QUALITY PAYMENT PROGRAM SMALL UNDERSERVED RURAL SUPPORT (QPP SURS) WEBINARDECEMBER 12, 3:30-4:30 ET AND DECEMBER 14, 11:00-12:00 ET

1

OVERCOMING CHALLENGES TO MIPS FOR SOLO PRACTITIONERS AND SMALL GROUP PRACTICES

OVERCOMING CHALLENGES TO MIPS

HOUSEKEEPING ANNOUNCEMENTS

▸

▸

▸

Please mute your computer speakers to avoid audio feedback

For assistance, enter your issue in the chat box

To ask a question, enter your inquiry in the chat box

2

OVERCOMING CHALLENGES TO MIPS

POLLING QUESTIONWhat is your role?▸

▸

▸

▸

▸

▸

▸

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 contractor

Other person helping practices prepare for MIPS

Other

3

POLLING QUESTIONWhat describes your plans for participating in MIPS for the transition year 2017?▸

▸

▸

▸

▸

We’re already totally prepared

We’ve taken steps that will allow us to do full year reporting

We’ve taken steps that will allow us to do partial year reporting

We’re planning to use the Test Pace to avoid penalty in the 2017 transition year

We’re just going to accept the penalty

4OVERCOMING CHALLENGES TO MIPS

FINAL POLLING QUESTIONIf you are struggling to participate in MIPS for 2017, what are the largest challenges you are encountering?

5OVERCOMING CHALLENGES TO MIPS

OVERCOMING CHALLENGES TO MIPS

CMS WELCOME

Adam RichardsDivision of ESRD, Population and Community Health

Center for Clinical Standards & Quality Centers for Medicare & Medicaid Services

6

OVERCOMING CHALLENGES TO MIPS

Anne Binns, MHA, Quality Improvement

Consultant, TMF Health Quality Institute

Bruce Spurlock, MDPresident & CEO,Cynosure Health

7

David Cook, MBA, CPHQ, CPHIMS, C(ASCP)TM

Troy Alan Sturgill, D.C., M.S. Regional Chiropractic &

Rehabilitation Inc., Director

OVERCOMING CHALLENGES TO MIPS

SETTING THE STAGE▸

▸

▸

Event Focus: Helping practices off to a late start preparing for 2017 MIPS reportingEvent Strategy: Focus on the essentials and the mechanics of how to do themTopic Overview:▸

▸

▸

▸

▸

Resources for free support and answers to your questions

What is MIPS in a nutshell & why is it required

Who is eligible to participate in MIPS

What can you still do now to avoid a penalty

How can you be in better shape this time next year

8

OVERCOMING CHALLENGES TO MIPS

RESOURCES FOR FREE SUPPORT9

Small, Underserved & Rural Direct Support Organizations (DSO)

Free technical assistance and advice available for small practices from CMS-funded DSOs. Contact information for each DSO 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:QPP@cms.hhs.gov

• Sources of support for larger practices and APM participants described in: https://qpp.cms.gov/docs/QPP_Technical_Assistance_Resource_Guide.pdf

QUESTION:

What is MIPS in a nutshell and why is it required?

10OVERCOMING CHALLENGES TO MIPS

WHAT MIPS IS & WHY IT EXISTS▸

▸

What it is: A process for linking payment to quality & efficiency by changing incentives; a replacement for earlier CMS programs including PQRSWhat it includes:

But you can still avoid a penalty without doing all these things!

11OVERCOMING CHALLENGES TO MIPS

WHAT MIPS IS & WHY IT EXISTS▸Upcoming deadlines & timelines

12OVERCOMING CHALLENGES TO MIPS

WHAT MIPS IS & WHY IT EXISTS▸Reporting options and advice on using them

13OVERCOMING CHALLENGES TO MIPS

If you haven’t started yet. . .

• Individual reporting may be easier

• Submitting claim forms with QDC & encounter codes may be simplest way to avoid penalty

• All but QM reporting using Test Pace require 90 days of activity

WHAT MIPS IS & WHY IT EXISTS▸

▸

Why it matters to CMS:▸

▸

Aligning payments with high quality & efficient care is in the best interest of patients and the healthcare systemMIPS is natural extension and improvement of PQRS & other prior CMS programs

Why it matters to clinicians:▸

▸

Supports individualized care using evidence-based guidelinesCompliance with documentation standards improves information sharing between practice and specialists my patients are referred to

14OVERCOMING CHALLENGES TO MIPS

QUESTION:

Who is eligible to participate in MIPS?

15OVERCOMING CHALLENGES TO MIPS

OVERCOMING CHALLENGES TO MIPS

MIPS ELIGIBILITY REQUIREMENTS▸

▸

▸

All MIPS-eligible clinician types and practices that meet minimum Medicare volume thresholds

Option to participate in groups or as individual clinicians

Clinicians participating in an advanced APM are excluded

16

OVERCOMING CHALLENGES TO MIPS

MIPS ELIGIBILITY REQUIREMENTS▸

▸

Changes in 2018 Final Rule do NOT impact 2017 MIPS reporting eligibility requirements

See page 7 of document below for information on changes in eligibility requirements for 2018 MIPS reporting:

https://www.cms.gov/Medicare/Quality-Payment-Program/Resource-Library/QPP-Year-2-Executive-Summary.pdf

MIPS-eligible clinicians affected by Hurricanes Harvey, Irma, Maria or Northern California wildfires will automatically avoid a penalty but can still receive a bonus based on data they submit:

See: https://www.cms.gov/Medicare/Quality-Payment-Program/Resource-Library/Interim-Final-Rule-with-Comment-fact-sheet.pdf

17

QUESTION:

▸What can you still do now to avoid a penalty for 2017?

18OVERCOMING CHALLENGES TO MIPS

OVERCOMING CHALLENGES TO MIPS

AVOIDING THE PENALTY: ONE OPTION ▸ One quality measure on one patient, one time or one improvement

activity (sometimes called “test method/test pace”)

19

Use the measure selector on the QPP website to identify options best suited for your practice available here:

https://qpp.cms.gov/mips/quality-measures

OVERCOMING CHALLENGES TO MIPS

AVOIDING THE PENALTY: ONE OPTION▸ How to submit quality measure information using claims

▸ Guidance available at:

▸ Checking to see if your data was submitted will require an EIDM account: https://www.cms.gov/Medicare/Medicare-Fee-for-Service-Payment/PhysicianFeedbackProgram/Downloads/Guide-for-Obtaining-a-New-User-EIDM-Account-with-a-Physician-Quality-and-Value-Programs-Role.pdf

20

https://www.cms.gov/Medicare/Quality-Payment-Program/Resource-Library/Claims-Data-Submission-Fact-Sheet.pdf

OVERCOMING CHALLENGES TO MIPS

AVOIDING THE PENALTY: A SECOND OPTION▸

▸

▸

Submit a QM with an EHR, QCDR or Qualified Registry

Advice on QCDR or Qualified registry options

▸

▸

Who has access to these options

How to use them to avoid a penalty

Advice on EHR Direct Vendor Options

▸

▸

▸

Determine what options your EHR vendor supports

Need to have account set up in EIDM

Work closely with vendor & get help from your DSO

21

OVERCOMING CHALLENGES TO MIPS

AVOIDING THE PENALTY: A THIRD OPTION▸ Attest to an improvement activity

▸ What needs to be done: an improvement activity of 90+ days in duration

22

• QI options available at: https://qpp.cms.gov/mips/improvement-activities

• Filter by 1 or more of 8 improvement areas

OVERCOMING CHALLENGES TO MIPS

AVOIDING THE PENALTY: THIRD OPTION▸ Attest to an improvement activity

▸ Advice on using improvement activities

▸ Explore improvement activities you’ve already been doinghttps://www.cms.gov/Medicare/Quality-Payment-Program/Resource-Library/MIPS-Improvement-Activities-Fact-Sheet.pdf

▸ Make and retain recommended documentation: https://www.cms.gov/Medicare/Quality-Payment-Program/Resource-Library/2017-MIPS-Data-Validation-Criteria-Quality-11-21-17.zip

23

OVERCOMING CHALLENGES TO MIPS

AVOIDING THE PENALTY: THIRD OPTION▸ Mechanics of attesting to your improvement activity

▸

▸

Submit through CMS portal

▸

▸

▸

Option available as of Jan. 1, 2018

Will require EIDM account

More details released as soon as portal design is finalized

Other options for attesting to improvement activities

▸

▸

Using EHRs or registries

Practical advice on leveraging EHRs for improvement activities

24

POLLING QUESTIONWhat other questions or unresolved challenges do you have about how you can submit quality measure or improvement activity information to avoid a 2017 penalty?

At the end of this event we encourage each of you to provide us with feedback at the following link: Feedback Form

25OVERCOMING CHALLENGES TO MIPS

QUESTION:

▸How can I get off to a faster start for 2018 MIPS reporting?

26OVERCOMING CHALLENGES TO MIPS

OVERCOMING CHALLENGES TO MIPS

ADVICE ON QUALITY MEASURES FOR 2018▸

▸

▸

Duration for data collection for quality measures—full year collection required

Pick measures benefiting your patients and practice

Prioritize measures you’re already collecting

27

OVERCOMING CHALLENGES TO MIPS

ADVICE ON IMPROVEMENT ACTIVITIES FOR 2018

▸

▸

▸

Duration for improvement activities—minimum of one quarter of activity required

Know what qualifies—you may already being doing one

Link improvement activities to other activities earning MIPS points

28

OVERCOMING CHALLENGES TO MIPS

ADVICE ON ACI FOR 2018▸

▸

While certified EHRs add value for practices and their patients, if you cannotmake this investment you can explore the option of requesting a NEW significanthardship exception that will reweight your ACI score weight to 0% (see pp 15-16of: https://www.cms.gov/Medicare/Quality-Payment-Program/Resource-Library/QPP-Year-2-Final-Rule-Fact-Sheet.pdf)

If you choose to invest in a new or upgraded certified EHR

▸

▸

▸

▸

Get advice from peers (in your specialty) and from QIN/SURS contractor

Verify certification status at: https://chpl.healthit.gov/#/search

Explore the costs for installation, maintenance & MIPS submission

Look for free or low cost options

29

OVERCOMING CHALLENGES TO MIPS

GENERAL ADVICE FOR 2018▸

▸

▸

How to succeed with little time and limited resources

▸

▸

▸

Lead by example

Access resources CMS provides

Maintain a positive attitude

Cost scoring counts 10%

Rely on free, CMS-funded resources

30

FREE RESOURCES FOR ASSISTANCE FROM CMS▸

▸

▸

▸

▸

▸

▸

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: QPP@cms.hhs.gov 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 Direct Support 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 Direct Support 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://qpp.cms.gov/docs/QPP_Technical_Assistance_Resource_Guide.pdf

Benefits of Electronic Health Records

Other national events about Quality Payment Program

Other national webinars focused on small practices

31OVERCOMING CHALLENGES TO MIPS

OVERCOMING CHALLENGES TO MIPS

RESOURCES FOR FREE SUPPORT32

Small, Underserved & Rural Direct Support Organizations (DSO)

Free technical assistance and advice available for small practices from CMS-funded DSOs. Contact information for each DSO 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:QPP@cms.hhs.gov

• Sources of support for larger practices and APM participants described in: https://qpp.cms.gov/docs/QPP_Technical_Assistance_Resource_Guide.pdf

WRAP-UP ACTIVITIES▸ Links to the recordings of the event are available here:

https://qppsurs.wordpress.com/resources/▸ Future webinar topics and timeframe:

▸

▸

▸

▸

January: MIPS Data Submission; Practical Advice for Small Group Practices and SoloPractitioners▸

▸

January 23 at 11:00 am ETJanuary 25 at 3:30 pm ET

February: Implications of the 2018 Final Rule for Small Group PracticesMarch: How to Prepare for MIPS Cost ScoringPlease provide feedback on this event: Feedback Form

Some of the materials contained in these slides is drawn from: https://www.cms.gov/Medicare/Quality-Initiatives-Patient-Assessment-Instruments/Value-Based-Programs/MACRA-MIPS-and-APMs/MIPS-ACI-Deep-Dive-Webinar-Slides.pdf. Slide decks created by event panelists also provided information reflected in this presentation. The input from project panelists is gratefully acknowledged.

Other documents on the QPP.CMS.GOV 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.

33OVERCOMING CHALLENGES TO MIPS