What Is Happening to PQRS and Meaningful Use? · 2016 Reporting Methods 9 Source: Wolfe, Ashby. Understanding PQRS and the Value- ased Modifier: MS’ Plan to Achieve High Value Care

What Is Happening to PQRS and Meaningful Use?

Kim Salamone, PhD, MPA

HSAG Vice President, Health Information Technology

Physician Quality Reporting System (PQRS)Quality Resources Use Reports (QRUR)

Objectives

• Introduce Health Services Advisory Group (HSAG)

• Discuss 2016 PQRS

– Deadlines

– Changes

– Requirements

– Impact on Value-based Modifier

• Discuss 2016 Meaningful Use (MU) Requirements

• Understand the transition process from PQRS, MU, and the value-based modifier into the Merit-based Incentive Payment System (MIPS)

2

Health Services Advisory Group (HSAG)

• Committed to improving quality of healthcare for more than 37 years

• Provides quality expertise to those who deliver care and those who receive care

• Engages healthcare providers, stakeholders, Medicare patients, families, and caregivers

• Provides technical assistance, convenes learning and action networks, and analyzes data for improvement

3

About HSAG (cont.)

4

HSAG is the Medicare Quality Innovation Network-Quality Improvement Organization (QIN-QIO) for California, Ohio,

Arizona, Florida, and the U.S. Virgin Islands.

Nearly 25 percent of the nation’s Medicare beneficiaries

Affordable Care

Act/National Quality

Strategy (NQS)

CMS* Quality Strategy

QIN-QIO Activities

1. Make care safer.2. Strengthen person and family

engagement.3. Promote effective

communication and coordination of care.

4. Promote prevention and treatment of chronic disease.

5. Work with communities to promote best practices of healthy living.

6. Make care affordable.Go

als

are

Ali

gn

ed

5

Common Missions

*The Centers for Medicare & Medicaid Services

What Is Happening to PQRS?

6

The Evolution of Physician Quality Reporting

2007 Physician Quality Reporting

Initiative is voluntary

2014 PQRS is mandatory

2015 PQRS and VM are mandatory

(+ or -) through Value-Based

Modifier (VBM)

7

Incentives Penalties PenaltiesPLUS

Adjustments

Two Options for Eligible Providers to Participate

8

As individuals

• Analyzed by their rendering/individual National Provider Identifier (NPI)

As a group*

• Under the group practice reporting option (GPRO) and analyzed by their tax identification number (TIN)

*Group registration deadline (June 30, 2015) has passed

Bill under Part B of the Medicare Physician Fee Schedule (MPFS)

2016 Reporting Methods

9Source: Wolfe, Ashby. Understanding PQRS and the Value-Based Modifier: CMS’ Plan to Achieve High Value Care Through Transforming Payment Systems. Centers for Medicare & Medicaid Services: June 2015.

Claims Qualified Registry

EHR/DSV QCDR GPRO Web

Interface

CAHPS Survey

Solo Physician X X X X

Solo Non-Physician Practitioner

X X X X

Groups 2-99 X X X X Optional

Groups 100+ X X X Mandatory

2016 Deadlines

Reporting Method Deadline Description

Claims2/24/2017

Last day for 2016 claims to be processed to determine the 2018 payment adjustment

Electronic Health Record (EHR) Direct or Data Submission Vendor (DSV)

2/28/2017Last day for EHRs to submit 2016 data

Qualified clinical data registries (QCDRs) using QRDA III format

2/28/2017Last day for QCDRs to submit 2016 data using QRDA format

GPRO Web Interface To be announced

The GPRO Web Interface submission period is in the first quarter of 2016

Qualified Clinical Data Registry (QCDRs) using XML format

3/31/2017Last day for QCDRs to submit 2016 data using XML format

Qualified registries 3/31/2017Last day for registries to submit 2016 data

10 http://www.aana.com/resources2/quality-reimbursement/Pages/2016-PQRS-FAQs.aspx#deadline

2016 PQRS Changes

• Definition of eligible professional (EP) for purposes of participating in PQRS

• Changes to the requirements for the QCDR and qualified registries

• QCDRs and qualified registries have more time in which to self-nominate and are available to groups w/o Consumer Assessment of Healthcare Providers and Systems (CAHPS).

• Revised auditing requirements for entities submitting PQRS quality measures data (qualified registries, QCDR, direct EHR, or direct DSV product)

11

Source: MLN Connects. Medicare Quality Reporting Programs: 2016 Physician Fee Schedule Final Rule. December 8, 2015.

• Medicare physicians– Doctor of Medicine– Doctor of Osteopathy– Doctor of Podiatric Medicine– Doctor of Optometry– Doctor of Oral Surgery– Doctor of Dental Medicine– Doctor of Chiropractic

• Practitioners– Physician Assistant– Nurse Practitioner*– Clinical Nurse Specialist*– Certified Registered Nurse

Anesthetist* (and Anesthesiologist Assistant)

– Certified Nurse Midwife*

– Clinical Social Worker

– Clinical Psychologist

– Registered Dietician

– Nutrition Professional

– Audiologist

• Therapists– Physical Therapist

– Occupational Therapist

– Qualified Speech-Language Therapist

Changes to Definition of EP

12Source: https://www.cms.gov/Medicare/Quality-Initiatives-Patient-Assessment-Instruments/PQRS/Downloads/2016_PQRS_List_of_EPs.pdf

2016 Changes to PQRS Reporting Criteria

• Changes to group practice Reporting Option (GPRO)– New QCDR reporting option

– Optional Consumer Assessment of Healthcare Providers and Systems (CAHPS) reporting for groups of 25-99

– Required CAHPS reporting for groups of 100 or more EPs regardless of reporting mechanism

• Changes for QCDR Vendors– Support TIN-level reporting

– New process for self-nomination and attestation

– Revised auditing requirements

13


2016 Changes to PQRS Reporting Criteria (cont.)

• Changes for Registry Vendors– New process for self-nomination and attestation

– Revised auditing requirements

• Changes for EHR Submission– Revised auditing requirements

14


2016 PQRS Requirements: Individual Reporting

• Claims: No changes, Nine measures covering at least three national strategy quality domains and reporting each measure on at least 50 percent of the Medicare Part B Fee-For-Service (FFS) patients

• Registry: No changes, Nine measures across three domains and 50 percent of Medicare Part B FFS patients

• Measures Groups via Registry: No changes, One measure group for 20 applicable patients of each EP, 11 out of the 20 must be Medicare Part B FFS, and measure groups containing a measure with a 0 percent performance rate will not be counted

15Source: MLN Connects. Medicare Quality Reporting Programs: 2016 Physician Fee Schedule Final Rule. December 8, 2015

2016 PQRS Requirements: Individual Reporting (cont.)

• EHR: No changes, If an EP’s EHR does not contain patient data for at least nine measures across three domains, then the EP must report on all the measures for which there is Medicare patient data.

• QCDR: No changes, nine measures across three domains and 50 percent of Medicare Part B FFS patients

16Source: MLN Connects. Medicare Quality Reporting Programs: 2016 Physician Fee Schedule Final Rule. December 8, 2015

2016 PQRS Requirements: GPRO

• Available reporting mechanisms:– Web Interface

– Registry

– EHR: Direct or DSV

– QCDR

– CAHPS for PQRS

• Still must register to report via GPRO – Report all CAHPS for PQRS survey measures via a certified survey

vendor AND

– Report on all measures included in the web interface (WI) for the first 248 consecutively ranked and assigned beneficiaries or 100 percent of assigned beneficiaries if fewer than 248 are assigned to the group.

17Source: MLN Connects. Medicare Quality Reporting Programs: 2016 Physician Fee Schedule Final Rule. December 8, 2015.

2016 PQRS Requirements: GPRO Web Interface

• Groups not reporting CAHPS for PQRS– Report on all measures included in the WI for the first 248

consecutively ranked and assigned beneficiaries or 100 percent of assigned beneficiaries if fewer than 248 are assigned to the group.

– Must report on at least one measure for which there is Medicare patient data.

• Groups reporting CAHPS for PQRS– Report all CAHPS for PQRS survey measures via a certified survey

vendor AND

– Report on all measures included in the WI for the first 248 consecutively ranked and assigned beneficiaries or 100 percent of assigned beneficiaries if fewer than 248 are assigned to the group.

– Must report on at least one measure for which there is Medicare patient data.


• Groups not reporting CAHPS for PQRS– Report at least nine measures, covering at least three of

the NQS domains of these measures, if a group practice has an EP that sees at least one Medicare patient in a face-to-face encounter, the group practice must report at least one measure in the PQRS cross-cutting measures set.

– If less than nine measures covering one to three NQS domains apply, group practices must report on each applicable measure, AND report each measure for at least 50 percent of the PQRS group practice’s Medicare Part B FFS patients seen during the reporting period Subject to Measure-Applicability Validation (MAV).

– Measures with 0 percent performance rate will not be counted.

19

2016 PQRS Requirements: GPRO Registry


• Groups reporting CAHPS for PQRS – Report all CAHPS for PQRS survey measures via a

certified survey vendor, AND

– Report six or more additional measures, outside of the CAHPS for PQRS survey, covering two or more NQS domains using the qualified registry If six or less measures covering two or less NQS domains apply, report each applicable measure.

– CAHPS for PQRS fulfills the cross-cutting measure requirement; PQRS group practices do not need to report an additional cross-cutting measure.

20

2016 PQRS Requirements: GPRO Registry (cont.)


• Groups not reporting CAHPS for PQRS– Report on nine measures covering three or more NQS domains,

If the direct EHR product or DSV does not contain patient data for nine or more measures covering three or more NQS domains then report measures for which there is patient data.

– Must report on at least one measure for which there is Medicare patient data

• Groups reporting CAHPS for PQRS – Report all CAHPS for PQRS survey measures via a certified

survey vendor, AND – Report at least six additional measures (outside CAHPS for

PQRS), covering two or more NQS domains using an EHR. If six or less measures apply, report all applicable measures of the non-CAHPS PQRS measures reported, a group must report on at least one measure for which there is Medicare patient data.

21

2016 PQRS Requirements: GPRO EHR (Direct or DSV)


2016 PQRS Requirements: GPRO QCDR (New)

• Two or more EPs participating in the GPRO have an option to report quality measures via a QCDR.

• For group practices of 2-99 EPs, same criterion as individual EPs to satisfactorily participate in a QCDR for the 2018 PQRS payment adjustment.

• Reporting period: January 1–December 31, 2016 for group practices participating in the GPRO, to satisfactorily participate in a QCDR to avoid the 2018 payment adjustment. This would be for the CY 2016 reporting period.


2016 PQRS Requirements: GPRO QCDR (New)

• Groups not reporting CAHPS for PQRS– Report on nine measures covering three or more NQS domains.

• Of these measures, must report two outcome measures.

• If less than two outcome measures apply, then must report at least one outcome measure and one of the following other measure types: one resource use, OR patient experience of care, OR efficiency appropriate use, OR patient safety measure.

• Groups reporting CAHPS for PQRS – Report all CAHPS for PQRS survey measures via a certified

survey vendor.

– Must report at least six additional measures, outside of CAHPS for PQRS, covering at least two NQS domains • At least one of these measures must be an outcome measure.


Revised Auditing Requirements

• QCDRs (available from the QCDRs Toolkit on CMS website)– Make available to CMS the contact information of each EP on behalf of

whom it submits data, including EP practice’s phone number, address, and, if applicable, email address.

– The vendor must retain all data submitted to CMS for the PQRS program for a minimum of seven years. • Upon request, provide CMS access to the QCDR’s database to review the

beneficiary data on which the QCDR-based submissions are based OR provide a copy of the actual data, including samples of patient level data.

• Registries (available from the Registry Toolkit on CMS website)– Same direction as the bullets listed above

– After data submission concludes, CMS will analyze the data submitted by qualified registries. If inaccurate data is found, CMS has the ability to audit and disqualify qualified registries.

• EHR submission

24

2016 PQRS Impact on the VBM

•A new per-claim adjustment under the Medicare Physician Fee Schedule that is applied at the group level to physiciansbilling under the Tax Identification Number (TIN)

•Assesses the quality of care furnished and the cost of that care, based on what is reported in PQRS

• Timeframe

• 2016: VBM for groups of 10+ EPs based on 2014 performance

• 2017: VBM for ALL physicians and groups of physicians based on 2015 performance

• 2018: VBM for ALL physicians and groups of physicians based on 2016 performance

25

Tying It All Together: Update for 2016

26Source: Wolfe, Ashby. Understanding PQRS and the Value-Based Modifier: CMS’ Plan to Achieve High Value Care Through Transforming Payment Systems. Centers for Medicare & Medicaid Services: June 2015.

What Is Happening to MU?

27

2016 MU: EHR Incentive Program

• Medicare

– No more incentives

– Penalties

• Failure to demonstrate results of -4 percent in CY2018 for 2016 MU

• Must report on nine measures across three domains and may report results including zeroes in numerator/denominator

• Medicaid

– Last year for AIU

• Alignment of PQRS/MU

– QRDA III on nine measures across three domains for a full CY

• All returning participants must use EHR reporting period of the full calendar year!

28

2016 MU Certification Requirements for Electronic Reporting of eCQMs*

29

In 2016 and 2017, Certified EHR (CEHRT) is required and providers

electing electronic reporting must create an electronic file that can be

accepted by CMS.

In 2018, CEHRT is required and all providers must create an electronic file that can be accepted

by CMS.

For any CY before 2018: Providers must use electronic reporting via EHR

technology certified to the 2014 Edition or the 2015 Edition

certification criteria.

For 2018 and subsequent years:Providers must use electronic

reporting via EHR technology certified to the 2015 Edition certification

criteria (certified to meet Quality Reporting Document Architecture

[QRDA] I and III standards).

Once the technology has been certified, it does not need to be recertified each time an annual update (QRDA Implementation Guide) is made.


* eCQMs = Electronic Clinical Quality Measures

2016 MU Direction: CMS Acting Director’s Comments

• Three themes have emerged that have shaped CMS’s agenda on MU

– Physicians are hampered by the lack of interoperability.

– Regulations in their current form result in documentation burden and can distract from patient care.

– EHR technology may be hard to use and cumbersome.

30

Source: CMS Blog. CMS Acting Administrator Andy Slavitt’s Comments at Healthcare Information and Management Systems Society (HIMSS) During Panel Discussion with Karen DeSalvo, MD, Acting Assistance Secretary for Health. March 2, 2016. Available at: https://blog.cms.gov/2016/03/02/cms-acting-administrator-andy-slavitts-comments-at-healthcare-information-and-management-systems-society-himss-during-panel-discussion-with-karen-desalvo-md-acting-assistant-secretary-for/

https://blog.cms.gov/2016/03/02/cms-acting-administrator-andy-slavitts-comments-at-healthcare-information-and-management-systems-society-himss-during-panel-discussion-with-karen-desalvo-md-acting-assistant-secretary-for/

• Addressing three areas in the Merit-Based Incentive Payment System (MACRA) based on feedback, focus groups, and interviews– Documentation overhead

• Stop measuring clicks.• Focus on the results technology can create when used as a tool.• Let outcomes rather than activities drive the agenda.

– Interoperability• Open application programming interfaces (APIs) in new Office of the

National Coordinator (ONC) certified electronic record technology (CERT) rule

• Closing the referral loop and patient engagement

– A shift to certified technology that is user-centered and flexible• Encourages competition • Open APIs allow third party developers to improve products, i.e.,

analytic applications, plug-ins and other tools.

31

2016 MU Direction: CMS Acting Director’s Comments

Source: CMS Blog. CMS Acting Administrator Andy Slavitt’s Comments at Healthcare Information and Management Systems Society (HIMSS) During Panel Discussion with Karen DeSalvo, MD, Acting Assistance Secretary for Health. March 2, 2016. Available at: https://blog.cms.gov/2016/03/02/cms-acting-administrator-andy-slavitts-comments-at-healthcare-information-and-management-systems-society-himss-during-panel-discussion-with-karen-desalvo-md-acting-assistant-secretary-for/

https://blog.cms.gov/2016/03/02/cms-acting-administrator-andy-slavitts-comments-at-healthcare-information-and-management-systems-society-himss-during-panel-discussion-with-karen-desalvo-md-acting-assistant-secretary-for/

2016 MU impact on the Value-based Modifier

32Source: Wolfe, Ashby. Understanding PQRS and the Value-Based Modifier. June 26, 2015; Presented at the Right Care Initiative/University of Best Practices meeting

2016 MU Impact on the Value-based Modifier

• The EHR Incentive Programs will move beyond the ‘staged’ approach to MU by 2018, helping providers prepare for MIPS and collectively move forward to a system based on the quality of care delivered.

• Physicians will be measured on their meaningful use of technology for the purpose of determining their Medicare payments.

33

Source: Centers for Medicare & Medicaid Services HIMSS 10 Conference & Exhibition. Transforming Health Through It. CMS Listening Session: EHR Incentive programs in 2018 & Beyond. February 29–March 4, 2016. Available at https://www.cms.gov/Regulations-and-Guidance/Legislation/EHRIncentivePrograms/Downloads/HIMSS16_56EHRStage3Beyond.pdf

The VBM

34

What is the VBM?

• Adjusts the Medicare Physician Fee Schedule (PFS) payments to a physician or group of physicians based on the quality and cost of care furnished to their Medicare FFS beneficiaries.

• Separate from payment adjustment for PQRS

35Source: Centers for Medicare & Medicaid Services. Computation of the 2016 Value Modifier. September 2015. Available at https://www.cms.gov/Medicare/Medicare-Fee-for-Service-Payment/PhysicianFeedbackProgram/Downloads/2016-VM-Fact-Sheet.pdf

https://www.cms.gov/Medicare/Medicare-Fee-for-Service-Payment/PhysicianFeedbackProgram/Downloads/2016-VM-Fact-Sheet.pdf

How Does the VBM Work?

36Wolfe, Ashby. Understanding PQRS and the Value-Based Modifier: CMS’ Plan to Achieve High Value Care Through Transforming Payment Systems. Centers for Medicare & Medicaid Services: June 2015.

• Category 1– TINs that met the criteria as

a group to avoid the 2016 payment adjustment OR

– At least 50 percent of EPs in the TIN met the criteria to avoid the 2016 PQRS payment adjustment as individuals

– The 2016 VBM will be calculated on TIN’s quality and cost performance in 2014 using the CMS quality-tiering methodology.

• Category 2– TINs subject to the 2016

VBM that do NOT meet the criteria for inclusion in Category 1

– 2016 VBM will be set at -2.0 percent downward adjustment.

– The adjustment applies in addition to any PQRS negative payment adjustments the TIN or individual EP in the TIN may incur.

2016 Application of VBM

37

Source: Centers for Medicare & Medicaid Services. Computation of the 2016 Value Modifier. September 2015. Available at https://www.cms.gov/Medicare/Medicare-Fee-for-Service-Payment/PhysicianFeedbackProgram/Downloads/2016-VM-Fact-Sheet.pdf


Low Quality Average Quality High Quality

Low Cost 0.0% +1 x AF* +2 x AF*

Average Cost 0.0% 0.0% +1 x AF*

High Cost 0.0% 0.0% 0.0%

Low Quality Average Quality High Quality

Low Cost 0.0% +1 x AF* +2 x AF*

Average Cost -1.0% 0.0% +1 x AF*

High Cost -2.0% -1.0% 0.0%

2016 Application of VBM

38

Quality-tiering categories and 2016 payment adjustment for TINs with 10–99 EPs

Quality-tiering categories and 2016 payment adjustment for TINs with 100 or more EPs

* Higher-performing TINs treating high-risk beneficiaries (based on mean CMS-Hierarchical Condition Categories [HCC] risk scores) will receive an additional adjustment of +1.0 x Adjustment Factor (AF).

Source: Centers for Medicare & Medicaid Services. Computation of the 2016 Value Modifier. September 2015. Available at https://www.cms.gov/Medicare/Medicare-Fee-for-Service-Payment/PhysicianFeedbackProgram/Downloads/2016-VM-Fact-Sheet.pdf


Source: Wolfe, Ashby. Understanding PQRS and the Value-Based Modifier: CMS’ Plan to Achieve High Value Care Through Transforming Payment Systems. Centers for Medicare & Medicaid Services: June 2015.

Payments Linked to Quality and Alternative Payment Models (APMs)

39

What Is MACRA? MACRA stands for the Medicare Access and CHIP Reauthorization Act of 2015, bipartisan legislation signed into law on April 16, 2015.

40

What Does MACRA Do?

• Repeals the Sustainable Growth Rate (SGR) Formula

• Changes the way that Medicare pays clinicians and establishes a new framework to reward clinicians for value over volume

• Streamlines multiple quality reporting programs into one new system: the Merit-Based Incentive Payment System (MIPS)

• Provides bonus payments for participation in eligible Alternative Payment Models (APMs)

41

MACRA Is Part of a Broader Push Towards Value and Quality

• In January 2015, the Department of Health and Human Services announced new goals for value-based payments and Alternative Payment Models in Medicare.

42 Source: The Centers for Medicare & Medicaid Services

Medicare Payment Prior to MACRA (cont.)

• Fee-for-service (FFS) payment system, where clinicians are paid based on volume of services, not value.

• The SGR was established in 1997 to control the cost of Medicare payments to physicians.

43

The SGR

Target

Medicare

expenditures

Overall

physician

costs

>IFAs calculated

by the SGR

Source: The Centers for Medicare & Medicaid Services

Medicare Payment Prior to MACRA: Volume, Not Value

• FFS payment system, where clinicians are paid based on volume of services, not value.

• The SGR was established in 1997 to control the cost of Medicare payments to physicians.

44

The SGR

Target

Medicare

expenditures

Overall

physician

costs

>IFPhysician payments

cut across the board


The SGR

Each year, Congress passed temporary “doc fixes” toavert cuts (no fix in 2015 would have meant a 21%cut in Medicare payments to clinicians).

MACRA replaces the SGR with a more predictable

payment method that incentivizes value.

Medicare Payment Prior to MACRA: The SGR

45

FFS payment system by which clinicians are paid based onvolume of services, not value.


Medicare Reporting Prior to MACRA

Currently, there are multiple quality and value reporting programs for Medicare clinicians:

46

PQRS VBMMedicare EHR

Incentive Program


Quality Payment Program

Medicare Reporting Under MACRA

MACRA streamlines these programs into the Quality Payment Program.

PQRS VBMMedicare EHR

Incentive Program

33

MIPS APMs


or

The system after MACRA:

Medicare FeeSchedule

Services provided

Adjustments

Final payment to clinician

MACRA Changes How Medicare Pays Clinicians (cont.)

48

MIPS

*or special lump sum bonuses through participation in eligible APMs


How Much Can MIPS Adjust Payments?

Based on a composite performance score, clinicians will receive+/- or neutral adjustments up to the percentages below.

+/-Maximum

Adjustments

AdjustedMedicare PartB payment to

clinician

+4%+5%+7%+9%

2019 2020 2021 2022 onward

-4% -5%-7%-9%

MIPS

The potential maximumadjustment % will

increase each year from2019 to 2022


The MIPS composite performance score will factor infour weighted categories:

MIPS

Composite

Performance

Score

QualityResource

use

Use of

certified EHR

technology

Clinical

practice

improvement

activities

What Will Determine My MIPS Score?


What Will Determine My MIPS Score? Resource Use (cont.)

• Quality (Replaces PQRS)– Worth 50 percent of composite score in year 1

– Six eCQM* measures with one cross-cutting and one outcome measure, reporting on 90 percent of eligible patients

– For individual clinicians and small groups (2-9), MIPS calculates two population measures based on claims data

– For groups with 10 or more clinicians, MIPS calculates three population measures

– Submission includes claims (80 percent of FFS eligible patients), QCDRs**, Qualified registry, EHR (90 percent of eligible patients) or Administrative claims (no submission required)

– Report data on all payers, unless using the CMS Web Interface or CAHPS*** for MIPS (CMS uses Part B sample)

51

*Electronic clinical quality measures (eCQMs)**Qualified Clinical Data Registries (QCDRs)*** Consumer Assessment of Healthcare Providers & Systems (CAHPS)


MIPS

Composite

Performance

Score

QualityResource

use

Use of

certified EHR

technology

Clinical

practice

improvement

activities



What Will Determine My MIPS Score? Resource Use (cont.)

• Resource Use

– Worth 10 percent of composite score in year 1

– Continuation of two measures from VBM: • Total per costs capita for all attributed beneficiaries

• Medicare spending per beneficiary (MSPB) with minor technical adjustments

– Also episode-based measures, as applicable to the MIPS eligible clinician

53


MIPS

Composite

Performance

Score

QualityResource

use

Use of

certified EHR

technology

Clinical

practice

improvement

activities




• Clinical Practice Improvement Activities (CPIA)– Worth 15 percent of composite score in year 1

– Activities include:• Those focused on care coordination

• Beneficiary engagement

• Patient safety

– 90 options for these activities

– Credit given for this category for participating in APMs or PCMH

– Submission of measures include attestation, QCDR, Qualified Registry, and EHR

55

a


MIPS

Composite

Performance

Score

QualityResource

use

Use of

certified EHR

technology

Clinical

practice

improvement

activities



What Will Determine My MIPS Score?Use of Certified EHR Technology (cont.)

• Advancing Care Information replaces MU

• Worth 25 percent of composite score

• Not an “all or nothing” anymore

• Focuses on Stage 3-like measures

– Interoperability

– Health information exchange

– Electronic care coordination

• Submission includes attestation, QCDR, qualified registry, and EHR

57

:

The MIPS composite performance score will factor in performance in 4 weighted categories:

:2MIPS

Composite Performance

ScoreQuality Resource use

aClinical practice improvement

activities

Use of certified EHR technology

What Will Determine My MIPS Score?Four Weighted Categories

58

50% 10% 15% 25%

45% 15% 15% 25%

30% 30% 15% 25%

% weights for quality and resource use are scheduled to adjust each year until 2021

2019

2020

2021


There are three groups of clinicians who will NOT be subject to MIPS:

FIRST year of Medicare

Part B participation

59

Certain participants in

ELIGIBLE APMsBelow low patient

volume threshold

Note: MIPS does not apply to hospitals or facilities

RECALL: Exception to Participation in MIPS


Conclusion

• Eligible providers MUST submit PQRS and Meaningful Use in 2016 through the normal submission or attestation process

• MIPS takes effect in 2017

• While PQRS and MU ‘sunset’, it is only the formal program that sunsets – the requirements are FOLDED into MIPS

• HSAG is funded by CMS to help the transition

60

Access Technical Assistance from the Medicare Quality Improvement Organization (QIO)

61

One-on-one

assistance

Learning events

Expert advice

HSAG is funded by CMS to

provide no-cost assistance to

providers.

Join Us!

Thank you!

Kim Salamone, PhD, MPA

HSAG Vice President, Health Information Technology

602.801.6960 | [email protected]

62

This material was prepared by Health Services Advisory Group, the Medicare Quality Improvement Organization for Ohio, 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. Publication

No. OH-11SOW-XC-03302016-01

Documents

What Is Happening to PQRS and Meaningful Use? · 2016 Reporting Methods 9 Source: Wolfe, Ashby. Understanding PQRS and the Value- ased Modifier: MS’ Plan to Achieve High Value Care