May 2017 Coffee Talk: Understanding the Quality Payment Program’s Group Reporting option and Support For Small Practices

Temaka Williams, MPH, MBA

May 11, 2017

This material was prepared by Telligen, Medicare Quality Innovation Network Quality Improvement

Organization, under contract with the Centers for Medicare & Medicaid Services (CMS), an agency of the U.S. Department of Health and Human Services. The contents presented do not necessarily reflect CMS policy. 11SOW-QIN-D1-05/11/17-2123

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• Telligen: Quality Innovation Network-Quality Improvement Organization (QIN-QIO) for Colorado, Illinois and Iowa

• Subject Matter Experts for CMS Quality Performance Initiatives

Telligen QIN-QIO

Sandy Swallow, CMA Program Specialist Iowa

Linda Brewer Sr. QI Facilitator I l linois

Temaka Williams HIT Advisor

I l linois

Courtnay Ryan QI Facilitator Colorado

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Today’s Objectives

• Understand the choice between reporting as an individual or as a group in the Quality Payment Program (QPP).

• Become familiar with who to contact for QPP support and technical assistance for small, underserved and rural practices.

VERSUS

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Quality Payment Program(QPP) Basics

• MACRA – Medicare Access and CHIP Reauthorization Act of 2015. Signed into law in April

2015.

• QPP – Quality Payment Program. The Quality Payment Program has two tracks you can

choose:

Advanced Alternative Payment Models (APMs) or

The Merit-based Incentive Payment System (MIPS)

• MIPS – Merit-Based Incentive Program. MIPS consolidates several physician quality

reporting and payment programs, which includes: Physician Quality Reporting System (PQRS), Meaningful Use (MU) and Value-based Payment Modifier (VBM) .

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Who is Eligible?

• Eligible: – Physicians (MD, DOs, Dentists, Optometrist, Podiatrists ), physician

assistants, clinical nurse specialists, nurse practitioners and nurse anesthetists

• Exempt: – Providers newly enrolled in Medicare Part B.

– Bills less than or equal to $30,000 in Part B allowable charges or provides care for less than or equal to 100 Part B-enrolled beneficiaries.

– Qualifying APM participants and Partial Qualifying APM participants that choose not to participate in MIPS.

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Eligibility Look Up Tool

https://qpp.cms.gov/

7 © 2016, Telligen, Inc.

Transition Year & Iterative Learning and Development Period

Test Year Submit Something

Neutral or small bonus

Avoid Penalty

Partial Year 90 day Submission

Neutral or small bonus

No penalty

Full Year Submission

Neutral or Moderate bonus

No penalty

Participate in an Advanced Payment

Model in 2017

Don’t Participate Receive -4% payment

adjustment

QPP “Pick Your Pace in 2017”

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MIPS Program: What Are Your Reporting Options?

Options

Individual Group

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MIPS: Reporting Options

Type Identification Mechanism

Individual • Single NPI tied to TIN • Submit individual-level data • Data submission via claims, EHR, registry or QCDR

Group • Set of clinicians identified by NPIs sharing common TIN • Submit group-level data • Data submission via CMS web interface (25+), EHR, registry

or QCDR

APM Entity Group

• Collection of entities participating in an APM that doesn’t qualify for Advanced APM or meet thresholds

• Submit MIPS data to avoid downward payment adjustment

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Data Submission Mechanisms for Individual and Group Reporting

Individual Reporting

Quality- Claims, QCDR Qualified Registry, EHR

ACI- Attestation, QCDR, Qualified Registry, EHR

IA: Attestation, QCDR, Qualified Registry

Group Reporting

Quality- QCDR, Qualified Registry, EHR, CMS Web Interface (25+)

ACI- Attestation, QCDR, Qualified Registry, EHR, CMS Web Interface

(25+)

IA: Attestation, QCDR, Qualified Registry, EHR, CMS Web Interface

(25+)

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Quality Performance Category (60% Weight)

• Things to Consider In Group Reporting – Group reporting via CMS Web Interface option for groups of 25

or more will be required to report on 15 measures in 2017.

– Group reporting via QCDR, Registry or EHR report at least six measures including at least one outcome measure.

– Claims reporting is NOT an option.

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Advancing Care Information Category (25% Weight)

• Things to Consider In Group Reporting – The data submission criteria for the ACI performance category is

the same as the individual level but the data submitted is aggregated.

– Base Score: Fulfill the 5 required measures for a minimum of 90 days

Security Risk Analysis

E-prescribing

Provide patient access

Send summary of care

Request/accept summary of care

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Cost Measures Category (0% Weight)

• Things to Consider In Group Reporting – The cost performance will have 0% weight for the 2017 transition

year and the weight will be increased in succeeding years.

– Eligible clinicians will receive feedback reports on this performance category.

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Improvement Activity Category (15% Weight)

• Things to Consider In Group Reporting – 90- day performance period for Improvement Activities.

– Must attest to two 20-point high weighted activities, four 10 point medium weighted activities, or another combination of high and medium weighted activities equaling 40 points or more.

– If at least once clinician in the group has been engaged in that activity for 90 continuous days, all clinicians in the group will receive credit.

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Group Reporting- Registration

Do I need to register? Only those groups of 25 or more who are reporting via the Web Interface program, or those groups with 2 or more administering the CAHPS for MIPS survey, need to register by June 30, 2017.

Do I need to do anything else? Even if your group registered in 2016, you may need to update your information before June 30, 2017 if:

• The number of eligible clinicians in your group has changed since 2016

• Your group wants to enroll in the Consumer Assessment of Health Providers and Systems (CAHPS) for MIPS survey

To register or update your group's information, you must have a valid Enterprise Identity Management (EIDM) account with a ‘Physician Quality and Value Programs’ role. For more information, visit https://portal.cms.gov

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Deciding to Report as a Group: Recap

• Groups must aggregate their data for each performance category.

• A physician who is considered low volume in a practice that is reporting MIPS as a group, that provider will no longer be considered exempt from MIPS. The low-volume physician’s performance will be included in the group score, and the provider will receive the same Medicare payment adjustment as the group.

• You will be assessed and scored as a group across all four performance categories.

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Now Available: Accredited Online Course – Quality Payment Program (QPP) in 2017: Pick Your Pace

• A new, online and self-paced course on participating in the Quality Payment Program and Picking a Pace that meets the needs of your practice is now available through the MLN Learning Management System!

• Visit: https://learner.mlnlms.com/Default.aspx

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Stay Connected to Telligen

https://telligenqinqio.com/events/ https://telligenqinqio.com/newsletters/newsletter-sign-up/

19 © 2016, Telligen, Inc.

Technical Assistance Programs

• Full Service, expert help • QIN QIOs (Telligen for Iowa, Colorado and Illinois)

• Quality Payment Program Service Center

• Help Desk 866-288-8292 or QPP@cms.hhs.gov

• QPP-SURS (Quality Payment Program – Small, Underserved and Rural Support)*

• Transforming Clinical Practice Initiative (TCPI)

• Iowa COMPASS PTN

• APM Learning Networks*

• Innovation Center’s Learning systems

• Self-service • QPP Website and Online Portal www.qpp.cms.gov

• 2016 Final Rule https://qpp.cms.gov/docs/CMS-5517-FC.pdf

What Support is Available to Clinicians?

Quality Payment Program Small, Underserved and Rural Support

(QPP-SURS) TMF Technical Assistance

My Contact Information

Pam Foyster

pamela.foyster@tmf.org

970-787-0192

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Email is best; if we need to set up a call, I can do that as well.

What is TMF QPP-SURS?

TMF Health Quality Institute works under contract with the Centers for Medicare & Medicaid Services to help small medical practices, including rural and medically underserved areas, prepare for and participate in the new Quality Payment Program.

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TMF QPP-SURS Region

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How TMF Can Support Your Practice

• Customized technical assistance

• Designed for practices with 15 or fewer eligible clinicians Rural practices

Health professional shortage areas

Medically underserved areas

• Provide support to clinicians by Assisting in the selection and reporting of MIPS Quality, Advancing

Care, and Improvement Activity measures

Review QRUR

Optimizing Health Information Technology

Evaluating practices’ options for joining an Advanced APM

• Support is provided at no cost to clinicians

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How to Request Technical Assistance

• Clinicians can complete a QPP-SURS Request for Support form Email QPP-SURS@tmf.org

• Join the QPP Learning & Action Network https://www.tmfqin.org/QPP Register for FREE access to information, education and

webinars/office hours

• For information from CMS, visit https://qpp.cms.gov QPP Fact Sheets ‘Pick your Pace’ QPP Videos QPP Q&A Documents MIPS Eligibility Look up Tool

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Support Request

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Upcoming Events

Let’s Talk QPP! Office Hours

May 17, 11 a.m. MT

> Register here

May 24, 11 a.m. MT

Find a list of all upcoming QPP events, with links to registration, at www.TMFQIN.org/QPP.

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Thanks talk to you soon!

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29 © 2016, Telligen, Inc.

• SURS (Small, Underserved and Rural Support) – Announced February 16

– 11 organizations awarded contracts

– Telligen provides assistance to Iowa, Nebraska, South Dakota and North Dakota

– No cost to practices

• Solo or small practices (15 or fewer clinicians) – Rural, health professional shortage areas (HPSA)

– Medically underserved areas (MUA)

• Outreach, guidance and direct technical assistance – Practice readiness, education, health IT optimization

– Strategic planning, assisting in the full transition to APM

Telligen QPP Resource Center

30 © 2016, Telligen, Inc.

Telligen QPP Resource Center Partners

31 © 2016, Telligen, Inc.

• SURS (Small, Underserved and Rural Support) Benefits – Point of contact to help you select Quality Measures and

Improvement Activities to fit your practice as well as to maximize your Advancing Care Information score

– Access to a Help Desk from 8:00 a.m. – 5:00 p.m. Central

– Office Hours on Tuesdays 9:00 – 11:00 a.m. and Thursdays 12:00 – 1:00 p.m. Central

– A monthly newsletter, including timely program updates from CMS, directly to your inbox

– Access to expertise for Health IT, chiropractic, behavioral health, PCMH and financial questions

Telligen QPP Resource Center Benefits

32 © 2016, Telligen, Inc.

• 844-358-4021

• qpp-surs@telligen.com

• Blog site: https://telligenqpp.com/ – Currently has calendar of events

– Will grow in content

Michelle Brunsen

• 515-453-8180

• mbrunsen@telligen.com

This material was prepared by Telligen, Quality Payment Program Small/Underserved/and Rural Support cont ractor under cont ract with the Centers for Medicare & Medicaid Services (CMS), an agency of the U.S. Department of Health & Human Services. The contents presented do not necessarily reflect CMS policy. HHSM-500-2017-00012C

Telligen QPP Resource Center – Contact Us Today!

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What the QPP Resource CenterTM Can Do for You Deb Gory, MS

Project Manager, Research Associate

Northern Illinois University

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• Together, Northern Illinois University and Northwestern University are helping Illinois providers navigate the quality payment program.

• They have a proven working relationship supporting providers in quality improvement and CMS initiatives.

• Through QPP of Illinois, providers can work with the same teams that have been successfully helping them with Meaningful Use, Practice Transformation Network and Healthy Hearts in the Heartland.

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QPP Support is Available

The Quality Payment Program Resource CenterTM for the Midwest, a CMS-funded collaboration among 10 key partners, is focused on supporting providers in small

practices, underserved or rural (SURS) areas. • Provides free help to eligible clinicians as they navigate QPP.

• Resource CenterTM web portal contains education and resources to assess

readiness, impact, and a score predictor • Resource CenterTM also provides expert QPP Advisors who are available via live

chat or phone support.

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Resource Center Approach

Even if the Resource Center is unable to assist

the provider, the Center will work to connect

them with another source of support, based on

practice size and needs.

The Resource Center will connect providers directly to:

• Quality Improvement Organizations (QIOs)

• Practice Transformation Networks (PTNs)

• Regional Extension Centers (RECs)

• One of the other 10 Quality Payment Program contractors (outside of the Midwest 7-state region)

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Questions?

If you practice in Illinois, we encourage you to contact us at:

info@QPP-IL.org or 844-QPP-DESK (844-777-9975)

Visit our website at qpp-il.org

You can also find more information at the Midwest Resource Center:

qppresourcecenter.com

And CMS:

qpp.cms.gov

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• Upcoming Coffee Talks with subject matter experts:

– Open discuss with Q & A – dedicated to your questions

– 2nd Thursday every month

– 11:00 a.m. CST for 1 hour

June 8, 2017

July 13, 2017

August 10, 2017

• Do you want to be added to your state’s contact list?

– Colorado: Courtnay Ryan; courtnay.ryan@area-d.hcqis.org

– Illinois: Temaka Williams; temaka.william@area-d.hcqis.org

– Illinois: Linda Brewer; linda.brewer@area-d.hcqis.org

– Iowa: Sandy Swallow; sandy.swallow@area-d.hcqis.org

We Are Here to Help – Stay Tuned!