understanding advanced alternative payment …...2018/09/09 · comprehensive primary care plus...
TRANSCRIPT
QUALITY PAYMENT PROGRAM SMALL UNDERSERVED RURAL SUPPORT (QPP SURS) WEBINARSEPTEMBER 11, 11:00 AM ET AND SEPTEMBER 13, 3:30 PM ET
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UNDERSTANDING ADVANCED ALTERNATIVE PAYMENT MODELS (APMS): ADVICE FOR SOLO AND SMALL GROUP PRACTICES
UNDERSTANDING ADVANCED ALTERNATIVE PAYMENT MODELS (APMS)
HOUSEKEEPING ANNOUNCEMENTS
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If you are listening to this webinar through your phone, please remember to mute your computer speakers.
For assistance, enter your issue in the chat box.
To ask a question, enter your inquiry in the chat box.
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UNDERSTANDING ADVANCED ALTERNATIVE PAYMENT MODELS (APMS)
POLLING QUESTIONWhat is your role?▸
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A clinician working in a practice with 15 or fewer clinicians
Non clinical staff from a practice with 15 or fewer clinicians
A clinician working in a practice with more than 15 clinicians
Non clinical staff in a practice with more than 15 clinicians
Quality Payment Program (QPP) contractor
Other person helping practices prepare for MIPS
Other
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UNDERSTANDING ADVANCED ALTERNATIVE PAYMENT MODELS (APMS)
POLLING QUESTIONWhy are you listening in on a webinar about alternative payment models?▸
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I’m not that familiar with them and want to learn a bit more
Our practice is exploring APM options and considering switching to one of them
Our practice is in the process of converting to a specific APM
Our practice is in an APM but reconsidering whether it’s the best option for us
Our practice is in an advanced APM
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UNDERSTANDING ADVANCED ALTERNATIVE PAYMENT MODELS (APMS)
POLLING QUESTIONIf you are considering APM participation, what are your greatest concerns?
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UNDERSTANDING ADVANCED ALTERNATIVE PAYMENT MODELS (APMS)
CMS WELCOME6
Brenda Gentles, RN, BS, MS
Division of ESRD, Population & Community Health
Centers for Medicare & Medicaid Services
QPP SURS Central Support Contractor COR
UNDERSTANDING ADVANCED ALTERNATIVE PAYMENT MODELS (APMS)
Bruce Spurlock, MDPresident & CEO,Cynosure Health
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Roger D. Wells, PAHoward County Medical
CenterSt. Paul, Nebraska
David Cook, MBA, CPHQ, CPHIMS, C(ASCP)TM
William Borden, MD, Chief Quality and Population Health Officer, Associate Professor of
Medicine and Health Policy, George Washington
University Medical Faculty Associates
UNDERSTANDING ADVANCED ALTERNATIVE PAYMENT MODELS (APMS)
SETTING THE STAGE▸
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Focus: Understanding how APMs and advanced APMs work and the pros and cons of APM participation.
Strategy: Discussion with panelists that understand APMs and provide practical advice on how to know if advanced APM participation will benefit your practice and patients.
Topic Overview: What an APM is and how that compares to the old payment models Small practice advantages for joining an APM and why you might consider joining an
APM Discussion of the types of APMs and how to select an APM best suited for your
practice
Using the Chat Box
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UNDERSTANDING ADVANCED ALTERNATIVE PAYMENT MODELS (APMS)
RESOURCES FOR FREE SUPPORT9
Technical Assistance Organizations
Free technical assistance and advice available for small practices from CMS-funded organizations. Contact information for each organization at: https://qpp.cms.gov/docs/QPP_Support_for_Small_Practices.pdf
• General information about QPP for eligible clinicians participating in MIPS or Advanced APMs: https://qpp.cms.gov/
• Questions to CMS about Quality Payment Program:[email protected]
• Sources of support for larger practices and APM participants described in: https://qpp.cms.gov/docs/QPP_Technical_Assistance_Resource_Guide.pdf
UNDERSTANDING ADVANCED ALTERNATIVE PAYMENT MODELS (APMS)
VIRTUAL GROUPS▸
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A virtual group can be made up of solo practitioners and groups of 10 or fewer eligible clinicians who come together “virtually” (no matter what specialty or location) to participate in MIPS for a performance period for a year.Advantages▸
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Policies that apply to groups generally apply to virtual groupsBenefits that apply to group data collection are the same Gain access to CMS portalShare quality and improvement activities without operational components
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UNDERSTANDING ADVANCED ALTERNATIVE PAYMENT MODELS (APMS)
VIRTUAL GROUPS▸
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Eligibility requirements:▸
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Solo practitioners who exceed the low-volume threshold individually, and are not a newly Medicare-enrolled eligible clinician, a Qualifying APM Participant (QP), or a Partial QP choosing not to participate in MIPS. Group that has 10 or fewer eligible clinicians and exceeds the low-volume threshold at the group level.
Solo practitioners and groups who want to form a virtual group must go through the election process.
Virtual groups election must occur prior to the beginning of the performance period and cannot be changed once the performance period starts.
▸ Elections must be made by December 31, 2018 for the 2019 performance year.
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QUESTION:
What is an alternative payment model (APM) and how does that compare to the standard or old payment models?
12UNDERSTANDING ADVANCED ALTERNATIVE PAYMENT MODELS (APMS)
UNDERSTANDING ADVANCED ALTERNATIVE PAYMENT MODELS (APMS)
TRADITIONAL PAYMENT MODELS▸
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Fee- for- service (FFS)▸
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Providers reimbursed based on the number of services they provide, or the number of procedures they order. Payments are unbundled and paid for separatelyBased on volume of services, not value
Original Value-Based Programs▸
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Goal to link provider performance of quality measures to provider paymentAt least a portion of payments vary based on the quality or efficiency of health care delivery Original Programs:▸
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End-Stage Renal Disease Quality Incentive Program (ESRD QIP)Hospital Value-Based Purchasing (HVBP) ProgramHospital Readmission Reduction (HRR) Program
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UNDERSTANDING ADVANCED ALTERNATIVE PAYMENT MODELS (APMS)
ALTERNATIVE PAYMENT MODEL▸
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Alternative Payment Models (APMs) are new value-based approaches to paying for medical care through Medicare that incentivize quality and value.
Can apply to a specific condition, care episode or population
One goal of APMs is to reduce clinician reporting burden.
May offer significant opportunities for eligible clinicians who are not ready for an advanced APM.
To find out more on how APMs are certified: https://www.cms.gov/Medicare/Quality-Payment-Program/Resource-Library/Alternative-Payment-Model-APM-Design-Toolkit.pdf
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QUESTION:
Why are some small practices joining APMs?
15UNDERSTANDING ADVANCED ALTERNATIVE PAYMENT MODELS (APMS)
UNDERSTANDING ADVANCED ALTERNATIVE PAYMENT MODELS (APMS)
ADVANTAGES OF JOINING AN APM16
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Benefits of care coordinationProvides flexibility and shared incentives and savingsPopulation management capabilitiesProvided opportunities and support▸Advantages of shared support such as health IT, data analytics, and quality
reporting.Clinicians and practices can receive greater rewards for taking on some risk related to patient outcomes
UNDERSTANDING ADVANCED ALTERNATIVE PAYMENT MODELS (APMS)
ADVANTAGES OF JOINING AN APM17
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Focus on outcomesReview of quality metrics at a global levelSmall practices don’t need to take the lead2026 fee-for-service schedule, adjustments higher for advanced APMs Potential financial rewards▸Can receive a 5% bonus in addition to APM adjustment
QUESTION:
How should small practices decide whether to transition to an APM?
18UNDERSTANDING ADVANCED ALTERNATIVE PAYMENT MODELS (APMS)
UNDERSTANDING ADVANCED ALTERNATIVE PAYMENT MODELS (APMS)
ADVANCED ALTERNATIVE PAYMENT MODEL19
▸ The Medicare Access and CHIP Reauthorization Act of 2015 (MACRA) requires CMS by law to implement an incentive program, referred to as the Quality Payment Program, that provides for two participation tracks:
DECIDE WHICH APM IS BEST FOR YOUR SMALLPRACTICE
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Advanced APMs
MIPS APMS
Accountable Care Organizations (ACOs)
20UNDERSTANDING ADVANCED ALTERNATIVE PAYMENT MODELS (APMS)
ADVANCED APMS▸
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Advanced APMs are a subset of APMs that provide added incentives for high-quality and cost -efficient care and require participants to use certified EHR technology and hold a financial stake in quality and cost outcomes of their beneficiaries.
Requirements:
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Requires participants to use certified EHR technology
Provides payment for covered professional services based on quality measures comparable to those used in the MIPS quality performance category
Either: (1) is a Medical Home Model expanded under CMS Innovation Center authority OR (2) requires participants to bear a more than nominal amount of financial risk.
21UNDERSTANDING ADVANCED ALTERNATIVE PAYMENT MODELS (APMS)
ADVANCED APMS THRESHOLDS▸To qualify for the 5% APM incentive payment for a year and be excluded from MIPS,
eligible clinicians must receive a certain percentage of payments for covered professional services or see a certain percentage of patients through an Advanced APM during the associated performance period.
22UNDERSTANDING ADVANCED ALTERNATIVE PAYMENT MODELS (APMS)
ADVANCED APM MODELS FOR 2018▸
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Bundled Payments for Care Improvement Advanced Model (BPCI Advanced)
Comprehensive ESRD Care (CEC) - Two-Sided Risk
Comprehensive Primary Care Plus (CPC+)
Medicare Accountable Care Organization (ACO) Track 1+ Model
Next Generation ACO Model
Shared Savings Program - Track 2
Shared Savings Program - Track 3
Oncology Care Model (OCM) - Two-Sided Risk
Comprehensive Care for Joint Replacement (CJR) Payment Model (Track 1- CEHRT)
23UNDERSTANDING ADVANCED ALTERNATIVE PAYMENT MODELS (APMS)
ALL-PAYER COMBINATION OPTION▸
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Available starting in Performance Year 2019
QP Determinations will be based on an eligible clinicians’ participation in a combination of both Advanced (Medicare) APMs and Other Payer Advanced APMs.
QP Determinations are conducted sequentially so that the Medicare Option is applied before the All-Payer Combination Option.
Only clinicians who do not meet the minimum patient count or payment amount threshold to become QPs under the Medicare Option (but still meet a lower threshold to participate in the All-Payer Combination Option) are able to request a QP determination under the All-Payer Combination Option.
24UNDERSTANDING ADVANCED ALTERNATIVE PAYMENT MODELS (APMS)
MIPS APMS▸
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Most Advanced APMs are also MIPS APMS
▸If an eligible clinician does not meet the threshold for sufficient payments or patients to be a qualifying participant (QP), they aren’t under the basic MIPS rules.
Goals
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Reduce eligible clinician reporting burden.
Maintain focus on the goals and objectives of APMs.
Uses APM-related performance to the extent practicable.
25UNDERSTANDING ADVANCED ALTERNATIVE PAYMENT MODELS (APMS)
MIPS APM REQUIREMENTS▸
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APM Entities participate in the APM under an agreement with CMS
APM Entities include one or more MIPS eligible clinicians on a Participation List
APM bases payment incentives on performance (either at the APM Entity or eligible clinician level) on cost/utilization and quality
26UNDERSTANDING ADVANCED ALTERNATIVE PAYMENT MODELS (APMS)
MIPS APM SCORING▸Clinicians in MIPS APMs are scored using the APM scoring standard
▸Established to reduce the reporting burden on participants by eliminating the need to report to both the APM and MIPS (e.g. don’t meet threshold requirement but are still in an APM or Advanced APM).
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ACCOUNTABLE CARE ORGANIZATIONS
▸ACOs are groups of doctors, hospitals, and other health care providers who come together voluntarily to give coordinated high-quality care to their Medicare patients.
28UNDERSTANDING ADVANCED ALTERNATIVE PAYMENT MODELS (APMS)
ACOS: ONE AND TWO SIDED▸
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One-sided models get to keep some of the savings generated (distributing savings among members) and don’t lose money if care costs more than expected. If you are in this kind of ACO, you’ll still need to report MIPS measures. ACO may report some of them.
ACOs start out as one-sided models, and as they gain confidence in their ability to generate savings while delivering high-quality care, they may evolve into two-sided models.
Two-sided models get to keep a bigger share of the savings generated, but if costs are higher than expected, the ACO (including you) may lose money. Two-sided models qualify as advanced APMs.
29UNDERSTANDING ADVANCED ALTERNATIVE PAYMENT MODELS (APMS)
QUESTION:
What next steps should I consider taking to further explore APMs or begin transitioning to one?
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WHAT TO CONSIDER FOR YOUR PRACTICE ▸
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Implementation time and burden
Practice readiness
How cost savings are generated and shared
Volume – how many patients
How patients are attributed
Support APMs provide for MIPS reporting and care coordination
Data needed to report
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APM FRAMEWORK▸
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Organizational Readiness
Clinical practice transformation
Financial risk
Reporting and Analytics
American College of Cardiology APM Framework: https://www.acc.org/tools-and-practice-support/advocacy-at-the-acc/health-policy-issue-center/alternative-payment-model-framework
32UNDERSTANDING ADVANCED ALTERNATIVE PAYMENT MODELS (APMS)
PRACTICAL TIPS ▸
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Understand the risks
Understand your options
Manage new processes
Look at your quality and cost metrics
Reach out to your colleagues
It’s a balancing act!
Enroll by the APM application deadline (different for each APM)
APM lookup tool: https://qpp.cms.gov/participation-lookup
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APM RESOURCES▸
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Clinicians can look up APM Status by NPI at: https://qpp.cms.gov/participation-lookup
Alternative Payment Models in the Quality Payment Program as of February 2018 : https://www.cms.gov/Medicare/Quality-Payment-Program/Resource-Library/Comprehensive-List-of-APMs.pdf
APM lookup tool: https://data.cms.gov/qplookup
Alternative Payment Model Design Toolkit: https://www.cms.gov/Medicare/Quality-Payment-Program/Resource-Library/Alternative-Payment-Model-APM-Design-Toolkit.pdf
MIPS APMs in the Quality Payment Program: https://www.cms.gov/Medicare/Quality-Payment-Program/Resource-Library/MIPS-APMs-in-the-Quality-Payment-Program.pdf
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FREE RESOURCES FOR ASSISTANCE FROM CMS▸
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QPP website: https://qpp.cms.gov/--includes information tailored for the needs of small practices https://www.cms.gov/Medicare/Quality-Initiatives-Patient-Assessment-Instruments/Value-Based-Programs/MACRA-MIPS-and-APMs/Quality-Payment-Program-Events.html
Contact the Quality Payment Program at: [email protected] or call 1-866-288-8292
Support and Available resources for Small, Underserved, and Rural Practices: https://qualitypaymentprogram.cms.gov/about/small-underserved-rural-practices
Small Underserved Rural Support Technical Assistance Organizations (see list on slide 9)
Contact information is available at: https://qpp.cms.gov/docs/QPP_Support_for_Small_Practices.pdf
Available websites of each Technical Assistance Organization
Types of help: needs assessments, webinars, technical support, links to peers you can talk with, assistance getting signed up to report through an approved channel that meets your practice’s needs
FREE Technical Assistance funded by CMS is also available for larger group practices and for clinicians interested in participating in an Alternative Payment Model. More information on those programs is available at: https://www.cms.gov/Medicare/Quality-Payment-Program/Resource-Library/Technical-Assistance-Resource-Guide.pdf
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FREE RESOURCES FOR ASSISTANCE FROM CMS
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Year 2 Overview Fact SheetImprovement Activities Fact SheetCost Performance Fact sheetPromoting Interoperability Fact SheetOffice of the National Coordinator for Health Information Technology (ONC)Data Submission fact sheetAPMs OverviewQPP Participation Status Lookup ToolQualifying APM Participants Methodology Fact SheetOther national webinars focused on small practicesOther national events about Quality Payment Program
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UNDERSTANDING ADVANCED ALTERNATIVE PAYMENT MODELS (APMS)
POLLING QUESTIONWhat best describes your interest in participating in a Virtual Group?▸
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I am not interested
I am interested, but I would like to know more before I decide
I do participate in a Virtual Group
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WRAP-UP ACTIVITIES▸
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Links to Q&A documents, transcripts, and recordings of the event are available here: https://qppsurs.wordpress.com/resources/October: Submitting your 2018 MIPS Data: Advice for Solo and Small Group Practices
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October 16, 2018 at 3:30 p.m. ET
October 18, 2018 at 11:00 a.m. ET
Please provide feedback on this event: Feedback Form
38UNDERSTANDING ADVANCED ALTERNATIVE PAYMENT MODELS (APMS)
REFERENCESSlide decks created by event panelists also provided information reflected in this presentation. The input from project panelists is gratefully acknowledged.
American College of Cardiology APM Framework: https://www.acc.org/tools-and-practice-support/advocacy-at-the-acc/health-policy-issue-center/alternative-payment-model-framework
HealthInsight, the Medicare Quality Innovation Network -Quality Improvement Organization for Nevada, New Mexico, Oregon and Utah: [email protected]
Other documents on the https://qpp.cms.gov/ and https://www.cms.gov/Medicare/Quality-Payment-Program/Resource-Library/Resource-library.html website provide additional detail about the MIPS program.
Disclaimer: This presentation was current at the time it was published or uploaded onto the web. Medicare policy changes periodically so links to the source documents have been provided within the document for your reference. This presentation was prepared as a service to the public and is not intended to grant rights or impose obligations. This presentation may contain references or links to statutes, regulations, or other policy materials. The information provided is only intended to be a general summary. It is not intended to take the place of either the written law or regulations. We encourage readers to review the specific statutes, regulations, and other interpretive materials for a full and accurate statement of their contents.
39UNDERSTANDING ADVANCED ALTERNATIVE PAYMENT MODELS (APMS)
ACRONYMSAPM – Alternative Payment ModelACO – Accountable Care Organization ACI – Advancing Care InformationCMS – Centers for Medicare & Medicaid ServicesER— Emergency RoomEOB— Explanation of BenefitsEIDM— Enterprise Identity Data Management MIPS – Merit-based Incentives Payment SystemPCHM— Patient Centered Medical HomePCP— Primary Care ProviderPI— Promoting Interoperability
PQRS— Physician Quality Reporting SystemIA – Improvement ActivitiesEHR – Electronic Health Records QCDR—Qualified Clinical Data RegistryQPP – Quality Payment ProgramQRUR— Quality and Resource Use ReportsSURS - Small Underserved Rural Support TIN—Tax Identification Number
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