested in innovation across the country
- Slide Number 14
- Slide Number 15
- Slide Number 16
- MACRA Goals
- The Quality Payment Program
- Pick Your Pace for Participation for the Transition Year
- Website httpsqppcmsgov
- Technical Support Available to Clinicians
- QPP Technical Assistance
- QPP Technical Assistance
- Slide Number 24
- Slide Number 25
- Slide Number 26
- Thank you
-
Quality Payment Program
15
Quality Payment Program
THE
MEDICARE ACCESS amp CHIP REAUTHORIZATION ACT
OF 2015
Quality Payment Program
MACRA Goals
Through MACRA HHS aims to
bull Offer multiple pathways with varying levels of risk and reward for providers to tie more of their payments to value
bull Over time expand the opportunities for a broad range of providers to participate in APMs
bull Minimize additional reporting burdens for APM participants
bull Promote understanding of each physicianrsquos or practitionerrsquos status with respect to MIPS andor APMs
bull Support multi-payer initiatives and the development of APMs in Medicaid Medicare Advantage and other payer arrangements
Quality Payment Program
The Quality Payment Program
The Quality Payment Program policy will
bull Reform Medicare Part B payments for more than 600000 clinicians
bull Improve care across the entire health care delivery system
Clinicians have two tracks to choose from
5
Quality Payment Program
Test
bull Submit some data after January 1 2017
bull Neutral payment adjustment
Partial Year
bull Report for 90-day period after January 1 2017
bull Neutral or positive payment adjustment
19
Pick Your Pace for Participation for the Transition Year
Full Year
bull Fully participate starting January 1 2017
bull Positive payment adjustment
MIPS
Not participating in the Quality Payment Program for the Transition Year will result in a negative 4 payment adjustment
Participate in an Advanced Alternative
Payment Model
bull Some practices may choose to participate in an Advanced Alternative Payment Model in 2017
Note Clinicians do not need to tell CMS which option they intend to
pursue
Quality Payment Program
Website httpsqppcmsgov
Quality Payment Program
Technical Support Available to CliniciansIntegrated Technical Assistance Program
- Full-service expert help
bull Quality Payment Program Service Center
bull Quality Innovation NetworkQuality Improvement Organizations
bull Quality Payment Program mdash Small Underserved and Rural Support
bull Transforming Clinical Practice Initiative
bull APM Learning Networks
- Self-service
bull QPP Online Portal
21
All support is FREE to clinicians
httpsqppcmsgoveducation
Quality Payment Program
QPP Technical Assistance
bull Technical Assistance organizations can help you- Understand the general requirements of the Quality Payment Program
- Review the information included in your Clinician Participation Letter andor help you use the MIPS Participation Look-up Tool to determine if you are included in the program
- Choose whether you will participate individually or as a part of a group
- Pick a participation pace for the 2017 transition year
- Identify appropriate MIPS measures and Improvement Activities based on your patients and practice structure
bull Map your current efforts to appropriate MIPS measures and Improvement Activities
- Determine a suitable submission mechanism(s) to report your data create a strategy for capturing data and guide you through the submission process
- Understand the MIPS scoring structure
- Analyze your performance data and trends
- Prepare to transition into an Alternative Payment Model (APM) or Advanced APMs
22
What program-specific services are available
Quality Payment Program
QPP Technical Assistance
bull Technical Assistance organizations can help you- Assess your practicersquos overall readiness for the Quality Payment Program
- Implement change management and strategic planning
- Redesign your practice workflow
- Optimize your current Health Information Technology (HIT) or begin integrating new forms of technology into your practice and select resources that meet your patientrsquos needs
- Form partnerships with other practices local stakeholders regional initiatives etc
- Participate in a quality improvement initiative if interested
23
What practice-specific services are available
Quality Payment Program
Quality Payment ProgramHow to get help
Two-minute QPP primer httpsyoutube96djML-m2Wo
Quality Payment Program
25httpswwwcmsgovNewsroomMediaReleaseDatabasePress-
releases2017-Press-releases-items2017-10-30html
Quality Payment Program
26
TwitterHashtaghttpstwittercomhashtagpatientsoverpaperworkref_src=twsrc5Egoogle7Ctwcamp5Eserp7Ctwgr5Ehashtag
Quality Payment Program
Thank you
27
Ashby Wolfe MD MPP MPH
Chief Medical Officer Region IX
Centers for Medicare and Medicaid Services
ashbywolfe1cmshhsgov
ResourceshttpswwwcmsgovResearch-Statistics-Data-and-SystemsMonitoring-
ProgramsMedicare-FFS-Compliance-ProgramsReducingProviderBurdenhtml
httpsqppcmsgov
httpswwwcmsgovNewsroomMediaReleaseDatabasePress-releases2017-Press-releases-items2017-10-30html
- Slide Number 1
- Disclaimer
- Objectives for today
- CMS OFFICES
- Slide Number 5
- Slide Number 6
- Slide Number 7
- Slide Number 8
- Slide Number 9
- Measure Alignment Efforts
- The CMS Innovation Center was created by the Affordable Care Act to develop test and implement new payment and delivery models
- Innovation Center Models
- CMS has engaged the health care delivery system and invested in innovation across the country
- Slide Number 14
- Slide Number 15
- Slide Number 16
- MACRA Goals
- The Quality Payment Program
- Pick Your Pace for Participation for the Transition Year
- Website httpsqppcmsgov
- Technical Support Available to Clinicians
- QPP Technical Assistance
- QPP Technical Assistance
- Slide Number 24
- Slide Number 25
- Slide Number 26
- Thank you
-
Quality Payment Program
THE
MEDICARE ACCESS amp CHIP REAUTHORIZATION ACT
OF 2015
Quality Payment Program
MACRA Goals
Through MACRA HHS aims to
bull Offer multiple pathways with varying levels of risk and reward for providers to tie more of their payments to value
bull Over time expand the opportunities for a broad range of providers to participate in APMs
bull Minimize additional reporting burdens for APM participants
bull Promote understanding of each physicianrsquos or practitionerrsquos status with respect to MIPS andor APMs
bull Support multi-payer initiatives and the development of APMs in Medicaid Medicare Advantage and other payer arrangements
Quality Payment Program
The Quality Payment Program
The Quality Payment Program policy will
bull Reform Medicare Part B payments for more than 600000 clinicians
bull Improve care across the entire health care delivery system
Clinicians have two tracks to choose from
5
Quality Payment Program
Test
bull Submit some data after January 1 2017
bull Neutral payment adjustment
Partial Year
bull Report for 90-day period after January 1 2017
bull Neutral or positive payment adjustment
19
Pick Your Pace for Participation for the Transition Year
Full Year
bull Fully participate starting January 1 2017
bull Positive payment adjustment
MIPS
Not participating in the Quality Payment Program for the Transition Year will result in a negative 4 payment adjustment
Participate in an Advanced Alternative
Payment Model
bull Some practices may choose to participate in an Advanced Alternative Payment Model in 2017
Note Clinicians do not need to tell CMS which option they intend to
pursue
Quality Payment Program
Website httpsqppcmsgov
Quality Payment Program
Technical Support Available to CliniciansIntegrated Technical Assistance Program
- Full-service expert help
bull Quality Payment Program Service Center
bull Quality Innovation NetworkQuality Improvement Organizations
bull Quality Payment Program mdash Small Underserved and Rural Support
bull Transforming Clinical Practice Initiative
bull APM Learning Networks
- Self-service
bull QPP Online Portal
21
All support is FREE to clinicians
httpsqppcmsgoveducation
Quality Payment Program
QPP Technical Assistance
bull Technical Assistance organizations can help you- Understand the general requirements of the Quality Payment Program
- Review the information included in your Clinician Participation Letter andor help you use the MIPS Participation Look-up Tool to determine if you are included in the program
- Choose whether you will participate individually or as a part of a group
- Pick a participation pace for the 2017 transition year
- Identify appropriate MIPS measures and Improvement Activities based on your patients and practice structure
bull Map your current efforts to appropriate MIPS measures and Improvement Activities
- Determine a suitable submission mechanism(s) to report your data create a strategy for capturing data and guide you through the submission process
- Understand the MIPS scoring structure
- Analyze your performance data and trends
- Prepare to transition into an Alternative Payment Model (APM) or Advanced APMs
22
What program-specific services are available
Quality Payment Program
QPP Technical Assistance
bull Technical Assistance organizations can help you- Assess your practicersquos overall readiness for the Quality Payment Program
- Implement change management and strategic planning
- Redesign your practice workflow
- Optimize your current Health Information Technology (HIT) or begin integrating new forms of technology into your practice and select resources that meet your patientrsquos needs
- Form partnerships with other practices local stakeholders regional initiatives etc
- Participate in a quality improvement initiative if interested
23
What practice-specific services are available
Quality Payment Program
Quality Payment ProgramHow to get help
Two-minute QPP primer httpsyoutube96djML-m2Wo
Quality Payment Program
25httpswwwcmsgovNewsroomMediaReleaseDatabasePress-
releases2017-Press-releases-items2017-10-30html
Quality Payment Program
26
TwitterHashtaghttpstwittercomhashtagpatientsoverpaperworkref_src=twsrc5Egoogle7Ctwcamp5Eserp7Ctwgr5Ehashtag
Quality Payment Program
Thank you
27
Ashby Wolfe MD MPP MPH
Chief Medical Officer Region IX
Centers for Medicare and Medicaid Services
ashbywolfe1cmshhsgov
ResourceshttpswwwcmsgovResearch-Statistics-Data-and-SystemsMonitoring-
ProgramsMedicare-FFS-Compliance-ProgramsReducingProviderBurdenhtml
httpsqppcmsgov
httpswwwcmsgovNewsroomMediaReleaseDatabasePress-releases2017-Press-releases-items2017-10-30html
- Slide Number 1
- Disclaimer
- Objectives for today
- CMS OFFICES
- Slide Number 5
- Slide Number 6
- Slide Number 7
- Slide Number 8
- Slide Number 9
- Measure Alignment Efforts
- The CMS Innovation Center was created by the Affordable Care Act to develop test and implement new payment and delivery models
- Innovation Center Models
- CMS has engaged the health care delivery system and invested in innovation across the country
- Slide Number 14
- Slide Number 15
- Slide Number 16
- MACRA Goals
- The Quality Payment Program
- Pick Your Pace for Participation for the Transition Year
- Website httpsqppcmsgov
- Technical Support Available to Clinicians
- QPP Technical Assistance
- QPP Technical Assistance
- Slide Number 24
- Slide Number 25
- Slide Number 26
- Thank you
-
Quality Payment Program
MACRA Goals
Through MACRA HHS aims to
bull Offer multiple pathways with varying levels of risk and reward for providers to tie more of their payments to value
bull Over time expand the opportunities for a broad range of providers to participate in APMs
bull Minimize additional reporting burdens for APM participants
bull Promote understanding of each physicianrsquos or practitionerrsquos status with respect to MIPS andor APMs
bull Support multi-payer initiatives and the development of APMs in Medicaid Medicare Advantage and other payer arrangements
Quality Payment Program
The Quality Payment Program
The Quality Payment Program policy will
bull Reform Medicare Part B payments for more than 600000 clinicians
bull Improve care across the entire health care delivery system
Clinicians have two tracks to choose from
5
Quality Payment Program
Test
bull Submit some data after January 1 2017
bull Neutral payment adjustment
Partial Year
bull Report for 90-day period after January 1 2017
bull Neutral or positive payment adjustment
19
Pick Your Pace for Participation for the Transition Year
Full Year
bull Fully participate starting January 1 2017
bull Positive payment adjustment
MIPS
Not participating in the Quality Payment Program for the Transition Year will result in a negative 4 payment adjustment
Participate in an Advanced Alternative
Payment Model
bull Some practices may choose to participate in an Advanced Alternative Payment Model in 2017
Note Clinicians do not need to tell CMS which option they intend to
pursue
Quality Payment Program
Website httpsqppcmsgov
Quality Payment Program
Technical Support Available to CliniciansIntegrated Technical Assistance Program
- Full-service expert help
bull Quality Payment Program Service Center
bull Quality Innovation NetworkQuality Improvement Organizations
bull Quality Payment Program mdash Small Underserved and Rural Support
bull Transforming Clinical Practice Initiative
bull APM Learning Networks
- Self-service
bull QPP Online Portal
21
All support is FREE to clinicians
httpsqppcmsgoveducation
Quality Payment Program
QPP Technical Assistance
bull Technical Assistance organizations can help you- Understand the general requirements of the Quality Payment Program
- Review the information included in your Clinician Participation Letter andor help you use the MIPS Participation Look-up Tool to determine if you are included in the program
- Choose whether you will participate individually or as a part of a group
- Pick a participation pace for the 2017 transition year
- Identify appropriate MIPS measures and Improvement Activities based on your patients and practice structure
bull Map your current efforts to appropriate MIPS measures and Improvement Activities
- Determine a suitable submission mechanism(s) to report your data create a strategy for capturing data and guide you through the submission process
- Understand the MIPS scoring structure
- Analyze your performance data and trends
- Prepare to transition into an Alternative Payment Model (APM) or Advanced APMs
22
What program-specific services are available
Quality Payment Program
QPP Technical Assistance
bull Technical Assistance organizations can help you- Assess your practicersquos overall readiness for the Quality Payment Program
- Implement change management and strategic planning
- Redesign your practice workflow
- Optimize your current Health Information Technology (HIT) or begin integrating new forms of technology into your practice and select resources that meet your patientrsquos needs
- Form partnerships with other practices local stakeholders regional initiatives etc
- Participate in a quality improvement initiative if interested
23
What practice-specific services are available
Quality Payment Program
Quality Payment ProgramHow to get help
Two-minute QPP primer httpsyoutube96djML-m2Wo
Quality Payment Program
25httpswwwcmsgovNewsroomMediaReleaseDatabasePress-
releases2017-Press-releases-items2017-10-30html
Quality Payment Program
26
TwitterHashtaghttpstwittercomhashtagpatientsoverpaperworkref_src=twsrc5Egoogle7Ctwcamp5Eserp7Ctwgr5Ehashtag
Quality Payment Program
Thank you
27
Ashby Wolfe MD MPP MPH
Chief Medical Officer Region IX
Centers for Medicare and Medicaid Services
ashbywolfe1cmshhsgov
ResourceshttpswwwcmsgovResearch-Statistics-Data-and-SystemsMonitoring-
ProgramsMedicare-FFS-Compliance-ProgramsReducingProviderBurdenhtml
httpsqppcmsgov
httpswwwcmsgovNewsroomMediaReleaseDatabasePress-releases2017-Press-releases-items2017-10-30html
- Slide Number 1
- Disclaimer
- Objectives for today
- CMS OFFICES
- Slide Number 5
- Slide Number 6
- Slide Number 7
- Slide Number 8
- Slide Number 9
- Measure Alignment Efforts
- The CMS Innovation Center was created by the Affordable Care Act to develop test and implement new payment and delivery models
- Innovation Center Models
- CMS has engaged the health care delivery system and invested in innovation across the country
- Slide Number 14
- Slide Number 15
- Slide Number 16
- MACRA Goals
- The Quality Payment Program
- Pick Your Pace for Participation for the Transition Year
- Website httpsqppcmsgov
- Technical Support Available to Clinicians
- QPP Technical Assistance
- QPP Technical Assistance
- Slide Number 24
- Slide Number 25
- Slide Number 26
- Thank you
-
Quality Payment Program
The Quality Payment Program
The Quality Payment Program policy will
bull Reform Medicare Part B payments for more than 600000 clinicians
bull Improve care across the entire health care delivery system
Clinicians have two tracks to choose from
5
Quality Payment Program
Test
bull Submit some data after January 1 2017
bull Neutral payment adjustment
Partial Year
bull Report for 90-day period after January 1 2017
bull Neutral or positive payment adjustment
19
Pick Your Pace for Participation for the Transition Year
Full Year
bull Fully participate starting January 1 2017
bull Positive payment adjustment
MIPS
Not participating in the Quality Payment Program for the Transition Year will result in a negative 4 payment adjustment
Participate in an Advanced Alternative
Payment Model
bull Some practices may choose to participate in an Advanced Alternative Payment Model in 2017
Note Clinicians do not need to tell CMS which option they intend to
pursue
Quality Payment Program
Website httpsqppcmsgov
Quality Payment Program
Technical Support Available to CliniciansIntegrated Technical Assistance Program
- Full-service expert help
bull Quality Payment Program Service Center
bull Quality Innovation NetworkQuality Improvement Organizations
bull Quality Payment Program mdash Small Underserved and Rural Support
bull Transforming Clinical Practice Initiative
bull APM Learning Networks
- Self-service
bull QPP Online Portal
21
All support is FREE to clinicians
httpsqppcmsgoveducation
Quality Payment Program
QPP Technical Assistance
bull Technical Assistance organizations can help you- Understand the general requirements of the Quality Payment Program
- Review the information included in your Clinician Participation Letter andor help you use the MIPS Participation Look-up Tool to determine if you are included in the program
- Choose whether you will participate individually or as a part of a group
- Pick a participation pace for the 2017 transition year
- Identify appropriate MIPS measures and Improvement Activities based on your patients and practice structure
bull Map your current efforts to appropriate MIPS measures and Improvement Activities
- Determine a suitable submission mechanism(s) to report your data create a strategy for capturing data and guide you through the submission process
- Understand the MIPS scoring structure
- Analyze your performance data and trends
- Prepare to transition into an Alternative Payment Model (APM) or Advanced APMs
22
What program-specific services are available
Quality Payment Program
QPP Technical Assistance
bull Technical Assistance organizations can help you- Assess your practicersquos overall readiness for the Quality Payment Program
- Implement change management and strategic planning
- Redesign your practice workflow
- Optimize your current Health Information Technology (HIT) or begin integrating new forms of technology into your practice and select resources that meet your patientrsquos needs
- Form partnerships with other practices local stakeholders regional initiatives etc
- Participate in a quality improvement initiative if interested
23
What practice-specific services are available
Quality Payment Program
Quality Payment ProgramHow to get help
Two-minute QPP primer httpsyoutube96djML-m2Wo
Quality Payment Program
25httpswwwcmsgovNewsroomMediaReleaseDatabasePress-
releases2017-Press-releases-items2017-10-30html
Quality Payment Program
26
TwitterHashtaghttpstwittercomhashtagpatientsoverpaperworkref_src=twsrc5Egoogle7Ctwcamp5Eserp7Ctwgr5Ehashtag
Quality Payment Program
Thank you
27
Ashby Wolfe MD MPP MPH
Chief Medical Officer Region IX
Centers for Medicare and Medicaid Services
ashbywolfe1cmshhsgov
ResourceshttpswwwcmsgovResearch-Statistics-Data-and-SystemsMonitoring-
ProgramsMedicare-FFS-Compliance-ProgramsReducingProviderBurdenhtml
httpsqppcmsgov
httpswwwcmsgovNewsroomMediaReleaseDatabasePress-releases2017-Press-releases-items2017-10-30html
- Slide Number 1
- Disclaimer
- Objectives for today
- CMS OFFICES
- Slide Number 5
- Slide Number 6
- Slide Number 7
- Slide Number 8
- Slide Number 9
- Measure Alignment Efforts
- The CMS Innovation Center was created by the Affordable Care Act to develop test and implement new payment and delivery models
- Innovation Center Models
- CMS has engaged the health care delivery system and invested in innovation across the country
- Slide Number 14
- Slide Number 15
- Slide Number 16
- MACRA Goals
- The Quality Payment Program
- Pick Your Pace for Participation for the Transition Year
- Website httpsqppcmsgov
- Technical Support Available to Clinicians
- QPP Technical Assistance
- QPP Technical Assistance
- Slide Number 24
- Slide Number 25
- Slide Number 26
- Thank you
-
Quality Payment Program
Test
bull Submit some data after January 1 2017
bull Neutral payment adjustment
Partial Year
bull Report for 90-day period after January 1 2017
bull Neutral or positive payment adjustment
19
Pick Your Pace for Participation for the Transition Year
Full Year
bull Fully participate starting January 1 2017
bull Positive payment adjustment
MIPS
Not participating in the Quality Payment Program for the Transition Year will result in a negative 4 payment adjustment
Participate in an Advanced Alternative
Payment Model
bull Some practices may choose to participate in an Advanced Alternative Payment Model in 2017
Note Clinicians do not need to tell CMS which option they intend to
pursue
Quality Payment Program
Website httpsqppcmsgov
Quality Payment Program
Technical Support Available to CliniciansIntegrated Technical Assistance Program
- Full-service expert help
bull Quality Payment Program Service Center
bull Quality Innovation NetworkQuality Improvement Organizations
bull Quality Payment Program mdash Small Underserved and Rural Support
bull Transforming Clinical Practice Initiative
bull APM Learning Networks
- Self-service
bull QPP Online Portal
21
All support is FREE to clinicians
httpsqppcmsgoveducation
Quality Payment Program
QPP Technical Assistance
bull Technical Assistance organizations can help you- Understand the general requirements of the Quality Payment Program
- Review the information included in your Clinician Participation Letter andor help you use the MIPS Participation Look-up Tool to determine if you are included in the program
- Choose whether you will participate individually or as a part of a group
- Pick a participation pace for the 2017 transition year
- Identify appropriate MIPS measures and Improvement Activities based on your patients and practice structure
bull Map your current efforts to appropriate MIPS measures and Improvement Activities
- Determine a suitable submission mechanism(s) to report your data create a strategy for capturing data and guide you through the submission process
- Understand the MIPS scoring structure
- Analyze your performance data and trends
- Prepare to transition into an Alternative Payment Model (APM) or Advanced APMs
22
What program-specific services are available
Quality Payment Program
QPP Technical Assistance
bull Technical Assistance organizations can help you- Assess your practicersquos overall readiness for the Quality Payment Program
- Implement change management and strategic planning
- Redesign your practice workflow
- Optimize your current Health Information Technology (HIT) or begin integrating new forms of technology into your practice and select resources that meet your patientrsquos needs
- Form partnerships with other practices local stakeholders regional initiatives etc
- Participate in a quality improvement initiative if interested
23
What practice-specific services are available
Quality Payment Program
Quality Payment ProgramHow to get help
Two-minute QPP primer httpsyoutube96djML-m2Wo
Quality Payment Program
25httpswwwcmsgovNewsroomMediaReleaseDatabasePress-
releases2017-Press-releases-items2017-10-30html
Quality Payment Program
26
TwitterHashtaghttpstwittercomhashtagpatientsoverpaperworkref_src=twsrc5Egoogle7Ctwcamp5Eserp7Ctwgr5Ehashtag
Quality Payment Program
Thank you
27
Ashby Wolfe MD MPP MPH
Chief Medical Officer Region IX
Centers for Medicare and Medicaid Services
ashbywolfe1cmshhsgov
ResourceshttpswwwcmsgovResearch-Statistics-Data-and-SystemsMonitoring-
ProgramsMedicare-FFS-Compliance-ProgramsReducingProviderBurdenhtml
httpsqppcmsgov
httpswwwcmsgovNewsroomMediaReleaseDatabasePress-releases2017-Press-releases-items2017-10-30html
- Slide Number 1
- Disclaimer
- Objectives for today
- CMS OFFICES
- Slide Number 5
- Slide Number 6
- Slide Number 7
- Slide Number 8
- Slide Number 9
- Measure Alignment Efforts
- The CMS Innovation Center was created by the Affordable Care Act to develop test and implement new payment and delivery models
- Innovation Center Models
- CMS has engaged the health care delivery system and invested in innovation across the country
- Slide Number 14
- Slide Number 15
- Slide Number 16
- MACRA Goals
- The Quality Payment Program
- Pick Your Pace for Participation for the Transition Year
- Website httpsqppcmsgov
- Technical Support Available to Clinicians
- QPP Technical Assistance
- QPP Technical Assistance
- Slide Number 24
- Slide Number 25
- Slide Number 26
- Thank you
-
Quality Payment Program
Website httpsqppcmsgov
Quality Payment Program
Technical Support Available to CliniciansIntegrated Technical Assistance Program
- Full-service expert help
bull Quality Payment Program Service Center
bull Quality Innovation NetworkQuality Improvement Organizations
bull Quality Payment Program mdash Small Underserved and Rural Support
bull Transforming Clinical Practice Initiative
bull APM Learning Networks
- Self-service
bull QPP Online Portal
21
All support is FREE to clinicians
httpsqppcmsgoveducation
Quality Payment Program
QPP Technical Assistance
bull Technical Assistance organizations can help you- Understand the general requirements of the Quality Payment Program
- Review the information included in your Clinician Participation Letter andor help you use the MIPS Participation Look-up Tool to determine if you are included in the program
- Choose whether you will participate individually or as a part of a group
- Pick a participation pace for the 2017 transition year
- Identify appropriate MIPS measures and Improvement Activities based on your patients and practice structure
bull Map your current efforts to appropriate MIPS measures and Improvement Activities
- Determine a suitable submission mechanism(s) to report your data create a strategy for capturing data and guide you through the submission process
- Understand the MIPS scoring structure
- Analyze your performance data and trends
- Prepare to transition into an Alternative Payment Model (APM) or Advanced APMs
22
What program-specific services are available
Quality Payment Program
QPP Technical Assistance
bull Technical Assistance organizations can help you- Assess your practicersquos overall readiness for the Quality Payment Program
- Implement change management and strategic planning
- Redesign your practice workflow
- Optimize your current Health Information Technology (HIT) or begin integrating new forms of technology into your practice and select resources that meet your patientrsquos needs
- Form partnerships with other practices local stakeholders regional initiatives etc
- Participate in a quality improvement initiative if interested
23
What practice-specific services are available
Quality Payment Program
Quality Payment ProgramHow to get help
Two-minute QPP primer httpsyoutube96djML-m2Wo
Quality Payment Program
25httpswwwcmsgovNewsroomMediaReleaseDatabasePress-
releases2017-Press-releases-items2017-10-30html
Quality Payment Program
26
TwitterHashtaghttpstwittercomhashtagpatientsoverpaperworkref_src=twsrc5Egoogle7Ctwcamp5Eserp7Ctwgr5Ehashtag
Quality Payment Program
Thank you
27
Ashby Wolfe MD MPP MPH
Chief Medical Officer Region IX
Centers for Medicare and Medicaid Services
ashbywolfe1cmshhsgov
ResourceshttpswwwcmsgovResearch-Statistics-Data-and-SystemsMonitoring-
ProgramsMedicare-FFS-Compliance-ProgramsReducingProviderBurdenhtml
httpsqppcmsgov
httpswwwcmsgovNewsroomMediaReleaseDatabasePress-releases2017-Press-releases-items2017-10-30html
- Slide Number 1
- Disclaimer
- Objectives for today
- CMS OFFICES
- Slide Number 5
- Slide Number 6
- Slide Number 7
- Slide Number 8
- Slide Number 9
- Measure Alignment Efforts
- The CMS Innovation Center was created by the Affordable Care Act to develop test and implement new payment and delivery models
- Innovation Center Models
- CMS has engaged the health care delivery system and invested in innovation across the country
- Slide Number 14
- Slide Number 15
- Slide Number 16
- MACRA Goals
- The Quality Payment Program
- Pick Your Pace for Participation for the Transition Year
- Website httpsqppcmsgov
- Technical Support Available to Clinicians
- QPP Technical Assistance
- QPP Technical Assistance
- Slide Number 24
- Slide Number 25
- Slide Number 26
- Thank you
-
Quality Payment Program
Technical Support Available to CliniciansIntegrated Technical Assistance Program
- Full-service expert help
bull Quality Payment Program Service Center
bull Quality Innovation NetworkQuality Improvement Organizations
bull Quality Payment Program mdash Small Underserved and Rural Support
bull Transforming Clinical Practice Initiative
bull APM Learning Networks
- Self-service
bull QPP Online Portal
21
All support is FREE to clinicians
httpsqppcmsgoveducation
Quality Payment Program
QPP Technical Assistance
bull Technical Assistance organizations can help you- Understand the general requirements of the Quality Payment Program
- Review the information included in your Clinician Participation Letter andor help you use the MIPS Participation Look-up Tool to determine if you are included in the program
- Choose whether you will participate individually or as a part of a group
- Pick a participation pace for the 2017 transition year
- Identify appropriate MIPS measures and Improvement Activities based on your patients and practice structure
bull Map your current efforts to appropriate MIPS measures and Improvement Activities
- Determine a suitable submission mechanism(s) to report your data create a strategy for capturing data and guide you through the submission process
- Understand the MIPS scoring structure
- Analyze your performance data and trends
- Prepare to transition into an Alternative Payment Model (APM) or Advanced APMs
22
What program-specific services are available
Quality Payment Program
QPP Technical Assistance
bull Technical Assistance organizations can help you- Assess your practicersquos overall readiness for the Quality Payment Program
- Implement change management and strategic planning
- Redesign your practice workflow
- Optimize your current Health Information Technology (HIT) or begin integrating new forms of technology into your practice and select resources that meet your patientrsquos needs
- Form partnerships with other practices local stakeholders regional initiatives etc
- Participate in a quality improvement initiative if interested
23
What practice-specific services are available
Quality Payment Program
Quality Payment ProgramHow to get help
Two-minute QPP primer httpsyoutube96djML-m2Wo
Quality Payment Program
25httpswwwcmsgovNewsroomMediaReleaseDatabasePress-
releases2017-Press-releases-items2017-10-30html
Quality Payment Program
26
TwitterHashtaghttpstwittercomhashtagpatientsoverpaperworkref_src=twsrc5Egoogle7Ctwcamp5Eserp7Ctwgr5Ehashtag
Quality Payment Program
Thank you
27
Ashby Wolfe MD MPP MPH
Chief Medical Officer Region IX
Centers for Medicare and Medicaid Services
ashbywolfe1cmshhsgov
ResourceshttpswwwcmsgovResearch-Statistics-Data-and-SystemsMonitoring-
ProgramsMedicare-FFS-Compliance-ProgramsReducingProviderBurdenhtml
httpsqppcmsgov
httpswwwcmsgovNewsroomMediaReleaseDatabasePress-releases2017-Press-releases-items2017-10-30html
- Slide Number 1
- Disclaimer
- Objectives for today
- CMS OFFICES
- Slide Number 5
- Slide Number 6
- Slide Number 7
- Slide Number 8
- Slide Number 9
- Measure Alignment Efforts
- The CMS Innovation Center was created by the Affordable Care Act to develop test and implement new payment and delivery models
- Innovation Center Models
- CMS has engaged the health care delivery system and invested in innovation across the country
- Slide Number 14
- Slide Number 15
- Slide Number 16
- MACRA Goals
- The Quality Payment Program
- Pick Your Pace for Participation for the Transition Year
- Website httpsqppcmsgov
- Technical Support Available to Clinicians
- QPP Technical Assistance
- QPP Technical Assistance
- Slide Number 24
- Slide Number 25
- Slide Number 26
- Thank you
-
Quality Payment Program
QPP Technical Assistance
bull Technical Assistance organizations can help you- Understand the general requirements of the Quality Payment Program
- Review the information included in your Clinician Participation Letter andor help you use the MIPS Participation Look-up Tool to determine if you are included in the program
- Choose whether you will participate individually or as a part of a group
- Pick a participation pace for the 2017 transition year
- Identify appropriate MIPS measures and Improvement Activities based on your patients and practice structure
bull Map your current efforts to appropriate MIPS measures and Improvement Activities
- Determine a suitable submission mechanism(s) to report your data create a strategy for capturing data and guide you through the submission process
- Understand the MIPS scoring structure
- Analyze your performance data and trends
- Prepare to transition into an Alternative Payment Model (APM) or Advanced APMs
22
What program-specific services are available
Quality Payment Program
QPP Technical Assistance
bull Technical Assistance organizations can help you- Assess your practicersquos overall readiness for the Quality Payment Program
- Implement change management and strategic planning
- Redesign your practice workflow
- Optimize your current Health Information Technology (HIT) or begin integrating new forms of technology into your practice and select resources that meet your patientrsquos needs
- Form partnerships with other practices local stakeholders regional initiatives etc
- Participate in a quality improvement initiative if interested
23
What practice-specific services are available
Quality Payment Program
Quality Payment ProgramHow to get help
Two-minute QPP primer httpsyoutube96djML-m2Wo
Quality Payment Program
25httpswwwcmsgovNewsroomMediaReleaseDatabasePress-
releases2017-Press-releases-items2017-10-30html
Quality Payment Program
26
TwitterHashtaghttpstwittercomhashtagpatientsoverpaperworkref_src=twsrc5Egoogle7Ctwcamp5Eserp7Ctwgr5Ehashtag
Quality Payment Program
Thank you
27
Ashby Wolfe MD MPP MPH
Chief Medical Officer Region IX
Centers for Medicare and Medicaid Services
ashbywolfe1cmshhsgov
ResourceshttpswwwcmsgovResearch-Statistics-Data-and-SystemsMonitoring-
ProgramsMedicare-FFS-Compliance-ProgramsReducingProviderBurdenhtml
httpsqppcmsgov
httpswwwcmsgovNewsroomMediaReleaseDatabasePress-releases2017-Press-releases-items2017-10-30html
- Slide Number 1
- Disclaimer
- Objectives for today
- CMS OFFICES
- Slide Number 5
- Slide Number 6
- Slide Number 7
- Slide Number 8
- Slide Number 9
- Measure Alignment Efforts
- The CMS Innovation Center was created by the Affordable Care Act to develop test and implement new payment and delivery models
- Innovation Center Models
- CMS has engaged the health care delivery system and invested in innovation across the country
- Slide Number 14
- Slide Number 15
- Slide Number 16
- MACRA Goals
- The Quality Payment Program
- Pick Your Pace for Participation for the Transition Year
- Website httpsqppcmsgov
- Technical Support Available to Clinicians
- QPP Technical Assistance
- QPP Technical Assistance
- Slide Number 24
- Slide Number 25
- Slide Number 26
- Thank you
-
Quality Payment Program
QPP Technical Assistance
bull Technical Assistance organizations can help you- Assess your practicersquos overall readiness for the Quality Payment Program
- Implement change management and strategic planning
- Redesign your practice workflow
- Optimize your current Health Information Technology (HIT) or begin integrating new forms of technology into your practice and select resources that meet your patientrsquos needs
- Form partnerships with other practices local stakeholders regional initiatives etc
- Participate in a quality improvement initiative if interested
23
What practice-specific services are available
Quality Payment Program
Quality Payment ProgramHow to get help
Two-minute QPP primer httpsyoutube96djML-m2Wo
Quality Payment Program
25httpswwwcmsgovNewsroomMediaReleaseDatabasePress-
releases2017-Press-releases-items2017-10-30html
Quality Payment Program
26
TwitterHashtaghttpstwittercomhashtagpatientsoverpaperworkref_src=twsrc5Egoogle7Ctwcamp5Eserp7Ctwgr5Ehashtag
Quality Payment Program
Thank you
27
Ashby Wolfe MD MPP MPH
Chief Medical Officer Region IX
Centers for Medicare and Medicaid Services
ashbywolfe1cmshhsgov
ResourceshttpswwwcmsgovResearch-Statistics-Data-and-SystemsMonitoring-
ProgramsMedicare-FFS-Compliance-ProgramsReducingProviderBurdenhtml
httpsqppcmsgov
httpswwwcmsgovNewsroomMediaReleaseDatabasePress-releases2017-Press-releases-items2017-10-30html
- Slide Number 1
- Disclaimer
- Objectives for today
- CMS OFFICES
- Slide Number 5
- Slide Number 6
- Slide Number 7
- Slide Number 8
- Slide Number 9
- Measure Alignment Efforts
- The CMS Innovation Center was created by the Affordable Care Act to develop test and implement new payment and delivery models
- Innovation Center Models
- CMS has engaged the health care delivery system and invested in innovation across the country
- Slide Number 14
- Slide Number 15
- Slide Number 16
- MACRA Goals
- The Quality Payment Program
- Pick Your Pace for Participation for the Transition Year
- Website httpsqppcmsgov
- Technical Support Available to Clinicians
- QPP Technical Assistance
- QPP Technical Assistance
- Slide Number 24
- Slide Number 25
- Slide Number 26
- Thank you
-
Quality Payment Program
Quality Payment ProgramHow to get help
Two-minute QPP primer httpsyoutube96djML-m2Wo
Quality Payment Program
25httpswwwcmsgovNewsroomMediaReleaseDatabasePress-
releases2017-Press-releases-items2017-10-30html
Quality Payment Program
26
TwitterHashtaghttpstwittercomhashtagpatientsoverpaperworkref_src=twsrc5Egoogle7Ctwcamp5Eserp7Ctwgr5Ehashtag
Quality Payment Program
Thank you
27
Ashby Wolfe MD MPP MPH
Chief Medical Officer Region IX
Centers for Medicare and Medicaid Services
ashbywolfe1cmshhsgov
ResourceshttpswwwcmsgovResearch-Statistics-Data-and-SystemsMonitoring-
ProgramsMedicare-FFS-Compliance-ProgramsReducingProviderBurdenhtml
httpsqppcmsgov
httpswwwcmsgovNewsroomMediaReleaseDatabasePress-releases2017-Press-releases-items2017-10-30html
- Slide Number 1
- Disclaimer
- Objectives for today
- CMS OFFICES
- Slide Number 5
- Slide Number 6
- Slide Number 7
- Slide Number 8
- Slide Number 9
- Measure Alignment Efforts
- The CMS Innovation Center was created by the Affordable Care Act to develop test and implement new payment and delivery models
- Innovation Center Models
- CMS has engaged the health care delivery system and invested in innovation across the country
- Slide Number 14
- Slide Number 15
- Slide Number 16
- MACRA Goals
- The Quality Payment Program
- Pick Your Pace for Participation for the Transition Year
- Website httpsqppcmsgov
- Technical Support Available to Clinicians
- QPP Technical Assistance
- QPP Technical Assistance
- Slide Number 24
- Slide Number 25
- Slide Number 26
- Thank you
-
Quality Payment Program
25httpswwwcmsgovNewsroomMediaReleaseDatabasePress-
releases2017-Press-releases-items2017-10-30html
Quality Payment Program
26
TwitterHashtaghttpstwittercomhashtagpatientsoverpaperworkref_src=twsrc5Egoogle7Ctwcamp5Eserp7Ctwgr5Ehashtag
Quality Payment Program
Thank you
27
Ashby Wolfe MD MPP MPH
Chief Medical Officer Region IX
Centers for Medicare and Medicaid Services
ashbywolfe1cmshhsgov
ResourceshttpswwwcmsgovResearch-Statistics-Data-and-SystemsMonitoring-
ProgramsMedicare-FFS-Compliance-ProgramsReducingProviderBurdenhtml
httpsqppcmsgov
httpswwwcmsgovNewsroomMediaReleaseDatabasePress-releases2017-Press-releases-items2017-10-30html
- Slide Number 1
- Disclaimer
- Objectives for today
- CMS OFFICES
- Slide Number 5
- Slide Number 6
- Slide Number 7
- Slide Number 8
- Slide Number 9
- Measure Alignment Efforts
- The CMS Innovation Center was created by the Affordable Care Act to develop test and implement new payment and delivery models
- Innovation Center Models
- CMS has engaged the health care delivery system and invested in innovation across the country
- Slide Number 14
- Slide Number 15
- Slide Number 16
- MACRA Goals
- The Quality Payment Program
- Pick Your Pace for Participation for the Transition Year
- Website httpsqppcmsgov
- Technical Support Available to Clinicians
- QPP Technical Assistance
- QPP Technical Assistance
- Slide Number 24
- Slide Number 25
- Slide Number 26
- Thank you
-
Quality Payment Program
26
TwitterHashtaghttpstwittercomhashtagpatientsoverpaperworkref_src=twsrc5Egoogle7Ctwcamp5Eserp7Ctwgr5Ehashtag
Quality Payment Program
Thank you
27
Ashby Wolfe MD MPP MPH
Chief Medical Officer Region IX
Centers for Medicare and Medicaid Services
ashbywolfe1cmshhsgov
ResourceshttpswwwcmsgovResearch-Statistics-Data-and-SystemsMonitoring-
ProgramsMedicare-FFS-Compliance-ProgramsReducingProviderBurdenhtml
httpsqppcmsgov
httpswwwcmsgovNewsroomMediaReleaseDatabasePress-releases2017-Press-releases-items2017-10-30html
- Slide Number 1
- Disclaimer
- Objectives for today
- CMS OFFICES
- Slide Number 5
- Slide Number 6
- Slide Number 7
- Slide Number 8
- Slide Number 9
- Measure Alignment Efforts
- The CMS Innovation Center was created by the Affordable Care Act to develop test and implement new payment and delivery models
- Innovation Center Models
- CMS has engaged the health care delivery system and invested in innovation across the country
- Slide Number 14
- Slide Number 15
- Slide Number 16
- MACRA Goals
- The Quality Payment Program
- Pick Your Pace for Participation for the Transition Year
- Website httpsqppcmsgov
- Technical Support Available to Clinicians
- QPP Technical Assistance
- QPP Technical Assistance
- Slide Number 24
- Slide Number 25
- Slide Number 26
- Thank you
-
Quality Payment Program
Thank you
27
Ashby Wolfe MD MPP MPH
Chief Medical Officer Region IX
Centers for Medicare and Medicaid Services
ashbywolfe1cmshhsgov
ResourceshttpswwwcmsgovResearch-Statistics-Data-and-SystemsMonitoring-
ProgramsMedicare-FFS-Compliance-ProgramsReducingProviderBurdenhtml
httpsqppcmsgov
httpswwwcmsgovNewsroomMediaReleaseDatabasePress-releases2017-Press-releases-items2017-10-30html
- Slide Number 1
- Disclaimer
- Objectives for today
- CMS OFFICES
- Slide Number 5
- Slide Number 6
- Slide Number 7
- Slide Number 8
- Slide Number 9
- Measure Alignment Efforts
- The CMS Innovation Center was created by the Affordable Care Act to develop test and implement new payment and delivery models
- Innovation Center Models
- CMS has engaged the health care delivery system and invested in innovation across the country
- Slide Number 14
- Slide Number 15
- Slide Number 16
- MACRA Goals
- The Quality Payment Program
- Pick Your Pace for Participation for the Transition Year
- Website httpsqppcmsgov
- Technical Support Available to Clinicians
- QPP Technical Assistance
- QPP Technical Assistance
- Slide Number 24
- Slide Number 25
- Slide Number 26
- Thank you
-