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Similar a Riding the Rapids of Payment Reform: Downstream Effects of Quality Reporting on Revenue Capture
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Riding the Rapids of Payment Reform: Downstream Effects of Quality Reporting on Revenue Capture
- 1. Riding the Rapids of Payment Reform? Downstream Effects of Quality Reporting on Revenue Capture
- 2. Introductions • Jodi Frei, PT MSMIIT, Northwestern Medical Center • William Presley, Vice President , Acmeware
- 3. Audience Poll • CIOs? • Providers? • IT Informatacists? • Quality Nurses? • Others?
- 4. Session Agenda • Background on Quality Programs • 2017 Quality Programs: VBP, MIPS, APM • Reporting, Scoring • Reimbursement, Financial Impact • Challenges and Opportunities • Infrastructure Considerations • Future Insights
- 5. Riding the Rapids “…often done on whitewater or different degrees of rough water, and generally represents a new and challenging environment for participants. Dealing with risk and the need for teamwork is often a part of the experience. “ Wikipedia Sounds familiar?
- 6. Background: Quality Measurement Programs Hospital Quality •EHR Incentive Program •Hospital Value-Based Purchasing •Inpatient Psychiatric Facilities •Inpatient Quality Reporting •HAC payment reduction program •Readmission reduction program •Outpatient Quality Reporting •Ambulatory Surgical Centers •The Joint Commission (TJC) Physician Quality •EHR Incentive Program •Physician Quality Reporting System (PQRS) •Value-Based Payment Modifier (VM) •eRX Quality Reporting Payment Model •Bundled Payments •Accountable Care Organizations (ACO) •Medicare Shared Savings Program •Patient Centered Medical Homes (PCMH)
- 7. Programs Driving Performance Based Reimbursement Hospital Quality • Value Based Purchasing (VBP) • Inpatient Quality Program (IQR) and MU • Hospital-Acquired Conditions (HAC) • Hospital Readmission Reduction (HRRP) Physician Quality • Merit-based Incentive Payment System (MIPS) Payment Model • Alternative Payment Model (APM) • Comprehensive Primary Care (CPC+)
- 9. Details Behind 2017 Quality Programs: MIPS
- 10. MACRA • Bipartisan legislation signed into law on April 16, 2015 • Repealed Sustainable Growth Rate Formula • Rewards providers for quality versus quantity • Combines existing quality programs into one • Participants: Part B Eligible Professionals
- 12. MIPS Overview • Combines components of PQRS, Value Modifier, and MU into one program • One composite performance score, 0-100 points, determined through 3 weighted categories • Budget neutral program rewarding quality performance • 2017 performance impacts 2019 payment
- 13. Current Physician Quality Programs
- 14. Merit-Based Incentive Program (MIPS) Quality Resource Use Advancing Care Clinical Practice Composite Scoring 1 - 100
- 15. 2017
- 16. MIPS Participants 2017: Medicare Part B Eligible • Physicians • PAs • NPs • Clinical nurse specialists • Certified registered nurse anesthetists 2019: Opened to other clinicians • PTs, OTs, SLPs • Nurse Midwives • Clinical Social Workers • Dietitians • Clinical Psychologists
- 17. MIPS Eligibility EC EC EC EC EC Hospitalist ED Provider Ortho Practice Family Practice EC Private Practice Acute Ambulatory
- 18. MIPS Participation Options Pick your pace • Option 1: Test the System by submitting partial data No negative, no positive 2019 adjustment • Option 2: Participate for Part of the Year Small positive 2019 adjustment available • Option 3: Participate Full Calendar Year Modest payment adjustment available • Option 4: Participate in APM 5% incentive payment available
- 19. MIPS Scoring: QUALITY DOMAIN Selection of 6 Measures; Reduced from PQRS 9, Minimum case requirement One Crosscutting Measure; One Outcome or High Priority 2-3 Claims Based Population Measures 1-10 Points per measure, based on historical benchmark Additional Points for Reporting Additional Measures
- 20. Converting Performance To Points CMS will create 10 deciles per measure based on national benchmarks of baseline period, 2 years prior 1-10 points assigned based on the decile within which the EP performs
- 21. MIPS Quality Performance Scorecard
- 22. MIPS Quality Performance Scorecard
- 23. Advancing Care 25% total MIPS score 5 measures required Extra points for reporting of additional measures
- 24. Meaningful Use vs Advancing Care Meaningful Use • Strict Reporting Requirement • Labor Intensive • Misaligned with Other Quality programs Advancing Care • Flexible Reporting • Streamlined • Aligned with Other Quality Programs
- 25. Summary of Advancing Care Measures Required Objective Measures: • Security Risk Analysis • e-Prescribing • Provide Patient Access • Send Summary of Care • Request/Accept Summary of Care For bonus credit, you can: • Report up to 4 additional measures • Report Public Health and Clinical Data Registry Reporting measures • Use certified EHR technology to complete certain improvement activities in the improvement activities performance category
- 26. Improvement Activities 15% of Total MIPS Score Maximum Score of 40 points Credit for involvement in Medical Home and APMs 90 available to accommodate specialists
- 27. Description of Improvement Activities 90 available aligned with: • Care Coordination • Beneficiary Engagement • Patient Safety • Expanded Practice Access • Population Management • Emergency Preparedness • Achieving Health Equity • Participation in APM
- 28. Improvement Activities: Scoring Scoring based on weighting • Up to 20 points for highly weighted activities • Medical Home, transformation of the clinic, public health priorities • Examples: Patient experience ratings, timely access for Medicaid patients • Up to 10 points for all other activities, considered medium weight. Most options are of medium weight Total high weight points + total medium points/total possible points (40) = % of Improvement Activities Score
- 29. Improvement Activities: Reporting Individual clinicians, groups or designated 3rd party vendors must designate Yes/No to each chosen activity Reporting Options: • Attestation • QCDR • Qualified Registry Reporting • EHR • Claims (If feasible, no other reporting necessary) • Groups of 25 or greater also have option of reporting via CMS Web Interface
- 30. Cost Catagory 0% of total MIPS score Replaces Value Modifier Claims based reporting *No additional reporting requirements Scoring is based on comparison to others *Those that provide the most efficient, effective care will receive greater scores
- 31. Cost Category: Measures 40 Episode Specific Measures *Specialty specific measures exist Up to 10 points are available per measure *Patient volumes per measure, typically 20, are required in order to qualify for measure
- 32. Cost Category: Scoring Example
- 34. How Do You Rate?
- 35. Revenue at Risk
- 36. Physician Revenue at Risk
- 37. Details Behind 2017 Quality Programs: APM
- 38. Advanced APMs • Clinicians who are involved with qualified ACOs, Medical Homes, etc • ACO must base payment on quality measures • Must meet patient volume and financial risk thresholds • In order to determine APM eligibility, all clinicians report through MIPs in 2017 • APM clinicians avoid MIPS reporting requirements and payment adjustments • Receive 5% APM incentive payment • Does not change how APMs reward value
- 40. ACO Reporting • Measures, means and frequency vary per ACO • Vermont: • Three ACOs coming under one umbrella - VCO • Data flowing from EMRs through HIE to ACO Data Repository Workbench One • PMPM Analyzer • ACO Explorer • Manual annual reporting process will phase out • Importance of thoroughly and accurately diagnosis and comorbidities
- 41. Details Behind 2017 Quality Programs: VBP
- 42. VBP Program Background • Funded by reductions from Diagnosis-Related Group (DRG) payments; Budget Neutral • Built on the Hospital Inpatient Quality Reporting (IQR) measure reporting infrastructure • Measures collected through the Hospital IQR Program infrastructure • Reimbursements based on either national benchmarks or internal improvements
- 43. VBP Program Domains and Measures
- 44. VBP Program Domains and Measures
- 45. VBP Program Domains and Measures
- 46. VBP Program Domains and Measures
- 47. VBP Program Domains and Measures
- 48. Value Based Purchasing Scoring • Scores for all measures generate total performance score • Types of points awarded • Achievement points • 0-10 based on comparison to all hospitals’ baseline period rates • Improvement points • 0-9 based on comparison to same hospital’s baseline period rates • Consistency points • 0-20 based on hospital’s HCAHPS scores compared to all hospitals’ baseline period rates
- 49. Financial Impact • Total amount of value-based incentive payments must equal the total amount withheld across all hospitals in the program. • For FY18 payment (2016 performance): 2% withhold • Value-based incentive payments = Sum of all hospital’s base- operating DRG*0.02 (withhold)
- 50. Revenue at Risk
- 51. Hospital Revenue at Risk Year IQR EHR MU VBP HAC HRRP 2013 2.0% MBU N/A 1.0% DRG N/A 1.0% DRG 2014 2.0% MBU N/A 1.25% DRG N/A 2.00% DRG 2015 25% MBU 25% MBU 1.50% DRG 1.0% DRG 3.00% DRG 2016 25% MBU 50% MBU 1.75% DRG 1.0% DRG 3.00% DRG 2017 25% MBU 75% MBU 2.00% DRG 1.0% DRG 3.00% DRG MBU = Market Basket Update DRG = Diagnosis-related group
- 52. Hospital Revenue at Risk .0% .0% .0% .0% .0% .0% .0% .0% 2013 2014 2015 2016 2017 IQR EHR VBP HAC HRRP
- 53. Financial Impact
- 54. Financial Impact
- 56. Infrastructure and Integration • EHR 2015 Edition (Stage 3) Upgrades for 2018 • Acute and Ambulatory EHR Integration • Data Warehouse Design • Quality Reporting Metrics and Alerting
- 58. Enhanced Oversight and Accountability ONC expands role of oversight Attest to cooperation with certain authorized IT surveillance and oversight activities Clinicians required to give access to their EHR No restriction of data sharing and interoperability
- 59. Challenges • Disparate Systems • Difficult to assess performance across settings • Creation of Clinical Alerts • Coding occurs post discharge • Understanding workflow required by eCQMs • Transition from free text and customized reporting
- 60. Conclusion • CMS is transitioning to what the they call "a new and more responsive regulatory framework." This new framework is based on the landmark bipartisan legislation called MACRA • As organizations transition from volume to value based reimbursement, both in the inpatient and outpatient realms, increased attention to quality outcomes is necessary • This involves focus on: • Standardized Workflow • Performance Reporting with Clinical Alerts • Clinical Surveillance Across Settings • Data Sharing - TOC
- 61. Questions • Jodi Frei, PT MSMIIT Northwestern Medical Center • William Presley, Vice President Acmeware
- 62. References • Physician Quality, Path to Value, http://www.acmeware.com/products.aspx • https://www.cms.gov/Medicare/Quality-Initiatives-Patient- Assessment-Instruments/Value-Based-Programs/MACRA- MIPS-and-APMs/MACRA-MIPS-and-APMs.html • https://www.cms.gov/Medicare/Quality-Initiatives-Patient- Assessment-Instruments/Value-Based-Programs/MACRA- MIPS-and-APMs/NPRM-QPP-Fact-Sheet.pdf • https://www.cms.gov/Medicare/Quality-Initiatives-Patient- Assessment-Instruments/Value-Based-Programs/MACRA- MIPS-and-APMs/MIPS-Scoring-Methodology-slide-deck.pdf • https://www.acog.org/-/media/Departments/Payment- Reform/ProposedCrosscuttingQualityMeasures.pdf?dmc=1 &ts=20160802T0014121685 • https://www.cms.gov/Medicare/Quality-Initiatives-Patient- Assessment-Instruments/Value-Based-Programs/MACRA- MIPS-and-APMs/CPIA-Performance-Category-slide-deck.pdf • https://www.cms.gov/Outreach-and-Education/Medicare- Learning-Network- MLN/MLNProducts/Downloads/Hospital_VBPurchasing_Fac t_Sheet_ICN907664.pdf • http://www.himss.org/news/cms-previews-quality- payment-program-changes-fy-2017-performance-year- allows-clinicians-pick-their • https://qpp.cms.gov • https://www.cms.gov/medicare/medicare-fee-for-service- payment/physicianfeedbackprogram/valuebasedpaymentm odifier.html • https://www.cms.gov/Medicare/Quality-Initiatives-Patient- Assessment-Instruments/Value-Based-Programs/MACRA- MIPS-and-APMs/Advancing-Care-Information-Fact-Sheet.pdf