medicaid mu and the quality payment program: connecting ... · attest to medicaid mu in 2017...
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MedicaidMUandtheQualityPaymentProgram:ConnectingtheDots
RachaelTomaskovic,MHA,PCMHCCE,CPHIMS
OutreachSpecialist,HealthIT andQPP-SURS
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Objectives
§ OverviewoftheMedicareAccessandCHIPReauthorizationActof2015(MACRA)
§ IntroducethecomponentsoftheQualityPaymentProgram§ StructureoftheMerit-BasedIncentivePaymentSystem(MIPS)
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Disclaimer
§ ThesourcematerialforthispresentationwastakendirectlyfromQPP.CMS.gov.Allinformationwascurrentatthetimethepresentationwaswritten.PleaserefertoQPP.CMS.gov forthemostcurrentQualityPaymentPrograminformation.
TheMedicareAccessandCHIPReauthorizationActof2015(MACRA)
§ SignedintolawonApril16,2015
§ RepealstheMedicaresustainablegrowthrate(SGR)formula
§ ChangesthewaythatMedicarerewardscliniciansforvalueovervolume
5/23/17 Copyright©2017AFMC,Inc.AllRightsReserved. 4Source:qpp.cms.gov
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MACRA
QualityPaymentProgram
Source:qpp.cms.gov
MIPSTheMerit-BasedIncentivePaymentSystem
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TwoAlignedProgramsin2017
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Medicare
BillMedicarePartBgreaterthan$30,000orseemorethan100Medicare
patients?
IfnotpartofanAdvancedAlternativePaymentModel,MIPSreporting
required.
Report3ofthe4MIPScategoriesin2017.
Medicaid
ParticipateintheMedicaidMUprograminthepast?
Stillabletoreachthe30%patientvolumethreshold?
AttesttoMedicaidMUin2017throughtheMAPIR
Medicare
BillMedicarePartBgreaterthan$30,000orseemorethan
100Medicarepatients?
Ifnotpartofanadvancedalternativepaymentmodel,MIPSreportingrequired
ReportthreeofthefourMIPScategoriesin2017
YES,REPORTTOBOTHPROGRAMSIN2017.
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MIPS
PQRS New Category
Medicare Meaningful
Use
Value Based
Modifier
Source:qpp.cms.gov
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MIPS:Whoqualifiesasaneligibleclinician?
WhoisconsideredaPhysician?
→ DoctorsofMedicineorOsteopathicMedicine(MDorDO)→ DoctorsofDentalMedicineorDentalSurgery(DDMorDDS)→ DoctorsofPodiatricMedicine(DPM)→ DoctorsofOptometry(OD)→ Chiropractors(DC)
Source:qpp.cms.gov
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Whowillnot participateinMIPS?
Duringone oftheyearlongdeterminationperiods:Sept.1,2015– Aug.31,2016Sept.1,2016– Aug.31,2017 Source:qpp.cms.gov
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MIPS:HowCliniciansareScored
2017
Source:qpp.cms.gov
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2017TransitionYear:PickYourPace
Source:qpp.cms.gov
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MIPSTestOption:MinimumRequirementtoAvoid4%Penalty
Source:qpp.cms.gov
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MIPSPartialParticipation
EligibleClinicianscanreportdifferent90dayperiodsforeachMIPScategory.CMSrecommendsquarterlyreportingbecausedataisreviewedquarterlybyCMS.
Source:qpp.cms.gov
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MIPSFullParticipation
Source:qpp.cms.gov
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MIPSParticipationNotes
Source:qpp.cms.gov
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Individualvs.GroupReporting
Source:qpp.cms.gov
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MIPSCategoryReportingMethods
Source:qpp.cms.gov
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MIPSQualityPerformanceCategory
Source:qpp.cms.gov
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MIPSQualityPerformanceCategory
Source:qpp.cms.gov
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MIPSQualityPerformanceCategory
Source:qpp.cms.gov
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MIPSQualityPerformanceCategory
Source:qpp.cms.gov
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MIPSQualityPerformanceCategory
Source:qpp.cms.gov
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MIPSCostPerformanceCategory
Ø Nodatasubmissionrequired;0%offinalscorein2017
Ø Calculatedfromadjudicatedclaims.Ø CMSwillstillprovidefeedbackonhowyouperformed
inthiscategoryin2017,butitwillnotaffectyour2019payments.
Ø UsesmeasurespreviouslyusedinthePhysicianValue-BasedModifierprogramorreportedintheQualityandResourceUseReport(QRUR)
CMSseekstoprovideclinicianswithinformationtoreducehealthcarespendingandpromotethedeliveryofhigh-valuecare.
Source:qpp.cms.gov
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MIPSImprovementActivities(IA)
Source:qpp.cms.gov
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MIPSImprovementActivities(IA)
Source:qpp.cms.gov
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MIPSImprovementActivities(IA)
Source:qpp.cms.gov
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MIPSImprovementActivities(IA)
Source:qpp.cms.gov
Source:qpp.cms.gov5/23/17 Copyright©2017AFMC,Inc.AllRightsReserved. 29
MIPSAdvancingCareInformation(ACI)PerformanceCategory
2014CEHRT2015CEHRT
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MIPSAdvancingCareInformation(ACI)PerformanceCategory
Source:qpp.cms.gov
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MIPSAdvancingCareInformation(ACI)PerformanceCategory
Source:qpp.cms.gov
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MIPSAdvancingCareInformation(ACI)PerformanceCategory
Source:qpp.cms.gov
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MIPSAdvancingCareInformation(ACI)PerformanceCategory
Source:qpp.cms.gov
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MIPSAdvancingCareInformation(ACI)PerformanceCategory
Source:qpp.cms.gov
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MIPSAdvancingCareInformation(ACI)PerformanceCategory
0or50points
0to90points
0to15points
TotalACIScore=0to100points(potentialfor155points,butcappedat100)
Source:qpp.cms.gov
ACIvsMedicaidMU
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ACI2017TransitionObjectivesandMeasures
1. ProtectPatientHealthInformation2. e-Prescribing3. HealthInformationExchange4. ProvidePatientAccess5. Patient-specificEducation6. View,Download,Transmit(Portal)7. SecureMessaging8. MedicationReconciliation9. ImmunizationRegistryReporting
Bonus:SyndromicSurveillance,SpecializedRegistryReporting,andReportingIAsviaEHR
MedicaidMU2017ObjectivesandMeasures
1. ProtectPatientHealthInformation2. ClinicalDecisionSupport3. CPOE(Medications,Labs,
Radiology)4. e-Prescribing5. HealthInformationExchange6. Patient-specificEducation7. MedicationReconciliation8. PatientPortalAccessandView,
Download,Transmit9. SecureMessaging
PublicHealthReporting(2Required)1. ImmunizationRegistryReporting2. SyndromicSurveillance3. SpecializedRegistry
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MIPSTechnicalAssistance
Source:qpp.cms.gov
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Questions?
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MACRA
QualityPaymentProgram
Source:qpp.cms.gov