title: advanced apms & mips apms - telligen qin-qio · date june 8th, 2017 title: advanced apms...
TRANSCRIPT
Date June 8th, 2017
Title: Advanced APMs & MIPS APMs
This material was prepared by Telligen, the 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-CO-D1-06/07/17-2169
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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 Iowa
Linda Brewer Illinois
Temaka Williams Illinois Courtnay Ryan
Colorado
3 © 2016, Telligen, Inc.
• Quality Payment Program General Updates
• Provide an overview of the Quality Payment Program Advanced Alternative Payment Model Track – Benefits, criteria, 2017 approved models, qualifying professionals,
resources
• Provide an overview of the MIPS – APM track – Participation, criteria, qualifying professionals, scoring, resources
Objectives
4 © 2016, Telligen, Inc.
Predictive Qualifying APM Participants (QP) Fact Sheet: https://innovation.cms.gov/Files/x/qpp-predictiveqp-methodfs.pdf
Quality Payment Program Overview Online Course
Quality Payment Program Pick Your Pace Online Course https://www.cms.gov/Medicare/Quality-Initiatives-Patient-Assessment-Instruments/Value-Based-Programs/MACRA-MIPS-and-APMs/Quality-Payment-Program-Events.html
2017 Clinical Quality Data Registry Approved List Released: https://qpp.cms.gov/docs/QPP_2017_CMS_Approved_QCDRs.pdf
QPP Updates - Stay Informed! www.qpp.cms.gov
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Disclaimer
• The information in this presentation is what we currently know as it has been explained by Centers for Medicare and Medicaid Services (CMS). The program is evolving with new rules and regulations to come.
• Slide Credits: Thank you to Dr. Mark Levine, CMS Region VII
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The Quality Payment Program (QPP)
• Medicare Access and CHIP Reauthorization Act “MACRA”
• Passed with Bipartisan Congressional Support
• Repealed the Sustainable Growth Rate
• Reforms Medicare Part B payments
• Provides Two Tracks: MIPS and APMs
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Quality Payment Program Strategic Goals
Improve Beneficiary Outcomes
Enhance Clinician Experience
Increase Adoption of
Advanced APMs
Improve Data & Information
Sharing
Maximize Participation
Ensure operational
excellence in program
implementation
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nc
Advanced Alternative Payment Models (APMs)
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New approach to paying for medical care through Medicare that incentives quality and value.
Developed by CMS
Innovation Center
Participants in APMs receive greater reward for taking on risk related to patient outcomes
What is an Alternative Payment Model?
10 © 2016, Telligen, Inc.
The Basics of Advanced APMs
APM
Advanced APM
What are Advanced APMs?
Requirements to be Considered an Advanced APM
Uses certified EHR technology
Collects quality measures data comparable to MIPS
Either:(1) is a Medical Home Model expanded under CMS Innovation Center authority OR (2) requires participants to bear more than a nominal amount of financial risk
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• 1. Requires participants to use certified EHR technology
• Requires that at least 50% of the clinicians in each APM Entity use certified EHR technology to document and communicate clinical care information with patients and other health care professionals.
Advanced APM Criterion 1
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• Bases payments on quality measures that are comparable to those used in the MIPS quality performance category.
• Ties payment to quality measures that are evidence-based, reliable, and valid.
• At least one of these measures must be an outcome measure if an appropriate outcome measure is available on the MIPS measure list.
Advanced APM Criterion 2
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is a Medical Home Model expanded under CMS Innovation Center authority,
OR
requires participants to bear a more than nominal amount of financial risk.
Advanced APM Criterion 3 (2 Parts)
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Are excluded from MIPS
Receive a 5% Lump Sum Bonus
Advanced APM Specific Rewards
Receive a higher Physician Fee Schedule Update starting in 2026
Benefits of a Participant in an Advanced APM
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2017 Advanced APMs: https://qpp.cms.gov/docs/QPP_Advanced_APMs_in_2017.pdf
2017 Eligible Advanced APMs Include:
Comprehensive ESRD Care Model
Comprehensive Primary Care Plus (CPC+)
Medicare Shared Savings Program Track 2 and 3
Next Generation ACO Model
Oncology Care Model Two-Sided Risk Arrangement
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What is a Qualifying APM Participant?
Qualifying APM Participants (QPs) are clinicians who have a certain % of Part B payments for professional services or patients furnished Part B professional services through an Advanced APM Entity.
Quality Payment Program
Qualifying APM Participant determinations are made at the Advanced APM Entity level, with certain exceptions:
individuals participating in multiple Advanced APM Entities, none of which meet the QP threshold as a group, and
eligible clinicians on an Affiliated Practitioner List when that list is used for the QP determination because there are no eligible clinicians on a Participation List for the Advanced APM Entity. For example, gain sharers in the Comprehensive Care for Joint Replacement Model will be assessed individually.
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How do Eligible Clinicians become Qualifying APM Participants?—Step 1
Quality Payment Program
How do Eligible Clinicians become Qualifying APM Participants?—Step 2
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Attributed (beneficiaries for whose cost and quality of care the APM Entity is responsible)
Attribution-eligible (all beneficiaries who could potentially be attributed)
These definitions are used for
calculating Threshold Scores
under both methods.
CMS will calculate a percentage “Threshold Score” for each Advanced APM Entity using two methods (payment amount and patient count).
Methods are based on Medicare Part B professional services and beneficiaries attributed to Advanced APM
CMS will use the method that results in a more favorable QP determination for each Advanced APM Entity.
Quality Payment Program
How do Eligible Clinicians become Qualifying APM Participants?—Step 2
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Payment Amount Method
$$$ for Part B professional services to attributed beneficiaries $$$ for Part B professional services to attribution-eligible beneficiaries
= Threshold Score %
Patient Count Method
# of attributed beneficiaries given Part B professional services # of attribution-eligible beneficiaries given Part B professional services
= Threshold Score %
The two methods for calculation are Payment Amount Method and Patient Count Method.
Quality Payment Program
How do Eligible Clinicians become Qualifying APM Participants?—Step 3
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Requirements for Incentive Payments for Significant Participation in Advanced APMs
(Clinicians must meet payment or patient requirements)
Performance Year 2017 2018 2019 2020 2021 2022 and later
Percentage of Payments through an Advanced APM
Percentage of Patients through an Advanced APM
The Threshold Score for each method is compared to the corresponding QP threshold table and CMS takes the better result.
Quality Payment Program
• The QP Performance Period is the period during which CMS will assess eligible
clinicians’ participation in Advanced APMs to determine if they will be QPs for the
payment year.
• The QP Performance Period for each payment year will be from January 1—August
31st of the calendar year that is two years prior to the payment year.
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What is the Performance Period for QPs?
Performance Period: QP status based on Advanced APM
participation
Incentive Determination: Add up payments for Part B
professional services furnished by QP
Payment: +5% lump sum payment made
(excluded from MIPS adjustment)
Quality Payment Program
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• During the QP Performance Period (January—August), CMS will take three
“snapshots” (March 31, June 30, August 31) to determine which eligible
clinicians are participating in an Advanced APM and whether they meet the
thresholds to become Qualifying APM Participants.
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What are the three “Snapshots” for QPs during the Performance Period?
MAR
31 JUN
30 AUG
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Quality Payment Program
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When Will Clinicians Learn their QP Status?
• Reaching the QP threshold at any one of the three QP
determinations will result in QP status for the eligible clinicians
in the Advanced APM Entity
• Eligible clinicians will be notified of their QP status after each
QP determination is complete (point D).
Feb 2017 Mar 2017 Apr 2017 May 2017
Jun 2017 Jul 2017 Aug 2017 Sep 2017 Oct 2017 Nov 2017 Jan 2017 Dec 2017
B C D
D C B
B C D
#1
#2
#3
A
A
A
Quality Payment Program
What if Clinicians do not meet the QP Payment or Patient Thresholds? • Clinicians who participate in Advanced APMs, but do not meet the
QP threshold, may become “Partial” Qualifying APM Participants
(Partial QPs).
• Partial QPs choose whether to participate in MIPS.
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Medicare-Only Partial QP Thresholds in Advanced APMs
Payment Year
2019 2020 2021 2022 2023 2024 and later
Percentage of
Payments
Percentage of Patients
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MIPS-APMs …the third track
MIPS Advanced APM
MIPS-APM
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MIPS-APM Basics
Requirements to be considered a MIPS-APM include: • Participate in the APM under an
agreement with CMS
• Include one or more MIPS eligible clinicians on a Participation List
• Bases payment incentives on performance (either at the APM Entity or eligible clinician level) on cost/utilization and quality
2017 Eligible MIPS-APMs
CEC Model CPC+ Model MSSP Track 1,2 & 3 Next Gen ACO OCM All arrangements
Note: APM scoring standard applies to APMs that meet these criteria
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How Do We Participate as a MIPS APM?
Quality
Performance
Category
Cost
Performance
Category
Improvement
Activities
Performance
Category
Advancing
Care
Information
Category
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Shared Saving Program (SSP) (All Tracks) under the APM Scoring Standard
Performance
Category
Reporting Requirements Performance Score Weight
Quality ACOs submit quality measures to the CMS Web Interface on behalf of their participating MIPS eligible clinicians
The MIPS quality performance category requirements and benchmarks will be used to score quality at the ACO level
50%
Cost MIPS clinicians will not be assessed on cost
N/A 0%
Improvement Activities (IA)
No additional reporting necessary CMS will assign the same IA score to each APM entity group based on the activities required of the participants in the SSP.
20%
Advancing Care Information
All ACO participant TINS in the ACO submit under this category according to the MIPS group reporting requirements.
All of the ACO Participant TIN scores will be aggregated as a weighted average based on the # of MIPS clinicians in each TIN to yield one APM Score
30%
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Next Generation ACO Model under the APM Scoring Card
Performance
Category
Reporting Requirements Performance Score Weight
Quality ACOs submit quality measures to the CMS Web Interface on behalf of their participating MIPS eligible clinicians
The MIPS quality performance category requirements and benchmarks will be used to score quality at the ACO level
50%
Cost MIPS clinicians will not be assessed on cost
N/A 0%
Improvement Activities (IA)
No additional reporting necessary CMS will assign the same IA score to each APM entity group based on the activities required of the participants in the SSP.
20%
Advancing Care Information
Each MIPS clinician in the APM Entity group reports ACI to MIPS through either group reporting at the TIN level or individual reporting
CMS will attribute one score to each MIPS clinician in the APM group.
30%
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All other MIPS APMs under the APM Scoring Card
Performance
Category
Reporting Requirements Performance Score Weight
Quality The APM Entity group will not be assessed on quality under MIPS in the first performance period.
N/A 0%
Cost MIPS clinicians will not be assessed on cost
N/A 0%
Improvement Activities (IA)
No additional reporting necessary CMS will assign the same IA score to each APM entity group based on the activities required of the participants in the SSP.
25%
Advancing Care Information
Each MIPS clinician in the APM Entity group reports ACI to MIPS through either group reporting at the TIN level or individual reporting
CMS will attribute one score to each MIPS clinician in the APM group.
75%
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MIPS APM Summary
• Reduce eligible clinician reporting burden
• Maintain focus on the goals and objectives of APMs
• Streamlined MIPS reporting and scoring for eligible clinicians in certain APMs
• Aggregates eligible clinician MIPS scores to the APM Entity level
• All eligible clinicians in an APM Entity receive the same MIPS final score
• Uses APM-related performance to the extent practicable
Goals
Tactics
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QPP APM Track Summary
Quality Payment Program
The Quality Payment Program provides additional rewards for participating in APMs.
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Not in APM In APM In Advanced APM
=
+ If you are a Qualifying
APM Participant (QP)
Potential financial rewards
+ APM-specific
rewards APM-specific
rewards
5% lump sum bonus
MIPS adjustments MIPS adjustments
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Telligen QIN-QIO is Here to Help!
• Experienced quality improvement advisors to provide expert technical assistance and quality improvement support for participating providers across the state
• Join the monthly webinars “Coffee Talks” with subject matter experts:
– Focused QPP topic
– Open discuss with Q & A – dedicated to your questions
– 2nd Thursday every month
– 11:00 a.m. CST for 1 hour
– July 13th – Aligning Quality Measures selection to ALL MIPS performance categories for more efficient outcomes. Register here
• Partner with Telligen QIO on practice improvement activities
– Participation with a QIO in a self-management training program (diabetes)
– Implementation of antibiotic stewardship program
– Implementation of a cardiac quality improvement program
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Resources –
• The Innovation Center’s Learning Systems provides specialized information on: • Successful Advanced APM participation
• The benefits of APM participation under MIPS
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Q & A Session!
Contacts: • Iowa – Sandy Swallow
– 515-223-2105
• Illinois – Linda Brewer
– 630-928-5819
• Illinois -Temaka Williams
– 630-928-5825
• Colorado – Courtnay Ryan
– 720-554-1711
www.TelligenQINQIO.com