unlocking the door to the quality payment program · •quality measure bonus points –2 points...
TRANSCRIPT
1
Unlocking the Door to the Quality Payment Program
IMGMA
Michelle Brunsen and Sandy Swallow
April 20 2017
2
Todayrsquos Objectives
bull Acknowledge the rationale for transformation to patient-focused care
bull Review the basic requirements of the Quality Payment Program (QPP)ndash Merit-Based Incentive System (MIPS)
ndash Advanced Alternative Payment Model (APM)
bull Recognize how this will impact clinicians working in your environment
bull Describe the specialized programs and resources available
3copy 2016 Telligen Inc
Medicare Trust Fund is Unsustainable
Rationale for Transformation
4
2016
30
85
2018
50
90
Rationale for Transformation
2014
20
gt80
2011
0
68
GoalsHistorical Performance (Pre-Announcement)
All Medicare FFS
FFS linked to quality
Alternative payment models
Source Burwell SM Setting Value-Based Payment Goals HHS Efforts to Improve US Health Care NEJM 2015 Jan 26 published online first
Linking Medicare FFS Payments
5
Encourage the integration and coordination of clinical care services Improve individual and population health Support innovation including for access
INCENTIVES
Bring electronic health information to the point of care for meaningful use
Create transparency on cost and quality information
Support consumer and clinician decision making
Focus Areas Description
CARE DELIVERY
INFORMATION
Promote value-based payment systems
ndash Test new alternative payment models
ndash Increase linkage of Medicaid Medicare FFS and other payments to value
Bring proven payment models to scale
Align quality measures
Domains for Transformation
Source Burwell SM Setting Value-Based Payment Goals HHS Efforts to Improve US Health Care NEJM 2015 Jan 26 published online first
6
Transformation Drivers
Comprehensive list of CMS quality and performance programs
Hospital Quality Physician
Quality
Reporting
PACE and Other
Setting Quality
Reporting
Payment
Model
Reporting
ldquoPopulationrdquo
Quality
Reporting
EHR Incentive Program
EHR Incentive Program
Inpatient Rehabilitation Facility
Medicare Shared Savings Program
Medicaid AdultQuality Reporting
PPS-Exempt Cancer Hospital
PQRS Nursing Home Compare Measures
Hospital Value-based Purchasing
CHIPRA Quality Reporting
Inpatient Psychiatric
Facilities
Value-based
Modifier (VM)
LTCH Quality
Reporting
Physician
Feedback
Health Insurance
Exchange Quality Reporting
HAC Payment Reduction Program
Maintenance of Certification
Hospice Quality Reporting
ESRD QIP MedicareAdvantage
Readmission Reduction Program
MACRA - QPP Home Health Quality Reporting
Innovations Pilots Medicare Part D
Outpatient Quality
Reporting
Post Acute Value
Based Purchasing
Ambulatory Surgical
Center
7
Medicare Access and Chip Reauthorization Act
Three most important need to knows about MACRA
Passed with bipartisan Congressional support in 2015
Introduces the Quality Payment Program (QPP)
Repeals SGR and ties payment for services to quality of care
8
What Impact Does MACRA Have on Clinicians
bull Alleviates the annual risk of payment cuts ndash Repeals Sustainable Growth Rate (SGR)
bull Provides more certainty of Medicare payments ndash 05 increase over the next 10 years
bull Reduces the reporting burden need for increase staffing and additional expensesndash Combines PQRS MU and VM programs into one single structure
bull Incentivizes care that focuses on improved quality outcomesndash Introduction of alternative payment models
9copy 2016 Telligen Inc
Medicare Part B ldquoEligible Cliniciansrdquo (ECs) in 2017 and 2018
bull Bill more than $30000 a year and provide care for more than 100 Medicare patients a year and are a
bull Physician (MD DO dentist chiropractor podiatrist optometrist)
bull Physician Assistant (PA)
bull Nurse Practitioner (NP)
bull Clinical Nurse Specialist (CNS)
bull Certified Registered Nurse Anesthetist (CRNA)
bull Secretary has discretion to specify additional eligible clinicians in 2019 (ie dietitians social workers PTs OTs Audiologists)
bull The majority will participate in MIPS with goal to transition to APMs
Who is Eligible for the Program
10
Who is Exempt from the Program
bull A new Medicare enrolled eligible clinician
bull A MIPS eligible clinician who does not exceed the low-volume threshold
Less than or equal to $30000 in Medicare Part B allowed charges for the year
Less than or equal to 100 Medicare patients during the year
(Thresholds are measured at the group level for group reporting and individual level for individual reporting)
bull Qualifying or a Partial Qualifying APM Participant not reporting on MIPS measures and activities but participating in an APM
Note Letters informing clinicians of their eligibility status will be received in late May per CMS
11
QPP What Happens in 2017
Alternative Payment Model
(APMs)bull ldquoSubstantial portionrdquo of
revenues from ldquoapproved alternated payment models
ndash 5 bonus each year from 2019-2024
ndash 075 increase per year beginning in 2026
Merit-based Incentive System (MIPS)
bull Clinicians receive a score of 0-100
bull Annually CMS will establish a threshold score based on the median composite performance scores of all providers
ndash Score above the threshold to receive bonus payments (up to 3 times the annual penalty cap)
ndash Performance scores will be reported on Physician Office Compare website
Eligible Clinicians Choose Your Path
12copy 2016 Telligen Inc
Pick Your Pace for Participation Your
Pace for Participation in 2017Pick Your Pace
for Participation in 2017Test PaceSubmit Something
Neutral or small bonus
Avoid Penalty
Partial Year 90 day Submission
Neutral or small bonus
No penalty
Full Year Submission
Neutral or Moderate bonus
No penalty
Participate in an Advanced Payment
Model in 2017
Donrsquot ParticipateReceive -4 payment
adjustment
QPP What Happens in 2017
Key Takeaway Positive adjustments are based on performance data submitted not the amount of information or length of time submitted
13copy 2016 Telligen Inc
Which Path is Right for You
bull Combines PQRS VM and MU into single improved reporting program
bull Legacy programs phase out
bull ECs earn a performance-based payment adjustment on the Medicare Part B PFS based on final score
ndash Adjusted either up down or neutral
bull The Final Score is calculated from quality data submitted in the performance categories
What is the Merit-Based Incentive Payment System
14
MIPS Timeline
MIPS payment adjustments only affect Medicare Part B participating Eligible Clinicians
2017Record quality data and
how you used technology
performance year1117 ndash 123117
2018Submit your quality data
reporting period1118 ndash 033118
MIPS performance feedback
(TIN-level) available mid-year
payment adjustments1119 ndash 123119
2019MIPS Eligible Clinicians earn
MIPS payment adjustments
based on submitted data
15
MIPS Reporting Options
Type Identification Mechanism
Individual bull Single NPI tied to TINbull Submit individual-level databull Data submission via claims EHR registry or QCDR
Group bull Set of clinicians identified by NPIs sharing common TINbull Submit group-level data bull Register as a group by June 30 2017bull Data submission via CMS web interface (25+) EHR registry
or QCDR
APM Entity Group orMIPS-APM
bull Collection of entities participating in an APM that donrsquot qualify for Advanced APM or meet thresholds
bull Submit MIPS data to avoid downward payment adjustment
16copy 2016 Telligen Inc
How will ECs be scored
MIPS Performance Categories for 2017
QualityReport on quality measures best
reflecting their practice
Advancing Care InformationReport customizable measures reflecting
their EHR use
Improvement ActivitiesSelect improvement activities that
match their practicersquos goals full credit if PCMH recognized
CostBeginning 2018 CMS will calculate
measures based on claims no reporting requirements from ECs
MIPS Performance Category Weights for 2017
Quality
ACI
IA
60
15
25
17
How much can MIPS adjust payments
bull Calculate the final score by sum of performance categories
bull Positive negative neutral adjustments based on CMS-established threshold
ndash Budget neutral program
bull Clinicians at or above performance threshold will receive a neutral or positive adjustment factor based on a linear sliding scale
bull Adjustments applied to a clinicianrsquos Medicare Part B claims
18copy 2016 Telligen Inc
Based on Reporting for Transition Year 2017
Final Score Payment Adjustment
gt 70 points bull Positive adjustmentbull Eligible for exceptional performance bonus ndash
minimum additional 05
4-69 points bull Neutral or Positive adjustment 0-4bull Not eligible for exceptional performance bonus
3 points bull Neutral 0 adjustment
0 points bull Negative payment adjustment of -4bull 0 points = does not participate
MIPS Payment Adjustments in CY 2019
Payment adjustment is based on Medicare Part B reimbursement at the TINNPI level
19
MIPS Performance Categories for 2017
Focus on
QualityPerformance Category
20
2017 Requirements for Quality Submissions
bull Most Participants report up to 6 Measuresndash 1 Outcome Measure (or intermediate outcome)
ndash If no Outcome Measure High Priority Measure
ndash If fewer than 6 measures apply submit all that apply
ndash 10 point decile scale minimum 3 pts for submission in 2017
ndash Use benchmarks to estimate points to predict your quality score
2017 Quality Benchmarks available at httpsqppcmsgovresourceseducation
bull Groups (25+) using the web interface report 15 quality measures for a full year
21
2017 Requirements for Quality Submissions
bull Quality Measure Bonus Points
ndash 2 Points for extra Outcome or Patient Experience Measures
ndash 1 Point for any other high priority measure
ndash Bonus points capped at 10 denominator
ndash Electronic submission bonus points 1 Point per measure for end-to-end electronic reporting
Qualification
o Clinical Data must be documented in CEHRT
o Processing must not include abstraction or pre-aggregation
o All mechanisms eligible except claims
EHR direct DSV Qualified Registry QCDR Web Interface
22
2017 Requirements for Quality Submissions
Payers Period
2017
Patient
Threshold
Rate
Period
2018
Patient
Threshold
Rate
Long Term
Rate
Claims Medicare Part
B
90 days 50 1 Year 60 90
Web
Interface
Medicare Part
B
1 Year 248 patients 1 Year 248 patients 248 patients
Qualified
Registry
All 90 days 50 1 Year 60 90
Qualified
Clinical Data
Registry
All 90 days 50 1 Year 60 90
EHR amp Data
Submission
Vendor
All 90 days 50 1 Year 60 90
23
MIPS Performance Categories for 2017
Focus on
Advancing Care Information
(ACI)Performance Category
24
2017 Requirements for ACI Submissions
Base Score bull Must report on either 4 or 5 measures specific to the EHR certification
bull Report either ldquoYesrdquo or a numerator of at least 1 bull All 50 Base Score points have to be earned to earn
Performance Points
Performance Score bull Based on performance rates for selected measures
Bonus Points bull Extra registry data connections (ie immunization clinical data registry)
bull Use of CEHRT in Improvement Activities
Reporting bull Attestation QCDR Qualified Registry EHR vendor or CMS Web Interface (groups of 25 or more)
HardshipsThresholds bull Allow for reweighting
ACI Scoring Methodology
25
2017 Requirements for ACI Submissions
Measures will contribute to the score in the
Performance Score measure set grouping
Base Measures
Security Risk Analysis
E-Prescribing
Provide Patient Access
HIE - Send a Summary of Care
HIE - RequestAccept a Summary of Care
(2015 only)
Performance Measures
Provide Patient Access
Patient-Specific Education
View Download and Transmit (VDT)
Secure Messaging
Patient-Generated Health Data
Send a Summary of Care
RequestAccept a Summary of Care
Clinical Information Reconciliation
Immunization Registry Reporting
26
MIPS Performance Categories for 2017
Focus on
Improvement Activities
(IA)Performance Category
27
2017 Requirements for IA Submissions
bull Maximum Points = 40 Pointsndash High weighted activities = 20 points
ndash Medium weighted activities = 10 points
bull Participation Thresholdsndash 90 days required
bull PCMH = Maximum Possible Points (40)
bull APM Participation = 50-100 of Maximum Possible Points at CMS discretion
bull Special Populations Points Doubledndash Practices with lt 15 providers
ndash Rural or HPSA practices
ndash Non-patient facing MIPS eligible clinicians
bull Reporting Options Qualified Registry EHR QCDR or CMS Web Interface (for groups 25 clinicians or more)
28
MIPS Performance Categories for 2017
Focus on
CostPerformance Category
29
2017 Requirements for Cost Category
bull Cost scoring weightndash 2017 0
ndash 2018 10
ndash 2019 30
bull CMS will calculate from claims over 40 episode-specific measures to account for differences among specialtiesndash Clinicians that deliver more efficient care achieve better
performance and score the highest points for cost measures
bull ldquoEpisodes of carerdquo roll up all costs of inpatient and outpatient care (including imaging laboratory drugs rehabilitation etc)
30
2017 Requirements for Cost Category
bull Expected Changes from the Value-Modifier Programndash Patients attributed at the TIN-NPI level
ndash Attributed to one PCP (group) to provider with highest volume by cost provides primary care
ndash Cost compared by decile ranking instead of + 1 standard deviation
ndash Risk adjustments for geographic payment rate beneficiary risk on socio-economic status and others
bull Episodes of Carendash Anticipate 10 for 2018 ndash most operational
ndash 40 being tracked
ndash Plan to develop patient condition groups and patient relationship categories
31
Initial Episode-based Cost Measures
bull Aorticmitral valve surgery
bull CABG
bull HipFemur Fracture or Dislocation Treatment
bull Cholecystectomy and common duct exploration
bull Colonoscopy and biopsy
bull TURP for BPH
bull Lens and cataract procedures
bull Hip replacement or repair
bull Knee arthroplasty
bull Mastectomy
CMS will still provide feedback on performance in these categories in 2017 but it will not affect your 2019 payments
32
Alternative Payment Model (APMs)
bull Create the adoption of payment models that move away from FFS and tie payment to value
bull Must be in an Advanced APM to participate
bull Must meet specific thresholds of ldquosubstantial portionsrdquo of revenue from ldquoapprovedrdquo alternate payment models
bull Receive 5 lump sum bonus for 2019 -2024
bull Receive higher fee schedule update for 2026 and beyond
Which Path is Right for You
33
What are Advanced APMs
Requirements to be an Advanced APM
bull Requires use of certified EHR technology
bull Base payment on quality measures comparable to those in MIPS
bull The practice must bear more than nominal financial risk or is in a Medical Home Model expanded under CMS Innovation Center authority
2017 Eligible Advanced APMs Include
Comprehensive ESRD Care Model
Comprehensive Primary Care Plus (CPC+)
Medicare Shared SavingsProgram Track 2 and 3
Next Generation ACO Model
Oncology Care Model Two-Sided Risk Arrangement
34
APM Scoring Standards
Category Reporting Requirements Category Scoring CategoryWeight
Quality (PQRS) The ACO submits Medicare Shared Savings Program quality measures on behalf of ACO participant TINs and their MIPS eligible clinicians via the CMS Web Interface Data is submitted on the first 248 consecutively ranked and assigned Medicare beneficiaries The ACO submits this information once for purposes of both the Medicare Shared Savings Program and MIPS
MIPS benchmarks will be used to assign one score at the APM Entity Group (ACO) level In other words all MIPS eligible clinicians on the certified ACO ProviderSupplier list will receive the same score (unless they are excluded from MIPS) Note that the performance of all clinicians in the ACO will contribute to this score even if they are not subject to MIPS payment adjustments
50
Cost (VM) MIPS eligible clinicians participating in the MSSP will not be assessed on cost No reporting necessary
NA 0
Improvement Activities (new)
No additional reporting necessary Full credit for the APM Entity group by virtue of MSSP participation
20
Advancing Care Information (MU)
ACO participant TINs will submit directly to MIPS via a MIPS data submission mechanism
ACO participant TIN scores will be aggregated as a weighted average to yield one score for the APM Entity group
30
35
Quality Payment Program Paths
Subsets of MIPS and APM Paths
Eligible Clinician
MIPSAPM
MIPS-APM Advanced
APM
36
MIPS-APM Reporting Option
Requirements to be considered a MIPS-APM includebull Participate in the APM under an
agreement with CMS
bull Include one or more MIPS eligible clinicians on a Participation List
ndash On at least one of the snapshot dates
(Mar 31 June 30 or Aug 31)
bull Bases payment incentives on performance (either at the APM Entity or eligible clinician level) on costutilization and quality
2017 Eligible MIPS-APMs
CEC Model CPC+ Model MSSP Track 12 amp 3 Next Gen ACO OCM All arrangements
Note APM scoring standard applies to APMs that meet these criteria
37
MIPS-APM Benefits
bull Streamlined quality reporting
bull Still eligible for shared savings payment
ndash Financial risk payments do not impact eligibility for positive MIPS payment adjustments
bull Favorable scoring under lsquoAPM Scoring Standardrsquo
ndash ACO participants receive full credit in the Improvement Activities Category by virtue of MSSP participation
ndash ACO participants are not subject to the Cost performance category of MIPS
ndash Potential lsquoliftingrsquo of final MIPS score by being assessed at the ACO level
38
We Are All Part of the Quality Payment Program
Creating an Identity Toward a Common Goal
bull CMS
bull Clinicians
bull Patients
bull Our Care Teams
bull Service Providers
We all share a similar goal to improve patient outcomes
39
Quality Payment Program
Where Can Eligible Clinicians Go For Help
40copy 2016 Telligen Inc
All Eligible Clinicians are supported by
bull Quality Payment Program Websitendash Learn about the program explore the measures and find educational tools and
resources
ndash httpsqppcmsgov
bull Quality Payment Program Service Centerndash Assist with questions
ndash qppCMShhsgov
ndash 1-866-288-8292
bull Innovations Centerrsquos Learning Systemsndash Provides specialized information on Advanced Alternative Payment Models (APMs)
ndash httpsinnovationcmsgov
Self Service Technical Support
41copy 2016 Telligen Inc
We are here to help
bull Experienced quality improvement advisors to provide expert technical assistance and support for participating providers across the state especially those in large practices health systems and ACO at no charge
bull Helps in meeting MIPS requirements through customized technical assistance including one-on-one assistance when needed
bull Offers monthly webinars and Coffee Talk open discussion
ndash Focused QPP topic
ndash Open discuss with Q amp A ndash dedicated to your questions
ndash 2nd Thursday every month
ndash 1100 am CST for 1 hour
Telligen QIN-QIO
42copy 2016 Telligen Inc
We are here to help
bull Provides monthly electronic newsletter with resources the latest research and healthcare news relevant to you
bull Provides the ldquoWeekly Digestrdquo with electronic email on upcoming learning opportunities
bull Offers a website with the latest resources and tools and post recorded webinars for future reference
bull Partner with Telligen QIO on practice improvement activitiesndash Participation with a QIO in a self-management training program (diabetes)
ndash Implementation of antibiotic stewardship program
ndash Implementation of a cardiac quality improvement program
Telligen QIN-QIO
43copy 2016 Telligen Inc
Primary Care amp Specialist Physicians
Model
bull Align with the criteria for innovative models set forth in the Quality Payment Program
bull Build the evidence base on practice transformation so that effective solutions can be scaled
bull Move clinician practices through 5 phases of transformation with support from
ndash Practice Transformation Networks (PTN)
ndash Support amp Alignment Networks (SAN)
ndash Quality Improvement Organizations and others
Transforming Clinical Practice Initiative
44copy 2016 Telligen Inc
Primary Care amp Specialist Physicians
Goalsbull Support clinicians in their practice transformation goals
bull Improve health outcomes for millions of Medicare Medicaid and CHIP beneficiaries
bull Build the evidence base on practice transformation so that effective solutions can be scale
bull Sustain efficient care delivery by reducing unnecessary testing and procedures
bull Reduce unnecessary hospitalizations
Contact Melissa Kapping kappingmihconlineorg
Transforming Clinical Practice Initiative
45copy 2016 Telligen Inc
bull SURS (Small Underserved and Rural Support) ndash Recently announced February 16
ndash 11 organizations awarded contracts
ndash Telligen provides assistance to Iowa Nebraska South Dakota and North Dakota
ndash No cost to practices
bull Solo or small practices (15 or fewer clinicians) ndash Rural health professional shortage areas (HPSA)
ndash Medically underserved areas (MUA)
bull Outreach guidance and direct technical assistancendash Practice readiness education health IT optimization
ndash Strategic planning assisting in the full transition to APM
Telligen QPP Resource Center
46
Contact Info
Michelle Brunsen Sr QI Advisor
515-453-8180
mbrunsentelligencom
Sandy Swallow Program Specialist
515-223-2105
Sandyswallowarea-dhcqisorg
Websites
bull wwwtelligenqinqiocom
bull wwwtelligenqppcom
bull wwwqppcmsgov
THANK YOU
This material was prepared by Telligen the Quality Payment Program Small
Underserved and Rural Support contractor for Iowa Nebraska North Dakota and
South Dakota under contract with the Centers for Medicare amp Medicaid Services
(CMS) an agency of the US Department of Health and Human Services The
contents presented do not necessarily reflect CMS policy HHSM-500-2017-00012C
This material was prepared by Telligen the Medicare Quality Innovation
Network Quality Improvement Organization under contract with the
Centers for Medicare amp Medicaid Services (CMS) an agency of the US
Department of Health and Human Services The contents presented do
not necessarily reflect CMS policy
2
Todayrsquos Objectives
bull Acknowledge the rationale for transformation to patient-focused care
bull Review the basic requirements of the Quality Payment Program (QPP)ndash Merit-Based Incentive System (MIPS)
ndash Advanced Alternative Payment Model (APM)
bull Recognize how this will impact clinicians working in your environment
bull Describe the specialized programs and resources available
3copy 2016 Telligen Inc
Medicare Trust Fund is Unsustainable
Rationale for Transformation
4
2016
30
85
2018
50
90
Rationale for Transformation
2014
20
gt80
2011
0
68
GoalsHistorical Performance (Pre-Announcement)
All Medicare FFS
FFS linked to quality
Alternative payment models
Source Burwell SM Setting Value-Based Payment Goals HHS Efforts to Improve US Health Care NEJM 2015 Jan 26 published online first
Linking Medicare FFS Payments
5
Encourage the integration and coordination of clinical care services Improve individual and population health Support innovation including for access
INCENTIVES
Bring electronic health information to the point of care for meaningful use
Create transparency on cost and quality information
Support consumer and clinician decision making
Focus Areas Description
CARE DELIVERY
INFORMATION
Promote value-based payment systems
ndash Test new alternative payment models
ndash Increase linkage of Medicaid Medicare FFS and other payments to value
Bring proven payment models to scale
Align quality measures
Domains for Transformation
Source Burwell SM Setting Value-Based Payment Goals HHS Efforts to Improve US Health Care NEJM 2015 Jan 26 published online first
6
Transformation Drivers
Comprehensive list of CMS quality and performance programs
Hospital Quality Physician
Quality
Reporting
PACE and Other
Setting Quality
Reporting
Payment
Model
Reporting
ldquoPopulationrdquo
Quality
Reporting
EHR Incentive Program
EHR Incentive Program
Inpatient Rehabilitation Facility
Medicare Shared Savings Program
Medicaid AdultQuality Reporting
PPS-Exempt Cancer Hospital
PQRS Nursing Home Compare Measures
Hospital Value-based Purchasing
CHIPRA Quality Reporting
Inpatient Psychiatric
Facilities
Value-based
Modifier (VM)
LTCH Quality
Reporting
Physician
Feedback
Health Insurance
Exchange Quality Reporting
HAC Payment Reduction Program
Maintenance of Certification
Hospice Quality Reporting
ESRD QIP MedicareAdvantage
Readmission Reduction Program
MACRA - QPP Home Health Quality Reporting
Innovations Pilots Medicare Part D
Outpatient Quality
Reporting
Post Acute Value
Based Purchasing
Ambulatory Surgical
Center
7
Medicare Access and Chip Reauthorization Act
Three most important need to knows about MACRA
Passed with bipartisan Congressional support in 2015
Introduces the Quality Payment Program (QPP)
Repeals SGR and ties payment for services to quality of care
8
What Impact Does MACRA Have on Clinicians
bull Alleviates the annual risk of payment cuts ndash Repeals Sustainable Growth Rate (SGR)
bull Provides more certainty of Medicare payments ndash 05 increase over the next 10 years
bull Reduces the reporting burden need for increase staffing and additional expensesndash Combines PQRS MU and VM programs into one single structure
bull Incentivizes care that focuses on improved quality outcomesndash Introduction of alternative payment models
9copy 2016 Telligen Inc
Medicare Part B ldquoEligible Cliniciansrdquo (ECs) in 2017 and 2018
bull Bill more than $30000 a year and provide care for more than 100 Medicare patients a year and are a
bull Physician (MD DO dentist chiropractor podiatrist optometrist)
bull Physician Assistant (PA)
bull Nurse Practitioner (NP)
bull Clinical Nurse Specialist (CNS)
bull Certified Registered Nurse Anesthetist (CRNA)
bull Secretary has discretion to specify additional eligible clinicians in 2019 (ie dietitians social workers PTs OTs Audiologists)
bull The majority will participate in MIPS with goal to transition to APMs
Who is Eligible for the Program
10
Who is Exempt from the Program
bull A new Medicare enrolled eligible clinician
bull A MIPS eligible clinician who does not exceed the low-volume threshold
Less than or equal to $30000 in Medicare Part B allowed charges for the year
Less than or equal to 100 Medicare patients during the year
(Thresholds are measured at the group level for group reporting and individual level for individual reporting)
bull Qualifying or a Partial Qualifying APM Participant not reporting on MIPS measures and activities but participating in an APM
Note Letters informing clinicians of their eligibility status will be received in late May per CMS
11
QPP What Happens in 2017
Alternative Payment Model
(APMs)bull ldquoSubstantial portionrdquo of
revenues from ldquoapproved alternated payment models
ndash 5 bonus each year from 2019-2024
ndash 075 increase per year beginning in 2026
Merit-based Incentive System (MIPS)
bull Clinicians receive a score of 0-100
bull Annually CMS will establish a threshold score based on the median composite performance scores of all providers
ndash Score above the threshold to receive bonus payments (up to 3 times the annual penalty cap)
ndash Performance scores will be reported on Physician Office Compare website
Eligible Clinicians Choose Your Path
12copy 2016 Telligen Inc
Pick Your Pace for Participation Your
Pace for Participation in 2017Pick Your Pace
for Participation in 2017Test PaceSubmit Something
Neutral or small bonus
Avoid Penalty
Partial Year 90 day Submission
Neutral or small bonus
No penalty
Full Year Submission
Neutral or Moderate bonus
No penalty
Participate in an Advanced Payment
Model in 2017
Donrsquot ParticipateReceive -4 payment
adjustment
QPP What Happens in 2017
Key Takeaway Positive adjustments are based on performance data submitted not the amount of information or length of time submitted
13copy 2016 Telligen Inc
Which Path is Right for You
bull Combines PQRS VM and MU into single improved reporting program
bull Legacy programs phase out
bull ECs earn a performance-based payment adjustment on the Medicare Part B PFS based on final score
ndash Adjusted either up down or neutral
bull The Final Score is calculated from quality data submitted in the performance categories
What is the Merit-Based Incentive Payment System
14
MIPS Timeline
MIPS payment adjustments only affect Medicare Part B participating Eligible Clinicians
2017Record quality data and
how you used technology
performance year1117 ndash 123117
2018Submit your quality data
reporting period1118 ndash 033118
MIPS performance feedback
(TIN-level) available mid-year
payment adjustments1119 ndash 123119
2019MIPS Eligible Clinicians earn
MIPS payment adjustments
based on submitted data
15
MIPS Reporting Options
Type Identification Mechanism
Individual bull Single NPI tied to TINbull Submit individual-level databull Data submission via claims EHR registry or QCDR
Group bull Set of clinicians identified by NPIs sharing common TINbull Submit group-level data bull Register as a group by June 30 2017bull Data submission via CMS web interface (25+) EHR registry
or QCDR
APM Entity Group orMIPS-APM
bull Collection of entities participating in an APM that donrsquot qualify for Advanced APM or meet thresholds
bull Submit MIPS data to avoid downward payment adjustment
16copy 2016 Telligen Inc
How will ECs be scored
MIPS Performance Categories for 2017
QualityReport on quality measures best
reflecting their practice
Advancing Care InformationReport customizable measures reflecting
their EHR use
Improvement ActivitiesSelect improvement activities that
match their practicersquos goals full credit if PCMH recognized
CostBeginning 2018 CMS will calculate
measures based on claims no reporting requirements from ECs
MIPS Performance Category Weights for 2017
Quality
ACI
IA
60
15
25
17
How much can MIPS adjust payments
bull Calculate the final score by sum of performance categories
bull Positive negative neutral adjustments based on CMS-established threshold
ndash Budget neutral program
bull Clinicians at or above performance threshold will receive a neutral or positive adjustment factor based on a linear sliding scale
bull Adjustments applied to a clinicianrsquos Medicare Part B claims
18copy 2016 Telligen Inc
Based on Reporting for Transition Year 2017
Final Score Payment Adjustment
gt 70 points bull Positive adjustmentbull Eligible for exceptional performance bonus ndash
minimum additional 05
4-69 points bull Neutral or Positive adjustment 0-4bull Not eligible for exceptional performance bonus
3 points bull Neutral 0 adjustment
0 points bull Negative payment adjustment of -4bull 0 points = does not participate
MIPS Payment Adjustments in CY 2019
Payment adjustment is based on Medicare Part B reimbursement at the TINNPI level
19
MIPS Performance Categories for 2017
Focus on
QualityPerformance Category
20
2017 Requirements for Quality Submissions
bull Most Participants report up to 6 Measuresndash 1 Outcome Measure (or intermediate outcome)
ndash If no Outcome Measure High Priority Measure
ndash If fewer than 6 measures apply submit all that apply
ndash 10 point decile scale minimum 3 pts for submission in 2017
ndash Use benchmarks to estimate points to predict your quality score
2017 Quality Benchmarks available at httpsqppcmsgovresourceseducation
bull Groups (25+) using the web interface report 15 quality measures for a full year
21
2017 Requirements for Quality Submissions
bull Quality Measure Bonus Points
ndash 2 Points for extra Outcome or Patient Experience Measures
ndash 1 Point for any other high priority measure
ndash Bonus points capped at 10 denominator
ndash Electronic submission bonus points 1 Point per measure for end-to-end electronic reporting
Qualification
o Clinical Data must be documented in CEHRT
o Processing must not include abstraction or pre-aggregation
o All mechanisms eligible except claims
EHR direct DSV Qualified Registry QCDR Web Interface
22
2017 Requirements for Quality Submissions
Payers Period
2017
Patient
Threshold
Rate
Period
2018
Patient
Threshold
Rate
Long Term
Rate
Claims Medicare Part
B
90 days 50 1 Year 60 90
Web
Interface
Medicare Part
B
1 Year 248 patients 1 Year 248 patients 248 patients
Qualified
Registry
All 90 days 50 1 Year 60 90
Qualified
Clinical Data
Registry
All 90 days 50 1 Year 60 90
EHR amp Data
Submission
Vendor
All 90 days 50 1 Year 60 90
23
MIPS Performance Categories for 2017
Focus on
Advancing Care Information
(ACI)Performance Category
24
2017 Requirements for ACI Submissions
Base Score bull Must report on either 4 or 5 measures specific to the EHR certification
bull Report either ldquoYesrdquo or a numerator of at least 1 bull All 50 Base Score points have to be earned to earn
Performance Points
Performance Score bull Based on performance rates for selected measures
Bonus Points bull Extra registry data connections (ie immunization clinical data registry)
bull Use of CEHRT in Improvement Activities
Reporting bull Attestation QCDR Qualified Registry EHR vendor or CMS Web Interface (groups of 25 or more)
HardshipsThresholds bull Allow for reweighting
ACI Scoring Methodology
25
2017 Requirements for ACI Submissions
Measures will contribute to the score in the
Performance Score measure set grouping
Base Measures
Security Risk Analysis
E-Prescribing
Provide Patient Access
HIE - Send a Summary of Care
HIE - RequestAccept a Summary of Care
(2015 only)
Performance Measures
Provide Patient Access
Patient-Specific Education
View Download and Transmit (VDT)
Secure Messaging
Patient-Generated Health Data
Send a Summary of Care
RequestAccept a Summary of Care
Clinical Information Reconciliation
Immunization Registry Reporting
26
MIPS Performance Categories for 2017
Focus on
Improvement Activities
(IA)Performance Category
27
2017 Requirements for IA Submissions
bull Maximum Points = 40 Pointsndash High weighted activities = 20 points
ndash Medium weighted activities = 10 points
bull Participation Thresholdsndash 90 days required
bull PCMH = Maximum Possible Points (40)
bull APM Participation = 50-100 of Maximum Possible Points at CMS discretion
bull Special Populations Points Doubledndash Practices with lt 15 providers
ndash Rural or HPSA practices
ndash Non-patient facing MIPS eligible clinicians
bull Reporting Options Qualified Registry EHR QCDR or CMS Web Interface (for groups 25 clinicians or more)
28
MIPS Performance Categories for 2017
Focus on
CostPerformance Category
29
2017 Requirements for Cost Category
bull Cost scoring weightndash 2017 0
ndash 2018 10
ndash 2019 30
bull CMS will calculate from claims over 40 episode-specific measures to account for differences among specialtiesndash Clinicians that deliver more efficient care achieve better
performance and score the highest points for cost measures
bull ldquoEpisodes of carerdquo roll up all costs of inpatient and outpatient care (including imaging laboratory drugs rehabilitation etc)
30
2017 Requirements for Cost Category
bull Expected Changes from the Value-Modifier Programndash Patients attributed at the TIN-NPI level
ndash Attributed to one PCP (group) to provider with highest volume by cost provides primary care
ndash Cost compared by decile ranking instead of + 1 standard deviation
ndash Risk adjustments for geographic payment rate beneficiary risk on socio-economic status and others
bull Episodes of Carendash Anticipate 10 for 2018 ndash most operational
ndash 40 being tracked
ndash Plan to develop patient condition groups and patient relationship categories
31
Initial Episode-based Cost Measures
bull Aorticmitral valve surgery
bull CABG
bull HipFemur Fracture or Dislocation Treatment
bull Cholecystectomy and common duct exploration
bull Colonoscopy and biopsy
bull TURP for BPH
bull Lens and cataract procedures
bull Hip replacement or repair
bull Knee arthroplasty
bull Mastectomy
CMS will still provide feedback on performance in these categories in 2017 but it will not affect your 2019 payments
32
Alternative Payment Model (APMs)
bull Create the adoption of payment models that move away from FFS and tie payment to value
bull Must be in an Advanced APM to participate
bull Must meet specific thresholds of ldquosubstantial portionsrdquo of revenue from ldquoapprovedrdquo alternate payment models
bull Receive 5 lump sum bonus for 2019 -2024
bull Receive higher fee schedule update for 2026 and beyond
Which Path is Right for You
33
What are Advanced APMs
Requirements to be an Advanced APM
bull Requires use of certified EHR technology
bull Base payment on quality measures comparable to those in MIPS
bull The practice must bear more than nominal financial risk or is in a Medical Home Model expanded under CMS Innovation Center authority
2017 Eligible Advanced APMs Include
Comprehensive ESRD Care Model
Comprehensive Primary Care Plus (CPC+)
Medicare Shared SavingsProgram Track 2 and 3
Next Generation ACO Model
Oncology Care Model Two-Sided Risk Arrangement
34
APM Scoring Standards
Category Reporting Requirements Category Scoring CategoryWeight
Quality (PQRS) The ACO submits Medicare Shared Savings Program quality measures on behalf of ACO participant TINs and their MIPS eligible clinicians via the CMS Web Interface Data is submitted on the first 248 consecutively ranked and assigned Medicare beneficiaries The ACO submits this information once for purposes of both the Medicare Shared Savings Program and MIPS
MIPS benchmarks will be used to assign one score at the APM Entity Group (ACO) level In other words all MIPS eligible clinicians on the certified ACO ProviderSupplier list will receive the same score (unless they are excluded from MIPS) Note that the performance of all clinicians in the ACO will contribute to this score even if they are not subject to MIPS payment adjustments
50
Cost (VM) MIPS eligible clinicians participating in the MSSP will not be assessed on cost No reporting necessary
NA 0
Improvement Activities (new)
No additional reporting necessary Full credit for the APM Entity group by virtue of MSSP participation
20
Advancing Care Information (MU)
ACO participant TINs will submit directly to MIPS via a MIPS data submission mechanism
ACO participant TIN scores will be aggregated as a weighted average to yield one score for the APM Entity group
30
35
Quality Payment Program Paths
Subsets of MIPS and APM Paths
Eligible Clinician
MIPSAPM
MIPS-APM Advanced
APM
36
MIPS-APM Reporting Option
Requirements to be considered a MIPS-APM includebull Participate in the APM under an
agreement with CMS
bull Include one or more MIPS eligible clinicians on a Participation List
ndash On at least one of the snapshot dates
(Mar 31 June 30 or Aug 31)
bull Bases payment incentives on performance (either at the APM Entity or eligible clinician level) on costutilization and quality
2017 Eligible MIPS-APMs
CEC Model CPC+ Model MSSP Track 12 amp 3 Next Gen ACO OCM All arrangements
Note APM scoring standard applies to APMs that meet these criteria
37
MIPS-APM Benefits
bull Streamlined quality reporting
bull Still eligible for shared savings payment
ndash Financial risk payments do not impact eligibility for positive MIPS payment adjustments
bull Favorable scoring under lsquoAPM Scoring Standardrsquo
ndash ACO participants receive full credit in the Improvement Activities Category by virtue of MSSP participation
ndash ACO participants are not subject to the Cost performance category of MIPS
ndash Potential lsquoliftingrsquo of final MIPS score by being assessed at the ACO level
38
We Are All Part of the Quality Payment Program
Creating an Identity Toward a Common Goal
bull CMS
bull Clinicians
bull Patients
bull Our Care Teams
bull Service Providers
We all share a similar goal to improve patient outcomes
39
Quality Payment Program
Where Can Eligible Clinicians Go For Help
40copy 2016 Telligen Inc
All Eligible Clinicians are supported by
bull Quality Payment Program Websitendash Learn about the program explore the measures and find educational tools and
resources
ndash httpsqppcmsgov
bull Quality Payment Program Service Centerndash Assist with questions
ndash qppCMShhsgov
ndash 1-866-288-8292
bull Innovations Centerrsquos Learning Systemsndash Provides specialized information on Advanced Alternative Payment Models (APMs)
ndash httpsinnovationcmsgov
Self Service Technical Support
41copy 2016 Telligen Inc
We are here to help
bull Experienced quality improvement advisors to provide expert technical assistance and support for participating providers across the state especially those in large practices health systems and ACO at no charge
bull Helps in meeting MIPS requirements through customized technical assistance including one-on-one assistance when needed
bull Offers monthly webinars and Coffee Talk open discussion
ndash Focused QPP topic
ndash Open discuss with Q amp A ndash dedicated to your questions
ndash 2nd Thursday every month
ndash 1100 am CST for 1 hour
Telligen QIN-QIO
42copy 2016 Telligen Inc
We are here to help
bull Provides monthly electronic newsletter with resources the latest research and healthcare news relevant to you
bull Provides the ldquoWeekly Digestrdquo with electronic email on upcoming learning opportunities
bull Offers a website with the latest resources and tools and post recorded webinars for future reference
bull Partner with Telligen QIO on practice improvement activitiesndash Participation with a QIO in a self-management training program (diabetes)
ndash Implementation of antibiotic stewardship program
ndash Implementation of a cardiac quality improvement program
Telligen QIN-QIO
43copy 2016 Telligen Inc
Primary Care amp Specialist Physicians
Model
bull Align with the criteria for innovative models set forth in the Quality Payment Program
bull Build the evidence base on practice transformation so that effective solutions can be scaled
bull Move clinician practices through 5 phases of transformation with support from
ndash Practice Transformation Networks (PTN)
ndash Support amp Alignment Networks (SAN)
ndash Quality Improvement Organizations and others
Transforming Clinical Practice Initiative
44copy 2016 Telligen Inc
Primary Care amp Specialist Physicians
Goalsbull Support clinicians in their practice transformation goals
bull Improve health outcomes for millions of Medicare Medicaid and CHIP beneficiaries
bull Build the evidence base on practice transformation so that effective solutions can be scale
bull Sustain efficient care delivery by reducing unnecessary testing and procedures
bull Reduce unnecessary hospitalizations
Contact Melissa Kapping kappingmihconlineorg
Transforming Clinical Practice Initiative
45copy 2016 Telligen Inc
bull SURS (Small Underserved and Rural Support) ndash Recently announced February 16
ndash 11 organizations awarded contracts
ndash Telligen provides assistance to Iowa Nebraska South Dakota and North Dakota
ndash No cost to practices
bull Solo or small practices (15 or fewer clinicians) ndash Rural health professional shortage areas (HPSA)
ndash Medically underserved areas (MUA)
bull Outreach guidance and direct technical assistancendash Practice readiness education health IT optimization
ndash Strategic planning assisting in the full transition to APM
Telligen QPP Resource Center
46
Contact Info
Michelle Brunsen Sr QI Advisor
515-453-8180
mbrunsentelligencom
Sandy Swallow Program Specialist
515-223-2105
Sandyswallowarea-dhcqisorg
Websites
bull wwwtelligenqinqiocom
bull wwwtelligenqppcom
bull wwwqppcmsgov
THANK YOU
This material was prepared by Telligen the Quality Payment Program Small
Underserved and Rural Support contractor for Iowa Nebraska North Dakota and
South Dakota under contract with the Centers for Medicare amp Medicaid Services
(CMS) an agency of the US Department of Health and Human Services The
contents presented do not necessarily reflect CMS policy HHSM-500-2017-00012C
This material was prepared by Telligen the Medicare Quality Innovation
Network Quality Improvement Organization under contract with the
Centers for Medicare amp Medicaid Services (CMS) an agency of the US
Department of Health and Human Services The contents presented do
not necessarily reflect CMS policy
3copy 2016 Telligen Inc
Medicare Trust Fund is Unsustainable
Rationale for Transformation
4
2016
30
85
2018
50
90
Rationale for Transformation
2014
20
gt80
2011
0
68
GoalsHistorical Performance (Pre-Announcement)
All Medicare FFS
FFS linked to quality
Alternative payment models
Source Burwell SM Setting Value-Based Payment Goals HHS Efforts to Improve US Health Care NEJM 2015 Jan 26 published online first
Linking Medicare FFS Payments
5
Encourage the integration and coordination of clinical care services Improve individual and population health Support innovation including for access
INCENTIVES
Bring electronic health information to the point of care for meaningful use
Create transparency on cost and quality information
Support consumer and clinician decision making
Focus Areas Description
CARE DELIVERY
INFORMATION
Promote value-based payment systems
ndash Test new alternative payment models
ndash Increase linkage of Medicaid Medicare FFS and other payments to value
Bring proven payment models to scale
Align quality measures
Domains for Transformation
Source Burwell SM Setting Value-Based Payment Goals HHS Efforts to Improve US Health Care NEJM 2015 Jan 26 published online first
6
Transformation Drivers
Comprehensive list of CMS quality and performance programs
Hospital Quality Physician
Quality
Reporting
PACE and Other
Setting Quality
Reporting
Payment
Model
Reporting
ldquoPopulationrdquo
Quality
Reporting
EHR Incentive Program
EHR Incentive Program
Inpatient Rehabilitation Facility
Medicare Shared Savings Program
Medicaid AdultQuality Reporting
PPS-Exempt Cancer Hospital
PQRS Nursing Home Compare Measures
Hospital Value-based Purchasing
CHIPRA Quality Reporting
Inpatient Psychiatric
Facilities
Value-based
Modifier (VM)
LTCH Quality
Reporting
Physician
Feedback
Health Insurance
Exchange Quality Reporting
HAC Payment Reduction Program
Maintenance of Certification
Hospice Quality Reporting
ESRD QIP MedicareAdvantage
Readmission Reduction Program
MACRA - QPP Home Health Quality Reporting
Innovations Pilots Medicare Part D
Outpatient Quality
Reporting
Post Acute Value
Based Purchasing
Ambulatory Surgical
Center
7
Medicare Access and Chip Reauthorization Act
Three most important need to knows about MACRA
Passed with bipartisan Congressional support in 2015
Introduces the Quality Payment Program (QPP)
Repeals SGR and ties payment for services to quality of care
8
What Impact Does MACRA Have on Clinicians
bull Alleviates the annual risk of payment cuts ndash Repeals Sustainable Growth Rate (SGR)
bull Provides more certainty of Medicare payments ndash 05 increase over the next 10 years
bull Reduces the reporting burden need for increase staffing and additional expensesndash Combines PQRS MU and VM programs into one single structure
bull Incentivizes care that focuses on improved quality outcomesndash Introduction of alternative payment models
9copy 2016 Telligen Inc
Medicare Part B ldquoEligible Cliniciansrdquo (ECs) in 2017 and 2018
bull Bill more than $30000 a year and provide care for more than 100 Medicare patients a year and are a
bull Physician (MD DO dentist chiropractor podiatrist optometrist)
bull Physician Assistant (PA)
bull Nurse Practitioner (NP)
bull Clinical Nurse Specialist (CNS)
bull Certified Registered Nurse Anesthetist (CRNA)
bull Secretary has discretion to specify additional eligible clinicians in 2019 (ie dietitians social workers PTs OTs Audiologists)
bull The majority will participate in MIPS with goal to transition to APMs
Who is Eligible for the Program
10
Who is Exempt from the Program
bull A new Medicare enrolled eligible clinician
bull A MIPS eligible clinician who does not exceed the low-volume threshold
Less than or equal to $30000 in Medicare Part B allowed charges for the year
Less than or equal to 100 Medicare patients during the year
(Thresholds are measured at the group level for group reporting and individual level for individual reporting)
bull Qualifying or a Partial Qualifying APM Participant not reporting on MIPS measures and activities but participating in an APM
Note Letters informing clinicians of their eligibility status will be received in late May per CMS
11
QPP What Happens in 2017
Alternative Payment Model
(APMs)bull ldquoSubstantial portionrdquo of
revenues from ldquoapproved alternated payment models
ndash 5 bonus each year from 2019-2024
ndash 075 increase per year beginning in 2026
Merit-based Incentive System (MIPS)
bull Clinicians receive a score of 0-100
bull Annually CMS will establish a threshold score based on the median composite performance scores of all providers
ndash Score above the threshold to receive bonus payments (up to 3 times the annual penalty cap)
ndash Performance scores will be reported on Physician Office Compare website
Eligible Clinicians Choose Your Path
12copy 2016 Telligen Inc
Pick Your Pace for Participation Your
Pace for Participation in 2017Pick Your Pace
for Participation in 2017Test PaceSubmit Something
Neutral or small bonus
Avoid Penalty
Partial Year 90 day Submission
Neutral or small bonus
No penalty
Full Year Submission
Neutral or Moderate bonus
No penalty
Participate in an Advanced Payment
Model in 2017
Donrsquot ParticipateReceive -4 payment
adjustment
QPP What Happens in 2017
Key Takeaway Positive adjustments are based on performance data submitted not the amount of information or length of time submitted
13copy 2016 Telligen Inc
Which Path is Right for You
bull Combines PQRS VM and MU into single improved reporting program
bull Legacy programs phase out
bull ECs earn a performance-based payment adjustment on the Medicare Part B PFS based on final score
ndash Adjusted either up down or neutral
bull The Final Score is calculated from quality data submitted in the performance categories
What is the Merit-Based Incentive Payment System
14
MIPS Timeline
MIPS payment adjustments only affect Medicare Part B participating Eligible Clinicians
2017Record quality data and
how you used technology
performance year1117 ndash 123117
2018Submit your quality data
reporting period1118 ndash 033118
MIPS performance feedback
(TIN-level) available mid-year
payment adjustments1119 ndash 123119
2019MIPS Eligible Clinicians earn
MIPS payment adjustments
based on submitted data
15
MIPS Reporting Options
Type Identification Mechanism
Individual bull Single NPI tied to TINbull Submit individual-level databull Data submission via claims EHR registry or QCDR
Group bull Set of clinicians identified by NPIs sharing common TINbull Submit group-level data bull Register as a group by June 30 2017bull Data submission via CMS web interface (25+) EHR registry
or QCDR
APM Entity Group orMIPS-APM
bull Collection of entities participating in an APM that donrsquot qualify for Advanced APM or meet thresholds
bull Submit MIPS data to avoid downward payment adjustment
16copy 2016 Telligen Inc
How will ECs be scored
MIPS Performance Categories for 2017
QualityReport on quality measures best
reflecting their practice
Advancing Care InformationReport customizable measures reflecting
their EHR use
Improvement ActivitiesSelect improvement activities that
match their practicersquos goals full credit if PCMH recognized
CostBeginning 2018 CMS will calculate
measures based on claims no reporting requirements from ECs
MIPS Performance Category Weights for 2017
Quality
ACI
IA
60
15
25
17
How much can MIPS adjust payments
bull Calculate the final score by sum of performance categories
bull Positive negative neutral adjustments based on CMS-established threshold
ndash Budget neutral program
bull Clinicians at or above performance threshold will receive a neutral or positive adjustment factor based on a linear sliding scale
bull Adjustments applied to a clinicianrsquos Medicare Part B claims
18copy 2016 Telligen Inc
Based on Reporting for Transition Year 2017
Final Score Payment Adjustment
gt 70 points bull Positive adjustmentbull Eligible for exceptional performance bonus ndash
minimum additional 05
4-69 points bull Neutral or Positive adjustment 0-4bull Not eligible for exceptional performance bonus
3 points bull Neutral 0 adjustment
0 points bull Negative payment adjustment of -4bull 0 points = does not participate
MIPS Payment Adjustments in CY 2019
Payment adjustment is based on Medicare Part B reimbursement at the TINNPI level
19
MIPS Performance Categories for 2017
Focus on
QualityPerformance Category
20
2017 Requirements for Quality Submissions
bull Most Participants report up to 6 Measuresndash 1 Outcome Measure (or intermediate outcome)
ndash If no Outcome Measure High Priority Measure
ndash If fewer than 6 measures apply submit all that apply
ndash 10 point decile scale minimum 3 pts for submission in 2017
ndash Use benchmarks to estimate points to predict your quality score
2017 Quality Benchmarks available at httpsqppcmsgovresourceseducation
bull Groups (25+) using the web interface report 15 quality measures for a full year
21
2017 Requirements for Quality Submissions
bull Quality Measure Bonus Points
ndash 2 Points for extra Outcome or Patient Experience Measures
ndash 1 Point for any other high priority measure
ndash Bonus points capped at 10 denominator
ndash Electronic submission bonus points 1 Point per measure for end-to-end electronic reporting
Qualification
o Clinical Data must be documented in CEHRT
o Processing must not include abstraction or pre-aggregation
o All mechanisms eligible except claims
EHR direct DSV Qualified Registry QCDR Web Interface
22
2017 Requirements for Quality Submissions
Payers Period
2017
Patient
Threshold
Rate
Period
2018
Patient
Threshold
Rate
Long Term
Rate
Claims Medicare Part
B
90 days 50 1 Year 60 90
Web
Interface
Medicare Part
B
1 Year 248 patients 1 Year 248 patients 248 patients
Qualified
Registry
All 90 days 50 1 Year 60 90
Qualified
Clinical Data
Registry
All 90 days 50 1 Year 60 90
EHR amp Data
Submission
Vendor
All 90 days 50 1 Year 60 90
23
MIPS Performance Categories for 2017
Focus on
Advancing Care Information
(ACI)Performance Category
24
2017 Requirements for ACI Submissions
Base Score bull Must report on either 4 or 5 measures specific to the EHR certification
bull Report either ldquoYesrdquo or a numerator of at least 1 bull All 50 Base Score points have to be earned to earn
Performance Points
Performance Score bull Based on performance rates for selected measures
Bonus Points bull Extra registry data connections (ie immunization clinical data registry)
bull Use of CEHRT in Improvement Activities
Reporting bull Attestation QCDR Qualified Registry EHR vendor or CMS Web Interface (groups of 25 or more)
HardshipsThresholds bull Allow for reweighting
ACI Scoring Methodology
25
2017 Requirements for ACI Submissions
Measures will contribute to the score in the
Performance Score measure set grouping
Base Measures
Security Risk Analysis
E-Prescribing
Provide Patient Access
HIE - Send a Summary of Care
HIE - RequestAccept a Summary of Care
(2015 only)
Performance Measures
Provide Patient Access
Patient-Specific Education
View Download and Transmit (VDT)
Secure Messaging
Patient-Generated Health Data
Send a Summary of Care
RequestAccept a Summary of Care
Clinical Information Reconciliation
Immunization Registry Reporting
26
MIPS Performance Categories for 2017
Focus on
Improvement Activities
(IA)Performance Category
27
2017 Requirements for IA Submissions
bull Maximum Points = 40 Pointsndash High weighted activities = 20 points
ndash Medium weighted activities = 10 points
bull Participation Thresholdsndash 90 days required
bull PCMH = Maximum Possible Points (40)
bull APM Participation = 50-100 of Maximum Possible Points at CMS discretion
bull Special Populations Points Doubledndash Practices with lt 15 providers
ndash Rural or HPSA practices
ndash Non-patient facing MIPS eligible clinicians
bull Reporting Options Qualified Registry EHR QCDR or CMS Web Interface (for groups 25 clinicians or more)
28
MIPS Performance Categories for 2017
Focus on
CostPerformance Category
29
2017 Requirements for Cost Category
bull Cost scoring weightndash 2017 0
ndash 2018 10
ndash 2019 30
bull CMS will calculate from claims over 40 episode-specific measures to account for differences among specialtiesndash Clinicians that deliver more efficient care achieve better
performance and score the highest points for cost measures
bull ldquoEpisodes of carerdquo roll up all costs of inpatient and outpatient care (including imaging laboratory drugs rehabilitation etc)
30
2017 Requirements for Cost Category
bull Expected Changes from the Value-Modifier Programndash Patients attributed at the TIN-NPI level
ndash Attributed to one PCP (group) to provider with highest volume by cost provides primary care
ndash Cost compared by decile ranking instead of + 1 standard deviation
ndash Risk adjustments for geographic payment rate beneficiary risk on socio-economic status and others
bull Episodes of Carendash Anticipate 10 for 2018 ndash most operational
ndash 40 being tracked
ndash Plan to develop patient condition groups and patient relationship categories
31
Initial Episode-based Cost Measures
bull Aorticmitral valve surgery
bull CABG
bull HipFemur Fracture or Dislocation Treatment
bull Cholecystectomy and common duct exploration
bull Colonoscopy and biopsy
bull TURP for BPH
bull Lens and cataract procedures
bull Hip replacement or repair
bull Knee arthroplasty
bull Mastectomy
CMS will still provide feedback on performance in these categories in 2017 but it will not affect your 2019 payments
32
Alternative Payment Model (APMs)
bull Create the adoption of payment models that move away from FFS and tie payment to value
bull Must be in an Advanced APM to participate
bull Must meet specific thresholds of ldquosubstantial portionsrdquo of revenue from ldquoapprovedrdquo alternate payment models
bull Receive 5 lump sum bonus for 2019 -2024
bull Receive higher fee schedule update for 2026 and beyond
Which Path is Right for You
33
What are Advanced APMs
Requirements to be an Advanced APM
bull Requires use of certified EHR technology
bull Base payment on quality measures comparable to those in MIPS
bull The practice must bear more than nominal financial risk or is in a Medical Home Model expanded under CMS Innovation Center authority
2017 Eligible Advanced APMs Include
Comprehensive ESRD Care Model
Comprehensive Primary Care Plus (CPC+)
Medicare Shared SavingsProgram Track 2 and 3
Next Generation ACO Model
Oncology Care Model Two-Sided Risk Arrangement
34
APM Scoring Standards
Category Reporting Requirements Category Scoring CategoryWeight
Quality (PQRS) The ACO submits Medicare Shared Savings Program quality measures on behalf of ACO participant TINs and their MIPS eligible clinicians via the CMS Web Interface Data is submitted on the first 248 consecutively ranked and assigned Medicare beneficiaries The ACO submits this information once for purposes of both the Medicare Shared Savings Program and MIPS
MIPS benchmarks will be used to assign one score at the APM Entity Group (ACO) level In other words all MIPS eligible clinicians on the certified ACO ProviderSupplier list will receive the same score (unless they are excluded from MIPS) Note that the performance of all clinicians in the ACO will contribute to this score even if they are not subject to MIPS payment adjustments
50
Cost (VM) MIPS eligible clinicians participating in the MSSP will not be assessed on cost No reporting necessary
NA 0
Improvement Activities (new)
No additional reporting necessary Full credit for the APM Entity group by virtue of MSSP participation
20
Advancing Care Information (MU)
ACO participant TINs will submit directly to MIPS via a MIPS data submission mechanism
ACO participant TIN scores will be aggregated as a weighted average to yield one score for the APM Entity group
30
35
Quality Payment Program Paths
Subsets of MIPS and APM Paths
Eligible Clinician
MIPSAPM
MIPS-APM Advanced
APM
36
MIPS-APM Reporting Option
Requirements to be considered a MIPS-APM includebull Participate in the APM under an
agreement with CMS
bull Include one or more MIPS eligible clinicians on a Participation List
ndash On at least one of the snapshot dates
(Mar 31 June 30 or Aug 31)
bull Bases payment incentives on performance (either at the APM Entity or eligible clinician level) on costutilization and quality
2017 Eligible MIPS-APMs
CEC Model CPC+ Model MSSP Track 12 amp 3 Next Gen ACO OCM All arrangements
Note APM scoring standard applies to APMs that meet these criteria
37
MIPS-APM Benefits
bull Streamlined quality reporting
bull Still eligible for shared savings payment
ndash Financial risk payments do not impact eligibility for positive MIPS payment adjustments
bull Favorable scoring under lsquoAPM Scoring Standardrsquo
ndash ACO participants receive full credit in the Improvement Activities Category by virtue of MSSP participation
ndash ACO participants are not subject to the Cost performance category of MIPS
ndash Potential lsquoliftingrsquo of final MIPS score by being assessed at the ACO level
38
We Are All Part of the Quality Payment Program
Creating an Identity Toward a Common Goal
bull CMS
bull Clinicians
bull Patients
bull Our Care Teams
bull Service Providers
We all share a similar goal to improve patient outcomes
39
Quality Payment Program
Where Can Eligible Clinicians Go For Help
40copy 2016 Telligen Inc
All Eligible Clinicians are supported by
bull Quality Payment Program Websitendash Learn about the program explore the measures and find educational tools and
resources
ndash httpsqppcmsgov
bull Quality Payment Program Service Centerndash Assist with questions
ndash qppCMShhsgov
ndash 1-866-288-8292
bull Innovations Centerrsquos Learning Systemsndash Provides specialized information on Advanced Alternative Payment Models (APMs)
ndash httpsinnovationcmsgov
Self Service Technical Support
41copy 2016 Telligen Inc
We are here to help
bull Experienced quality improvement advisors to provide expert technical assistance and support for participating providers across the state especially those in large practices health systems and ACO at no charge
bull Helps in meeting MIPS requirements through customized technical assistance including one-on-one assistance when needed
bull Offers monthly webinars and Coffee Talk open discussion
ndash Focused QPP topic
ndash Open discuss with Q amp A ndash dedicated to your questions
ndash 2nd Thursday every month
ndash 1100 am CST for 1 hour
Telligen QIN-QIO
42copy 2016 Telligen Inc
We are here to help
bull Provides monthly electronic newsletter with resources the latest research and healthcare news relevant to you
bull Provides the ldquoWeekly Digestrdquo with electronic email on upcoming learning opportunities
bull Offers a website with the latest resources and tools and post recorded webinars for future reference
bull Partner with Telligen QIO on practice improvement activitiesndash Participation with a QIO in a self-management training program (diabetes)
ndash Implementation of antibiotic stewardship program
ndash Implementation of a cardiac quality improvement program
Telligen QIN-QIO
43copy 2016 Telligen Inc
Primary Care amp Specialist Physicians
Model
bull Align with the criteria for innovative models set forth in the Quality Payment Program
bull Build the evidence base on practice transformation so that effective solutions can be scaled
bull Move clinician practices through 5 phases of transformation with support from
ndash Practice Transformation Networks (PTN)
ndash Support amp Alignment Networks (SAN)
ndash Quality Improvement Organizations and others
Transforming Clinical Practice Initiative
44copy 2016 Telligen Inc
Primary Care amp Specialist Physicians
Goalsbull Support clinicians in their practice transformation goals
bull Improve health outcomes for millions of Medicare Medicaid and CHIP beneficiaries
bull Build the evidence base on practice transformation so that effective solutions can be scale
bull Sustain efficient care delivery by reducing unnecessary testing and procedures
bull Reduce unnecessary hospitalizations
Contact Melissa Kapping kappingmihconlineorg
Transforming Clinical Practice Initiative
45copy 2016 Telligen Inc
bull SURS (Small Underserved and Rural Support) ndash Recently announced February 16
ndash 11 organizations awarded contracts
ndash Telligen provides assistance to Iowa Nebraska South Dakota and North Dakota
ndash No cost to practices
bull Solo or small practices (15 or fewer clinicians) ndash Rural health professional shortage areas (HPSA)
ndash Medically underserved areas (MUA)
bull Outreach guidance and direct technical assistancendash Practice readiness education health IT optimization
ndash Strategic planning assisting in the full transition to APM
Telligen QPP Resource Center
46
Contact Info
Michelle Brunsen Sr QI Advisor
515-453-8180
mbrunsentelligencom
Sandy Swallow Program Specialist
515-223-2105
Sandyswallowarea-dhcqisorg
Websites
bull wwwtelligenqinqiocom
bull wwwtelligenqppcom
bull wwwqppcmsgov
THANK YOU
This material was prepared by Telligen the Quality Payment Program Small
Underserved and Rural Support contractor for Iowa Nebraska North Dakota and
South Dakota under contract with the Centers for Medicare amp Medicaid Services
(CMS) an agency of the US Department of Health and Human Services The
contents presented do not necessarily reflect CMS policy HHSM-500-2017-00012C
This material was prepared by Telligen the Medicare Quality Innovation
Network Quality Improvement Organization under contract with the
Centers for Medicare amp Medicaid Services (CMS) an agency of the US
Department of Health and Human Services The contents presented do
not necessarily reflect CMS policy
4
2016
30
85
2018
50
90
Rationale for Transformation
2014
20
gt80
2011
0
68
GoalsHistorical Performance (Pre-Announcement)
All Medicare FFS
FFS linked to quality
Alternative payment models
Source Burwell SM Setting Value-Based Payment Goals HHS Efforts to Improve US Health Care NEJM 2015 Jan 26 published online first
Linking Medicare FFS Payments
5
Encourage the integration and coordination of clinical care services Improve individual and population health Support innovation including for access
INCENTIVES
Bring electronic health information to the point of care for meaningful use
Create transparency on cost and quality information
Support consumer and clinician decision making
Focus Areas Description
CARE DELIVERY
INFORMATION
Promote value-based payment systems
ndash Test new alternative payment models
ndash Increase linkage of Medicaid Medicare FFS and other payments to value
Bring proven payment models to scale
Align quality measures
Domains for Transformation
Source Burwell SM Setting Value-Based Payment Goals HHS Efforts to Improve US Health Care NEJM 2015 Jan 26 published online first
6
Transformation Drivers
Comprehensive list of CMS quality and performance programs
Hospital Quality Physician
Quality
Reporting
PACE and Other
Setting Quality
Reporting
Payment
Model
Reporting
ldquoPopulationrdquo
Quality
Reporting
EHR Incentive Program
EHR Incentive Program
Inpatient Rehabilitation Facility
Medicare Shared Savings Program
Medicaid AdultQuality Reporting
PPS-Exempt Cancer Hospital
PQRS Nursing Home Compare Measures
Hospital Value-based Purchasing
CHIPRA Quality Reporting
Inpatient Psychiatric
Facilities
Value-based
Modifier (VM)
LTCH Quality
Reporting
Physician
Feedback
Health Insurance
Exchange Quality Reporting
HAC Payment Reduction Program
Maintenance of Certification
Hospice Quality Reporting
ESRD QIP MedicareAdvantage
Readmission Reduction Program
MACRA - QPP Home Health Quality Reporting
Innovations Pilots Medicare Part D
Outpatient Quality
Reporting
Post Acute Value
Based Purchasing
Ambulatory Surgical
Center
7
Medicare Access and Chip Reauthorization Act
Three most important need to knows about MACRA
Passed with bipartisan Congressional support in 2015
Introduces the Quality Payment Program (QPP)
Repeals SGR and ties payment for services to quality of care
8
What Impact Does MACRA Have on Clinicians
bull Alleviates the annual risk of payment cuts ndash Repeals Sustainable Growth Rate (SGR)
bull Provides more certainty of Medicare payments ndash 05 increase over the next 10 years
bull Reduces the reporting burden need for increase staffing and additional expensesndash Combines PQRS MU and VM programs into one single structure
bull Incentivizes care that focuses on improved quality outcomesndash Introduction of alternative payment models
9copy 2016 Telligen Inc
Medicare Part B ldquoEligible Cliniciansrdquo (ECs) in 2017 and 2018
bull Bill more than $30000 a year and provide care for more than 100 Medicare patients a year and are a
bull Physician (MD DO dentist chiropractor podiatrist optometrist)
bull Physician Assistant (PA)
bull Nurse Practitioner (NP)
bull Clinical Nurse Specialist (CNS)
bull Certified Registered Nurse Anesthetist (CRNA)
bull Secretary has discretion to specify additional eligible clinicians in 2019 (ie dietitians social workers PTs OTs Audiologists)
bull The majority will participate in MIPS with goal to transition to APMs
Who is Eligible for the Program
10
Who is Exempt from the Program
bull A new Medicare enrolled eligible clinician
bull A MIPS eligible clinician who does not exceed the low-volume threshold
Less than or equal to $30000 in Medicare Part B allowed charges for the year
Less than or equal to 100 Medicare patients during the year
(Thresholds are measured at the group level for group reporting and individual level for individual reporting)
bull Qualifying or a Partial Qualifying APM Participant not reporting on MIPS measures and activities but participating in an APM
Note Letters informing clinicians of their eligibility status will be received in late May per CMS
11
QPP What Happens in 2017
Alternative Payment Model
(APMs)bull ldquoSubstantial portionrdquo of
revenues from ldquoapproved alternated payment models
ndash 5 bonus each year from 2019-2024
ndash 075 increase per year beginning in 2026
Merit-based Incentive System (MIPS)
bull Clinicians receive a score of 0-100
bull Annually CMS will establish a threshold score based on the median composite performance scores of all providers
ndash Score above the threshold to receive bonus payments (up to 3 times the annual penalty cap)
ndash Performance scores will be reported on Physician Office Compare website
Eligible Clinicians Choose Your Path
12copy 2016 Telligen Inc
Pick Your Pace for Participation Your
Pace for Participation in 2017Pick Your Pace
for Participation in 2017Test PaceSubmit Something
Neutral or small bonus
Avoid Penalty
Partial Year 90 day Submission
Neutral or small bonus
No penalty
Full Year Submission
Neutral or Moderate bonus
No penalty
Participate in an Advanced Payment
Model in 2017
Donrsquot ParticipateReceive -4 payment
adjustment
QPP What Happens in 2017
Key Takeaway Positive adjustments are based on performance data submitted not the amount of information or length of time submitted
13copy 2016 Telligen Inc
Which Path is Right for You
bull Combines PQRS VM and MU into single improved reporting program
bull Legacy programs phase out
bull ECs earn a performance-based payment adjustment on the Medicare Part B PFS based on final score
ndash Adjusted either up down or neutral
bull The Final Score is calculated from quality data submitted in the performance categories
What is the Merit-Based Incentive Payment System
14
MIPS Timeline
MIPS payment adjustments only affect Medicare Part B participating Eligible Clinicians
2017Record quality data and
how you used technology
performance year1117 ndash 123117
2018Submit your quality data
reporting period1118 ndash 033118
MIPS performance feedback
(TIN-level) available mid-year
payment adjustments1119 ndash 123119
2019MIPS Eligible Clinicians earn
MIPS payment adjustments
based on submitted data
15
MIPS Reporting Options
Type Identification Mechanism
Individual bull Single NPI tied to TINbull Submit individual-level databull Data submission via claims EHR registry or QCDR
Group bull Set of clinicians identified by NPIs sharing common TINbull Submit group-level data bull Register as a group by June 30 2017bull Data submission via CMS web interface (25+) EHR registry
or QCDR
APM Entity Group orMIPS-APM
bull Collection of entities participating in an APM that donrsquot qualify for Advanced APM or meet thresholds
bull Submit MIPS data to avoid downward payment adjustment
16copy 2016 Telligen Inc
How will ECs be scored
MIPS Performance Categories for 2017
QualityReport on quality measures best
reflecting their practice
Advancing Care InformationReport customizable measures reflecting
their EHR use
Improvement ActivitiesSelect improvement activities that
match their practicersquos goals full credit if PCMH recognized
CostBeginning 2018 CMS will calculate
measures based on claims no reporting requirements from ECs
MIPS Performance Category Weights for 2017
Quality
ACI
IA
60
15
25
17
How much can MIPS adjust payments
bull Calculate the final score by sum of performance categories
bull Positive negative neutral adjustments based on CMS-established threshold
ndash Budget neutral program
bull Clinicians at or above performance threshold will receive a neutral or positive adjustment factor based on a linear sliding scale
bull Adjustments applied to a clinicianrsquos Medicare Part B claims
18copy 2016 Telligen Inc
Based on Reporting for Transition Year 2017
Final Score Payment Adjustment
gt 70 points bull Positive adjustmentbull Eligible for exceptional performance bonus ndash
minimum additional 05
4-69 points bull Neutral or Positive adjustment 0-4bull Not eligible for exceptional performance bonus
3 points bull Neutral 0 adjustment
0 points bull Negative payment adjustment of -4bull 0 points = does not participate
MIPS Payment Adjustments in CY 2019
Payment adjustment is based on Medicare Part B reimbursement at the TINNPI level
19
MIPS Performance Categories for 2017
Focus on
QualityPerformance Category
20
2017 Requirements for Quality Submissions
bull Most Participants report up to 6 Measuresndash 1 Outcome Measure (or intermediate outcome)
ndash If no Outcome Measure High Priority Measure
ndash If fewer than 6 measures apply submit all that apply
ndash 10 point decile scale minimum 3 pts for submission in 2017
ndash Use benchmarks to estimate points to predict your quality score
2017 Quality Benchmarks available at httpsqppcmsgovresourceseducation
bull Groups (25+) using the web interface report 15 quality measures for a full year
21
2017 Requirements for Quality Submissions
bull Quality Measure Bonus Points
ndash 2 Points for extra Outcome or Patient Experience Measures
ndash 1 Point for any other high priority measure
ndash Bonus points capped at 10 denominator
ndash Electronic submission bonus points 1 Point per measure for end-to-end electronic reporting
Qualification
o Clinical Data must be documented in CEHRT
o Processing must not include abstraction or pre-aggregation
o All mechanisms eligible except claims
EHR direct DSV Qualified Registry QCDR Web Interface
22
2017 Requirements for Quality Submissions
Payers Period
2017
Patient
Threshold
Rate
Period
2018
Patient
Threshold
Rate
Long Term
Rate
Claims Medicare Part
B
90 days 50 1 Year 60 90
Web
Interface
Medicare Part
B
1 Year 248 patients 1 Year 248 patients 248 patients
Qualified
Registry
All 90 days 50 1 Year 60 90
Qualified
Clinical Data
Registry
All 90 days 50 1 Year 60 90
EHR amp Data
Submission
Vendor
All 90 days 50 1 Year 60 90
23
MIPS Performance Categories for 2017
Focus on
Advancing Care Information
(ACI)Performance Category
24
2017 Requirements for ACI Submissions
Base Score bull Must report on either 4 or 5 measures specific to the EHR certification
bull Report either ldquoYesrdquo or a numerator of at least 1 bull All 50 Base Score points have to be earned to earn
Performance Points
Performance Score bull Based on performance rates for selected measures
Bonus Points bull Extra registry data connections (ie immunization clinical data registry)
bull Use of CEHRT in Improvement Activities
Reporting bull Attestation QCDR Qualified Registry EHR vendor or CMS Web Interface (groups of 25 or more)
HardshipsThresholds bull Allow for reweighting
ACI Scoring Methodology
25
2017 Requirements for ACI Submissions
Measures will contribute to the score in the
Performance Score measure set grouping
Base Measures
Security Risk Analysis
E-Prescribing
Provide Patient Access
HIE - Send a Summary of Care
HIE - RequestAccept a Summary of Care
(2015 only)
Performance Measures
Provide Patient Access
Patient-Specific Education
View Download and Transmit (VDT)
Secure Messaging
Patient-Generated Health Data
Send a Summary of Care
RequestAccept a Summary of Care
Clinical Information Reconciliation
Immunization Registry Reporting
26
MIPS Performance Categories for 2017
Focus on
Improvement Activities
(IA)Performance Category
27
2017 Requirements for IA Submissions
bull Maximum Points = 40 Pointsndash High weighted activities = 20 points
ndash Medium weighted activities = 10 points
bull Participation Thresholdsndash 90 days required
bull PCMH = Maximum Possible Points (40)
bull APM Participation = 50-100 of Maximum Possible Points at CMS discretion
bull Special Populations Points Doubledndash Practices with lt 15 providers
ndash Rural or HPSA practices
ndash Non-patient facing MIPS eligible clinicians
bull Reporting Options Qualified Registry EHR QCDR or CMS Web Interface (for groups 25 clinicians or more)
28
MIPS Performance Categories for 2017
Focus on
CostPerformance Category
29
2017 Requirements for Cost Category
bull Cost scoring weightndash 2017 0
ndash 2018 10
ndash 2019 30
bull CMS will calculate from claims over 40 episode-specific measures to account for differences among specialtiesndash Clinicians that deliver more efficient care achieve better
performance and score the highest points for cost measures
bull ldquoEpisodes of carerdquo roll up all costs of inpatient and outpatient care (including imaging laboratory drugs rehabilitation etc)
30
2017 Requirements for Cost Category
bull Expected Changes from the Value-Modifier Programndash Patients attributed at the TIN-NPI level
ndash Attributed to one PCP (group) to provider with highest volume by cost provides primary care
ndash Cost compared by decile ranking instead of + 1 standard deviation
ndash Risk adjustments for geographic payment rate beneficiary risk on socio-economic status and others
bull Episodes of Carendash Anticipate 10 for 2018 ndash most operational
ndash 40 being tracked
ndash Plan to develop patient condition groups and patient relationship categories
31
Initial Episode-based Cost Measures
bull Aorticmitral valve surgery
bull CABG
bull HipFemur Fracture or Dislocation Treatment
bull Cholecystectomy and common duct exploration
bull Colonoscopy and biopsy
bull TURP for BPH
bull Lens and cataract procedures
bull Hip replacement or repair
bull Knee arthroplasty
bull Mastectomy
CMS will still provide feedback on performance in these categories in 2017 but it will not affect your 2019 payments
32
Alternative Payment Model (APMs)
bull Create the adoption of payment models that move away from FFS and tie payment to value
bull Must be in an Advanced APM to participate
bull Must meet specific thresholds of ldquosubstantial portionsrdquo of revenue from ldquoapprovedrdquo alternate payment models
bull Receive 5 lump sum bonus for 2019 -2024
bull Receive higher fee schedule update for 2026 and beyond
Which Path is Right for You
33
What are Advanced APMs
Requirements to be an Advanced APM
bull Requires use of certified EHR technology
bull Base payment on quality measures comparable to those in MIPS
bull The practice must bear more than nominal financial risk or is in a Medical Home Model expanded under CMS Innovation Center authority
2017 Eligible Advanced APMs Include
Comprehensive ESRD Care Model
Comprehensive Primary Care Plus (CPC+)
Medicare Shared SavingsProgram Track 2 and 3
Next Generation ACO Model
Oncology Care Model Two-Sided Risk Arrangement
34
APM Scoring Standards
Category Reporting Requirements Category Scoring CategoryWeight
Quality (PQRS) The ACO submits Medicare Shared Savings Program quality measures on behalf of ACO participant TINs and their MIPS eligible clinicians via the CMS Web Interface Data is submitted on the first 248 consecutively ranked and assigned Medicare beneficiaries The ACO submits this information once for purposes of both the Medicare Shared Savings Program and MIPS
MIPS benchmarks will be used to assign one score at the APM Entity Group (ACO) level In other words all MIPS eligible clinicians on the certified ACO ProviderSupplier list will receive the same score (unless they are excluded from MIPS) Note that the performance of all clinicians in the ACO will contribute to this score even if they are not subject to MIPS payment adjustments
50
Cost (VM) MIPS eligible clinicians participating in the MSSP will not be assessed on cost No reporting necessary
NA 0
Improvement Activities (new)
No additional reporting necessary Full credit for the APM Entity group by virtue of MSSP participation
20
Advancing Care Information (MU)
ACO participant TINs will submit directly to MIPS via a MIPS data submission mechanism
ACO participant TIN scores will be aggregated as a weighted average to yield one score for the APM Entity group
30
35
Quality Payment Program Paths
Subsets of MIPS and APM Paths
Eligible Clinician
MIPSAPM
MIPS-APM Advanced
APM
36
MIPS-APM Reporting Option
Requirements to be considered a MIPS-APM includebull Participate in the APM under an
agreement with CMS
bull Include one or more MIPS eligible clinicians on a Participation List
ndash On at least one of the snapshot dates
(Mar 31 June 30 or Aug 31)
bull Bases payment incentives on performance (either at the APM Entity or eligible clinician level) on costutilization and quality
2017 Eligible MIPS-APMs
CEC Model CPC+ Model MSSP Track 12 amp 3 Next Gen ACO OCM All arrangements
Note APM scoring standard applies to APMs that meet these criteria
37
MIPS-APM Benefits
bull Streamlined quality reporting
bull Still eligible for shared savings payment
ndash Financial risk payments do not impact eligibility for positive MIPS payment adjustments
bull Favorable scoring under lsquoAPM Scoring Standardrsquo
ndash ACO participants receive full credit in the Improvement Activities Category by virtue of MSSP participation
ndash ACO participants are not subject to the Cost performance category of MIPS
ndash Potential lsquoliftingrsquo of final MIPS score by being assessed at the ACO level
38
We Are All Part of the Quality Payment Program
Creating an Identity Toward a Common Goal
bull CMS
bull Clinicians
bull Patients
bull Our Care Teams
bull Service Providers
We all share a similar goal to improve patient outcomes
39
Quality Payment Program
Where Can Eligible Clinicians Go For Help
40copy 2016 Telligen Inc
All Eligible Clinicians are supported by
bull Quality Payment Program Websitendash Learn about the program explore the measures and find educational tools and
resources
ndash httpsqppcmsgov
bull Quality Payment Program Service Centerndash Assist with questions
ndash qppCMShhsgov
ndash 1-866-288-8292
bull Innovations Centerrsquos Learning Systemsndash Provides specialized information on Advanced Alternative Payment Models (APMs)
ndash httpsinnovationcmsgov
Self Service Technical Support
41copy 2016 Telligen Inc
We are here to help
bull Experienced quality improvement advisors to provide expert technical assistance and support for participating providers across the state especially those in large practices health systems and ACO at no charge
bull Helps in meeting MIPS requirements through customized technical assistance including one-on-one assistance when needed
bull Offers monthly webinars and Coffee Talk open discussion
ndash Focused QPP topic
ndash Open discuss with Q amp A ndash dedicated to your questions
ndash 2nd Thursday every month
ndash 1100 am CST for 1 hour
Telligen QIN-QIO
42copy 2016 Telligen Inc
We are here to help
bull Provides monthly electronic newsletter with resources the latest research and healthcare news relevant to you
bull Provides the ldquoWeekly Digestrdquo with electronic email on upcoming learning opportunities
bull Offers a website with the latest resources and tools and post recorded webinars for future reference
bull Partner with Telligen QIO on practice improvement activitiesndash Participation with a QIO in a self-management training program (diabetes)
ndash Implementation of antibiotic stewardship program
ndash Implementation of a cardiac quality improvement program
Telligen QIN-QIO
43copy 2016 Telligen Inc
Primary Care amp Specialist Physicians
Model
bull Align with the criteria for innovative models set forth in the Quality Payment Program
bull Build the evidence base on practice transformation so that effective solutions can be scaled
bull Move clinician practices through 5 phases of transformation with support from
ndash Practice Transformation Networks (PTN)
ndash Support amp Alignment Networks (SAN)
ndash Quality Improvement Organizations and others
Transforming Clinical Practice Initiative
44copy 2016 Telligen Inc
Primary Care amp Specialist Physicians
Goalsbull Support clinicians in their practice transformation goals
bull Improve health outcomes for millions of Medicare Medicaid and CHIP beneficiaries
bull Build the evidence base on practice transformation so that effective solutions can be scale
bull Sustain efficient care delivery by reducing unnecessary testing and procedures
bull Reduce unnecessary hospitalizations
Contact Melissa Kapping kappingmihconlineorg
Transforming Clinical Practice Initiative
45copy 2016 Telligen Inc
bull SURS (Small Underserved and Rural Support) ndash Recently announced February 16
ndash 11 organizations awarded contracts
ndash Telligen provides assistance to Iowa Nebraska South Dakota and North Dakota
ndash No cost to practices
bull Solo or small practices (15 or fewer clinicians) ndash Rural health professional shortage areas (HPSA)
ndash Medically underserved areas (MUA)
bull Outreach guidance and direct technical assistancendash Practice readiness education health IT optimization
ndash Strategic planning assisting in the full transition to APM
Telligen QPP Resource Center
46
Contact Info
Michelle Brunsen Sr QI Advisor
515-453-8180
mbrunsentelligencom
Sandy Swallow Program Specialist
515-223-2105
Sandyswallowarea-dhcqisorg
Websites
bull wwwtelligenqinqiocom
bull wwwtelligenqppcom
bull wwwqppcmsgov
THANK YOU
This material was prepared by Telligen the Quality Payment Program Small
Underserved and Rural Support contractor for Iowa Nebraska North Dakota and
South Dakota under contract with the Centers for Medicare amp Medicaid Services
(CMS) an agency of the US Department of Health and Human Services The
contents presented do not necessarily reflect CMS policy HHSM-500-2017-00012C
This material was prepared by Telligen the Medicare Quality Innovation
Network Quality Improvement Organization under contract with the
Centers for Medicare amp Medicaid Services (CMS) an agency of the US
Department of Health and Human Services The contents presented do
not necessarily reflect CMS policy
5
Encourage the integration and coordination of clinical care services Improve individual and population health Support innovation including for access
INCENTIVES
Bring electronic health information to the point of care for meaningful use
Create transparency on cost and quality information
Support consumer and clinician decision making
Focus Areas Description
CARE DELIVERY
INFORMATION
Promote value-based payment systems
ndash Test new alternative payment models
ndash Increase linkage of Medicaid Medicare FFS and other payments to value
Bring proven payment models to scale
Align quality measures
Domains for Transformation
Source Burwell SM Setting Value-Based Payment Goals HHS Efforts to Improve US Health Care NEJM 2015 Jan 26 published online first
6
Transformation Drivers
Comprehensive list of CMS quality and performance programs
Hospital Quality Physician
Quality
Reporting
PACE and Other
Setting Quality
Reporting
Payment
Model
Reporting
ldquoPopulationrdquo
Quality
Reporting
EHR Incentive Program
EHR Incentive Program
Inpatient Rehabilitation Facility
Medicare Shared Savings Program
Medicaid AdultQuality Reporting
PPS-Exempt Cancer Hospital
PQRS Nursing Home Compare Measures
Hospital Value-based Purchasing
CHIPRA Quality Reporting
Inpatient Psychiatric
Facilities
Value-based
Modifier (VM)
LTCH Quality
Reporting
Physician
Feedback
Health Insurance
Exchange Quality Reporting
HAC Payment Reduction Program
Maintenance of Certification
Hospice Quality Reporting
ESRD QIP MedicareAdvantage
Readmission Reduction Program
MACRA - QPP Home Health Quality Reporting
Innovations Pilots Medicare Part D
Outpatient Quality
Reporting
Post Acute Value
Based Purchasing
Ambulatory Surgical
Center
7
Medicare Access and Chip Reauthorization Act
Three most important need to knows about MACRA
Passed with bipartisan Congressional support in 2015
Introduces the Quality Payment Program (QPP)
Repeals SGR and ties payment for services to quality of care
8
What Impact Does MACRA Have on Clinicians
bull Alleviates the annual risk of payment cuts ndash Repeals Sustainable Growth Rate (SGR)
bull Provides more certainty of Medicare payments ndash 05 increase over the next 10 years
bull Reduces the reporting burden need for increase staffing and additional expensesndash Combines PQRS MU and VM programs into one single structure
bull Incentivizes care that focuses on improved quality outcomesndash Introduction of alternative payment models
9copy 2016 Telligen Inc
Medicare Part B ldquoEligible Cliniciansrdquo (ECs) in 2017 and 2018
bull Bill more than $30000 a year and provide care for more than 100 Medicare patients a year and are a
bull Physician (MD DO dentist chiropractor podiatrist optometrist)
bull Physician Assistant (PA)
bull Nurse Practitioner (NP)
bull Clinical Nurse Specialist (CNS)
bull Certified Registered Nurse Anesthetist (CRNA)
bull Secretary has discretion to specify additional eligible clinicians in 2019 (ie dietitians social workers PTs OTs Audiologists)
bull The majority will participate in MIPS with goal to transition to APMs
Who is Eligible for the Program
10
Who is Exempt from the Program
bull A new Medicare enrolled eligible clinician
bull A MIPS eligible clinician who does not exceed the low-volume threshold
Less than or equal to $30000 in Medicare Part B allowed charges for the year
Less than or equal to 100 Medicare patients during the year
(Thresholds are measured at the group level for group reporting and individual level for individual reporting)
bull Qualifying or a Partial Qualifying APM Participant not reporting on MIPS measures and activities but participating in an APM
Note Letters informing clinicians of their eligibility status will be received in late May per CMS
11
QPP What Happens in 2017
Alternative Payment Model
(APMs)bull ldquoSubstantial portionrdquo of
revenues from ldquoapproved alternated payment models
ndash 5 bonus each year from 2019-2024
ndash 075 increase per year beginning in 2026
Merit-based Incentive System (MIPS)
bull Clinicians receive a score of 0-100
bull Annually CMS will establish a threshold score based on the median composite performance scores of all providers
ndash Score above the threshold to receive bonus payments (up to 3 times the annual penalty cap)
ndash Performance scores will be reported on Physician Office Compare website
Eligible Clinicians Choose Your Path
12copy 2016 Telligen Inc
Pick Your Pace for Participation Your
Pace for Participation in 2017Pick Your Pace
for Participation in 2017Test PaceSubmit Something
Neutral or small bonus
Avoid Penalty
Partial Year 90 day Submission
Neutral or small bonus
No penalty
Full Year Submission
Neutral or Moderate bonus
No penalty
Participate in an Advanced Payment
Model in 2017
Donrsquot ParticipateReceive -4 payment
adjustment
QPP What Happens in 2017
Key Takeaway Positive adjustments are based on performance data submitted not the amount of information or length of time submitted
13copy 2016 Telligen Inc
Which Path is Right for You
bull Combines PQRS VM and MU into single improved reporting program
bull Legacy programs phase out
bull ECs earn a performance-based payment adjustment on the Medicare Part B PFS based on final score
ndash Adjusted either up down or neutral
bull The Final Score is calculated from quality data submitted in the performance categories
What is the Merit-Based Incentive Payment System
14
MIPS Timeline
MIPS payment adjustments only affect Medicare Part B participating Eligible Clinicians
2017Record quality data and
how you used technology
performance year1117 ndash 123117
2018Submit your quality data
reporting period1118 ndash 033118
MIPS performance feedback
(TIN-level) available mid-year
payment adjustments1119 ndash 123119
2019MIPS Eligible Clinicians earn
MIPS payment adjustments
based on submitted data
15
MIPS Reporting Options
Type Identification Mechanism
Individual bull Single NPI tied to TINbull Submit individual-level databull Data submission via claims EHR registry or QCDR
Group bull Set of clinicians identified by NPIs sharing common TINbull Submit group-level data bull Register as a group by June 30 2017bull Data submission via CMS web interface (25+) EHR registry
or QCDR
APM Entity Group orMIPS-APM
bull Collection of entities participating in an APM that donrsquot qualify for Advanced APM or meet thresholds
bull Submit MIPS data to avoid downward payment adjustment
16copy 2016 Telligen Inc
How will ECs be scored
MIPS Performance Categories for 2017
QualityReport on quality measures best
reflecting their practice
Advancing Care InformationReport customizable measures reflecting
their EHR use
Improvement ActivitiesSelect improvement activities that
match their practicersquos goals full credit if PCMH recognized
CostBeginning 2018 CMS will calculate
measures based on claims no reporting requirements from ECs
MIPS Performance Category Weights for 2017
Quality
ACI
IA
60
15
25
17
How much can MIPS adjust payments
bull Calculate the final score by sum of performance categories
bull Positive negative neutral adjustments based on CMS-established threshold
ndash Budget neutral program
bull Clinicians at or above performance threshold will receive a neutral or positive adjustment factor based on a linear sliding scale
bull Adjustments applied to a clinicianrsquos Medicare Part B claims
18copy 2016 Telligen Inc
Based on Reporting for Transition Year 2017
Final Score Payment Adjustment
gt 70 points bull Positive adjustmentbull Eligible for exceptional performance bonus ndash
minimum additional 05
4-69 points bull Neutral or Positive adjustment 0-4bull Not eligible for exceptional performance bonus
3 points bull Neutral 0 adjustment
0 points bull Negative payment adjustment of -4bull 0 points = does not participate
MIPS Payment Adjustments in CY 2019
Payment adjustment is based on Medicare Part B reimbursement at the TINNPI level
19
MIPS Performance Categories for 2017
Focus on
QualityPerformance Category
20
2017 Requirements for Quality Submissions
bull Most Participants report up to 6 Measuresndash 1 Outcome Measure (or intermediate outcome)
ndash If no Outcome Measure High Priority Measure
ndash If fewer than 6 measures apply submit all that apply
ndash 10 point decile scale minimum 3 pts for submission in 2017
ndash Use benchmarks to estimate points to predict your quality score
2017 Quality Benchmarks available at httpsqppcmsgovresourceseducation
bull Groups (25+) using the web interface report 15 quality measures for a full year
21
2017 Requirements for Quality Submissions
bull Quality Measure Bonus Points
ndash 2 Points for extra Outcome or Patient Experience Measures
ndash 1 Point for any other high priority measure
ndash Bonus points capped at 10 denominator
ndash Electronic submission bonus points 1 Point per measure for end-to-end electronic reporting
Qualification
o Clinical Data must be documented in CEHRT
o Processing must not include abstraction or pre-aggregation
o All mechanisms eligible except claims
EHR direct DSV Qualified Registry QCDR Web Interface
22
2017 Requirements for Quality Submissions
Payers Period
2017
Patient
Threshold
Rate
Period
2018
Patient
Threshold
Rate
Long Term
Rate
Claims Medicare Part
B
90 days 50 1 Year 60 90
Web
Interface
Medicare Part
B
1 Year 248 patients 1 Year 248 patients 248 patients
Qualified
Registry
All 90 days 50 1 Year 60 90
Qualified
Clinical Data
Registry
All 90 days 50 1 Year 60 90
EHR amp Data
Submission
Vendor
All 90 days 50 1 Year 60 90
23
MIPS Performance Categories for 2017
Focus on
Advancing Care Information
(ACI)Performance Category
24
2017 Requirements for ACI Submissions
Base Score bull Must report on either 4 or 5 measures specific to the EHR certification
bull Report either ldquoYesrdquo or a numerator of at least 1 bull All 50 Base Score points have to be earned to earn
Performance Points
Performance Score bull Based on performance rates for selected measures
Bonus Points bull Extra registry data connections (ie immunization clinical data registry)
bull Use of CEHRT in Improvement Activities
Reporting bull Attestation QCDR Qualified Registry EHR vendor or CMS Web Interface (groups of 25 or more)
HardshipsThresholds bull Allow for reweighting
ACI Scoring Methodology
25
2017 Requirements for ACI Submissions
Measures will contribute to the score in the
Performance Score measure set grouping
Base Measures
Security Risk Analysis
E-Prescribing
Provide Patient Access
HIE - Send a Summary of Care
HIE - RequestAccept a Summary of Care
(2015 only)
Performance Measures
Provide Patient Access
Patient-Specific Education
View Download and Transmit (VDT)
Secure Messaging
Patient-Generated Health Data
Send a Summary of Care
RequestAccept a Summary of Care
Clinical Information Reconciliation
Immunization Registry Reporting
26
MIPS Performance Categories for 2017
Focus on
Improvement Activities
(IA)Performance Category
27
2017 Requirements for IA Submissions
bull Maximum Points = 40 Pointsndash High weighted activities = 20 points
ndash Medium weighted activities = 10 points
bull Participation Thresholdsndash 90 days required
bull PCMH = Maximum Possible Points (40)
bull APM Participation = 50-100 of Maximum Possible Points at CMS discretion
bull Special Populations Points Doubledndash Practices with lt 15 providers
ndash Rural or HPSA practices
ndash Non-patient facing MIPS eligible clinicians
bull Reporting Options Qualified Registry EHR QCDR or CMS Web Interface (for groups 25 clinicians or more)
28
MIPS Performance Categories for 2017
Focus on
CostPerformance Category
29
2017 Requirements for Cost Category
bull Cost scoring weightndash 2017 0
ndash 2018 10
ndash 2019 30
bull CMS will calculate from claims over 40 episode-specific measures to account for differences among specialtiesndash Clinicians that deliver more efficient care achieve better
performance and score the highest points for cost measures
bull ldquoEpisodes of carerdquo roll up all costs of inpatient and outpatient care (including imaging laboratory drugs rehabilitation etc)
30
2017 Requirements for Cost Category
bull Expected Changes from the Value-Modifier Programndash Patients attributed at the TIN-NPI level
ndash Attributed to one PCP (group) to provider with highest volume by cost provides primary care
ndash Cost compared by decile ranking instead of + 1 standard deviation
ndash Risk adjustments for geographic payment rate beneficiary risk on socio-economic status and others
bull Episodes of Carendash Anticipate 10 for 2018 ndash most operational
ndash 40 being tracked
ndash Plan to develop patient condition groups and patient relationship categories
31
Initial Episode-based Cost Measures
bull Aorticmitral valve surgery
bull CABG
bull HipFemur Fracture or Dislocation Treatment
bull Cholecystectomy and common duct exploration
bull Colonoscopy and biopsy
bull TURP for BPH
bull Lens and cataract procedures
bull Hip replacement or repair
bull Knee arthroplasty
bull Mastectomy
CMS will still provide feedback on performance in these categories in 2017 but it will not affect your 2019 payments
32
Alternative Payment Model (APMs)
bull Create the adoption of payment models that move away from FFS and tie payment to value
bull Must be in an Advanced APM to participate
bull Must meet specific thresholds of ldquosubstantial portionsrdquo of revenue from ldquoapprovedrdquo alternate payment models
bull Receive 5 lump sum bonus for 2019 -2024
bull Receive higher fee schedule update for 2026 and beyond
Which Path is Right for You
33
What are Advanced APMs
Requirements to be an Advanced APM
bull Requires use of certified EHR technology
bull Base payment on quality measures comparable to those in MIPS
bull The practice must bear more than nominal financial risk or is in a Medical Home Model expanded under CMS Innovation Center authority
2017 Eligible Advanced APMs Include
Comprehensive ESRD Care Model
Comprehensive Primary Care Plus (CPC+)
Medicare Shared SavingsProgram Track 2 and 3
Next Generation ACO Model
Oncology Care Model Two-Sided Risk Arrangement
34
APM Scoring Standards
Category Reporting Requirements Category Scoring CategoryWeight
Quality (PQRS) The ACO submits Medicare Shared Savings Program quality measures on behalf of ACO participant TINs and their MIPS eligible clinicians via the CMS Web Interface Data is submitted on the first 248 consecutively ranked and assigned Medicare beneficiaries The ACO submits this information once for purposes of both the Medicare Shared Savings Program and MIPS
MIPS benchmarks will be used to assign one score at the APM Entity Group (ACO) level In other words all MIPS eligible clinicians on the certified ACO ProviderSupplier list will receive the same score (unless they are excluded from MIPS) Note that the performance of all clinicians in the ACO will contribute to this score even if they are not subject to MIPS payment adjustments
50
Cost (VM) MIPS eligible clinicians participating in the MSSP will not be assessed on cost No reporting necessary
NA 0
Improvement Activities (new)
No additional reporting necessary Full credit for the APM Entity group by virtue of MSSP participation
20
Advancing Care Information (MU)
ACO participant TINs will submit directly to MIPS via a MIPS data submission mechanism
ACO participant TIN scores will be aggregated as a weighted average to yield one score for the APM Entity group
30
35
Quality Payment Program Paths
Subsets of MIPS and APM Paths
Eligible Clinician
MIPSAPM
MIPS-APM Advanced
APM
36
MIPS-APM Reporting Option
Requirements to be considered a MIPS-APM includebull Participate in the APM under an
agreement with CMS
bull Include one or more MIPS eligible clinicians on a Participation List
ndash On at least one of the snapshot dates
(Mar 31 June 30 or Aug 31)
bull Bases payment incentives on performance (either at the APM Entity or eligible clinician level) on costutilization and quality
2017 Eligible MIPS-APMs
CEC Model CPC+ Model MSSP Track 12 amp 3 Next Gen ACO OCM All arrangements
Note APM scoring standard applies to APMs that meet these criteria
37
MIPS-APM Benefits
bull Streamlined quality reporting
bull Still eligible for shared savings payment
ndash Financial risk payments do not impact eligibility for positive MIPS payment adjustments
bull Favorable scoring under lsquoAPM Scoring Standardrsquo
ndash ACO participants receive full credit in the Improvement Activities Category by virtue of MSSP participation
ndash ACO participants are not subject to the Cost performance category of MIPS
ndash Potential lsquoliftingrsquo of final MIPS score by being assessed at the ACO level
38
We Are All Part of the Quality Payment Program
Creating an Identity Toward a Common Goal
bull CMS
bull Clinicians
bull Patients
bull Our Care Teams
bull Service Providers
We all share a similar goal to improve patient outcomes
39
Quality Payment Program
Where Can Eligible Clinicians Go For Help
40copy 2016 Telligen Inc
All Eligible Clinicians are supported by
bull Quality Payment Program Websitendash Learn about the program explore the measures and find educational tools and
resources
ndash httpsqppcmsgov
bull Quality Payment Program Service Centerndash Assist with questions
ndash qppCMShhsgov
ndash 1-866-288-8292
bull Innovations Centerrsquos Learning Systemsndash Provides specialized information on Advanced Alternative Payment Models (APMs)
ndash httpsinnovationcmsgov
Self Service Technical Support
41copy 2016 Telligen Inc
We are here to help
bull Experienced quality improvement advisors to provide expert technical assistance and support for participating providers across the state especially those in large practices health systems and ACO at no charge
bull Helps in meeting MIPS requirements through customized technical assistance including one-on-one assistance when needed
bull Offers monthly webinars and Coffee Talk open discussion
ndash Focused QPP topic
ndash Open discuss with Q amp A ndash dedicated to your questions
ndash 2nd Thursday every month
ndash 1100 am CST for 1 hour
Telligen QIN-QIO
42copy 2016 Telligen Inc
We are here to help
bull Provides monthly electronic newsletter with resources the latest research and healthcare news relevant to you
bull Provides the ldquoWeekly Digestrdquo with electronic email on upcoming learning opportunities
bull Offers a website with the latest resources and tools and post recorded webinars for future reference
bull Partner with Telligen QIO on practice improvement activitiesndash Participation with a QIO in a self-management training program (diabetes)
ndash Implementation of antibiotic stewardship program
ndash Implementation of a cardiac quality improvement program
Telligen QIN-QIO
43copy 2016 Telligen Inc
Primary Care amp Specialist Physicians
Model
bull Align with the criteria for innovative models set forth in the Quality Payment Program
bull Build the evidence base on practice transformation so that effective solutions can be scaled
bull Move clinician practices through 5 phases of transformation with support from
ndash Practice Transformation Networks (PTN)
ndash Support amp Alignment Networks (SAN)
ndash Quality Improvement Organizations and others
Transforming Clinical Practice Initiative
44copy 2016 Telligen Inc
Primary Care amp Specialist Physicians
Goalsbull Support clinicians in their practice transformation goals
bull Improve health outcomes for millions of Medicare Medicaid and CHIP beneficiaries
bull Build the evidence base on practice transformation so that effective solutions can be scale
bull Sustain efficient care delivery by reducing unnecessary testing and procedures
bull Reduce unnecessary hospitalizations
Contact Melissa Kapping kappingmihconlineorg
Transforming Clinical Practice Initiative
45copy 2016 Telligen Inc
bull SURS (Small Underserved and Rural Support) ndash Recently announced February 16
ndash 11 organizations awarded contracts
ndash Telligen provides assistance to Iowa Nebraska South Dakota and North Dakota
ndash No cost to practices
bull Solo or small practices (15 or fewer clinicians) ndash Rural health professional shortage areas (HPSA)
ndash Medically underserved areas (MUA)
bull Outreach guidance and direct technical assistancendash Practice readiness education health IT optimization
ndash Strategic planning assisting in the full transition to APM
Telligen QPP Resource Center
46
Contact Info
Michelle Brunsen Sr QI Advisor
515-453-8180
mbrunsentelligencom
Sandy Swallow Program Specialist
515-223-2105
Sandyswallowarea-dhcqisorg
Websites
bull wwwtelligenqinqiocom
bull wwwtelligenqppcom
bull wwwqppcmsgov
THANK YOU
This material was prepared by Telligen the Quality Payment Program Small
Underserved and Rural Support contractor for Iowa Nebraska North Dakota and
South Dakota under contract with the Centers for Medicare amp Medicaid Services
(CMS) an agency of the US Department of Health and Human Services The
contents presented do not necessarily reflect CMS policy HHSM-500-2017-00012C
This material was prepared by Telligen the Medicare Quality Innovation
Network Quality Improvement Organization under contract with the
Centers for Medicare amp Medicaid Services (CMS) an agency of the US
Department of Health and Human Services The contents presented do
not necessarily reflect CMS policy
6
Transformation Drivers
Comprehensive list of CMS quality and performance programs
Hospital Quality Physician
Quality
Reporting
PACE and Other
Setting Quality
Reporting
Payment
Model
Reporting
ldquoPopulationrdquo
Quality
Reporting
EHR Incentive Program
EHR Incentive Program
Inpatient Rehabilitation Facility
Medicare Shared Savings Program
Medicaid AdultQuality Reporting
PPS-Exempt Cancer Hospital
PQRS Nursing Home Compare Measures
Hospital Value-based Purchasing
CHIPRA Quality Reporting
Inpatient Psychiatric
Facilities
Value-based
Modifier (VM)
LTCH Quality
Reporting
Physician
Feedback
Health Insurance
Exchange Quality Reporting
HAC Payment Reduction Program
Maintenance of Certification
Hospice Quality Reporting
ESRD QIP MedicareAdvantage
Readmission Reduction Program
MACRA - QPP Home Health Quality Reporting
Innovations Pilots Medicare Part D
Outpatient Quality
Reporting
Post Acute Value
Based Purchasing
Ambulatory Surgical
Center
7
Medicare Access and Chip Reauthorization Act
Three most important need to knows about MACRA
Passed with bipartisan Congressional support in 2015
Introduces the Quality Payment Program (QPP)
Repeals SGR and ties payment for services to quality of care
8
What Impact Does MACRA Have on Clinicians
bull Alleviates the annual risk of payment cuts ndash Repeals Sustainable Growth Rate (SGR)
bull Provides more certainty of Medicare payments ndash 05 increase over the next 10 years
bull Reduces the reporting burden need for increase staffing and additional expensesndash Combines PQRS MU and VM programs into one single structure
bull Incentivizes care that focuses on improved quality outcomesndash Introduction of alternative payment models
9copy 2016 Telligen Inc
Medicare Part B ldquoEligible Cliniciansrdquo (ECs) in 2017 and 2018
bull Bill more than $30000 a year and provide care for more than 100 Medicare patients a year and are a
bull Physician (MD DO dentist chiropractor podiatrist optometrist)
bull Physician Assistant (PA)
bull Nurse Practitioner (NP)
bull Clinical Nurse Specialist (CNS)
bull Certified Registered Nurse Anesthetist (CRNA)
bull Secretary has discretion to specify additional eligible clinicians in 2019 (ie dietitians social workers PTs OTs Audiologists)
bull The majority will participate in MIPS with goal to transition to APMs
Who is Eligible for the Program
10
Who is Exempt from the Program
bull A new Medicare enrolled eligible clinician
bull A MIPS eligible clinician who does not exceed the low-volume threshold
Less than or equal to $30000 in Medicare Part B allowed charges for the year
Less than or equal to 100 Medicare patients during the year
(Thresholds are measured at the group level for group reporting and individual level for individual reporting)
bull Qualifying or a Partial Qualifying APM Participant not reporting on MIPS measures and activities but participating in an APM
Note Letters informing clinicians of their eligibility status will be received in late May per CMS
11
QPP What Happens in 2017
Alternative Payment Model
(APMs)bull ldquoSubstantial portionrdquo of
revenues from ldquoapproved alternated payment models
ndash 5 bonus each year from 2019-2024
ndash 075 increase per year beginning in 2026
Merit-based Incentive System (MIPS)
bull Clinicians receive a score of 0-100
bull Annually CMS will establish a threshold score based on the median composite performance scores of all providers
ndash Score above the threshold to receive bonus payments (up to 3 times the annual penalty cap)
ndash Performance scores will be reported on Physician Office Compare website
Eligible Clinicians Choose Your Path
12copy 2016 Telligen Inc
Pick Your Pace for Participation Your
Pace for Participation in 2017Pick Your Pace
for Participation in 2017Test PaceSubmit Something
Neutral or small bonus
Avoid Penalty
Partial Year 90 day Submission
Neutral or small bonus
No penalty
Full Year Submission
Neutral or Moderate bonus
No penalty
Participate in an Advanced Payment
Model in 2017
Donrsquot ParticipateReceive -4 payment
adjustment
QPP What Happens in 2017
Key Takeaway Positive adjustments are based on performance data submitted not the amount of information or length of time submitted
13copy 2016 Telligen Inc
Which Path is Right for You
bull Combines PQRS VM and MU into single improved reporting program
bull Legacy programs phase out
bull ECs earn a performance-based payment adjustment on the Medicare Part B PFS based on final score
ndash Adjusted either up down or neutral
bull The Final Score is calculated from quality data submitted in the performance categories
What is the Merit-Based Incentive Payment System
14
MIPS Timeline
MIPS payment adjustments only affect Medicare Part B participating Eligible Clinicians
2017Record quality data and
how you used technology
performance year1117 ndash 123117
2018Submit your quality data
reporting period1118 ndash 033118
MIPS performance feedback
(TIN-level) available mid-year
payment adjustments1119 ndash 123119
2019MIPS Eligible Clinicians earn
MIPS payment adjustments
based on submitted data
15
MIPS Reporting Options
Type Identification Mechanism
Individual bull Single NPI tied to TINbull Submit individual-level databull Data submission via claims EHR registry or QCDR
Group bull Set of clinicians identified by NPIs sharing common TINbull Submit group-level data bull Register as a group by June 30 2017bull Data submission via CMS web interface (25+) EHR registry
or QCDR
APM Entity Group orMIPS-APM
bull Collection of entities participating in an APM that donrsquot qualify for Advanced APM or meet thresholds
bull Submit MIPS data to avoid downward payment adjustment
16copy 2016 Telligen Inc
How will ECs be scored
MIPS Performance Categories for 2017
QualityReport on quality measures best
reflecting their practice
Advancing Care InformationReport customizable measures reflecting
their EHR use
Improvement ActivitiesSelect improvement activities that
match their practicersquos goals full credit if PCMH recognized
CostBeginning 2018 CMS will calculate
measures based on claims no reporting requirements from ECs
MIPS Performance Category Weights for 2017
Quality
ACI
IA
60
15
25
17
How much can MIPS adjust payments
bull Calculate the final score by sum of performance categories
bull Positive negative neutral adjustments based on CMS-established threshold
ndash Budget neutral program
bull Clinicians at or above performance threshold will receive a neutral or positive adjustment factor based on a linear sliding scale
bull Adjustments applied to a clinicianrsquos Medicare Part B claims
18copy 2016 Telligen Inc
Based on Reporting for Transition Year 2017
Final Score Payment Adjustment
gt 70 points bull Positive adjustmentbull Eligible for exceptional performance bonus ndash
minimum additional 05
4-69 points bull Neutral or Positive adjustment 0-4bull Not eligible for exceptional performance bonus
3 points bull Neutral 0 adjustment
0 points bull Negative payment adjustment of -4bull 0 points = does not participate
MIPS Payment Adjustments in CY 2019
Payment adjustment is based on Medicare Part B reimbursement at the TINNPI level
19
MIPS Performance Categories for 2017
Focus on
QualityPerformance Category
20
2017 Requirements for Quality Submissions
bull Most Participants report up to 6 Measuresndash 1 Outcome Measure (or intermediate outcome)
ndash If no Outcome Measure High Priority Measure
ndash If fewer than 6 measures apply submit all that apply
ndash 10 point decile scale minimum 3 pts for submission in 2017
ndash Use benchmarks to estimate points to predict your quality score
2017 Quality Benchmarks available at httpsqppcmsgovresourceseducation
bull Groups (25+) using the web interface report 15 quality measures for a full year
21
2017 Requirements for Quality Submissions
bull Quality Measure Bonus Points
ndash 2 Points for extra Outcome or Patient Experience Measures
ndash 1 Point for any other high priority measure
ndash Bonus points capped at 10 denominator
ndash Electronic submission bonus points 1 Point per measure for end-to-end electronic reporting
Qualification
o Clinical Data must be documented in CEHRT
o Processing must not include abstraction or pre-aggregation
o All mechanisms eligible except claims
EHR direct DSV Qualified Registry QCDR Web Interface
22
2017 Requirements for Quality Submissions
Payers Period
2017
Patient
Threshold
Rate
Period
2018
Patient
Threshold
Rate
Long Term
Rate
Claims Medicare Part
B
90 days 50 1 Year 60 90
Web
Interface
Medicare Part
B
1 Year 248 patients 1 Year 248 patients 248 patients
Qualified
Registry
All 90 days 50 1 Year 60 90
Qualified
Clinical Data
Registry
All 90 days 50 1 Year 60 90
EHR amp Data
Submission
Vendor
All 90 days 50 1 Year 60 90
23
MIPS Performance Categories for 2017
Focus on
Advancing Care Information
(ACI)Performance Category
24
2017 Requirements for ACI Submissions
Base Score bull Must report on either 4 or 5 measures specific to the EHR certification
bull Report either ldquoYesrdquo or a numerator of at least 1 bull All 50 Base Score points have to be earned to earn
Performance Points
Performance Score bull Based on performance rates for selected measures
Bonus Points bull Extra registry data connections (ie immunization clinical data registry)
bull Use of CEHRT in Improvement Activities
Reporting bull Attestation QCDR Qualified Registry EHR vendor or CMS Web Interface (groups of 25 or more)
HardshipsThresholds bull Allow for reweighting
ACI Scoring Methodology
25
2017 Requirements for ACI Submissions
Measures will contribute to the score in the
Performance Score measure set grouping
Base Measures
Security Risk Analysis
E-Prescribing
Provide Patient Access
HIE - Send a Summary of Care
HIE - RequestAccept a Summary of Care
(2015 only)
Performance Measures
Provide Patient Access
Patient-Specific Education
View Download and Transmit (VDT)
Secure Messaging
Patient-Generated Health Data
Send a Summary of Care
RequestAccept a Summary of Care
Clinical Information Reconciliation
Immunization Registry Reporting
26
MIPS Performance Categories for 2017
Focus on
Improvement Activities
(IA)Performance Category
27
2017 Requirements for IA Submissions
bull Maximum Points = 40 Pointsndash High weighted activities = 20 points
ndash Medium weighted activities = 10 points
bull Participation Thresholdsndash 90 days required
bull PCMH = Maximum Possible Points (40)
bull APM Participation = 50-100 of Maximum Possible Points at CMS discretion
bull Special Populations Points Doubledndash Practices with lt 15 providers
ndash Rural or HPSA practices
ndash Non-patient facing MIPS eligible clinicians
bull Reporting Options Qualified Registry EHR QCDR or CMS Web Interface (for groups 25 clinicians or more)
28
MIPS Performance Categories for 2017
Focus on
CostPerformance Category
29
2017 Requirements for Cost Category
bull Cost scoring weightndash 2017 0
ndash 2018 10
ndash 2019 30
bull CMS will calculate from claims over 40 episode-specific measures to account for differences among specialtiesndash Clinicians that deliver more efficient care achieve better
performance and score the highest points for cost measures
bull ldquoEpisodes of carerdquo roll up all costs of inpatient and outpatient care (including imaging laboratory drugs rehabilitation etc)
30
2017 Requirements for Cost Category
bull Expected Changes from the Value-Modifier Programndash Patients attributed at the TIN-NPI level
ndash Attributed to one PCP (group) to provider with highest volume by cost provides primary care
ndash Cost compared by decile ranking instead of + 1 standard deviation
ndash Risk adjustments for geographic payment rate beneficiary risk on socio-economic status and others
bull Episodes of Carendash Anticipate 10 for 2018 ndash most operational
ndash 40 being tracked
ndash Plan to develop patient condition groups and patient relationship categories
31
Initial Episode-based Cost Measures
bull Aorticmitral valve surgery
bull CABG
bull HipFemur Fracture or Dislocation Treatment
bull Cholecystectomy and common duct exploration
bull Colonoscopy and biopsy
bull TURP for BPH
bull Lens and cataract procedures
bull Hip replacement or repair
bull Knee arthroplasty
bull Mastectomy
CMS will still provide feedback on performance in these categories in 2017 but it will not affect your 2019 payments
32
Alternative Payment Model (APMs)
bull Create the adoption of payment models that move away from FFS and tie payment to value
bull Must be in an Advanced APM to participate
bull Must meet specific thresholds of ldquosubstantial portionsrdquo of revenue from ldquoapprovedrdquo alternate payment models
bull Receive 5 lump sum bonus for 2019 -2024
bull Receive higher fee schedule update for 2026 and beyond
Which Path is Right for You
33
What are Advanced APMs
Requirements to be an Advanced APM
bull Requires use of certified EHR technology
bull Base payment on quality measures comparable to those in MIPS
bull The practice must bear more than nominal financial risk or is in a Medical Home Model expanded under CMS Innovation Center authority
2017 Eligible Advanced APMs Include
Comprehensive ESRD Care Model
Comprehensive Primary Care Plus (CPC+)
Medicare Shared SavingsProgram Track 2 and 3
Next Generation ACO Model
Oncology Care Model Two-Sided Risk Arrangement
34
APM Scoring Standards
Category Reporting Requirements Category Scoring CategoryWeight
Quality (PQRS) The ACO submits Medicare Shared Savings Program quality measures on behalf of ACO participant TINs and their MIPS eligible clinicians via the CMS Web Interface Data is submitted on the first 248 consecutively ranked and assigned Medicare beneficiaries The ACO submits this information once for purposes of both the Medicare Shared Savings Program and MIPS
MIPS benchmarks will be used to assign one score at the APM Entity Group (ACO) level In other words all MIPS eligible clinicians on the certified ACO ProviderSupplier list will receive the same score (unless they are excluded from MIPS) Note that the performance of all clinicians in the ACO will contribute to this score even if they are not subject to MIPS payment adjustments
50
Cost (VM) MIPS eligible clinicians participating in the MSSP will not be assessed on cost No reporting necessary
NA 0
Improvement Activities (new)
No additional reporting necessary Full credit for the APM Entity group by virtue of MSSP participation
20
Advancing Care Information (MU)
ACO participant TINs will submit directly to MIPS via a MIPS data submission mechanism
ACO participant TIN scores will be aggregated as a weighted average to yield one score for the APM Entity group
30
35
Quality Payment Program Paths
Subsets of MIPS and APM Paths
Eligible Clinician
MIPSAPM
MIPS-APM Advanced
APM
36
MIPS-APM Reporting Option
Requirements to be considered a MIPS-APM includebull Participate in the APM under an
agreement with CMS
bull Include one or more MIPS eligible clinicians on a Participation List
ndash On at least one of the snapshot dates
(Mar 31 June 30 or Aug 31)
bull Bases payment incentives on performance (either at the APM Entity or eligible clinician level) on costutilization and quality
2017 Eligible MIPS-APMs
CEC Model CPC+ Model MSSP Track 12 amp 3 Next Gen ACO OCM All arrangements
Note APM scoring standard applies to APMs that meet these criteria
37
MIPS-APM Benefits
bull Streamlined quality reporting
bull Still eligible for shared savings payment
ndash Financial risk payments do not impact eligibility for positive MIPS payment adjustments
bull Favorable scoring under lsquoAPM Scoring Standardrsquo
ndash ACO participants receive full credit in the Improvement Activities Category by virtue of MSSP participation
ndash ACO participants are not subject to the Cost performance category of MIPS
ndash Potential lsquoliftingrsquo of final MIPS score by being assessed at the ACO level
38
We Are All Part of the Quality Payment Program
Creating an Identity Toward a Common Goal
bull CMS
bull Clinicians
bull Patients
bull Our Care Teams
bull Service Providers
We all share a similar goal to improve patient outcomes
39
Quality Payment Program
Where Can Eligible Clinicians Go For Help
40copy 2016 Telligen Inc
All Eligible Clinicians are supported by
bull Quality Payment Program Websitendash Learn about the program explore the measures and find educational tools and
resources
ndash httpsqppcmsgov
bull Quality Payment Program Service Centerndash Assist with questions
ndash qppCMShhsgov
ndash 1-866-288-8292
bull Innovations Centerrsquos Learning Systemsndash Provides specialized information on Advanced Alternative Payment Models (APMs)
ndash httpsinnovationcmsgov
Self Service Technical Support
41copy 2016 Telligen Inc
We are here to help
bull Experienced quality improvement advisors to provide expert technical assistance and support for participating providers across the state especially those in large practices health systems and ACO at no charge
bull Helps in meeting MIPS requirements through customized technical assistance including one-on-one assistance when needed
bull Offers monthly webinars and Coffee Talk open discussion
ndash Focused QPP topic
ndash Open discuss with Q amp A ndash dedicated to your questions
ndash 2nd Thursday every month
ndash 1100 am CST for 1 hour
Telligen QIN-QIO
42copy 2016 Telligen Inc
We are here to help
bull Provides monthly electronic newsletter with resources the latest research and healthcare news relevant to you
bull Provides the ldquoWeekly Digestrdquo with electronic email on upcoming learning opportunities
bull Offers a website with the latest resources and tools and post recorded webinars for future reference
bull Partner with Telligen QIO on practice improvement activitiesndash Participation with a QIO in a self-management training program (diabetes)
ndash Implementation of antibiotic stewardship program
ndash Implementation of a cardiac quality improvement program
Telligen QIN-QIO
43copy 2016 Telligen Inc
Primary Care amp Specialist Physicians
Model
bull Align with the criteria for innovative models set forth in the Quality Payment Program
bull Build the evidence base on practice transformation so that effective solutions can be scaled
bull Move clinician practices through 5 phases of transformation with support from
ndash Practice Transformation Networks (PTN)
ndash Support amp Alignment Networks (SAN)
ndash Quality Improvement Organizations and others
Transforming Clinical Practice Initiative
44copy 2016 Telligen Inc
Primary Care amp Specialist Physicians
Goalsbull Support clinicians in their practice transformation goals
bull Improve health outcomes for millions of Medicare Medicaid and CHIP beneficiaries
bull Build the evidence base on practice transformation so that effective solutions can be scale
bull Sustain efficient care delivery by reducing unnecessary testing and procedures
bull Reduce unnecessary hospitalizations
Contact Melissa Kapping kappingmihconlineorg
Transforming Clinical Practice Initiative
45copy 2016 Telligen Inc
bull SURS (Small Underserved and Rural Support) ndash Recently announced February 16
ndash 11 organizations awarded contracts
ndash Telligen provides assistance to Iowa Nebraska South Dakota and North Dakota
ndash No cost to practices
bull Solo or small practices (15 or fewer clinicians) ndash Rural health professional shortage areas (HPSA)
ndash Medically underserved areas (MUA)
bull Outreach guidance and direct technical assistancendash Practice readiness education health IT optimization
ndash Strategic planning assisting in the full transition to APM
Telligen QPP Resource Center
46
Contact Info
Michelle Brunsen Sr QI Advisor
515-453-8180
mbrunsentelligencom
Sandy Swallow Program Specialist
515-223-2105
Sandyswallowarea-dhcqisorg
Websites
bull wwwtelligenqinqiocom
bull wwwtelligenqppcom
bull wwwqppcmsgov
THANK YOU
This material was prepared by Telligen the Quality Payment Program Small
Underserved and Rural Support contractor for Iowa Nebraska North Dakota and
South Dakota under contract with the Centers for Medicare amp Medicaid Services
(CMS) an agency of the US Department of Health and Human Services The
contents presented do not necessarily reflect CMS policy HHSM-500-2017-00012C
This material was prepared by Telligen the Medicare Quality Innovation
Network Quality Improvement Organization under contract with the
Centers for Medicare amp Medicaid Services (CMS) an agency of the US
Department of Health and Human Services The contents presented do
not necessarily reflect CMS policy
7
Medicare Access and Chip Reauthorization Act
Three most important need to knows about MACRA
Passed with bipartisan Congressional support in 2015
Introduces the Quality Payment Program (QPP)
Repeals SGR and ties payment for services to quality of care
8
What Impact Does MACRA Have on Clinicians
bull Alleviates the annual risk of payment cuts ndash Repeals Sustainable Growth Rate (SGR)
bull Provides more certainty of Medicare payments ndash 05 increase over the next 10 years
bull Reduces the reporting burden need for increase staffing and additional expensesndash Combines PQRS MU and VM programs into one single structure
bull Incentivizes care that focuses on improved quality outcomesndash Introduction of alternative payment models
9copy 2016 Telligen Inc
Medicare Part B ldquoEligible Cliniciansrdquo (ECs) in 2017 and 2018
bull Bill more than $30000 a year and provide care for more than 100 Medicare patients a year and are a
bull Physician (MD DO dentist chiropractor podiatrist optometrist)
bull Physician Assistant (PA)
bull Nurse Practitioner (NP)
bull Clinical Nurse Specialist (CNS)
bull Certified Registered Nurse Anesthetist (CRNA)
bull Secretary has discretion to specify additional eligible clinicians in 2019 (ie dietitians social workers PTs OTs Audiologists)
bull The majority will participate in MIPS with goal to transition to APMs
Who is Eligible for the Program
10
Who is Exempt from the Program
bull A new Medicare enrolled eligible clinician
bull A MIPS eligible clinician who does not exceed the low-volume threshold
Less than or equal to $30000 in Medicare Part B allowed charges for the year
Less than or equal to 100 Medicare patients during the year
(Thresholds are measured at the group level for group reporting and individual level for individual reporting)
bull Qualifying or a Partial Qualifying APM Participant not reporting on MIPS measures and activities but participating in an APM
Note Letters informing clinicians of their eligibility status will be received in late May per CMS
11
QPP What Happens in 2017
Alternative Payment Model
(APMs)bull ldquoSubstantial portionrdquo of
revenues from ldquoapproved alternated payment models
ndash 5 bonus each year from 2019-2024
ndash 075 increase per year beginning in 2026
Merit-based Incentive System (MIPS)
bull Clinicians receive a score of 0-100
bull Annually CMS will establish a threshold score based on the median composite performance scores of all providers
ndash Score above the threshold to receive bonus payments (up to 3 times the annual penalty cap)
ndash Performance scores will be reported on Physician Office Compare website
Eligible Clinicians Choose Your Path
12copy 2016 Telligen Inc
Pick Your Pace for Participation Your
Pace for Participation in 2017Pick Your Pace
for Participation in 2017Test PaceSubmit Something
Neutral or small bonus
Avoid Penalty
Partial Year 90 day Submission
Neutral or small bonus
No penalty
Full Year Submission
Neutral or Moderate bonus
No penalty
Participate in an Advanced Payment
Model in 2017
Donrsquot ParticipateReceive -4 payment
adjustment
QPP What Happens in 2017
Key Takeaway Positive adjustments are based on performance data submitted not the amount of information or length of time submitted
13copy 2016 Telligen Inc
Which Path is Right for You
bull Combines PQRS VM and MU into single improved reporting program
bull Legacy programs phase out
bull ECs earn a performance-based payment adjustment on the Medicare Part B PFS based on final score
ndash Adjusted either up down or neutral
bull The Final Score is calculated from quality data submitted in the performance categories
What is the Merit-Based Incentive Payment System
14
MIPS Timeline
MIPS payment adjustments only affect Medicare Part B participating Eligible Clinicians
2017Record quality data and
how you used technology
performance year1117 ndash 123117
2018Submit your quality data
reporting period1118 ndash 033118
MIPS performance feedback
(TIN-level) available mid-year
payment adjustments1119 ndash 123119
2019MIPS Eligible Clinicians earn
MIPS payment adjustments
based on submitted data
15
MIPS Reporting Options
Type Identification Mechanism
Individual bull Single NPI tied to TINbull Submit individual-level databull Data submission via claims EHR registry or QCDR
Group bull Set of clinicians identified by NPIs sharing common TINbull Submit group-level data bull Register as a group by June 30 2017bull Data submission via CMS web interface (25+) EHR registry
or QCDR
APM Entity Group orMIPS-APM
bull Collection of entities participating in an APM that donrsquot qualify for Advanced APM or meet thresholds
bull Submit MIPS data to avoid downward payment adjustment
16copy 2016 Telligen Inc
How will ECs be scored
MIPS Performance Categories for 2017
QualityReport on quality measures best
reflecting their practice
Advancing Care InformationReport customizable measures reflecting
their EHR use
Improvement ActivitiesSelect improvement activities that
match their practicersquos goals full credit if PCMH recognized
CostBeginning 2018 CMS will calculate
measures based on claims no reporting requirements from ECs
MIPS Performance Category Weights for 2017
Quality
ACI
IA
60
15
25
17
How much can MIPS adjust payments
bull Calculate the final score by sum of performance categories
bull Positive negative neutral adjustments based on CMS-established threshold
ndash Budget neutral program
bull Clinicians at or above performance threshold will receive a neutral or positive adjustment factor based on a linear sliding scale
bull Adjustments applied to a clinicianrsquos Medicare Part B claims
18copy 2016 Telligen Inc
Based on Reporting for Transition Year 2017
Final Score Payment Adjustment
gt 70 points bull Positive adjustmentbull Eligible for exceptional performance bonus ndash
minimum additional 05
4-69 points bull Neutral or Positive adjustment 0-4bull Not eligible for exceptional performance bonus
3 points bull Neutral 0 adjustment
0 points bull Negative payment adjustment of -4bull 0 points = does not participate
MIPS Payment Adjustments in CY 2019
Payment adjustment is based on Medicare Part B reimbursement at the TINNPI level
19
MIPS Performance Categories for 2017
Focus on
QualityPerformance Category
20
2017 Requirements for Quality Submissions
bull Most Participants report up to 6 Measuresndash 1 Outcome Measure (or intermediate outcome)
ndash If no Outcome Measure High Priority Measure
ndash If fewer than 6 measures apply submit all that apply
ndash 10 point decile scale minimum 3 pts for submission in 2017
ndash Use benchmarks to estimate points to predict your quality score
2017 Quality Benchmarks available at httpsqppcmsgovresourceseducation
bull Groups (25+) using the web interface report 15 quality measures for a full year
21
2017 Requirements for Quality Submissions
bull Quality Measure Bonus Points
ndash 2 Points for extra Outcome or Patient Experience Measures
ndash 1 Point for any other high priority measure
ndash Bonus points capped at 10 denominator
ndash Electronic submission bonus points 1 Point per measure for end-to-end electronic reporting
Qualification
o Clinical Data must be documented in CEHRT
o Processing must not include abstraction or pre-aggregation
o All mechanisms eligible except claims
EHR direct DSV Qualified Registry QCDR Web Interface
22
2017 Requirements for Quality Submissions
Payers Period
2017
Patient
Threshold
Rate
Period
2018
Patient
Threshold
Rate
Long Term
Rate
Claims Medicare Part
B
90 days 50 1 Year 60 90
Web
Interface
Medicare Part
B
1 Year 248 patients 1 Year 248 patients 248 patients
Qualified
Registry
All 90 days 50 1 Year 60 90
Qualified
Clinical Data
Registry
All 90 days 50 1 Year 60 90
EHR amp Data
Submission
Vendor
All 90 days 50 1 Year 60 90
23
MIPS Performance Categories for 2017
Focus on
Advancing Care Information
(ACI)Performance Category
24
2017 Requirements for ACI Submissions
Base Score bull Must report on either 4 or 5 measures specific to the EHR certification
bull Report either ldquoYesrdquo or a numerator of at least 1 bull All 50 Base Score points have to be earned to earn
Performance Points
Performance Score bull Based on performance rates for selected measures
Bonus Points bull Extra registry data connections (ie immunization clinical data registry)
bull Use of CEHRT in Improvement Activities
Reporting bull Attestation QCDR Qualified Registry EHR vendor or CMS Web Interface (groups of 25 or more)
HardshipsThresholds bull Allow for reweighting
ACI Scoring Methodology
25
2017 Requirements for ACI Submissions
Measures will contribute to the score in the
Performance Score measure set grouping
Base Measures
Security Risk Analysis
E-Prescribing
Provide Patient Access
HIE - Send a Summary of Care
HIE - RequestAccept a Summary of Care
(2015 only)
Performance Measures
Provide Patient Access
Patient-Specific Education
View Download and Transmit (VDT)
Secure Messaging
Patient-Generated Health Data
Send a Summary of Care
RequestAccept a Summary of Care
Clinical Information Reconciliation
Immunization Registry Reporting
26
MIPS Performance Categories for 2017
Focus on
Improvement Activities
(IA)Performance Category
27
2017 Requirements for IA Submissions
bull Maximum Points = 40 Pointsndash High weighted activities = 20 points
ndash Medium weighted activities = 10 points
bull Participation Thresholdsndash 90 days required
bull PCMH = Maximum Possible Points (40)
bull APM Participation = 50-100 of Maximum Possible Points at CMS discretion
bull Special Populations Points Doubledndash Practices with lt 15 providers
ndash Rural or HPSA practices
ndash Non-patient facing MIPS eligible clinicians
bull Reporting Options Qualified Registry EHR QCDR or CMS Web Interface (for groups 25 clinicians or more)
28
MIPS Performance Categories for 2017
Focus on
CostPerformance Category
29
2017 Requirements for Cost Category
bull Cost scoring weightndash 2017 0
ndash 2018 10
ndash 2019 30
bull CMS will calculate from claims over 40 episode-specific measures to account for differences among specialtiesndash Clinicians that deliver more efficient care achieve better
performance and score the highest points for cost measures
bull ldquoEpisodes of carerdquo roll up all costs of inpatient and outpatient care (including imaging laboratory drugs rehabilitation etc)
30
2017 Requirements for Cost Category
bull Expected Changes from the Value-Modifier Programndash Patients attributed at the TIN-NPI level
ndash Attributed to one PCP (group) to provider with highest volume by cost provides primary care
ndash Cost compared by decile ranking instead of + 1 standard deviation
ndash Risk adjustments for geographic payment rate beneficiary risk on socio-economic status and others
bull Episodes of Carendash Anticipate 10 for 2018 ndash most operational
ndash 40 being tracked
ndash Plan to develop patient condition groups and patient relationship categories
31
Initial Episode-based Cost Measures
bull Aorticmitral valve surgery
bull CABG
bull HipFemur Fracture or Dislocation Treatment
bull Cholecystectomy and common duct exploration
bull Colonoscopy and biopsy
bull TURP for BPH
bull Lens and cataract procedures
bull Hip replacement or repair
bull Knee arthroplasty
bull Mastectomy
CMS will still provide feedback on performance in these categories in 2017 but it will not affect your 2019 payments
32
Alternative Payment Model (APMs)
bull Create the adoption of payment models that move away from FFS and tie payment to value
bull Must be in an Advanced APM to participate
bull Must meet specific thresholds of ldquosubstantial portionsrdquo of revenue from ldquoapprovedrdquo alternate payment models
bull Receive 5 lump sum bonus for 2019 -2024
bull Receive higher fee schedule update for 2026 and beyond
Which Path is Right for You
33
What are Advanced APMs
Requirements to be an Advanced APM
bull Requires use of certified EHR technology
bull Base payment on quality measures comparable to those in MIPS
bull The practice must bear more than nominal financial risk or is in a Medical Home Model expanded under CMS Innovation Center authority
2017 Eligible Advanced APMs Include
Comprehensive ESRD Care Model
Comprehensive Primary Care Plus (CPC+)
Medicare Shared SavingsProgram Track 2 and 3
Next Generation ACO Model
Oncology Care Model Two-Sided Risk Arrangement
34
APM Scoring Standards
Category Reporting Requirements Category Scoring CategoryWeight
Quality (PQRS) The ACO submits Medicare Shared Savings Program quality measures on behalf of ACO participant TINs and their MIPS eligible clinicians via the CMS Web Interface Data is submitted on the first 248 consecutively ranked and assigned Medicare beneficiaries The ACO submits this information once for purposes of both the Medicare Shared Savings Program and MIPS
MIPS benchmarks will be used to assign one score at the APM Entity Group (ACO) level In other words all MIPS eligible clinicians on the certified ACO ProviderSupplier list will receive the same score (unless they are excluded from MIPS) Note that the performance of all clinicians in the ACO will contribute to this score even if they are not subject to MIPS payment adjustments
50
Cost (VM) MIPS eligible clinicians participating in the MSSP will not be assessed on cost No reporting necessary
NA 0
Improvement Activities (new)
No additional reporting necessary Full credit for the APM Entity group by virtue of MSSP participation
20
Advancing Care Information (MU)
ACO participant TINs will submit directly to MIPS via a MIPS data submission mechanism
ACO participant TIN scores will be aggregated as a weighted average to yield one score for the APM Entity group
30
35
Quality Payment Program Paths
Subsets of MIPS and APM Paths
Eligible Clinician
MIPSAPM
MIPS-APM Advanced
APM
36
MIPS-APM Reporting Option
Requirements to be considered a MIPS-APM includebull Participate in the APM under an
agreement with CMS
bull Include one or more MIPS eligible clinicians on a Participation List
ndash On at least one of the snapshot dates
(Mar 31 June 30 or Aug 31)
bull Bases payment incentives on performance (either at the APM Entity or eligible clinician level) on costutilization and quality
2017 Eligible MIPS-APMs
CEC Model CPC+ Model MSSP Track 12 amp 3 Next Gen ACO OCM All arrangements
Note APM scoring standard applies to APMs that meet these criteria
37
MIPS-APM Benefits
bull Streamlined quality reporting
bull Still eligible for shared savings payment
ndash Financial risk payments do not impact eligibility for positive MIPS payment adjustments
bull Favorable scoring under lsquoAPM Scoring Standardrsquo
ndash ACO participants receive full credit in the Improvement Activities Category by virtue of MSSP participation
ndash ACO participants are not subject to the Cost performance category of MIPS
ndash Potential lsquoliftingrsquo of final MIPS score by being assessed at the ACO level
38
We Are All Part of the Quality Payment Program
Creating an Identity Toward a Common Goal
bull CMS
bull Clinicians
bull Patients
bull Our Care Teams
bull Service Providers
We all share a similar goal to improve patient outcomes
39
Quality Payment Program
Where Can Eligible Clinicians Go For Help
40copy 2016 Telligen Inc
All Eligible Clinicians are supported by
bull Quality Payment Program Websitendash Learn about the program explore the measures and find educational tools and
resources
ndash httpsqppcmsgov
bull Quality Payment Program Service Centerndash Assist with questions
ndash qppCMShhsgov
ndash 1-866-288-8292
bull Innovations Centerrsquos Learning Systemsndash Provides specialized information on Advanced Alternative Payment Models (APMs)
ndash httpsinnovationcmsgov
Self Service Technical Support
41copy 2016 Telligen Inc
We are here to help
bull Experienced quality improvement advisors to provide expert technical assistance and support for participating providers across the state especially those in large practices health systems and ACO at no charge
bull Helps in meeting MIPS requirements through customized technical assistance including one-on-one assistance when needed
bull Offers monthly webinars and Coffee Talk open discussion
ndash Focused QPP topic
ndash Open discuss with Q amp A ndash dedicated to your questions
ndash 2nd Thursday every month
ndash 1100 am CST for 1 hour
Telligen QIN-QIO
42copy 2016 Telligen Inc
We are here to help
bull Provides monthly electronic newsletter with resources the latest research and healthcare news relevant to you
bull Provides the ldquoWeekly Digestrdquo with electronic email on upcoming learning opportunities
bull Offers a website with the latest resources and tools and post recorded webinars for future reference
bull Partner with Telligen QIO on practice improvement activitiesndash Participation with a QIO in a self-management training program (diabetes)
ndash Implementation of antibiotic stewardship program
ndash Implementation of a cardiac quality improvement program
Telligen QIN-QIO
43copy 2016 Telligen Inc
Primary Care amp Specialist Physicians
Model
bull Align with the criteria for innovative models set forth in the Quality Payment Program
bull Build the evidence base on practice transformation so that effective solutions can be scaled
bull Move clinician practices through 5 phases of transformation with support from
ndash Practice Transformation Networks (PTN)
ndash Support amp Alignment Networks (SAN)
ndash Quality Improvement Organizations and others
Transforming Clinical Practice Initiative
44copy 2016 Telligen Inc
Primary Care amp Specialist Physicians
Goalsbull Support clinicians in their practice transformation goals
bull Improve health outcomes for millions of Medicare Medicaid and CHIP beneficiaries
bull Build the evidence base on practice transformation so that effective solutions can be scale
bull Sustain efficient care delivery by reducing unnecessary testing and procedures
bull Reduce unnecessary hospitalizations
Contact Melissa Kapping kappingmihconlineorg
Transforming Clinical Practice Initiative
45copy 2016 Telligen Inc
bull SURS (Small Underserved and Rural Support) ndash Recently announced February 16
ndash 11 organizations awarded contracts
ndash Telligen provides assistance to Iowa Nebraska South Dakota and North Dakota
ndash No cost to practices
bull Solo or small practices (15 or fewer clinicians) ndash Rural health professional shortage areas (HPSA)
ndash Medically underserved areas (MUA)
bull Outreach guidance and direct technical assistancendash Practice readiness education health IT optimization
ndash Strategic planning assisting in the full transition to APM
Telligen QPP Resource Center
46
Contact Info
Michelle Brunsen Sr QI Advisor
515-453-8180
mbrunsentelligencom
Sandy Swallow Program Specialist
515-223-2105
Sandyswallowarea-dhcqisorg
Websites
bull wwwtelligenqinqiocom
bull wwwtelligenqppcom
bull wwwqppcmsgov
THANK YOU
This material was prepared by Telligen the Quality Payment Program Small
Underserved and Rural Support contractor for Iowa Nebraska North Dakota and
South Dakota under contract with the Centers for Medicare amp Medicaid Services
(CMS) an agency of the US Department of Health and Human Services The
contents presented do not necessarily reflect CMS policy HHSM-500-2017-00012C
This material was prepared by Telligen the Medicare Quality Innovation
Network Quality Improvement Organization under contract with the
Centers for Medicare amp Medicaid Services (CMS) an agency of the US
Department of Health and Human Services The contents presented do
not necessarily reflect CMS policy
8
What Impact Does MACRA Have on Clinicians
bull Alleviates the annual risk of payment cuts ndash Repeals Sustainable Growth Rate (SGR)
bull Provides more certainty of Medicare payments ndash 05 increase over the next 10 years
bull Reduces the reporting burden need for increase staffing and additional expensesndash Combines PQRS MU and VM programs into one single structure
bull Incentivizes care that focuses on improved quality outcomesndash Introduction of alternative payment models
9copy 2016 Telligen Inc
Medicare Part B ldquoEligible Cliniciansrdquo (ECs) in 2017 and 2018
bull Bill more than $30000 a year and provide care for more than 100 Medicare patients a year and are a
bull Physician (MD DO dentist chiropractor podiatrist optometrist)
bull Physician Assistant (PA)
bull Nurse Practitioner (NP)
bull Clinical Nurse Specialist (CNS)
bull Certified Registered Nurse Anesthetist (CRNA)
bull Secretary has discretion to specify additional eligible clinicians in 2019 (ie dietitians social workers PTs OTs Audiologists)
bull The majority will participate in MIPS with goal to transition to APMs
Who is Eligible for the Program
10
Who is Exempt from the Program
bull A new Medicare enrolled eligible clinician
bull A MIPS eligible clinician who does not exceed the low-volume threshold
Less than or equal to $30000 in Medicare Part B allowed charges for the year
Less than or equal to 100 Medicare patients during the year
(Thresholds are measured at the group level for group reporting and individual level for individual reporting)
bull Qualifying or a Partial Qualifying APM Participant not reporting on MIPS measures and activities but participating in an APM
Note Letters informing clinicians of their eligibility status will be received in late May per CMS
11
QPP What Happens in 2017
Alternative Payment Model
(APMs)bull ldquoSubstantial portionrdquo of
revenues from ldquoapproved alternated payment models
ndash 5 bonus each year from 2019-2024
ndash 075 increase per year beginning in 2026
Merit-based Incentive System (MIPS)
bull Clinicians receive a score of 0-100
bull Annually CMS will establish a threshold score based on the median composite performance scores of all providers
ndash Score above the threshold to receive bonus payments (up to 3 times the annual penalty cap)
ndash Performance scores will be reported on Physician Office Compare website
Eligible Clinicians Choose Your Path
12copy 2016 Telligen Inc
Pick Your Pace for Participation Your
Pace for Participation in 2017Pick Your Pace
for Participation in 2017Test PaceSubmit Something
Neutral or small bonus
Avoid Penalty
Partial Year 90 day Submission
Neutral or small bonus
No penalty
Full Year Submission
Neutral or Moderate bonus
No penalty
Participate in an Advanced Payment
Model in 2017
Donrsquot ParticipateReceive -4 payment
adjustment
QPP What Happens in 2017
Key Takeaway Positive adjustments are based on performance data submitted not the amount of information or length of time submitted
13copy 2016 Telligen Inc
Which Path is Right for You
bull Combines PQRS VM and MU into single improved reporting program
bull Legacy programs phase out
bull ECs earn a performance-based payment adjustment on the Medicare Part B PFS based on final score
ndash Adjusted either up down or neutral
bull The Final Score is calculated from quality data submitted in the performance categories
What is the Merit-Based Incentive Payment System
14
MIPS Timeline
MIPS payment adjustments only affect Medicare Part B participating Eligible Clinicians
2017Record quality data and
how you used technology
performance year1117 ndash 123117
2018Submit your quality data
reporting period1118 ndash 033118
MIPS performance feedback
(TIN-level) available mid-year
payment adjustments1119 ndash 123119
2019MIPS Eligible Clinicians earn
MIPS payment adjustments
based on submitted data
15
MIPS Reporting Options
Type Identification Mechanism
Individual bull Single NPI tied to TINbull Submit individual-level databull Data submission via claims EHR registry or QCDR
Group bull Set of clinicians identified by NPIs sharing common TINbull Submit group-level data bull Register as a group by June 30 2017bull Data submission via CMS web interface (25+) EHR registry
or QCDR
APM Entity Group orMIPS-APM
bull Collection of entities participating in an APM that donrsquot qualify for Advanced APM or meet thresholds
bull Submit MIPS data to avoid downward payment adjustment
16copy 2016 Telligen Inc
How will ECs be scored
MIPS Performance Categories for 2017
QualityReport on quality measures best
reflecting their practice
Advancing Care InformationReport customizable measures reflecting
their EHR use
Improvement ActivitiesSelect improvement activities that
match their practicersquos goals full credit if PCMH recognized
CostBeginning 2018 CMS will calculate
measures based on claims no reporting requirements from ECs
MIPS Performance Category Weights for 2017
Quality
ACI
IA
60
15
25
17
How much can MIPS adjust payments
bull Calculate the final score by sum of performance categories
bull Positive negative neutral adjustments based on CMS-established threshold
ndash Budget neutral program
bull Clinicians at or above performance threshold will receive a neutral or positive adjustment factor based on a linear sliding scale
bull Adjustments applied to a clinicianrsquos Medicare Part B claims
18copy 2016 Telligen Inc
Based on Reporting for Transition Year 2017
Final Score Payment Adjustment
gt 70 points bull Positive adjustmentbull Eligible for exceptional performance bonus ndash
minimum additional 05
4-69 points bull Neutral or Positive adjustment 0-4bull Not eligible for exceptional performance bonus
3 points bull Neutral 0 adjustment
0 points bull Negative payment adjustment of -4bull 0 points = does not participate
MIPS Payment Adjustments in CY 2019
Payment adjustment is based on Medicare Part B reimbursement at the TINNPI level
19
MIPS Performance Categories for 2017
Focus on
QualityPerformance Category
20
2017 Requirements for Quality Submissions
bull Most Participants report up to 6 Measuresndash 1 Outcome Measure (or intermediate outcome)
ndash If no Outcome Measure High Priority Measure
ndash If fewer than 6 measures apply submit all that apply
ndash 10 point decile scale minimum 3 pts for submission in 2017
ndash Use benchmarks to estimate points to predict your quality score
2017 Quality Benchmarks available at httpsqppcmsgovresourceseducation
bull Groups (25+) using the web interface report 15 quality measures for a full year
21
2017 Requirements for Quality Submissions
bull Quality Measure Bonus Points
ndash 2 Points for extra Outcome or Patient Experience Measures
ndash 1 Point for any other high priority measure
ndash Bonus points capped at 10 denominator
ndash Electronic submission bonus points 1 Point per measure for end-to-end electronic reporting
Qualification
o Clinical Data must be documented in CEHRT
o Processing must not include abstraction or pre-aggregation
o All mechanisms eligible except claims
EHR direct DSV Qualified Registry QCDR Web Interface
22
2017 Requirements for Quality Submissions
Payers Period
2017
Patient
Threshold
Rate
Period
2018
Patient
Threshold
Rate
Long Term
Rate
Claims Medicare Part
B
90 days 50 1 Year 60 90
Web
Interface
Medicare Part
B
1 Year 248 patients 1 Year 248 patients 248 patients
Qualified
Registry
All 90 days 50 1 Year 60 90
Qualified
Clinical Data
Registry
All 90 days 50 1 Year 60 90
EHR amp Data
Submission
Vendor
All 90 days 50 1 Year 60 90
23
MIPS Performance Categories for 2017
Focus on
Advancing Care Information
(ACI)Performance Category
24
2017 Requirements for ACI Submissions
Base Score bull Must report on either 4 or 5 measures specific to the EHR certification
bull Report either ldquoYesrdquo or a numerator of at least 1 bull All 50 Base Score points have to be earned to earn
Performance Points
Performance Score bull Based on performance rates for selected measures
Bonus Points bull Extra registry data connections (ie immunization clinical data registry)
bull Use of CEHRT in Improvement Activities
Reporting bull Attestation QCDR Qualified Registry EHR vendor or CMS Web Interface (groups of 25 or more)
HardshipsThresholds bull Allow for reweighting
ACI Scoring Methodology
25
2017 Requirements for ACI Submissions
Measures will contribute to the score in the
Performance Score measure set grouping
Base Measures
Security Risk Analysis
E-Prescribing
Provide Patient Access
HIE - Send a Summary of Care
HIE - RequestAccept a Summary of Care
(2015 only)
Performance Measures
Provide Patient Access
Patient-Specific Education
View Download and Transmit (VDT)
Secure Messaging
Patient-Generated Health Data
Send a Summary of Care
RequestAccept a Summary of Care
Clinical Information Reconciliation
Immunization Registry Reporting
26
MIPS Performance Categories for 2017
Focus on
Improvement Activities
(IA)Performance Category
27
2017 Requirements for IA Submissions
bull Maximum Points = 40 Pointsndash High weighted activities = 20 points
ndash Medium weighted activities = 10 points
bull Participation Thresholdsndash 90 days required
bull PCMH = Maximum Possible Points (40)
bull APM Participation = 50-100 of Maximum Possible Points at CMS discretion
bull Special Populations Points Doubledndash Practices with lt 15 providers
ndash Rural or HPSA practices
ndash Non-patient facing MIPS eligible clinicians
bull Reporting Options Qualified Registry EHR QCDR or CMS Web Interface (for groups 25 clinicians or more)
28
MIPS Performance Categories for 2017
Focus on
CostPerformance Category
29
2017 Requirements for Cost Category
bull Cost scoring weightndash 2017 0
ndash 2018 10
ndash 2019 30
bull CMS will calculate from claims over 40 episode-specific measures to account for differences among specialtiesndash Clinicians that deliver more efficient care achieve better
performance and score the highest points for cost measures
bull ldquoEpisodes of carerdquo roll up all costs of inpatient and outpatient care (including imaging laboratory drugs rehabilitation etc)
30
2017 Requirements for Cost Category
bull Expected Changes from the Value-Modifier Programndash Patients attributed at the TIN-NPI level
ndash Attributed to one PCP (group) to provider with highest volume by cost provides primary care
ndash Cost compared by decile ranking instead of + 1 standard deviation
ndash Risk adjustments for geographic payment rate beneficiary risk on socio-economic status and others
bull Episodes of Carendash Anticipate 10 for 2018 ndash most operational
ndash 40 being tracked
ndash Plan to develop patient condition groups and patient relationship categories
31
Initial Episode-based Cost Measures
bull Aorticmitral valve surgery
bull CABG
bull HipFemur Fracture or Dislocation Treatment
bull Cholecystectomy and common duct exploration
bull Colonoscopy and biopsy
bull TURP for BPH
bull Lens and cataract procedures
bull Hip replacement or repair
bull Knee arthroplasty
bull Mastectomy
CMS will still provide feedback on performance in these categories in 2017 but it will not affect your 2019 payments
32
Alternative Payment Model (APMs)
bull Create the adoption of payment models that move away from FFS and tie payment to value
bull Must be in an Advanced APM to participate
bull Must meet specific thresholds of ldquosubstantial portionsrdquo of revenue from ldquoapprovedrdquo alternate payment models
bull Receive 5 lump sum bonus for 2019 -2024
bull Receive higher fee schedule update for 2026 and beyond
Which Path is Right for You
33
What are Advanced APMs
Requirements to be an Advanced APM
bull Requires use of certified EHR technology
bull Base payment on quality measures comparable to those in MIPS
bull The practice must bear more than nominal financial risk or is in a Medical Home Model expanded under CMS Innovation Center authority
2017 Eligible Advanced APMs Include
Comprehensive ESRD Care Model
Comprehensive Primary Care Plus (CPC+)
Medicare Shared SavingsProgram Track 2 and 3
Next Generation ACO Model
Oncology Care Model Two-Sided Risk Arrangement
34
APM Scoring Standards
Category Reporting Requirements Category Scoring CategoryWeight
Quality (PQRS) The ACO submits Medicare Shared Savings Program quality measures on behalf of ACO participant TINs and their MIPS eligible clinicians via the CMS Web Interface Data is submitted on the first 248 consecutively ranked and assigned Medicare beneficiaries The ACO submits this information once for purposes of both the Medicare Shared Savings Program and MIPS
MIPS benchmarks will be used to assign one score at the APM Entity Group (ACO) level In other words all MIPS eligible clinicians on the certified ACO ProviderSupplier list will receive the same score (unless they are excluded from MIPS) Note that the performance of all clinicians in the ACO will contribute to this score even if they are not subject to MIPS payment adjustments
50
Cost (VM) MIPS eligible clinicians participating in the MSSP will not be assessed on cost No reporting necessary
NA 0
Improvement Activities (new)
No additional reporting necessary Full credit for the APM Entity group by virtue of MSSP participation
20
Advancing Care Information (MU)
ACO participant TINs will submit directly to MIPS via a MIPS data submission mechanism
ACO participant TIN scores will be aggregated as a weighted average to yield one score for the APM Entity group
30
35
Quality Payment Program Paths
Subsets of MIPS and APM Paths
Eligible Clinician
MIPSAPM
MIPS-APM Advanced
APM
36
MIPS-APM Reporting Option
Requirements to be considered a MIPS-APM includebull Participate in the APM under an
agreement with CMS
bull Include one or more MIPS eligible clinicians on a Participation List
ndash On at least one of the snapshot dates
(Mar 31 June 30 or Aug 31)
bull Bases payment incentives on performance (either at the APM Entity or eligible clinician level) on costutilization and quality
2017 Eligible MIPS-APMs
CEC Model CPC+ Model MSSP Track 12 amp 3 Next Gen ACO OCM All arrangements
Note APM scoring standard applies to APMs that meet these criteria
37
MIPS-APM Benefits
bull Streamlined quality reporting
bull Still eligible for shared savings payment
ndash Financial risk payments do not impact eligibility for positive MIPS payment adjustments
bull Favorable scoring under lsquoAPM Scoring Standardrsquo
ndash ACO participants receive full credit in the Improvement Activities Category by virtue of MSSP participation
ndash ACO participants are not subject to the Cost performance category of MIPS
ndash Potential lsquoliftingrsquo of final MIPS score by being assessed at the ACO level
38
We Are All Part of the Quality Payment Program
Creating an Identity Toward a Common Goal
bull CMS
bull Clinicians
bull Patients
bull Our Care Teams
bull Service Providers
We all share a similar goal to improve patient outcomes
39
Quality Payment Program
Where Can Eligible Clinicians Go For Help
40copy 2016 Telligen Inc
All Eligible Clinicians are supported by
bull Quality Payment Program Websitendash Learn about the program explore the measures and find educational tools and
resources
ndash httpsqppcmsgov
bull Quality Payment Program Service Centerndash Assist with questions
ndash qppCMShhsgov
ndash 1-866-288-8292
bull Innovations Centerrsquos Learning Systemsndash Provides specialized information on Advanced Alternative Payment Models (APMs)
ndash httpsinnovationcmsgov
Self Service Technical Support
41copy 2016 Telligen Inc
We are here to help
bull Experienced quality improvement advisors to provide expert technical assistance and support for participating providers across the state especially those in large practices health systems and ACO at no charge
bull Helps in meeting MIPS requirements through customized technical assistance including one-on-one assistance when needed
bull Offers monthly webinars and Coffee Talk open discussion
ndash Focused QPP topic
ndash Open discuss with Q amp A ndash dedicated to your questions
ndash 2nd Thursday every month
ndash 1100 am CST for 1 hour
Telligen QIN-QIO
42copy 2016 Telligen Inc
We are here to help
bull Provides monthly electronic newsletter with resources the latest research and healthcare news relevant to you
bull Provides the ldquoWeekly Digestrdquo with electronic email on upcoming learning opportunities
bull Offers a website with the latest resources and tools and post recorded webinars for future reference
bull Partner with Telligen QIO on practice improvement activitiesndash Participation with a QIO in a self-management training program (diabetes)
ndash Implementation of antibiotic stewardship program
ndash Implementation of a cardiac quality improvement program
Telligen QIN-QIO
43copy 2016 Telligen Inc
Primary Care amp Specialist Physicians
Model
bull Align with the criteria for innovative models set forth in the Quality Payment Program
bull Build the evidence base on practice transformation so that effective solutions can be scaled
bull Move clinician practices through 5 phases of transformation with support from
ndash Practice Transformation Networks (PTN)
ndash Support amp Alignment Networks (SAN)
ndash Quality Improvement Organizations and others
Transforming Clinical Practice Initiative
44copy 2016 Telligen Inc
Primary Care amp Specialist Physicians
Goalsbull Support clinicians in their practice transformation goals
bull Improve health outcomes for millions of Medicare Medicaid and CHIP beneficiaries
bull Build the evidence base on practice transformation so that effective solutions can be scale
bull Sustain efficient care delivery by reducing unnecessary testing and procedures
bull Reduce unnecessary hospitalizations
Contact Melissa Kapping kappingmihconlineorg
Transforming Clinical Practice Initiative
45copy 2016 Telligen Inc
bull SURS (Small Underserved and Rural Support) ndash Recently announced February 16
ndash 11 organizations awarded contracts
ndash Telligen provides assistance to Iowa Nebraska South Dakota and North Dakota
ndash No cost to practices
bull Solo or small practices (15 or fewer clinicians) ndash Rural health professional shortage areas (HPSA)
ndash Medically underserved areas (MUA)
bull Outreach guidance and direct technical assistancendash Practice readiness education health IT optimization
ndash Strategic planning assisting in the full transition to APM
Telligen QPP Resource Center
46
Contact Info
Michelle Brunsen Sr QI Advisor
515-453-8180
mbrunsentelligencom
Sandy Swallow Program Specialist
515-223-2105
Sandyswallowarea-dhcqisorg
Websites
bull wwwtelligenqinqiocom
bull wwwtelligenqppcom
bull wwwqppcmsgov
THANK YOU
This material was prepared by Telligen the Quality Payment Program Small
Underserved and Rural Support contractor for Iowa Nebraska North Dakota and
South Dakota under contract with the Centers for Medicare amp Medicaid Services
(CMS) an agency of the US Department of Health and Human Services The
contents presented do not necessarily reflect CMS policy HHSM-500-2017-00012C
This material was prepared by Telligen the Medicare Quality Innovation
Network Quality Improvement Organization under contract with the
Centers for Medicare amp Medicaid Services (CMS) an agency of the US
Department of Health and Human Services The contents presented do
not necessarily reflect CMS policy
9copy 2016 Telligen Inc
Medicare Part B ldquoEligible Cliniciansrdquo (ECs) in 2017 and 2018
bull Bill more than $30000 a year and provide care for more than 100 Medicare patients a year and are a
bull Physician (MD DO dentist chiropractor podiatrist optometrist)
bull Physician Assistant (PA)
bull Nurse Practitioner (NP)
bull Clinical Nurse Specialist (CNS)
bull Certified Registered Nurse Anesthetist (CRNA)
bull Secretary has discretion to specify additional eligible clinicians in 2019 (ie dietitians social workers PTs OTs Audiologists)
bull The majority will participate in MIPS with goal to transition to APMs
Who is Eligible for the Program
10
Who is Exempt from the Program
bull A new Medicare enrolled eligible clinician
bull A MIPS eligible clinician who does not exceed the low-volume threshold
Less than or equal to $30000 in Medicare Part B allowed charges for the year
Less than or equal to 100 Medicare patients during the year
(Thresholds are measured at the group level for group reporting and individual level for individual reporting)
bull Qualifying or a Partial Qualifying APM Participant not reporting on MIPS measures and activities but participating in an APM
Note Letters informing clinicians of their eligibility status will be received in late May per CMS
11
QPP What Happens in 2017
Alternative Payment Model
(APMs)bull ldquoSubstantial portionrdquo of
revenues from ldquoapproved alternated payment models
ndash 5 bonus each year from 2019-2024
ndash 075 increase per year beginning in 2026
Merit-based Incentive System (MIPS)
bull Clinicians receive a score of 0-100
bull Annually CMS will establish a threshold score based on the median composite performance scores of all providers
ndash Score above the threshold to receive bonus payments (up to 3 times the annual penalty cap)
ndash Performance scores will be reported on Physician Office Compare website
Eligible Clinicians Choose Your Path
12copy 2016 Telligen Inc
Pick Your Pace for Participation Your
Pace for Participation in 2017Pick Your Pace
for Participation in 2017Test PaceSubmit Something
Neutral or small bonus
Avoid Penalty
Partial Year 90 day Submission
Neutral or small bonus
No penalty
Full Year Submission
Neutral or Moderate bonus
No penalty
Participate in an Advanced Payment
Model in 2017
Donrsquot ParticipateReceive -4 payment
adjustment
QPP What Happens in 2017
Key Takeaway Positive adjustments are based on performance data submitted not the amount of information or length of time submitted
13copy 2016 Telligen Inc
Which Path is Right for You
bull Combines PQRS VM and MU into single improved reporting program
bull Legacy programs phase out
bull ECs earn a performance-based payment adjustment on the Medicare Part B PFS based on final score
ndash Adjusted either up down or neutral
bull The Final Score is calculated from quality data submitted in the performance categories
What is the Merit-Based Incentive Payment System
14
MIPS Timeline
MIPS payment adjustments only affect Medicare Part B participating Eligible Clinicians
2017Record quality data and
how you used technology
performance year1117 ndash 123117
2018Submit your quality data
reporting period1118 ndash 033118
MIPS performance feedback
(TIN-level) available mid-year
payment adjustments1119 ndash 123119
2019MIPS Eligible Clinicians earn
MIPS payment adjustments
based on submitted data
15
MIPS Reporting Options
Type Identification Mechanism
Individual bull Single NPI tied to TINbull Submit individual-level databull Data submission via claims EHR registry or QCDR
Group bull Set of clinicians identified by NPIs sharing common TINbull Submit group-level data bull Register as a group by June 30 2017bull Data submission via CMS web interface (25+) EHR registry
or QCDR
APM Entity Group orMIPS-APM
bull Collection of entities participating in an APM that donrsquot qualify for Advanced APM or meet thresholds
bull Submit MIPS data to avoid downward payment adjustment
16copy 2016 Telligen Inc
How will ECs be scored
MIPS Performance Categories for 2017
QualityReport on quality measures best
reflecting their practice
Advancing Care InformationReport customizable measures reflecting
their EHR use
Improvement ActivitiesSelect improvement activities that
match their practicersquos goals full credit if PCMH recognized
CostBeginning 2018 CMS will calculate
measures based on claims no reporting requirements from ECs
MIPS Performance Category Weights for 2017
Quality
ACI
IA
60
15
25
17
How much can MIPS adjust payments
bull Calculate the final score by sum of performance categories
bull Positive negative neutral adjustments based on CMS-established threshold
ndash Budget neutral program
bull Clinicians at or above performance threshold will receive a neutral or positive adjustment factor based on a linear sliding scale
bull Adjustments applied to a clinicianrsquos Medicare Part B claims
18copy 2016 Telligen Inc
Based on Reporting for Transition Year 2017
Final Score Payment Adjustment
gt 70 points bull Positive adjustmentbull Eligible for exceptional performance bonus ndash
minimum additional 05
4-69 points bull Neutral or Positive adjustment 0-4bull Not eligible for exceptional performance bonus
3 points bull Neutral 0 adjustment
0 points bull Negative payment adjustment of -4bull 0 points = does not participate
MIPS Payment Adjustments in CY 2019
Payment adjustment is based on Medicare Part B reimbursement at the TINNPI level
19
MIPS Performance Categories for 2017
Focus on
QualityPerformance Category
20
2017 Requirements for Quality Submissions
bull Most Participants report up to 6 Measuresndash 1 Outcome Measure (or intermediate outcome)
ndash If no Outcome Measure High Priority Measure
ndash If fewer than 6 measures apply submit all that apply
ndash 10 point decile scale minimum 3 pts for submission in 2017
ndash Use benchmarks to estimate points to predict your quality score
2017 Quality Benchmarks available at httpsqppcmsgovresourceseducation
bull Groups (25+) using the web interface report 15 quality measures for a full year
21
2017 Requirements for Quality Submissions
bull Quality Measure Bonus Points
ndash 2 Points for extra Outcome or Patient Experience Measures
ndash 1 Point for any other high priority measure
ndash Bonus points capped at 10 denominator
ndash Electronic submission bonus points 1 Point per measure for end-to-end electronic reporting
Qualification
o Clinical Data must be documented in CEHRT
o Processing must not include abstraction or pre-aggregation
o All mechanisms eligible except claims
EHR direct DSV Qualified Registry QCDR Web Interface
22
2017 Requirements for Quality Submissions
Payers Period
2017
Patient
Threshold
Rate
Period
2018
Patient
Threshold
Rate
Long Term
Rate
Claims Medicare Part
B
90 days 50 1 Year 60 90
Web
Interface
Medicare Part
B
1 Year 248 patients 1 Year 248 patients 248 patients
Qualified
Registry
All 90 days 50 1 Year 60 90
Qualified
Clinical Data
Registry
All 90 days 50 1 Year 60 90
EHR amp Data
Submission
Vendor
All 90 days 50 1 Year 60 90
23
MIPS Performance Categories for 2017
Focus on
Advancing Care Information
(ACI)Performance Category
24
2017 Requirements for ACI Submissions
Base Score bull Must report on either 4 or 5 measures specific to the EHR certification
bull Report either ldquoYesrdquo or a numerator of at least 1 bull All 50 Base Score points have to be earned to earn
Performance Points
Performance Score bull Based on performance rates for selected measures
Bonus Points bull Extra registry data connections (ie immunization clinical data registry)
bull Use of CEHRT in Improvement Activities
Reporting bull Attestation QCDR Qualified Registry EHR vendor or CMS Web Interface (groups of 25 or more)
HardshipsThresholds bull Allow for reweighting
ACI Scoring Methodology
25
2017 Requirements for ACI Submissions
Measures will contribute to the score in the
Performance Score measure set grouping
Base Measures
Security Risk Analysis
E-Prescribing
Provide Patient Access
HIE - Send a Summary of Care
HIE - RequestAccept a Summary of Care
(2015 only)
Performance Measures
Provide Patient Access
Patient-Specific Education
View Download and Transmit (VDT)
Secure Messaging
Patient-Generated Health Data
Send a Summary of Care
RequestAccept a Summary of Care
Clinical Information Reconciliation
Immunization Registry Reporting
26
MIPS Performance Categories for 2017
Focus on
Improvement Activities
(IA)Performance Category
27
2017 Requirements for IA Submissions
bull Maximum Points = 40 Pointsndash High weighted activities = 20 points
ndash Medium weighted activities = 10 points
bull Participation Thresholdsndash 90 days required
bull PCMH = Maximum Possible Points (40)
bull APM Participation = 50-100 of Maximum Possible Points at CMS discretion
bull Special Populations Points Doubledndash Practices with lt 15 providers
ndash Rural or HPSA practices
ndash Non-patient facing MIPS eligible clinicians
bull Reporting Options Qualified Registry EHR QCDR or CMS Web Interface (for groups 25 clinicians or more)
28
MIPS Performance Categories for 2017
Focus on
CostPerformance Category
29
2017 Requirements for Cost Category
bull Cost scoring weightndash 2017 0
ndash 2018 10
ndash 2019 30
bull CMS will calculate from claims over 40 episode-specific measures to account for differences among specialtiesndash Clinicians that deliver more efficient care achieve better
performance and score the highest points for cost measures
bull ldquoEpisodes of carerdquo roll up all costs of inpatient and outpatient care (including imaging laboratory drugs rehabilitation etc)
30
2017 Requirements for Cost Category
bull Expected Changes from the Value-Modifier Programndash Patients attributed at the TIN-NPI level
ndash Attributed to one PCP (group) to provider with highest volume by cost provides primary care
ndash Cost compared by decile ranking instead of + 1 standard deviation
ndash Risk adjustments for geographic payment rate beneficiary risk on socio-economic status and others
bull Episodes of Carendash Anticipate 10 for 2018 ndash most operational
ndash 40 being tracked
ndash Plan to develop patient condition groups and patient relationship categories
31
Initial Episode-based Cost Measures
bull Aorticmitral valve surgery
bull CABG
bull HipFemur Fracture or Dislocation Treatment
bull Cholecystectomy and common duct exploration
bull Colonoscopy and biopsy
bull TURP for BPH
bull Lens and cataract procedures
bull Hip replacement or repair
bull Knee arthroplasty
bull Mastectomy
CMS will still provide feedback on performance in these categories in 2017 but it will not affect your 2019 payments
32
Alternative Payment Model (APMs)
bull Create the adoption of payment models that move away from FFS and tie payment to value
bull Must be in an Advanced APM to participate
bull Must meet specific thresholds of ldquosubstantial portionsrdquo of revenue from ldquoapprovedrdquo alternate payment models
bull Receive 5 lump sum bonus for 2019 -2024
bull Receive higher fee schedule update for 2026 and beyond
Which Path is Right for You
33
What are Advanced APMs
Requirements to be an Advanced APM
bull Requires use of certified EHR technology
bull Base payment on quality measures comparable to those in MIPS
bull The practice must bear more than nominal financial risk or is in a Medical Home Model expanded under CMS Innovation Center authority
2017 Eligible Advanced APMs Include
Comprehensive ESRD Care Model
Comprehensive Primary Care Plus (CPC+)
Medicare Shared SavingsProgram Track 2 and 3
Next Generation ACO Model
Oncology Care Model Two-Sided Risk Arrangement
34
APM Scoring Standards
Category Reporting Requirements Category Scoring CategoryWeight
Quality (PQRS) The ACO submits Medicare Shared Savings Program quality measures on behalf of ACO participant TINs and their MIPS eligible clinicians via the CMS Web Interface Data is submitted on the first 248 consecutively ranked and assigned Medicare beneficiaries The ACO submits this information once for purposes of both the Medicare Shared Savings Program and MIPS
MIPS benchmarks will be used to assign one score at the APM Entity Group (ACO) level In other words all MIPS eligible clinicians on the certified ACO ProviderSupplier list will receive the same score (unless they are excluded from MIPS) Note that the performance of all clinicians in the ACO will contribute to this score even if they are not subject to MIPS payment adjustments
50
Cost (VM) MIPS eligible clinicians participating in the MSSP will not be assessed on cost No reporting necessary
NA 0
Improvement Activities (new)
No additional reporting necessary Full credit for the APM Entity group by virtue of MSSP participation
20
Advancing Care Information (MU)
ACO participant TINs will submit directly to MIPS via a MIPS data submission mechanism
ACO participant TIN scores will be aggregated as a weighted average to yield one score for the APM Entity group
30
35
Quality Payment Program Paths
Subsets of MIPS and APM Paths
Eligible Clinician
MIPSAPM
MIPS-APM Advanced
APM
36
MIPS-APM Reporting Option
Requirements to be considered a MIPS-APM includebull Participate in the APM under an
agreement with CMS
bull Include one or more MIPS eligible clinicians on a Participation List
ndash On at least one of the snapshot dates
(Mar 31 June 30 or Aug 31)
bull Bases payment incentives on performance (either at the APM Entity or eligible clinician level) on costutilization and quality
2017 Eligible MIPS-APMs
CEC Model CPC+ Model MSSP Track 12 amp 3 Next Gen ACO OCM All arrangements
Note APM scoring standard applies to APMs that meet these criteria
37
MIPS-APM Benefits
bull Streamlined quality reporting
bull Still eligible for shared savings payment
ndash Financial risk payments do not impact eligibility for positive MIPS payment adjustments
bull Favorable scoring under lsquoAPM Scoring Standardrsquo
ndash ACO participants receive full credit in the Improvement Activities Category by virtue of MSSP participation
ndash ACO participants are not subject to the Cost performance category of MIPS
ndash Potential lsquoliftingrsquo of final MIPS score by being assessed at the ACO level
38
We Are All Part of the Quality Payment Program
Creating an Identity Toward a Common Goal
bull CMS
bull Clinicians
bull Patients
bull Our Care Teams
bull Service Providers
We all share a similar goal to improve patient outcomes
39
Quality Payment Program
Where Can Eligible Clinicians Go For Help
40copy 2016 Telligen Inc
All Eligible Clinicians are supported by
bull Quality Payment Program Websitendash Learn about the program explore the measures and find educational tools and
resources
ndash httpsqppcmsgov
bull Quality Payment Program Service Centerndash Assist with questions
ndash qppCMShhsgov
ndash 1-866-288-8292
bull Innovations Centerrsquos Learning Systemsndash Provides specialized information on Advanced Alternative Payment Models (APMs)
ndash httpsinnovationcmsgov
Self Service Technical Support
41copy 2016 Telligen Inc
We are here to help
bull Experienced quality improvement advisors to provide expert technical assistance and support for participating providers across the state especially those in large practices health systems and ACO at no charge
bull Helps in meeting MIPS requirements through customized technical assistance including one-on-one assistance when needed
bull Offers monthly webinars and Coffee Talk open discussion
ndash Focused QPP topic
ndash Open discuss with Q amp A ndash dedicated to your questions
ndash 2nd Thursday every month
ndash 1100 am CST for 1 hour
Telligen QIN-QIO
42copy 2016 Telligen Inc
We are here to help
bull Provides monthly electronic newsletter with resources the latest research and healthcare news relevant to you
bull Provides the ldquoWeekly Digestrdquo with electronic email on upcoming learning opportunities
bull Offers a website with the latest resources and tools and post recorded webinars for future reference
bull Partner with Telligen QIO on practice improvement activitiesndash Participation with a QIO in a self-management training program (diabetes)
ndash Implementation of antibiotic stewardship program
ndash Implementation of a cardiac quality improvement program
Telligen QIN-QIO
43copy 2016 Telligen Inc
Primary Care amp Specialist Physicians
Model
bull Align with the criteria for innovative models set forth in the Quality Payment Program
bull Build the evidence base on practice transformation so that effective solutions can be scaled
bull Move clinician practices through 5 phases of transformation with support from
ndash Practice Transformation Networks (PTN)
ndash Support amp Alignment Networks (SAN)
ndash Quality Improvement Organizations and others
Transforming Clinical Practice Initiative
44copy 2016 Telligen Inc
Primary Care amp Specialist Physicians
Goalsbull Support clinicians in their practice transformation goals
bull Improve health outcomes for millions of Medicare Medicaid and CHIP beneficiaries
bull Build the evidence base on practice transformation so that effective solutions can be scale
bull Sustain efficient care delivery by reducing unnecessary testing and procedures
bull Reduce unnecessary hospitalizations
Contact Melissa Kapping kappingmihconlineorg
Transforming Clinical Practice Initiative
45copy 2016 Telligen Inc
bull SURS (Small Underserved and Rural Support) ndash Recently announced February 16
ndash 11 organizations awarded contracts
ndash Telligen provides assistance to Iowa Nebraska South Dakota and North Dakota
ndash No cost to practices
bull Solo or small practices (15 or fewer clinicians) ndash Rural health professional shortage areas (HPSA)
ndash Medically underserved areas (MUA)
bull Outreach guidance and direct technical assistancendash Practice readiness education health IT optimization
ndash Strategic planning assisting in the full transition to APM
Telligen QPP Resource Center
46
Contact Info
Michelle Brunsen Sr QI Advisor
515-453-8180
mbrunsentelligencom
Sandy Swallow Program Specialist
515-223-2105
Sandyswallowarea-dhcqisorg
Websites
bull wwwtelligenqinqiocom
bull wwwtelligenqppcom
bull wwwqppcmsgov
THANK YOU
This material was prepared by Telligen the Quality Payment Program Small
Underserved and Rural Support contractor for Iowa Nebraska North Dakota and
South Dakota under contract with the Centers for Medicare amp Medicaid Services
(CMS) an agency of the US Department of Health and Human Services The
contents presented do not necessarily reflect CMS policy HHSM-500-2017-00012C
This material was prepared by Telligen the Medicare Quality Innovation
Network Quality Improvement Organization under contract with the
Centers for Medicare amp Medicaid Services (CMS) an agency of the US
Department of Health and Human Services The contents presented do
not necessarily reflect CMS policy
10
Who is Exempt from the Program
bull A new Medicare enrolled eligible clinician
bull A MIPS eligible clinician who does not exceed the low-volume threshold
Less than or equal to $30000 in Medicare Part B allowed charges for the year
Less than or equal to 100 Medicare patients during the year
(Thresholds are measured at the group level for group reporting and individual level for individual reporting)
bull Qualifying or a Partial Qualifying APM Participant not reporting on MIPS measures and activities but participating in an APM
Note Letters informing clinicians of their eligibility status will be received in late May per CMS
11
QPP What Happens in 2017
Alternative Payment Model
(APMs)bull ldquoSubstantial portionrdquo of
revenues from ldquoapproved alternated payment models
ndash 5 bonus each year from 2019-2024
ndash 075 increase per year beginning in 2026
Merit-based Incentive System (MIPS)
bull Clinicians receive a score of 0-100
bull Annually CMS will establish a threshold score based on the median composite performance scores of all providers
ndash Score above the threshold to receive bonus payments (up to 3 times the annual penalty cap)
ndash Performance scores will be reported on Physician Office Compare website
Eligible Clinicians Choose Your Path
12copy 2016 Telligen Inc
Pick Your Pace for Participation Your
Pace for Participation in 2017Pick Your Pace
for Participation in 2017Test PaceSubmit Something
Neutral or small bonus
Avoid Penalty
Partial Year 90 day Submission
Neutral or small bonus
No penalty
Full Year Submission
Neutral or Moderate bonus
No penalty
Participate in an Advanced Payment
Model in 2017
Donrsquot ParticipateReceive -4 payment
adjustment
QPP What Happens in 2017
Key Takeaway Positive adjustments are based on performance data submitted not the amount of information or length of time submitted
13copy 2016 Telligen Inc
Which Path is Right for You
bull Combines PQRS VM and MU into single improved reporting program
bull Legacy programs phase out
bull ECs earn a performance-based payment adjustment on the Medicare Part B PFS based on final score
ndash Adjusted either up down or neutral
bull The Final Score is calculated from quality data submitted in the performance categories
What is the Merit-Based Incentive Payment System
14
MIPS Timeline
MIPS payment adjustments only affect Medicare Part B participating Eligible Clinicians
2017Record quality data and
how you used technology
performance year1117 ndash 123117
2018Submit your quality data
reporting period1118 ndash 033118
MIPS performance feedback
(TIN-level) available mid-year
payment adjustments1119 ndash 123119
2019MIPS Eligible Clinicians earn
MIPS payment adjustments
based on submitted data
15
MIPS Reporting Options
Type Identification Mechanism
Individual bull Single NPI tied to TINbull Submit individual-level databull Data submission via claims EHR registry or QCDR
Group bull Set of clinicians identified by NPIs sharing common TINbull Submit group-level data bull Register as a group by June 30 2017bull Data submission via CMS web interface (25+) EHR registry
or QCDR
APM Entity Group orMIPS-APM
bull Collection of entities participating in an APM that donrsquot qualify for Advanced APM or meet thresholds
bull Submit MIPS data to avoid downward payment adjustment
16copy 2016 Telligen Inc
How will ECs be scored
MIPS Performance Categories for 2017
QualityReport on quality measures best
reflecting their practice
Advancing Care InformationReport customizable measures reflecting
their EHR use
Improvement ActivitiesSelect improvement activities that
match their practicersquos goals full credit if PCMH recognized
CostBeginning 2018 CMS will calculate
measures based on claims no reporting requirements from ECs
MIPS Performance Category Weights for 2017
Quality
ACI
IA
60
15
25
17
How much can MIPS adjust payments
bull Calculate the final score by sum of performance categories
bull Positive negative neutral adjustments based on CMS-established threshold
ndash Budget neutral program
bull Clinicians at or above performance threshold will receive a neutral or positive adjustment factor based on a linear sliding scale
bull Adjustments applied to a clinicianrsquos Medicare Part B claims
18copy 2016 Telligen Inc
Based on Reporting for Transition Year 2017
Final Score Payment Adjustment
gt 70 points bull Positive adjustmentbull Eligible for exceptional performance bonus ndash
minimum additional 05
4-69 points bull Neutral or Positive adjustment 0-4bull Not eligible for exceptional performance bonus
3 points bull Neutral 0 adjustment
0 points bull Negative payment adjustment of -4bull 0 points = does not participate
MIPS Payment Adjustments in CY 2019
Payment adjustment is based on Medicare Part B reimbursement at the TINNPI level
19
MIPS Performance Categories for 2017
Focus on
QualityPerformance Category
20
2017 Requirements for Quality Submissions
bull Most Participants report up to 6 Measuresndash 1 Outcome Measure (or intermediate outcome)
ndash If no Outcome Measure High Priority Measure
ndash If fewer than 6 measures apply submit all that apply
ndash 10 point decile scale minimum 3 pts for submission in 2017
ndash Use benchmarks to estimate points to predict your quality score
2017 Quality Benchmarks available at httpsqppcmsgovresourceseducation
bull Groups (25+) using the web interface report 15 quality measures for a full year
21
2017 Requirements for Quality Submissions
bull Quality Measure Bonus Points
ndash 2 Points for extra Outcome or Patient Experience Measures
ndash 1 Point for any other high priority measure
ndash Bonus points capped at 10 denominator
ndash Electronic submission bonus points 1 Point per measure for end-to-end electronic reporting
Qualification
o Clinical Data must be documented in CEHRT
o Processing must not include abstraction or pre-aggregation
o All mechanisms eligible except claims
EHR direct DSV Qualified Registry QCDR Web Interface
22
2017 Requirements for Quality Submissions
Payers Period
2017
Patient
Threshold
Rate
Period
2018
Patient
Threshold
Rate
Long Term
Rate
Claims Medicare Part
B
90 days 50 1 Year 60 90
Web
Interface
Medicare Part
B
1 Year 248 patients 1 Year 248 patients 248 patients
Qualified
Registry
All 90 days 50 1 Year 60 90
Qualified
Clinical Data
Registry
All 90 days 50 1 Year 60 90
EHR amp Data
Submission
Vendor
All 90 days 50 1 Year 60 90
23
MIPS Performance Categories for 2017
Focus on
Advancing Care Information
(ACI)Performance Category
24
2017 Requirements for ACI Submissions
Base Score bull Must report on either 4 or 5 measures specific to the EHR certification
bull Report either ldquoYesrdquo or a numerator of at least 1 bull All 50 Base Score points have to be earned to earn
Performance Points
Performance Score bull Based on performance rates for selected measures
Bonus Points bull Extra registry data connections (ie immunization clinical data registry)
bull Use of CEHRT in Improvement Activities
Reporting bull Attestation QCDR Qualified Registry EHR vendor or CMS Web Interface (groups of 25 or more)
HardshipsThresholds bull Allow for reweighting
ACI Scoring Methodology
25
2017 Requirements for ACI Submissions
Measures will contribute to the score in the
Performance Score measure set grouping
Base Measures
Security Risk Analysis
E-Prescribing
Provide Patient Access
HIE - Send a Summary of Care
HIE - RequestAccept a Summary of Care
(2015 only)
Performance Measures
Provide Patient Access
Patient-Specific Education
View Download and Transmit (VDT)
Secure Messaging
Patient-Generated Health Data
Send a Summary of Care
RequestAccept a Summary of Care
Clinical Information Reconciliation
Immunization Registry Reporting
26
MIPS Performance Categories for 2017
Focus on
Improvement Activities
(IA)Performance Category
27
2017 Requirements for IA Submissions
bull Maximum Points = 40 Pointsndash High weighted activities = 20 points
ndash Medium weighted activities = 10 points
bull Participation Thresholdsndash 90 days required
bull PCMH = Maximum Possible Points (40)
bull APM Participation = 50-100 of Maximum Possible Points at CMS discretion
bull Special Populations Points Doubledndash Practices with lt 15 providers
ndash Rural or HPSA practices
ndash Non-patient facing MIPS eligible clinicians
bull Reporting Options Qualified Registry EHR QCDR or CMS Web Interface (for groups 25 clinicians or more)
28
MIPS Performance Categories for 2017
Focus on
CostPerformance Category
29
2017 Requirements for Cost Category
bull Cost scoring weightndash 2017 0
ndash 2018 10
ndash 2019 30
bull CMS will calculate from claims over 40 episode-specific measures to account for differences among specialtiesndash Clinicians that deliver more efficient care achieve better
performance and score the highest points for cost measures
bull ldquoEpisodes of carerdquo roll up all costs of inpatient and outpatient care (including imaging laboratory drugs rehabilitation etc)
30
2017 Requirements for Cost Category
bull Expected Changes from the Value-Modifier Programndash Patients attributed at the TIN-NPI level
ndash Attributed to one PCP (group) to provider with highest volume by cost provides primary care
ndash Cost compared by decile ranking instead of + 1 standard deviation
ndash Risk adjustments for geographic payment rate beneficiary risk on socio-economic status and others
bull Episodes of Carendash Anticipate 10 for 2018 ndash most operational
ndash 40 being tracked
ndash Plan to develop patient condition groups and patient relationship categories
31
Initial Episode-based Cost Measures
bull Aorticmitral valve surgery
bull CABG
bull HipFemur Fracture or Dislocation Treatment
bull Cholecystectomy and common duct exploration
bull Colonoscopy and biopsy
bull TURP for BPH
bull Lens and cataract procedures
bull Hip replacement or repair
bull Knee arthroplasty
bull Mastectomy
CMS will still provide feedback on performance in these categories in 2017 but it will not affect your 2019 payments
32
Alternative Payment Model (APMs)
bull Create the adoption of payment models that move away from FFS and tie payment to value
bull Must be in an Advanced APM to participate
bull Must meet specific thresholds of ldquosubstantial portionsrdquo of revenue from ldquoapprovedrdquo alternate payment models
bull Receive 5 lump sum bonus for 2019 -2024
bull Receive higher fee schedule update for 2026 and beyond
Which Path is Right for You
33
What are Advanced APMs
Requirements to be an Advanced APM
bull Requires use of certified EHR technology
bull Base payment on quality measures comparable to those in MIPS
bull The practice must bear more than nominal financial risk or is in a Medical Home Model expanded under CMS Innovation Center authority
2017 Eligible Advanced APMs Include
Comprehensive ESRD Care Model
Comprehensive Primary Care Plus (CPC+)
Medicare Shared SavingsProgram Track 2 and 3
Next Generation ACO Model
Oncology Care Model Two-Sided Risk Arrangement
34
APM Scoring Standards
Category Reporting Requirements Category Scoring CategoryWeight
Quality (PQRS) The ACO submits Medicare Shared Savings Program quality measures on behalf of ACO participant TINs and their MIPS eligible clinicians via the CMS Web Interface Data is submitted on the first 248 consecutively ranked and assigned Medicare beneficiaries The ACO submits this information once for purposes of both the Medicare Shared Savings Program and MIPS
MIPS benchmarks will be used to assign one score at the APM Entity Group (ACO) level In other words all MIPS eligible clinicians on the certified ACO ProviderSupplier list will receive the same score (unless they are excluded from MIPS) Note that the performance of all clinicians in the ACO will contribute to this score even if they are not subject to MIPS payment adjustments
50
Cost (VM) MIPS eligible clinicians participating in the MSSP will not be assessed on cost No reporting necessary
NA 0
Improvement Activities (new)
No additional reporting necessary Full credit for the APM Entity group by virtue of MSSP participation
20
Advancing Care Information (MU)
ACO participant TINs will submit directly to MIPS via a MIPS data submission mechanism
ACO participant TIN scores will be aggregated as a weighted average to yield one score for the APM Entity group
30
35
Quality Payment Program Paths
Subsets of MIPS and APM Paths
Eligible Clinician
MIPSAPM
MIPS-APM Advanced
APM
36
MIPS-APM Reporting Option
Requirements to be considered a MIPS-APM includebull Participate in the APM under an
agreement with CMS
bull Include one or more MIPS eligible clinicians on a Participation List
ndash On at least one of the snapshot dates
(Mar 31 June 30 or Aug 31)
bull Bases payment incentives on performance (either at the APM Entity or eligible clinician level) on costutilization and quality
2017 Eligible MIPS-APMs
CEC Model CPC+ Model MSSP Track 12 amp 3 Next Gen ACO OCM All arrangements
Note APM scoring standard applies to APMs that meet these criteria
37
MIPS-APM Benefits
bull Streamlined quality reporting
bull Still eligible for shared savings payment
ndash Financial risk payments do not impact eligibility for positive MIPS payment adjustments
bull Favorable scoring under lsquoAPM Scoring Standardrsquo
ndash ACO participants receive full credit in the Improvement Activities Category by virtue of MSSP participation
ndash ACO participants are not subject to the Cost performance category of MIPS
ndash Potential lsquoliftingrsquo of final MIPS score by being assessed at the ACO level
38
We Are All Part of the Quality Payment Program
Creating an Identity Toward a Common Goal
bull CMS
bull Clinicians
bull Patients
bull Our Care Teams
bull Service Providers
We all share a similar goal to improve patient outcomes
39
Quality Payment Program
Where Can Eligible Clinicians Go For Help
40copy 2016 Telligen Inc
All Eligible Clinicians are supported by
bull Quality Payment Program Websitendash Learn about the program explore the measures and find educational tools and
resources
ndash httpsqppcmsgov
bull Quality Payment Program Service Centerndash Assist with questions
ndash qppCMShhsgov
ndash 1-866-288-8292
bull Innovations Centerrsquos Learning Systemsndash Provides specialized information on Advanced Alternative Payment Models (APMs)
ndash httpsinnovationcmsgov
Self Service Technical Support
41copy 2016 Telligen Inc
We are here to help
bull Experienced quality improvement advisors to provide expert technical assistance and support for participating providers across the state especially those in large practices health systems and ACO at no charge
bull Helps in meeting MIPS requirements through customized technical assistance including one-on-one assistance when needed
bull Offers monthly webinars and Coffee Talk open discussion
ndash Focused QPP topic
ndash Open discuss with Q amp A ndash dedicated to your questions
ndash 2nd Thursday every month
ndash 1100 am CST for 1 hour
Telligen QIN-QIO
42copy 2016 Telligen Inc
We are here to help
bull Provides monthly electronic newsletter with resources the latest research and healthcare news relevant to you
bull Provides the ldquoWeekly Digestrdquo with electronic email on upcoming learning opportunities
bull Offers a website with the latest resources and tools and post recorded webinars for future reference
bull Partner with Telligen QIO on practice improvement activitiesndash Participation with a QIO in a self-management training program (diabetes)
ndash Implementation of antibiotic stewardship program
ndash Implementation of a cardiac quality improvement program
Telligen QIN-QIO
43copy 2016 Telligen Inc
Primary Care amp Specialist Physicians
Model
bull Align with the criteria for innovative models set forth in the Quality Payment Program
bull Build the evidence base on practice transformation so that effective solutions can be scaled
bull Move clinician practices through 5 phases of transformation with support from
ndash Practice Transformation Networks (PTN)
ndash Support amp Alignment Networks (SAN)
ndash Quality Improvement Organizations and others
Transforming Clinical Practice Initiative
44copy 2016 Telligen Inc
Primary Care amp Specialist Physicians
Goalsbull Support clinicians in their practice transformation goals
bull Improve health outcomes for millions of Medicare Medicaid and CHIP beneficiaries
bull Build the evidence base on practice transformation so that effective solutions can be scale
bull Sustain efficient care delivery by reducing unnecessary testing and procedures
bull Reduce unnecessary hospitalizations
Contact Melissa Kapping kappingmihconlineorg
Transforming Clinical Practice Initiative
45copy 2016 Telligen Inc
bull SURS (Small Underserved and Rural Support) ndash Recently announced February 16
ndash 11 organizations awarded contracts
ndash Telligen provides assistance to Iowa Nebraska South Dakota and North Dakota
ndash No cost to practices
bull Solo or small practices (15 or fewer clinicians) ndash Rural health professional shortage areas (HPSA)
ndash Medically underserved areas (MUA)
bull Outreach guidance and direct technical assistancendash Practice readiness education health IT optimization
ndash Strategic planning assisting in the full transition to APM
Telligen QPP Resource Center
46
Contact Info
Michelle Brunsen Sr QI Advisor
515-453-8180
mbrunsentelligencom
Sandy Swallow Program Specialist
515-223-2105
Sandyswallowarea-dhcqisorg
Websites
bull wwwtelligenqinqiocom
bull wwwtelligenqppcom
bull wwwqppcmsgov
THANK YOU
This material was prepared by Telligen the Quality Payment Program Small
Underserved and Rural Support contractor for Iowa Nebraska North Dakota and
South Dakota under contract with the Centers for Medicare amp Medicaid Services
(CMS) an agency of the US Department of Health and Human Services The
contents presented do not necessarily reflect CMS policy HHSM-500-2017-00012C
This material was prepared by Telligen the Medicare Quality Innovation
Network Quality Improvement Organization under contract with the
Centers for Medicare amp Medicaid Services (CMS) an agency of the US
Department of Health and Human Services The contents presented do
not necessarily reflect CMS policy
11
QPP What Happens in 2017
Alternative Payment Model
(APMs)bull ldquoSubstantial portionrdquo of
revenues from ldquoapproved alternated payment models
ndash 5 bonus each year from 2019-2024
ndash 075 increase per year beginning in 2026
Merit-based Incentive System (MIPS)
bull Clinicians receive a score of 0-100
bull Annually CMS will establish a threshold score based on the median composite performance scores of all providers
ndash Score above the threshold to receive bonus payments (up to 3 times the annual penalty cap)
ndash Performance scores will be reported on Physician Office Compare website
Eligible Clinicians Choose Your Path
12copy 2016 Telligen Inc
Pick Your Pace for Participation Your
Pace for Participation in 2017Pick Your Pace
for Participation in 2017Test PaceSubmit Something
Neutral or small bonus
Avoid Penalty
Partial Year 90 day Submission
Neutral or small bonus
No penalty
Full Year Submission
Neutral or Moderate bonus
No penalty
Participate in an Advanced Payment
Model in 2017
Donrsquot ParticipateReceive -4 payment
adjustment
QPP What Happens in 2017
Key Takeaway Positive adjustments are based on performance data submitted not the amount of information or length of time submitted
13copy 2016 Telligen Inc
Which Path is Right for You
bull Combines PQRS VM and MU into single improved reporting program
bull Legacy programs phase out
bull ECs earn a performance-based payment adjustment on the Medicare Part B PFS based on final score
ndash Adjusted either up down or neutral
bull The Final Score is calculated from quality data submitted in the performance categories
What is the Merit-Based Incentive Payment System
14
MIPS Timeline
MIPS payment adjustments only affect Medicare Part B participating Eligible Clinicians
2017Record quality data and
how you used technology
performance year1117 ndash 123117
2018Submit your quality data
reporting period1118 ndash 033118
MIPS performance feedback
(TIN-level) available mid-year
payment adjustments1119 ndash 123119
2019MIPS Eligible Clinicians earn
MIPS payment adjustments
based on submitted data
15
MIPS Reporting Options
Type Identification Mechanism
Individual bull Single NPI tied to TINbull Submit individual-level databull Data submission via claims EHR registry or QCDR
Group bull Set of clinicians identified by NPIs sharing common TINbull Submit group-level data bull Register as a group by June 30 2017bull Data submission via CMS web interface (25+) EHR registry
or QCDR
APM Entity Group orMIPS-APM
bull Collection of entities participating in an APM that donrsquot qualify for Advanced APM or meet thresholds
bull Submit MIPS data to avoid downward payment adjustment
16copy 2016 Telligen Inc
How will ECs be scored
MIPS Performance Categories for 2017
QualityReport on quality measures best
reflecting their practice
Advancing Care InformationReport customizable measures reflecting
their EHR use
Improvement ActivitiesSelect improvement activities that
match their practicersquos goals full credit if PCMH recognized
CostBeginning 2018 CMS will calculate
measures based on claims no reporting requirements from ECs
MIPS Performance Category Weights for 2017
Quality
ACI
IA
60
15
25
17
How much can MIPS adjust payments
bull Calculate the final score by sum of performance categories
bull Positive negative neutral adjustments based on CMS-established threshold
ndash Budget neutral program
bull Clinicians at or above performance threshold will receive a neutral or positive adjustment factor based on a linear sliding scale
bull Adjustments applied to a clinicianrsquos Medicare Part B claims
18copy 2016 Telligen Inc
Based on Reporting for Transition Year 2017
Final Score Payment Adjustment
gt 70 points bull Positive adjustmentbull Eligible for exceptional performance bonus ndash
minimum additional 05
4-69 points bull Neutral or Positive adjustment 0-4bull Not eligible for exceptional performance bonus
3 points bull Neutral 0 adjustment
0 points bull Negative payment adjustment of -4bull 0 points = does not participate
MIPS Payment Adjustments in CY 2019
Payment adjustment is based on Medicare Part B reimbursement at the TINNPI level
19
MIPS Performance Categories for 2017
Focus on
QualityPerformance Category
20
2017 Requirements for Quality Submissions
bull Most Participants report up to 6 Measuresndash 1 Outcome Measure (or intermediate outcome)
ndash If no Outcome Measure High Priority Measure
ndash If fewer than 6 measures apply submit all that apply
ndash 10 point decile scale minimum 3 pts for submission in 2017
ndash Use benchmarks to estimate points to predict your quality score
2017 Quality Benchmarks available at httpsqppcmsgovresourceseducation
bull Groups (25+) using the web interface report 15 quality measures for a full year
21
2017 Requirements for Quality Submissions
bull Quality Measure Bonus Points
ndash 2 Points for extra Outcome or Patient Experience Measures
ndash 1 Point for any other high priority measure
ndash Bonus points capped at 10 denominator
ndash Electronic submission bonus points 1 Point per measure for end-to-end electronic reporting
Qualification
o Clinical Data must be documented in CEHRT
o Processing must not include abstraction or pre-aggregation
o All mechanisms eligible except claims
EHR direct DSV Qualified Registry QCDR Web Interface
22
2017 Requirements for Quality Submissions
Payers Period
2017
Patient
Threshold
Rate
Period
2018
Patient
Threshold
Rate
Long Term
Rate
Claims Medicare Part
B
90 days 50 1 Year 60 90
Web
Interface
Medicare Part
B
1 Year 248 patients 1 Year 248 patients 248 patients
Qualified
Registry
All 90 days 50 1 Year 60 90
Qualified
Clinical Data
Registry
All 90 days 50 1 Year 60 90
EHR amp Data
Submission
Vendor
All 90 days 50 1 Year 60 90
23
MIPS Performance Categories for 2017
Focus on
Advancing Care Information
(ACI)Performance Category
24
2017 Requirements for ACI Submissions
Base Score bull Must report on either 4 or 5 measures specific to the EHR certification
bull Report either ldquoYesrdquo or a numerator of at least 1 bull All 50 Base Score points have to be earned to earn
Performance Points
Performance Score bull Based on performance rates for selected measures
Bonus Points bull Extra registry data connections (ie immunization clinical data registry)
bull Use of CEHRT in Improvement Activities
Reporting bull Attestation QCDR Qualified Registry EHR vendor or CMS Web Interface (groups of 25 or more)
HardshipsThresholds bull Allow for reweighting
ACI Scoring Methodology
25
2017 Requirements for ACI Submissions
Measures will contribute to the score in the
Performance Score measure set grouping
Base Measures
Security Risk Analysis
E-Prescribing
Provide Patient Access
HIE - Send a Summary of Care
HIE - RequestAccept a Summary of Care
(2015 only)
Performance Measures
Provide Patient Access
Patient-Specific Education
View Download and Transmit (VDT)
Secure Messaging
Patient-Generated Health Data
Send a Summary of Care
RequestAccept a Summary of Care
Clinical Information Reconciliation
Immunization Registry Reporting
26
MIPS Performance Categories for 2017
Focus on
Improvement Activities
(IA)Performance Category
27
2017 Requirements for IA Submissions
bull Maximum Points = 40 Pointsndash High weighted activities = 20 points
ndash Medium weighted activities = 10 points
bull Participation Thresholdsndash 90 days required
bull PCMH = Maximum Possible Points (40)
bull APM Participation = 50-100 of Maximum Possible Points at CMS discretion
bull Special Populations Points Doubledndash Practices with lt 15 providers
ndash Rural or HPSA practices
ndash Non-patient facing MIPS eligible clinicians
bull Reporting Options Qualified Registry EHR QCDR or CMS Web Interface (for groups 25 clinicians or more)
28
MIPS Performance Categories for 2017
Focus on
CostPerformance Category
29
2017 Requirements for Cost Category
bull Cost scoring weightndash 2017 0
ndash 2018 10
ndash 2019 30
bull CMS will calculate from claims over 40 episode-specific measures to account for differences among specialtiesndash Clinicians that deliver more efficient care achieve better
performance and score the highest points for cost measures
bull ldquoEpisodes of carerdquo roll up all costs of inpatient and outpatient care (including imaging laboratory drugs rehabilitation etc)
30
2017 Requirements for Cost Category
bull Expected Changes from the Value-Modifier Programndash Patients attributed at the TIN-NPI level
ndash Attributed to one PCP (group) to provider with highest volume by cost provides primary care
ndash Cost compared by decile ranking instead of + 1 standard deviation
ndash Risk adjustments for geographic payment rate beneficiary risk on socio-economic status and others
bull Episodes of Carendash Anticipate 10 for 2018 ndash most operational
ndash 40 being tracked
ndash Plan to develop patient condition groups and patient relationship categories
31
Initial Episode-based Cost Measures
bull Aorticmitral valve surgery
bull CABG
bull HipFemur Fracture or Dislocation Treatment
bull Cholecystectomy and common duct exploration
bull Colonoscopy and biopsy
bull TURP for BPH
bull Lens and cataract procedures
bull Hip replacement or repair
bull Knee arthroplasty
bull Mastectomy
CMS will still provide feedback on performance in these categories in 2017 but it will not affect your 2019 payments
32
Alternative Payment Model (APMs)
bull Create the adoption of payment models that move away from FFS and tie payment to value
bull Must be in an Advanced APM to participate
bull Must meet specific thresholds of ldquosubstantial portionsrdquo of revenue from ldquoapprovedrdquo alternate payment models
bull Receive 5 lump sum bonus for 2019 -2024
bull Receive higher fee schedule update for 2026 and beyond
Which Path is Right for You
33
What are Advanced APMs
Requirements to be an Advanced APM
bull Requires use of certified EHR technology
bull Base payment on quality measures comparable to those in MIPS
bull The practice must bear more than nominal financial risk or is in a Medical Home Model expanded under CMS Innovation Center authority
2017 Eligible Advanced APMs Include
Comprehensive ESRD Care Model
Comprehensive Primary Care Plus (CPC+)
Medicare Shared SavingsProgram Track 2 and 3
Next Generation ACO Model
Oncology Care Model Two-Sided Risk Arrangement
34
APM Scoring Standards
Category Reporting Requirements Category Scoring CategoryWeight
Quality (PQRS) The ACO submits Medicare Shared Savings Program quality measures on behalf of ACO participant TINs and their MIPS eligible clinicians via the CMS Web Interface Data is submitted on the first 248 consecutively ranked and assigned Medicare beneficiaries The ACO submits this information once for purposes of both the Medicare Shared Savings Program and MIPS
MIPS benchmarks will be used to assign one score at the APM Entity Group (ACO) level In other words all MIPS eligible clinicians on the certified ACO ProviderSupplier list will receive the same score (unless they are excluded from MIPS) Note that the performance of all clinicians in the ACO will contribute to this score even if they are not subject to MIPS payment adjustments
50
Cost (VM) MIPS eligible clinicians participating in the MSSP will not be assessed on cost No reporting necessary
NA 0
Improvement Activities (new)
No additional reporting necessary Full credit for the APM Entity group by virtue of MSSP participation
20
Advancing Care Information (MU)
ACO participant TINs will submit directly to MIPS via a MIPS data submission mechanism
ACO participant TIN scores will be aggregated as a weighted average to yield one score for the APM Entity group
30
35
Quality Payment Program Paths
Subsets of MIPS and APM Paths
Eligible Clinician
MIPSAPM
MIPS-APM Advanced
APM
36
MIPS-APM Reporting Option
Requirements to be considered a MIPS-APM includebull Participate in the APM under an
agreement with CMS
bull Include one or more MIPS eligible clinicians on a Participation List
ndash On at least one of the snapshot dates
(Mar 31 June 30 or Aug 31)
bull Bases payment incentives on performance (either at the APM Entity or eligible clinician level) on costutilization and quality
2017 Eligible MIPS-APMs
CEC Model CPC+ Model MSSP Track 12 amp 3 Next Gen ACO OCM All arrangements
Note APM scoring standard applies to APMs that meet these criteria
37
MIPS-APM Benefits
bull Streamlined quality reporting
bull Still eligible for shared savings payment
ndash Financial risk payments do not impact eligibility for positive MIPS payment adjustments
bull Favorable scoring under lsquoAPM Scoring Standardrsquo
ndash ACO participants receive full credit in the Improvement Activities Category by virtue of MSSP participation
ndash ACO participants are not subject to the Cost performance category of MIPS
ndash Potential lsquoliftingrsquo of final MIPS score by being assessed at the ACO level
38
We Are All Part of the Quality Payment Program
Creating an Identity Toward a Common Goal
bull CMS
bull Clinicians
bull Patients
bull Our Care Teams
bull Service Providers
We all share a similar goal to improve patient outcomes
39
Quality Payment Program
Where Can Eligible Clinicians Go For Help
40copy 2016 Telligen Inc
All Eligible Clinicians are supported by
bull Quality Payment Program Websitendash Learn about the program explore the measures and find educational tools and
resources
ndash httpsqppcmsgov
bull Quality Payment Program Service Centerndash Assist with questions
ndash qppCMShhsgov
ndash 1-866-288-8292
bull Innovations Centerrsquos Learning Systemsndash Provides specialized information on Advanced Alternative Payment Models (APMs)
ndash httpsinnovationcmsgov
Self Service Technical Support
41copy 2016 Telligen Inc
We are here to help
bull Experienced quality improvement advisors to provide expert technical assistance and support for participating providers across the state especially those in large practices health systems and ACO at no charge
bull Helps in meeting MIPS requirements through customized technical assistance including one-on-one assistance when needed
bull Offers monthly webinars and Coffee Talk open discussion
ndash Focused QPP topic
ndash Open discuss with Q amp A ndash dedicated to your questions
ndash 2nd Thursday every month
ndash 1100 am CST for 1 hour
Telligen QIN-QIO
42copy 2016 Telligen Inc
We are here to help
bull Provides monthly electronic newsletter with resources the latest research and healthcare news relevant to you
bull Provides the ldquoWeekly Digestrdquo with electronic email on upcoming learning opportunities
bull Offers a website with the latest resources and tools and post recorded webinars for future reference
bull Partner with Telligen QIO on practice improvement activitiesndash Participation with a QIO in a self-management training program (diabetes)
ndash Implementation of antibiotic stewardship program
ndash Implementation of a cardiac quality improvement program
Telligen QIN-QIO
43copy 2016 Telligen Inc
Primary Care amp Specialist Physicians
Model
bull Align with the criteria for innovative models set forth in the Quality Payment Program
bull Build the evidence base on practice transformation so that effective solutions can be scaled
bull Move clinician practices through 5 phases of transformation with support from
ndash Practice Transformation Networks (PTN)
ndash Support amp Alignment Networks (SAN)
ndash Quality Improvement Organizations and others
Transforming Clinical Practice Initiative
44copy 2016 Telligen Inc
Primary Care amp Specialist Physicians
Goalsbull Support clinicians in their practice transformation goals
bull Improve health outcomes for millions of Medicare Medicaid and CHIP beneficiaries
bull Build the evidence base on practice transformation so that effective solutions can be scale
bull Sustain efficient care delivery by reducing unnecessary testing and procedures
bull Reduce unnecessary hospitalizations
Contact Melissa Kapping kappingmihconlineorg
Transforming Clinical Practice Initiative
45copy 2016 Telligen Inc
bull SURS (Small Underserved and Rural Support) ndash Recently announced February 16
ndash 11 organizations awarded contracts
ndash Telligen provides assistance to Iowa Nebraska South Dakota and North Dakota
ndash No cost to practices
bull Solo or small practices (15 or fewer clinicians) ndash Rural health professional shortage areas (HPSA)
ndash Medically underserved areas (MUA)
bull Outreach guidance and direct technical assistancendash Practice readiness education health IT optimization
ndash Strategic planning assisting in the full transition to APM
Telligen QPP Resource Center
46
Contact Info
Michelle Brunsen Sr QI Advisor
515-453-8180
mbrunsentelligencom
Sandy Swallow Program Specialist
515-223-2105
Sandyswallowarea-dhcqisorg
Websites
bull wwwtelligenqinqiocom
bull wwwtelligenqppcom
bull wwwqppcmsgov
THANK YOU
This material was prepared by Telligen the Quality Payment Program Small
Underserved and Rural Support contractor for Iowa Nebraska North Dakota and
South Dakota under contract with the Centers for Medicare amp Medicaid Services
(CMS) an agency of the US Department of Health and Human Services The
contents presented do not necessarily reflect CMS policy HHSM-500-2017-00012C
This material was prepared by Telligen the Medicare Quality Innovation
Network Quality Improvement Organization under contract with the
Centers for Medicare amp Medicaid Services (CMS) an agency of the US
Department of Health and Human Services The contents presented do
not necessarily reflect CMS policy
12copy 2016 Telligen Inc
Pick Your Pace for Participation Your
Pace for Participation in 2017Pick Your Pace
for Participation in 2017Test PaceSubmit Something
Neutral or small bonus
Avoid Penalty
Partial Year 90 day Submission
Neutral or small bonus
No penalty
Full Year Submission
Neutral or Moderate bonus
No penalty
Participate in an Advanced Payment
Model in 2017
Donrsquot ParticipateReceive -4 payment
adjustment
QPP What Happens in 2017
Key Takeaway Positive adjustments are based on performance data submitted not the amount of information or length of time submitted
13copy 2016 Telligen Inc
Which Path is Right for You
bull Combines PQRS VM and MU into single improved reporting program
bull Legacy programs phase out
bull ECs earn a performance-based payment adjustment on the Medicare Part B PFS based on final score
ndash Adjusted either up down or neutral
bull The Final Score is calculated from quality data submitted in the performance categories
What is the Merit-Based Incentive Payment System
14
MIPS Timeline
MIPS payment adjustments only affect Medicare Part B participating Eligible Clinicians
2017Record quality data and
how you used technology
performance year1117 ndash 123117
2018Submit your quality data
reporting period1118 ndash 033118
MIPS performance feedback
(TIN-level) available mid-year
payment adjustments1119 ndash 123119
2019MIPS Eligible Clinicians earn
MIPS payment adjustments
based on submitted data
15
MIPS Reporting Options
Type Identification Mechanism
Individual bull Single NPI tied to TINbull Submit individual-level databull Data submission via claims EHR registry or QCDR
Group bull Set of clinicians identified by NPIs sharing common TINbull Submit group-level data bull Register as a group by June 30 2017bull Data submission via CMS web interface (25+) EHR registry
or QCDR
APM Entity Group orMIPS-APM
bull Collection of entities participating in an APM that donrsquot qualify for Advanced APM or meet thresholds
bull Submit MIPS data to avoid downward payment adjustment
16copy 2016 Telligen Inc
How will ECs be scored
MIPS Performance Categories for 2017
QualityReport on quality measures best
reflecting their practice
Advancing Care InformationReport customizable measures reflecting
their EHR use
Improvement ActivitiesSelect improvement activities that
match their practicersquos goals full credit if PCMH recognized
CostBeginning 2018 CMS will calculate
measures based on claims no reporting requirements from ECs
MIPS Performance Category Weights for 2017
Quality
ACI
IA
60
15
25
17
How much can MIPS adjust payments
bull Calculate the final score by sum of performance categories
bull Positive negative neutral adjustments based on CMS-established threshold
ndash Budget neutral program
bull Clinicians at or above performance threshold will receive a neutral or positive adjustment factor based on a linear sliding scale
bull Adjustments applied to a clinicianrsquos Medicare Part B claims
18copy 2016 Telligen Inc
Based on Reporting for Transition Year 2017
Final Score Payment Adjustment
gt 70 points bull Positive adjustmentbull Eligible for exceptional performance bonus ndash
minimum additional 05
4-69 points bull Neutral or Positive adjustment 0-4bull Not eligible for exceptional performance bonus
3 points bull Neutral 0 adjustment
0 points bull Negative payment adjustment of -4bull 0 points = does not participate
MIPS Payment Adjustments in CY 2019
Payment adjustment is based on Medicare Part B reimbursement at the TINNPI level
19
MIPS Performance Categories for 2017
Focus on
QualityPerformance Category
20
2017 Requirements for Quality Submissions
bull Most Participants report up to 6 Measuresndash 1 Outcome Measure (or intermediate outcome)
ndash If no Outcome Measure High Priority Measure
ndash If fewer than 6 measures apply submit all that apply
ndash 10 point decile scale minimum 3 pts for submission in 2017
ndash Use benchmarks to estimate points to predict your quality score
2017 Quality Benchmarks available at httpsqppcmsgovresourceseducation
bull Groups (25+) using the web interface report 15 quality measures for a full year
21
2017 Requirements for Quality Submissions
bull Quality Measure Bonus Points
ndash 2 Points for extra Outcome or Patient Experience Measures
ndash 1 Point for any other high priority measure
ndash Bonus points capped at 10 denominator
ndash Electronic submission bonus points 1 Point per measure for end-to-end electronic reporting
Qualification
o Clinical Data must be documented in CEHRT
o Processing must not include abstraction or pre-aggregation
o All mechanisms eligible except claims
EHR direct DSV Qualified Registry QCDR Web Interface
22
2017 Requirements for Quality Submissions
Payers Period
2017
Patient
Threshold
Rate
Period
2018
Patient
Threshold
Rate
Long Term
Rate
Claims Medicare Part
B
90 days 50 1 Year 60 90
Web
Interface
Medicare Part
B
1 Year 248 patients 1 Year 248 patients 248 patients
Qualified
Registry
All 90 days 50 1 Year 60 90
Qualified
Clinical Data
Registry
All 90 days 50 1 Year 60 90
EHR amp Data
Submission
Vendor
All 90 days 50 1 Year 60 90
23
MIPS Performance Categories for 2017
Focus on
Advancing Care Information
(ACI)Performance Category
24
2017 Requirements for ACI Submissions
Base Score bull Must report on either 4 or 5 measures specific to the EHR certification
bull Report either ldquoYesrdquo or a numerator of at least 1 bull All 50 Base Score points have to be earned to earn
Performance Points
Performance Score bull Based on performance rates for selected measures
Bonus Points bull Extra registry data connections (ie immunization clinical data registry)
bull Use of CEHRT in Improvement Activities
Reporting bull Attestation QCDR Qualified Registry EHR vendor or CMS Web Interface (groups of 25 or more)
HardshipsThresholds bull Allow for reweighting
ACI Scoring Methodology
25
2017 Requirements for ACI Submissions
Measures will contribute to the score in the
Performance Score measure set grouping
Base Measures
Security Risk Analysis
E-Prescribing
Provide Patient Access
HIE - Send a Summary of Care
HIE - RequestAccept a Summary of Care
(2015 only)
Performance Measures
Provide Patient Access
Patient-Specific Education
View Download and Transmit (VDT)
Secure Messaging
Patient-Generated Health Data
Send a Summary of Care
RequestAccept a Summary of Care
Clinical Information Reconciliation
Immunization Registry Reporting
26
MIPS Performance Categories for 2017
Focus on
Improvement Activities
(IA)Performance Category
27
2017 Requirements for IA Submissions
bull Maximum Points = 40 Pointsndash High weighted activities = 20 points
ndash Medium weighted activities = 10 points
bull Participation Thresholdsndash 90 days required
bull PCMH = Maximum Possible Points (40)
bull APM Participation = 50-100 of Maximum Possible Points at CMS discretion
bull Special Populations Points Doubledndash Practices with lt 15 providers
ndash Rural or HPSA practices
ndash Non-patient facing MIPS eligible clinicians
bull Reporting Options Qualified Registry EHR QCDR or CMS Web Interface (for groups 25 clinicians or more)
28
MIPS Performance Categories for 2017
Focus on
CostPerformance Category
29
2017 Requirements for Cost Category
bull Cost scoring weightndash 2017 0
ndash 2018 10
ndash 2019 30
bull CMS will calculate from claims over 40 episode-specific measures to account for differences among specialtiesndash Clinicians that deliver more efficient care achieve better
performance and score the highest points for cost measures
bull ldquoEpisodes of carerdquo roll up all costs of inpatient and outpatient care (including imaging laboratory drugs rehabilitation etc)
30
2017 Requirements for Cost Category
bull Expected Changes from the Value-Modifier Programndash Patients attributed at the TIN-NPI level
ndash Attributed to one PCP (group) to provider with highest volume by cost provides primary care
ndash Cost compared by decile ranking instead of + 1 standard deviation
ndash Risk adjustments for geographic payment rate beneficiary risk on socio-economic status and others
bull Episodes of Carendash Anticipate 10 for 2018 ndash most operational
ndash 40 being tracked
ndash Plan to develop patient condition groups and patient relationship categories
31
Initial Episode-based Cost Measures
bull Aorticmitral valve surgery
bull CABG
bull HipFemur Fracture or Dislocation Treatment
bull Cholecystectomy and common duct exploration
bull Colonoscopy and biopsy
bull TURP for BPH
bull Lens and cataract procedures
bull Hip replacement or repair
bull Knee arthroplasty
bull Mastectomy
CMS will still provide feedback on performance in these categories in 2017 but it will not affect your 2019 payments
32
Alternative Payment Model (APMs)
bull Create the adoption of payment models that move away from FFS and tie payment to value
bull Must be in an Advanced APM to participate
bull Must meet specific thresholds of ldquosubstantial portionsrdquo of revenue from ldquoapprovedrdquo alternate payment models
bull Receive 5 lump sum bonus for 2019 -2024
bull Receive higher fee schedule update for 2026 and beyond
Which Path is Right for You
33
What are Advanced APMs
Requirements to be an Advanced APM
bull Requires use of certified EHR technology
bull Base payment on quality measures comparable to those in MIPS
bull The practice must bear more than nominal financial risk or is in a Medical Home Model expanded under CMS Innovation Center authority
2017 Eligible Advanced APMs Include
Comprehensive ESRD Care Model
Comprehensive Primary Care Plus (CPC+)
Medicare Shared SavingsProgram Track 2 and 3
Next Generation ACO Model
Oncology Care Model Two-Sided Risk Arrangement
34
APM Scoring Standards
Category Reporting Requirements Category Scoring CategoryWeight
Quality (PQRS) The ACO submits Medicare Shared Savings Program quality measures on behalf of ACO participant TINs and their MIPS eligible clinicians via the CMS Web Interface Data is submitted on the first 248 consecutively ranked and assigned Medicare beneficiaries The ACO submits this information once for purposes of both the Medicare Shared Savings Program and MIPS
MIPS benchmarks will be used to assign one score at the APM Entity Group (ACO) level In other words all MIPS eligible clinicians on the certified ACO ProviderSupplier list will receive the same score (unless they are excluded from MIPS) Note that the performance of all clinicians in the ACO will contribute to this score even if they are not subject to MIPS payment adjustments
50
Cost (VM) MIPS eligible clinicians participating in the MSSP will not be assessed on cost No reporting necessary
NA 0
Improvement Activities (new)
No additional reporting necessary Full credit for the APM Entity group by virtue of MSSP participation
20
Advancing Care Information (MU)
ACO participant TINs will submit directly to MIPS via a MIPS data submission mechanism
ACO participant TIN scores will be aggregated as a weighted average to yield one score for the APM Entity group
30
35
Quality Payment Program Paths
Subsets of MIPS and APM Paths
Eligible Clinician
MIPSAPM
MIPS-APM Advanced
APM
36
MIPS-APM Reporting Option
Requirements to be considered a MIPS-APM includebull Participate in the APM under an
agreement with CMS
bull Include one or more MIPS eligible clinicians on a Participation List
ndash On at least one of the snapshot dates
(Mar 31 June 30 or Aug 31)
bull Bases payment incentives on performance (either at the APM Entity or eligible clinician level) on costutilization and quality
2017 Eligible MIPS-APMs
CEC Model CPC+ Model MSSP Track 12 amp 3 Next Gen ACO OCM All arrangements
Note APM scoring standard applies to APMs that meet these criteria
37
MIPS-APM Benefits
bull Streamlined quality reporting
bull Still eligible for shared savings payment
ndash Financial risk payments do not impact eligibility for positive MIPS payment adjustments
bull Favorable scoring under lsquoAPM Scoring Standardrsquo
ndash ACO participants receive full credit in the Improvement Activities Category by virtue of MSSP participation
ndash ACO participants are not subject to the Cost performance category of MIPS
ndash Potential lsquoliftingrsquo of final MIPS score by being assessed at the ACO level
38
We Are All Part of the Quality Payment Program
Creating an Identity Toward a Common Goal
bull CMS
bull Clinicians
bull Patients
bull Our Care Teams
bull Service Providers
We all share a similar goal to improve patient outcomes
39
Quality Payment Program
Where Can Eligible Clinicians Go For Help
40copy 2016 Telligen Inc
All Eligible Clinicians are supported by
bull Quality Payment Program Websitendash Learn about the program explore the measures and find educational tools and
resources
ndash httpsqppcmsgov
bull Quality Payment Program Service Centerndash Assist with questions
ndash qppCMShhsgov
ndash 1-866-288-8292
bull Innovations Centerrsquos Learning Systemsndash Provides specialized information on Advanced Alternative Payment Models (APMs)
ndash httpsinnovationcmsgov
Self Service Technical Support
41copy 2016 Telligen Inc
We are here to help
bull Experienced quality improvement advisors to provide expert technical assistance and support for participating providers across the state especially those in large practices health systems and ACO at no charge
bull Helps in meeting MIPS requirements through customized technical assistance including one-on-one assistance when needed
bull Offers monthly webinars and Coffee Talk open discussion
ndash Focused QPP topic
ndash Open discuss with Q amp A ndash dedicated to your questions
ndash 2nd Thursday every month
ndash 1100 am CST for 1 hour
Telligen QIN-QIO
42copy 2016 Telligen Inc
We are here to help
bull Provides monthly electronic newsletter with resources the latest research and healthcare news relevant to you
bull Provides the ldquoWeekly Digestrdquo with electronic email on upcoming learning opportunities
bull Offers a website with the latest resources and tools and post recorded webinars for future reference
bull Partner with Telligen QIO on practice improvement activitiesndash Participation with a QIO in a self-management training program (diabetes)
ndash Implementation of antibiotic stewardship program
ndash Implementation of a cardiac quality improvement program
Telligen QIN-QIO
43copy 2016 Telligen Inc
Primary Care amp Specialist Physicians
Model
bull Align with the criteria for innovative models set forth in the Quality Payment Program
bull Build the evidence base on practice transformation so that effective solutions can be scaled
bull Move clinician practices through 5 phases of transformation with support from
ndash Practice Transformation Networks (PTN)
ndash Support amp Alignment Networks (SAN)
ndash Quality Improvement Organizations and others
Transforming Clinical Practice Initiative
44copy 2016 Telligen Inc
Primary Care amp Specialist Physicians
Goalsbull Support clinicians in their practice transformation goals
bull Improve health outcomes for millions of Medicare Medicaid and CHIP beneficiaries
bull Build the evidence base on practice transformation so that effective solutions can be scale
bull Sustain efficient care delivery by reducing unnecessary testing and procedures
bull Reduce unnecessary hospitalizations
Contact Melissa Kapping kappingmihconlineorg
Transforming Clinical Practice Initiative
45copy 2016 Telligen Inc
bull SURS (Small Underserved and Rural Support) ndash Recently announced February 16
ndash 11 organizations awarded contracts
ndash Telligen provides assistance to Iowa Nebraska South Dakota and North Dakota
ndash No cost to practices
bull Solo or small practices (15 or fewer clinicians) ndash Rural health professional shortage areas (HPSA)
ndash Medically underserved areas (MUA)
bull Outreach guidance and direct technical assistancendash Practice readiness education health IT optimization
ndash Strategic planning assisting in the full transition to APM
Telligen QPP Resource Center
46
Contact Info
Michelle Brunsen Sr QI Advisor
515-453-8180
mbrunsentelligencom
Sandy Swallow Program Specialist
515-223-2105
Sandyswallowarea-dhcqisorg
Websites
bull wwwtelligenqinqiocom
bull wwwtelligenqppcom
bull wwwqppcmsgov
THANK YOU
This material was prepared by Telligen the Quality Payment Program Small
Underserved and Rural Support contractor for Iowa Nebraska North Dakota and
South Dakota under contract with the Centers for Medicare amp Medicaid Services
(CMS) an agency of the US Department of Health and Human Services The
contents presented do not necessarily reflect CMS policy HHSM-500-2017-00012C
This material was prepared by Telligen the Medicare Quality Innovation
Network Quality Improvement Organization under contract with the
Centers for Medicare amp Medicaid Services (CMS) an agency of the US
Department of Health and Human Services The contents presented do
not necessarily reflect CMS policy
13copy 2016 Telligen Inc
Which Path is Right for You
bull Combines PQRS VM and MU into single improved reporting program
bull Legacy programs phase out
bull ECs earn a performance-based payment adjustment on the Medicare Part B PFS based on final score
ndash Adjusted either up down or neutral
bull The Final Score is calculated from quality data submitted in the performance categories
What is the Merit-Based Incentive Payment System
14
MIPS Timeline
MIPS payment adjustments only affect Medicare Part B participating Eligible Clinicians
2017Record quality data and
how you used technology
performance year1117 ndash 123117
2018Submit your quality data
reporting period1118 ndash 033118
MIPS performance feedback
(TIN-level) available mid-year
payment adjustments1119 ndash 123119
2019MIPS Eligible Clinicians earn
MIPS payment adjustments
based on submitted data
15
MIPS Reporting Options
Type Identification Mechanism
Individual bull Single NPI tied to TINbull Submit individual-level databull Data submission via claims EHR registry or QCDR
Group bull Set of clinicians identified by NPIs sharing common TINbull Submit group-level data bull Register as a group by June 30 2017bull Data submission via CMS web interface (25+) EHR registry
or QCDR
APM Entity Group orMIPS-APM
bull Collection of entities participating in an APM that donrsquot qualify for Advanced APM or meet thresholds
bull Submit MIPS data to avoid downward payment adjustment
16copy 2016 Telligen Inc
How will ECs be scored
MIPS Performance Categories for 2017
QualityReport on quality measures best
reflecting their practice
Advancing Care InformationReport customizable measures reflecting
their EHR use
Improvement ActivitiesSelect improvement activities that
match their practicersquos goals full credit if PCMH recognized
CostBeginning 2018 CMS will calculate
measures based on claims no reporting requirements from ECs
MIPS Performance Category Weights for 2017
Quality
ACI
IA
60
15
25
17
How much can MIPS adjust payments
bull Calculate the final score by sum of performance categories
bull Positive negative neutral adjustments based on CMS-established threshold
ndash Budget neutral program
bull Clinicians at or above performance threshold will receive a neutral or positive adjustment factor based on a linear sliding scale
bull Adjustments applied to a clinicianrsquos Medicare Part B claims
18copy 2016 Telligen Inc
Based on Reporting for Transition Year 2017
Final Score Payment Adjustment
gt 70 points bull Positive adjustmentbull Eligible for exceptional performance bonus ndash
minimum additional 05
4-69 points bull Neutral or Positive adjustment 0-4bull Not eligible for exceptional performance bonus
3 points bull Neutral 0 adjustment
0 points bull Negative payment adjustment of -4bull 0 points = does not participate
MIPS Payment Adjustments in CY 2019
Payment adjustment is based on Medicare Part B reimbursement at the TINNPI level
19
MIPS Performance Categories for 2017
Focus on
QualityPerformance Category
20
2017 Requirements for Quality Submissions
bull Most Participants report up to 6 Measuresndash 1 Outcome Measure (or intermediate outcome)
ndash If no Outcome Measure High Priority Measure
ndash If fewer than 6 measures apply submit all that apply
ndash 10 point decile scale minimum 3 pts for submission in 2017
ndash Use benchmarks to estimate points to predict your quality score
2017 Quality Benchmarks available at httpsqppcmsgovresourceseducation
bull Groups (25+) using the web interface report 15 quality measures for a full year
21
2017 Requirements for Quality Submissions
bull Quality Measure Bonus Points
ndash 2 Points for extra Outcome or Patient Experience Measures
ndash 1 Point for any other high priority measure
ndash Bonus points capped at 10 denominator
ndash Electronic submission bonus points 1 Point per measure for end-to-end electronic reporting
Qualification
o Clinical Data must be documented in CEHRT
o Processing must not include abstraction or pre-aggregation
o All mechanisms eligible except claims
EHR direct DSV Qualified Registry QCDR Web Interface
22
2017 Requirements for Quality Submissions
Payers Period
2017
Patient
Threshold
Rate
Period
2018
Patient
Threshold
Rate
Long Term
Rate
Claims Medicare Part
B
90 days 50 1 Year 60 90
Web
Interface
Medicare Part
B
1 Year 248 patients 1 Year 248 patients 248 patients
Qualified
Registry
All 90 days 50 1 Year 60 90
Qualified
Clinical Data
Registry
All 90 days 50 1 Year 60 90
EHR amp Data
Submission
Vendor
All 90 days 50 1 Year 60 90
23
MIPS Performance Categories for 2017
Focus on
Advancing Care Information
(ACI)Performance Category
24
2017 Requirements for ACI Submissions
Base Score bull Must report on either 4 or 5 measures specific to the EHR certification
bull Report either ldquoYesrdquo or a numerator of at least 1 bull All 50 Base Score points have to be earned to earn
Performance Points
Performance Score bull Based on performance rates for selected measures
Bonus Points bull Extra registry data connections (ie immunization clinical data registry)
bull Use of CEHRT in Improvement Activities
Reporting bull Attestation QCDR Qualified Registry EHR vendor or CMS Web Interface (groups of 25 or more)
HardshipsThresholds bull Allow for reweighting
ACI Scoring Methodology
25
2017 Requirements for ACI Submissions
Measures will contribute to the score in the
Performance Score measure set grouping
Base Measures
Security Risk Analysis
E-Prescribing
Provide Patient Access
HIE - Send a Summary of Care
HIE - RequestAccept a Summary of Care
(2015 only)
Performance Measures
Provide Patient Access
Patient-Specific Education
View Download and Transmit (VDT)
Secure Messaging
Patient-Generated Health Data
Send a Summary of Care
RequestAccept a Summary of Care
Clinical Information Reconciliation
Immunization Registry Reporting
26
MIPS Performance Categories for 2017
Focus on
Improvement Activities
(IA)Performance Category
27
2017 Requirements for IA Submissions
bull Maximum Points = 40 Pointsndash High weighted activities = 20 points
ndash Medium weighted activities = 10 points
bull Participation Thresholdsndash 90 days required
bull PCMH = Maximum Possible Points (40)
bull APM Participation = 50-100 of Maximum Possible Points at CMS discretion
bull Special Populations Points Doubledndash Practices with lt 15 providers
ndash Rural or HPSA practices
ndash Non-patient facing MIPS eligible clinicians
bull Reporting Options Qualified Registry EHR QCDR or CMS Web Interface (for groups 25 clinicians or more)
28
MIPS Performance Categories for 2017
Focus on
CostPerformance Category
29
2017 Requirements for Cost Category
bull Cost scoring weightndash 2017 0
ndash 2018 10
ndash 2019 30
bull CMS will calculate from claims over 40 episode-specific measures to account for differences among specialtiesndash Clinicians that deliver more efficient care achieve better
performance and score the highest points for cost measures
bull ldquoEpisodes of carerdquo roll up all costs of inpatient and outpatient care (including imaging laboratory drugs rehabilitation etc)
30
2017 Requirements for Cost Category
bull Expected Changes from the Value-Modifier Programndash Patients attributed at the TIN-NPI level
ndash Attributed to one PCP (group) to provider with highest volume by cost provides primary care
ndash Cost compared by decile ranking instead of + 1 standard deviation
ndash Risk adjustments for geographic payment rate beneficiary risk on socio-economic status and others
bull Episodes of Carendash Anticipate 10 for 2018 ndash most operational
ndash 40 being tracked
ndash Plan to develop patient condition groups and patient relationship categories
31
Initial Episode-based Cost Measures
bull Aorticmitral valve surgery
bull CABG
bull HipFemur Fracture or Dislocation Treatment
bull Cholecystectomy and common duct exploration
bull Colonoscopy and biopsy
bull TURP for BPH
bull Lens and cataract procedures
bull Hip replacement or repair
bull Knee arthroplasty
bull Mastectomy
CMS will still provide feedback on performance in these categories in 2017 but it will not affect your 2019 payments
32
Alternative Payment Model (APMs)
bull Create the adoption of payment models that move away from FFS and tie payment to value
bull Must be in an Advanced APM to participate
bull Must meet specific thresholds of ldquosubstantial portionsrdquo of revenue from ldquoapprovedrdquo alternate payment models
bull Receive 5 lump sum bonus for 2019 -2024
bull Receive higher fee schedule update for 2026 and beyond
Which Path is Right for You
33
What are Advanced APMs
Requirements to be an Advanced APM
bull Requires use of certified EHR technology
bull Base payment on quality measures comparable to those in MIPS
bull The practice must bear more than nominal financial risk or is in a Medical Home Model expanded under CMS Innovation Center authority
2017 Eligible Advanced APMs Include
Comprehensive ESRD Care Model
Comprehensive Primary Care Plus (CPC+)
Medicare Shared SavingsProgram Track 2 and 3
Next Generation ACO Model
Oncology Care Model Two-Sided Risk Arrangement
34
APM Scoring Standards
Category Reporting Requirements Category Scoring CategoryWeight
Quality (PQRS) The ACO submits Medicare Shared Savings Program quality measures on behalf of ACO participant TINs and their MIPS eligible clinicians via the CMS Web Interface Data is submitted on the first 248 consecutively ranked and assigned Medicare beneficiaries The ACO submits this information once for purposes of both the Medicare Shared Savings Program and MIPS
MIPS benchmarks will be used to assign one score at the APM Entity Group (ACO) level In other words all MIPS eligible clinicians on the certified ACO ProviderSupplier list will receive the same score (unless they are excluded from MIPS) Note that the performance of all clinicians in the ACO will contribute to this score even if they are not subject to MIPS payment adjustments
50
Cost (VM) MIPS eligible clinicians participating in the MSSP will not be assessed on cost No reporting necessary
NA 0
Improvement Activities (new)
No additional reporting necessary Full credit for the APM Entity group by virtue of MSSP participation
20
Advancing Care Information (MU)
ACO participant TINs will submit directly to MIPS via a MIPS data submission mechanism
ACO participant TIN scores will be aggregated as a weighted average to yield one score for the APM Entity group
30
35
Quality Payment Program Paths
Subsets of MIPS and APM Paths
Eligible Clinician
MIPSAPM
MIPS-APM Advanced
APM
36
MIPS-APM Reporting Option
Requirements to be considered a MIPS-APM includebull Participate in the APM under an
agreement with CMS
bull Include one or more MIPS eligible clinicians on a Participation List
ndash On at least one of the snapshot dates
(Mar 31 June 30 or Aug 31)
bull Bases payment incentives on performance (either at the APM Entity or eligible clinician level) on costutilization and quality
2017 Eligible MIPS-APMs
CEC Model CPC+ Model MSSP Track 12 amp 3 Next Gen ACO OCM All arrangements
Note APM scoring standard applies to APMs that meet these criteria
37
MIPS-APM Benefits
bull Streamlined quality reporting
bull Still eligible for shared savings payment
ndash Financial risk payments do not impact eligibility for positive MIPS payment adjustments
bull Favorable scoring under lsquoAPM Scoring Standardrsquo
ndash ACO participants receive full credit in the Improvement Activities Category by virtue of MSSP participation
ndash ACO participants are not subject to the Cost performance category of MIPS
ndash Potential lsquoliftingrsquo of final MIPS score by being assessed at the ACO level
38
We Are All Part of the Quality Payment Program
Creating an Identity Toward a Common Goal
bull CMS
bull Clinicians
bull Patients
bull Our Care Teams
bull Service Providers
We all share a similar goal to improve patient outcomes
39
Quality Payment Program
Where Can Eligible Clinicians Go For Help
40copy 2016 Telligen Inc
All Eligible Clinicians are supported by
bull Quality Payment Program Websitendash Learn about the program explore the measures and find educational tools and
resources
ndash httpsqppcmsgov
bull Quality Payment Program Service Centerndash Assist with questions
ndash qppCMShhsgov
ndash 1-866-288-8292
bull Innovations Centerrsquos Learning Systemsndash Provides specialized information on Advanced Alternative Payment Models (APMs)
ndash httpsinnovationcmsgov
Self Service Technical Support
41copy 2016 Telligen Inc
We are here to help
bull Experienced quality improvement advisors to provide expert technical assistance and support for participating providers across the state especially those in large practices health systems and ACO at no charge
bull Helps in meeting MIPS requirements through customized technical assistance including one-on-one assistance when needed
bull Offers monthly webinars and Coffee Talk open discussion
ndash Focused QPP topic
ndash Open discuss with Q amp A ndash dedicated to your questions
ndash 2nd Thursday every month
ndash 1100 am CST for 1 hour
Telligen QIN-QIO
42copy 2016 Telligen Inc
We are here to help
bull Provides monthly electronic newsletter with resources the latest research and healthcare news relevant to you
bull Provides the ldquoWeekly Digestrdquo with electronic email on upcoming learning opportunities
bull Offers a website with the latest resources and tools and post recorded webinars for future reference
bull Partner with Telligen QIO on practice improvement activitiesndash Participation with a QIO in a self-management training program (diabetes)
ndash Implementation of antibiotic stewardship program
ndash Implementation of a cardiac quality improvement program
Telligen QIN-QIO
43copy 2016 Telligen Inc
Primary Care amp Specialist Physicians
Model
bull Align with the criteria for innovative models set forth in the Quality Payment Program
bull Build the evidence base on practice transformation so that effective solutions can be scaled
bull Move clinician practices through 5 phases of transformation with support from
ndash Practice Transformation Networks (PTN)
ndash Support amp Alignment Networks (SAN)
ndash Quality Improvement Organizations and others
Transforming Clinical Practice Initiative
44copy 2016 Telligen Inc
Primary Care amp Specialist Physicians
Goalsbull Support clinicians in their practice transformation goals
bull Improve health outcomes for millions of Medicare Medicaid and CHIP beneficiaries
bull Build the evidence base on practice transformation so that effective solutions can be scale
bull Sustain efficient care delivery by reducing unnecessary testing and procedures
bull Reduce unnecessary hospitalizations
Contact Melissa Kapping kappingmihconlineorg
Transforming Clinical Practice Initiative
45copy 2016 Telligen Inc
bull SURS (Small Underserved and Rural Support) ndash Recently announced February 16
ndash 11 organizations awarded contracts
ndash Telligen provides assistance to Iowa Nebraska South Dakota and North Dakota
ndash No cost to practices
bull Solo or small practices (15 or fewer clinicians) ndash Rural health professional shortage areas (HPSA)
ndash Medically underserved areas (MUA)
bull Outreach guidance and direct technical assistancendash Practice readiness education health IT optimization
ndash Strategic planning assisting in the full transition to APM
Telligen QPP Resource Center
46
Contact Info
Michelle Brunsen Sr QI Advisor
515-453-8180
mbrunsentelligencom
Sandy Swallow Program Specialist
515-223-2105
Sandyswallowarea-dhcqisorg
Websites
bull wwwtelligenqinqiocom
bull wwwtelligenqppcom
bull wwwqppcmsgov
THANK YOU
This material was prepared by Telligen the Quality Payment Program Small
Underserved and Rural Support contractor for Iowa Nebraska North Dakota and
South Dakota under contract with the Centers for Medicare amp Medicaid Services
(CMS) an agency of the US Department of Health and Human Services The
contents presented do not necessarily reflect CMS policy HHSM-500-2017-00012C
This material was prepared by Telligen the Medicare Quality Innovation
Network Quality Improvement Organization under contract with the
Centers for Medicare amp Medicaid Services (CMS) an agency of the US
Department of Health and Human Services The contents presented do
not necessarily reflect CMS policy
14
MIPS Timeline
MIPS payment adjustments only affect Medicare Part B participating Eligible Clinicians
2017Record quality data and
how you used technology
performance year1117 ndash 123117
2018Submit your quality data
reporting period1118 ndash 033118
MIPS performance feedback
(TIN-level) available mid-year
payment adjustments1119 ndash 123119
2019MIPS Eligible Clinicians earn
MIPS payment adjustments
based on submitted data
15
MIPS Reporting Options
Type Identification Mechanism
Individual bull Single NPI tied to TINbull Submit individual-level databull Data submission via claims EHR registry or QCDR
Group bull Set of clinicians identified by NPIs sharing common TINbull Submit group-level data bull Register as a group by June 30 2017bull Data submission via CMS web interface (25+) EHR registry
or QCDR
APM Entity Group orMIPS-APM
bull Collection of entities participating in an APM that donrsquot qualify for Advanced APM or meet thresholds
bull Submit MIPS data to avoid downward payment adjustment
16copy 2016 Telligen Inc
How will ECs be scored
MIPS Performance Categories for 2017
QualityReport on quality measures best
reflecting their practice
Advancing Care InformationReport customizable measures reflecting
their EHR use
Improvement ActivitiesSelect improvement activities that
match their practicersquos goals full credit if PCMH recognized
CostBeginning 2018 CMS will calculate
measures based on claims no reporting requirements from ECs
MIPS Performance Category Weights for 2017
Quality
ACI
IA
60
15
25
17
How much can MIPS adjust payments
bull Calculate the final score by sum of performance categories
bull Positive negative neutral adjustments based on CMS-established threshold
ndash Budget neutral program
bull Clinicians at or above performance threshold will receive a neutral or positive adjustment factor based on a linear sliding scale
bull Adjustments applied to a clinicianrsquos Medicare Part B claims
18copy 2016 Telligen Inc
Based on Reporting for Transition Year 2017
Final Score Payment Adjustment
gt 70 points bull Positive adjustmentbull Eligible for exceptional performance bonus ndash
minimum additional 05
4-69 points bull Neutral or Positive adjustment 0-4bull Not eligible for exceptional performance bonus
3 points bull Neutral 0 adjustment
0 points bull Negative payment adjustment of -4bull 0 points = does not participate
MIPS Payment Adjustments in CY 2019
Payment adjustment is based on Medicare Part B reimbursement at the TINNPI level
19
MIPS Performance Categories for 2017
Focus on
QualityPerformance Category
20
2017 Requirements for Quality Submissions
bull Most Participants report up to 6 Measuresndash 1 Outcome Measure (or intermediate outcome)
ndash If no Outcome Measure High Priority Measure
ndash If fewer than 6 measures apply submit all that apply
ndash 10 point decile scale minimum 3 pts for submission in 2017
ndash Use benchmarks to estimate points to predict your quality score
2017 Quality Benchmarks available at httpsqppcmsgovresourceseducation
bull Groups (25+) using the web interface report 15 quality measures for a full year
21
2017 Requirements for Quality Submissions
bull Quality Measure Bonus Points
ndash 2 Points for extra Outcome or Patient Experience Measures
ndash 1 Point for any other high priority measure
ndash Bonus points capped at 10 denominator
ndash Electronic submission bonus points 1 Point per measure for end-to-end electronic reporting
Qualification
o Clinical Data must be documented in CEHRT
o Processing must not include abstraction or pre-aggregation
o All mechanisms eligible except claims
EHR direct DSV Qualified Registry QCDR Web Interface
22
2017 Requirements for Quality Submissions
Payers Period
2017
Patient
Threshold
Rate
Period
2018
Patient
Threshold
Rate
Long Term
Rate
Claims Medicare Part
B
90 days 50 1 Year 60 90
Web
Interface
Medicare Part
B
1 Year 248 patients 1 Year 248 patients 248 patients
Qualified
Registry
All 90 days 50 1 Year 60 90
Qualified
Clinical Data
Registry
All 90 days 50 1 Year 60 90
EHR amp Data
Submission
Vendor
All 90 days 50 1 Year 60 90
23
MIPS Performance Categories for 2017
Focus on
Advancing Care Information
(ACI)Performance Category
24
2017 Requirements for ACI Submissions
Base Score bull Must report on either 4 or 5 measures specific to the EHR certification
bull Report either ldquoYesrdquo or a numerator of at least 1 bull All 50 Base Score points have to be earned to earn
Performance Points
Performance Score bull Based on performance rates for selected measures
Bonus Points bull Extra registry data connections (ie immunization clinical data registry)
bull Use of CEHRT in Improvement Activities
Reporting bull Attestation QCDR Qualified Registry EHR vendor or CMS Web Interface (groups of 25 or more)
HardshipsThresholds bull Allow for reweighting
ACI Scoring Methodology
25
2017 Requirements for ACI Submissions
Measures will contribute to the score in the
Performance Score measure set grouping
Base Measures
Security Risk Analysis
E-Prescribing
Provide Patient Access
HIE - Send a Summary of Care
HIE - RequestAccept a Summary of Care
(2015 only)
Performance Measures
Provide Patient Access
Patient-Specific Education
View Download and Transmit (VDT)
Secure Messaging
Patient-Generated Health Data
Send a Summary of Care
RequestAccept a Summary of Care
Clinical Information Reconciliation
Immunization Registry Reporting
26
MIPS Performance Categories for 2017
Focus on
Improvement Activities
(IA)Performance Category
27
2017 Requirements for IA Submissions
bull Maximum Points = 40 Pointsndash High weighted activities = 20 points
ndash Medium weighted activities = 10 points
bull Participation Thresholdsndash 90 days required
bull PCMH = Maximum Possible Points (40)
bull APM Participation = 50-100 of Maximum Possible Points at CMS discretion
bull Special Populations Points Doubledndash Practices with lt 15 providers
ndash Rural or HPSA practices
ndash Non-patient facing MIPS eligible clinicians
bull Reporting Options Qualified Registry EHR QCDR or CMS Web Interface (for groups 25 clinicians or more)
28
MIPS Performance Categories for 2017
Focus on
CostPerformance Category
29
2017 Requirements for Cost Category
bull Cost scoring weightndash 2017 0
ndash 2018 10
ndash 2019 30
bull CMS will calculate from claims over 40 episode-specific measures to account for differences among specialtiesndash Clinicians that deliver more efficient care achieve better
performance and score the highest points for cost measures
bull ldquoEpisodes of carerdquo roll up all costs of inpatient and outpatient care (including imaging laboratory drugs rehabilitation etc)
30
2017 Requirements for Cost Category
bull Expected Changes from the Value-Modifier Programndash Patients attributed at the TIN-NPI level
ndash Attributed to one PCP (group) to provider with highest volume by cost provides primary care
ndash Cost compared by decile ranking instead of + 1 standard deviation
ndash Risk adjustments for geographic payment rate beneficiary risk on socio-economic status and others
bull Episodes of Carendash Anticipate 10 for 2018 ndash most operational
ndash 40 being tracked
ndash Plan to develop patient condition groups and patient relationship categories
31
Initial Episode-based Cost Measures
bull Aorticmitral valve surgery
bull CABG
bull HipFemur Fracture or Dislocation Treatment
bull Cholecystectomy and common duct exploration
bull Colonoscopy and biopsy
bull TURP for BPH
bull Lens and cataract procedures
bull Hip replacement or repair
bull Knee arthroplasty
bull Mastectomy
CMS will still provide feedback on performance in these categories in 2017 but it will not affect your 2019 payments
32
Alternative Payment Model (APMs)
bull Create the adoption of payment models that move away from FFS and tie payment to value
bull Must be in an Advanced APM to participate
bull Must meet specific thresholds of ldquosubstantial portionsrdquo of revenue from ldquoapprovedrdquo alternate payment models
bull Receive 5 lump sum bonus for 2019 -2024
bull Receive higher fee schedule update for 2026 and beyond
Which Path is Right for You
33
What are Advanced APMs
Requirements to be an Advanced APM
bull Requires use of certified EHR technology
bull Base payment on quality measures comparable to those in MIPS
bull The practice must bear more than nominal financial risk or is in a Medical Home Model expanded under CMS Innovation Center authority
2017 Eligible Advanced APMs Include
Comprehensive ESRD Care Model
Comprehensive Primary Care Plus (CPC+)
Medicare Shared SavingsProgram Track 2 and 3
Next Generation ACO Model
Oncology Care Model Two-Sided Risk Arrangement
34
APM Scoring Standards
Category Reporting Requirements Category Scoring CategoryWeight
Quality (PQRS) The ACO submits Medicare Shared Savings Program quality measures on behalf of ACO participant TINs and their MIPS eligible clinicians via the CMS Web Interface Data is submitted on the first 248 consecutively ranked and assigned Medicare beneficiaries The ACO submits this information once for purposes of both the Medicare Shared Savings Program and MIPS
MIPS benchmarks will be used to assign one score at the APM Entity Group (ACO) level In other words all MIPS eligible clinicians on the certified ACO ProviderSupplier list will receive the same score (unless they are excluded from MIPS) Note that the performance of all clinicians in the ACO will contribute to this score even if they are not subject to MIPS payment adjustments
50
Cost (VM) MIPS eligible clinicians participating in the MSSP will not be assessed on cost No reporting necessary
NA 0
Improvement Activities (new)
No additional reporting necessary Full credit for the APM Entity group by virtue of MSSP participation
20
Advancing Care Information (MU)
ACO participant TINs will submit directly to MIPS via a MIPS data submission mechanism
ACO participant TIN scores will be aggregated as a weighted average to yield one score for the APM Entity group
30
35
Quality Payment Program Paths
Subsets of MIPS and APM Paths
Eligible Clinician
MIPSAPM
MIPS-APM Advanced
APM
36
MIPS-APM Reporting Option
Requirements to be considered a MIPS-APM includebull Participate in the APM under an
agreement with CMS
bull Include one or more MIPS eligible clinicians on a Participation List
ndash On at least one of the snapshot dates
(Mar 31 June 30 or Aug 31)
bull Bases payment incentives on performance (either at the APM Entity or eligible clinician level) on costutilization and quality
2017 Eligible MIPS-APMs
CEC Model CPC+ Model MSSP Track 12 amp 3 Next Gen ACO OCM All arrangements
Note APM scoring standard applies to APMs that meet these criteria
37
MIPS-APM Benefits
bull Streamlined quality reporting
bull Still eligible for shared savings payment
ndash Financial risk payments do not impact eligibility for positive MIPS payment adjustments
bull Favorable scoring under lsquoAPM Scoring Standardrsquo
ndash ACO participants receive full credit in the Improvement Activities Category by virtue of MSSP participation
ndash ACO participants are not subject to the Cost performance category of MIPS
ndash Potential lsquoliftingrsquo of final MIPS score by being assessed at the ACO level
38
We Are All Part of the Quality Payment Program
Creating an Identity Toward a Common Goal
bull CMS
bull Clinicians
bull Patients
bull Our Care Teams
bull Service Providers
We all share a similar goal to improve patient outcomes
39
Quality Payment Program
Where Can Eligible Clinicians Go For Help
40copy 2016 Telligen Inc
All Eligible Clinicians are supported by
bull Quality Payment Program Websitendash Learn about the program explore the measures and find educational tools and
resources
ndash httpsqppcmsgov
bull Quality Payment Program Service Centerndash Assist with questions
ndash qppCMShhsgov
ndash 1-866-288-8292
bull Innovations Centerrsquos Learning Systemsndash Provides specialized information on Advanced Alternative Payment Models (APMs)
ndash httpsinnovationcmsgov
Self Service Technical Support
41copy 2016 Telligen Inc
We are here to help
bull Experienced quality improvement advisors to provide expert technical assistance and support for participating providers across the state especially those in large practices health systems and ACO at no charge
bull Helps in meeting MIPS requirements through customized technical assistance including one-on-one assistance when needed
bull Offers monthly webinars and Coffee Talk open discussion
ndash Focused QPP topic
ndash Open discuss with Q amp A ndash dedicated to your questions
ndash 2nd Thursday every month
ndash 1100 am CST for 1 hour
Telligen QIN-QIO
42copy 2016 Telligen Inc
We are here to help
bull Provides monthly electronic newsletter with resources the latest research and healthcare news relevant to you
bull Provides the ldquoWeekly Digestrdquo with electronic email on upcoming learning opportunities
bull Offers a website with the latest resources and tools and post recorded webinars for future reference
bull Partner with Telligen QIO on practice improvement activitiesndash Participation with a QIO in a self-management training program (diabetes)
ndash Implementation of antibiotic stewardship program
ndash Implementation of a cardiac quality improvement program
Telligen QIN-QIO
43copy 2016 Telligen Inc
Primary Care amp Specialist Physicians
Model
bull Align with the criteria for innovative models set forth in the Quality Payment Program
bull Build the evidence base on practice transformation so that effective solutions can be scaled
bull Move clinician practices through 5 phases of transformation with support from
ndash Practice Transformation Networks (PTN)
ndash Support amp Alignment Networks (SAN)
ndash Quality Improvement Organizations and others
Transforming Clinical Practice Initiative
44copy 2016 Telligen Inc
Primary Care amp Specialist Physicians
Goalsbull Support clinicians in their practice transformation goals
bull Improve health outcomes for millions of Medicare Medicaid and CHIP beneficiaries
bull Build the evidence base on practice transformation so that effective solutions can be scale
bull Sustain efficient care delivery by reducing unnecessary testing and procedures
bull Reduce unnecessary hospitalizations
Contact Melissa Kapping kappingmihconlineorg
Transforming Clinical Practice Initiative
45copy 2016 Telligen Inc
bull SURS (Small Underserved and Rural Support) ndash Recently announced February 16
ndash 11 organizations awarded contracts
ndash Telligen provides assistance to Iowa Nebraska South Dakota and North Dakota
ndash No cost to practices
bull Solo or small practices (15 or fewer clinicians) ndash Rural health professional shortage areas (HPSA)
ndash Medically underserved areas (MUA)
bull Outreach guidance and direct technical assistancendash Practice readiness education health IT optimization
ndash Strategic planning assisting in the full transition to APM
Telligen QPP Resource Center
46
Contact Info
Michelle Brunsen Sr QI Advisor
515-453-8180
mbrunsentelligencom
Sandy Swallow Program Specialist
515-223-2105
Sandyswallowarea-dhcqisorg
Websites
bull wwwtelligenqinqiocom
bull wwwtelligenqppcom
bull wwwqppcmsgov
THANK YOU
This material was prepared by Telligen the Quality Payment Program Small
Underserved and Rural Support contractor for Iowa Nebraska North Dakota and
South Dakota under contract with the Centers for Medicare amp Medicaid Services
(CMS) an agency of the US Department of Health and Human Services The
contents presented do not necessarily reflect CMS policy HHSM-500-2017-00012C
This material was prepared by Telligen the Medicare Quality Innovation
Network Quality Improvement Organization under contract with the
Centers for Medicare amp Medicaid Services (CMS) an agency of the US
Department of Health and Human Services The contents presented do
not necessarily reflect CMS policy
15
MIPS Reporting Options
Type Identification Mechanism
Individual bull Single NPI tied to TINbull Submit individual-level databull Data submission via claims EHR registry or QCDR
Group bull Set of clinicians identified by NPIs sharing common TINbull Submit group-level data bull Register as a group by June 30 2017bull Data submission via CMS web interface (25+) EHR registry
or QCDR
APM Entity Group orMIPS-APM
bull Collection of entities participating in an APM that donrsquot qualify for Advanced APM or meet thresholds
bull Submit MIPS data to avoid downward payment adjustment
16copy 2016 Telligen Inc
How will ECs be scored
MIPS Performance Categories for 2017
QualityReport on quality measures best
reflecting their practice
Advancing Care InformationReport customizable measures reflecting
their EHR use
Improvement ActivitiesSelect improvement activities that
match their practicersquos goals full credit if PCMH recognized
CostBeginning 2018 CMS will calculate
measures based on claims no reporting requirements from ECs
MIPS Performance Category Weights for 2017
Quality
ACI
IA
60
15
25
17
How much can MIPS adjust payments
bull Calculate the final score by sum of performance categories
bull Positive negative neutral adjustments based on CMS-established threshold
ndash Budget neutral program
bull Clinicians at or above performance threshold will receive a neutral or positive adjustment factor based on a linear sliding scale
bull Adjustments applied to a clinicianrsquos Medicare Part B claims
18copy 2016 Telligen Inc
Based on Reporting for Transition Year 2017
Final Score Payment Adjustment
gt 70 points bull Positive adjustmentbull Eligible for exceptional performance bonus ndash
minimum additional 05
4-69 points bull Neutral or Positive adjustment 0-4bull Not eligible for exceptional performance bonus
3 points bull Neutral 0 adjustment
0 points bull Negative payment adjustment of -4bull 0 points = does not participate
MIPS Payment Adjustments in CY 2019
Payment adjustment is based on Medicare Part B reimbursement at the TINNPI level
19
MIPS Performance Categories for 2017
Focus on
QualityPerformance Category
20
2017 Requirements for Quality Submissions
bull Most Participants report up to 6 Measuresndash 1 Outcome Measure (or intermediate outcome)
ndash If no Outcome Measure High Priority Measure
ndash If fewer than 6 measures apply submit all that apply
ndash 10 point decile scale minimum 3 pts for submission in 2017
ndash Use benchmarks to estimate points to predict your quality score
2017 Quality Benchmarks available at httpsqppcmsgovresourceseducation
bull Groups (25+) using the web interface report 15 quality measures for a full year
21
2017 Requirements for Quality Submissions
bull Quality Measure Bonus Points
ndash 2 Points for extra Outcome or Patient Experience Measures
ndash 1 Point for any other high priority measure
ndash Bonus points capped at 10 denominator
ndash Electronic submission bonus points 1 Point per measure for end-to-end electronic reporting
Qualification
o Clinical Data must be documented in CEHRT
o Processing must not include abstraction or pre-aggregation
o All mechanisms eligible except claims
EHR direct DSV Qualified Registry QCDR Web Interface
22
2017 Requirements for Quality Submissions
Payers Period
2017
Patient
Threshold
Rate
Period
2018
Patient
Threshold
Rate
Long Term
Rate
Claims Medicare Part
B
90 days 50 1 Year 60 90
Web
Interface
Medicare Part
B
1 Year 248 patients 1 Year 248 patients 248 patients
Qualified
Registry
All 90 days 50 1 Year 60 90
Qualified
Clinical Data
Registry
All 90 days 50 1 Year 60 90
EHR amp Data
Submission
Vendor
All 90 days 50 1 Year 60 90
23
MIPS Performance Categories for 2017
Focus on
Advancing Care Information
(ACI)Performance Category
24
2017 Requirements for ACI Submissions
Base Score bull Must report on either 4 or 5 measures specific to the EHR certification
bull Report either ldquoYesrdquo or a numerator of at least 1 bull All 50 Base Score points have to be earned to earn
Performance Points
Performance Score bull Based on performance rates for selected measures
Bonus Points bull Extra registry data connections (ie immunization clinical data registry)
bull Use of CEHRT in Improvement Activities
Reporting bull Attestation QCDR Qualified Registry EHR vendor or CMS Web Interface (groups of 25 or more)
HardshipsThresholds bull Allow for reweighting
ACI Scoring Methodology
25
2017 Requirements for ACI Submissions
Measures will contribute to the score in the
Performance Score measure set grouping
Base Measures
Security Risk Analysis
E-Prescribing
Provide Patient Access
HIE - Send a Summary of Care
HIE - RequestAccept a Summary of Care
(2015 only)
Performance Measures
Provide Patient Access
Patient-Specific Education
View Download and Transmit (VDT)
Secure Messaging
Patient-Generated Health Data
Send a Summary of Care
RequestAccept a Summary of Care
Clinical Information Reconciliation
Immunization Registry Reporting
26
MIPS Performance Categories for 2017
Focus on
Improvement Activities
(IA)Performance Category
27
2017 Requirements for IA Submissions
bull Maximum Points = 40 Pointsndash High weighted activities = 20 points
ndash Medium weighted activities = 10 points
bull Participation Thresholdsndash 90 days required
bull PCMH = Maximum Possible Points (40)
bull APM Participation = 50-100 of Maximum Possible Points at CMS discretion
bull Special Populations Points Doubledndash Practices with lt 15 providers
ndash Rural or HPSA practices
ndash Non-patient facing MIPS eligible clinicians
bull Reporting Options Qualified Registry EHR QCDR or CMS Web Interface (for groups 25 clinicians or more)
28
MIPS Performance Categories for 2017
Focus on
CostPerformance Category
29
2017 Requirements for Cost Category
bull Cost scoring weightndash 2017 0
ndash 2018 10
ndash 2019 30
bull CMS will calculate from claims over 40 episode-specific measures to account for differences among specialtiesndash Clinicians that deliver more efficient care achieve better
performance and score the highest points for cost measures
bull ldquoEpisodes of carerdquo roll up all costs of inpatient and outpatient care (including imaging laboratory drugs rehabilitation etc)
30
2017 Requirements for Cost Category
bull Expected Changes from the Value-Modifier Programndash Patients attributed at the TIN-NPI level
ndash Attributed to one PCP (group) to provider with highest volume by cost provides primary care
ndash Cost compared by decile ranking instead of + 1 standard deviation
ndash Risk adjustments for geographic payment rate beneficiary risk on socio-economic status and others
bull Episodes of Carendash Anticipate 10 for 2018 ndash most operational
ndash 40 being tracked
ndash Plan to develop patient condition groups and patient relationship categories
31
Initial Episode-based Cost Measures
bull Aorticmitral valve surgery
bull CABG
bull HipFemur Fracture or Dislocation Treatment
bull Cholecystectomy and common duct exploration
bull Colonoscopy and biopsy
bull TURP for BPH
bull Lens and cataract procedures
bull Hip replacement or repair
bull Knee arthroplasty
bull Mastectomy
CMS will still provide feedback on performance in these categories in 2017 but it will not affect your 2019 payments
32
Alternative Payment Model (APMs)
bull Create the adoption of payment models that move away from FFS and tie payment to value
bull Must be in an Advanced APM to participate
bull Must meet specific thresholds of ldquosubstantial portionsrdquo of revenue from ldquoapprovedrdquo alternate payment models
bull Receive 5 lump sum bonus for 2019 -2024
bull Receive higher fee schedule update for 2026 and beyond
Which Path is Right for You
33
What are Advanced APMs
Requirements to be an Advanced APM
bull Requires use of certified EHR technology
bull Base payment on quality measures comparable to those in MIPS
bull The practice must bear more than nominal financial risk or is in a Medical Home Model expanded under CMS Innovation Center authority
2017 Eligible Advanced APMs Include
Comprehensive ESRD Care Model
Comprehensive Primary Care Plus (CPC+)
Medicare Shared SavingsProgram Track 2 and 3
Next Generation ACO Model
Oncology Care Model Two-Sided Risk Arrangement
34
APM Scoring Standards
Category Reporting Requirements Category Scoring CategoryWeight
Quality (PQRS) The ACO submits Medicare Shared Savings Program quality measures on behalf of ACO participant TINs and their MIPS eligible clinicians via the CMS Web Interface Data is submitted on the first 248 consecutively ranked and assigned Medicare beneficiaries The ACO submits this information once for purposes of both the Medicare Shared Savings Program and MIPS
MIPS benchmarks will be used to assign one score at the APM Entity Group (ACO) level In other words all MIPS eligible clinicians on the certified ACO ProviderSupplier list will receive the same score (unless they are excluded from MIPS) Note that the performance of all clinicians in the ACO will contribute to this score even if they are not subject to MIPS payment adjustments
50
Cost (VM) MIPS eligible clinicians participating in the MSSP will not be assessed on cost No reporting necessary
NA 0
Improvement Activities (new)
No additional reporting necessary Full credit for the APM Entity group by virtue of MSSP participation
20
Advancing Care Information (MU)
ACO participant TINs will submit directly to MIPS via a MIPS data submission mechanism
ACO participant TIN scores will be aggregated as a weighted average to yield one score for the APM Entity group
30
35
Quality Payment Program Paths
Subsets of MIPS and APM Paths
Eligible Clinician
MIPSAPM
MIPS-APM Advanced
APM
36
MIPS-APM Reporting Option
Requirements to be considered a MIPS-APM includebull Participate in the APM under an
agreement with CMS
bull Include one or more MIPS eligible clinicians on a Participation List
ndash On at least one of the snapshot dates
(Mar 31 June 30 or Aug 31)
bull Bases payment incentives on performance (either at the APM Entity or eligible clinician level) on costutilization and quality
2017 Eligible MIPS-APMs
CEC Model CPC+ Model MSSP Track 12 amp 3 Next Gen ACO OCM All arrangements
Note APM scoring standard applies to APMs that meet these criteria
37
MIPS-APM Benefits
bull Streamlined quality reporting
bull Still eligible for shared savings payment
ndash Financial risk payments do not impact eligibility for positive MIPS payment adjustments
bull Favorable scoring under lsquoAPM Scoring Standardrsquo
ndash ACO participants receive full credit in the Improvement Activities Category by virtue of MSSP participation
ndash ACO participants are not subject to the Cost performance category of MIPS
ndash Potential lsquoliftingrsquo of final MIPS score by being assessed at the ACO level
38
We Are All Part of the Quality Payment Program
Creating an Identity Toward a Common Goal
bull CMS
bull Clinicians
bull Patients
bull Our Care Teams
bull Service Providers
We all share a similar goal to improve patient outcomes
39
Quality Payment Program
Where Can Eligible Clinicians Go For Help
40copy 2016 Telligen Inc
All Eligible Clinicians are supported by
bull Quality Payment Program Websitendash Learn about the program explore the measures and find educational tools and
resources
ndash httpsqppcmsgov
bull Quality Payment Program Service Centerndash Assist with questions
ndash qppCMShhsgov
ndash 1-866-288-8292
bull Innovations Centerrsquos Learning Systemsndash Provides specialized information on Advanced Alternative Payment Models (APMs)
ndash httpsinnovationcmsgov
Self Service Technical Support
41copy 2016 Telligen Inc
We are here to help
bull Experienced quality improvement advisors to provide expert technical assistance and support for participating providers across the state especially those in large practices health systems and ACO at no charge
bull Helps in meeting MIPS requirements through customized technical assistance including one-on-one assistance when needed
bull Offers monthly webinars and Coffee Talk open discussion
ndash Focused QPP topic
ndash Open discuss with Q amp A ndash dedicated to your questions
ndash 2nd Thursday every month
ndash 1100 am CST for 1 hour
Telligen QIN-QIO
42copy 2016 Telligen Inc
We are here to help
bull Provides monthly electronic newsletter with resources the latest research and healthcare news relevant to you
bull Provides the ldquoWeekly Digestrdquo with electronic email on upcoming learning opportunities
bull Offers a website with the latest resources and tools and post recorded webinars for future reference
bull Partner with Telligen QIO on practice improvement activitiesndash Participation with a QIO in a self-management training program (diabetes)
ndash Implementation of antibiotic stewardship program
ndash Implementation of a cardiac quality improvement program
Telligen QIN-QIO
43copy 2016 Telligen Inc
Primary Care amp Specialist Physicians
Model
bull Align with the criteria for innovative models set forth in the Quality Payment Program
bull Build the evidence base on practice transformation so that effective solutions can be scaled
bull Move clinician practices through 5 phases of transformation with support from
ndash Practice Transformation Networks (PTN)
ndash Support amp Alignment Networks (SAN)
ndash Quality Improvement Organizations and others
Transforming Clinical Practice Initiative
44copy 2016 Telligen Inc
Primary Care amp Specialist Physicians
Goalsbull Support clinicians in their practice transformation goals
bull Improve health outcomes for millions of Medicare Medicaid and CHIP beneficiaries
bull Build the evidence base on practice transformation so that effective solutions can be scale
bull Sustain efficient care delivery by reducing unnecessary testing and procedures
bull Reduce unnecessary hospitalizations
Contact Melissa Kapping kappingmihconlineorg
Transforming Clinical Practice Initiative
45copy 2016 Telligen Inc
bull SURS (Small Underserved and Rural Support) ndash Recently announced February 16
ndash 11 organizations awarded contracts
ndash Telligen provides assistance to Iowa Nebraska South Dakota and North Dakota
ndash No cost to practices
bull Solo or small practices (15 or fewer clinicians) ndash Rural health professional shortage areas (HPSA)
ndash Medically underserved areas (MUA)
bull Outreach guidance and direct technical assistancendash Practice readiness education health IT optimization
ndash Strategic planning assisting in the full transition to APM
Telligen QPP Resource Center
46
Contact Info
Michelle Brunsen Sr QI Advisor
515-453-8180
mbrunsentelligencom
Sandy Swallow Program Specialist
515-223-2105
Sandyswallowarea-dhcqisorg
Websites
bull wwwtelligenqinqiocom
bull wwwtelligenqppcom
bull wwwqppcmsgov
THANK YOU
This material was prepared by Telligen the Quality Payment Program Small
Underserved and Rural Support contractor for Iowa Nebraska North Dakota and
South Dakota under contract with the Centers for Medicare amp Medicaid Services
(CMS) an agency of the US Department of Health and Human Services The
contents presented do not necessarily reflect CMS policy HHSM-500-2017-00012C
This material was prepared by Telligen the Medicare Quality Innovation
Network Quality Improvement Organization under contract with the
Centers for Medicare amp Medicaid Services (CMS) an agency of the US
Department of Health and Human Services The contents presented do
not necessarily reflect CMS policy
16copy 2016 Telligen Inc
How will ECs be scored
MIPS Performance Categories for 2017
QualityReport on quality measures best
reflecting their practice
Advancing Care InformationReport customizable measures reflecting
their EHR use
Improvement ActivitiesSelect improvement activities that
match their practicersquos goals full credit if PCMH recognized
CostBeginning 2018 CMS will calculate
measures based on claims no reporting requirements from ECs
MIPS Performance Category Weights for 2017
Quality
ACI
IA
60
15
25
17
How much can MIPS adjust payments
bull Calculate the final score by sum of performance categories
bull Positive negative neutral adjustments based on CMS-established threshold
ndash Budget neutral program
bull Clinicians at or above performance threshold will receive a neutral or positive adjustment factor based on a linear sliding scale
bull Adjustments applied to a clinicianrsquos Medicare Part B claims
18copy 2016 Telligen Inc
Based on Reporting for Transition Year 2017
Final Score Payment Adjustment
gt 70 points bull Positive adjustmentbull Eligible for exceptional performance bonus ndash
minimum additional 05
4-69 points bull Neutral or Positive adjustment 0-4bull Not eligible for exceptional performance bonus
3 points bull Neutral 0 adjustment
0 points bull Negative payment adjustment of -4bull 0 points = does not participate
MIPS Payment Adjustments in CY 2019
Payment adjustment is based on Medicare Part B reimbursement at the TINNPI level
19
MIPS Performance Categories for 2017
Focus on
QualityPerformance Category
20
2017 Requirements for Quality Submissions
bull Most Participants report up to 6 Measuresndash 1 Outcome Measure (or intermediate outcome)
ndash If no Outcome Measure High Priority Measure
ndash If fewer than 6 measures apply submit all that apply
ndash 10 point decile scale minimum 3 pts for submission in 2017
ndash Use benchmarks to estimate points to predict your quality score
2017 Quality Benchmarks available at httpsqppcmsgovresourceseducation
bull Groups (25+) using the web interface report 15 quality measures for a full year
21
2017 Requirements for Quality Submissions
bull Quality Measure Bonus Points
ndash 2 Points for extra Outcome or Patient Experience Measures
ndash 1 Point for any other high priority measure
ndash Bonus points capped at 10 denominator
ndash Electronic submission bonus points 1 Point per measure for end-to-end electronic reporting
Qualification
o Clinical Data must be documented in CEHRT
o Processing must not include abstraction or pre-aggregation
o All mechanisms eligible except claims
EHR direct DSV Qualified Registry QCDR Web Interface
22
2017 Requirements for Quality Submissions
Payers Period
2017
Patient
Threshold
Rate
Period
2018
Patient
Threshold
Rate
Long Term
Rate
Claims Medicare Part
B
90 days 50 1 Year 60 90
Web
Interface
Medicare Part
B
1 Year 248 patients 1 Year 248 patients 248 patients
Qualified
Registry
All 90 days 50 1 Year 60 90
Qualified
Clinical Data
Registry
All 90 days 50 1 Year 60 90
EHR amp Data
Submission
Vendor
All 90 days 50 1 Year 60 90
23
MIPS Performance Categories for 2017
Focus on
Advancing Care Information
(ACI)Performance Category
24
2017 Requirements for ACI Submissions
Base Score bull Must report on either 4 or 5 measures specific to the EHR certification
bull Report either ldquoYesrdquo or a numerator of at least 1 bull All 50 Base Score points have to be earned to earn
Performance Points
Performance Score bull Based on performance rates for selected measures
Bonus Points bull Extra registry data connections (ie immunization clinical data registry)
bull Use of CEHRT in Improvement Activities
Reporting bull Attestation QCDR Qualified Registry EHR vendor or CMS Web Interface (groups of 25 or more)
HardshipsThresholds bull Allow for reweighting
ACI Scoring Methodology
25
2017 Requirements for ACI Submissions
Measures will contribute to the score in the
Performance Score measure set grouping
Base Measures
Security Risk Analysis
E-Prescribing
Provide Patient Access
HIE - Send a Summary of Care
HIE - RequestAccept a Summary of Care
(2015 only)
Performance Measures
Provide Patient Access
Patient-Specific Education
View Download and Transmit (VDT)
Secure Messaging
Patient-Generated Health Data
Send a Summary of Care
RequestAccept a Summary of Care
Clinical Information Reconciliation
Immunization Registry Reporting
26
MIPS Performance Categories for 2017
Focus on
Improvement Activities
(IA)Performance Category
27
2017 Requirements for IA Submissions
bull Maximum Points = 40 Pointsndash High weighted activities = 20 points
ndash Medium weighted activities = 10 points
bull Participation Thresholdsndash 90 days required
bull PCMH = Maximum Possible Points (40)
bull APM Participation = 50-100 of Maximum Possible Points at CMS discretion
bull Special Populations Points Doubledndash Practices with lt 15 providers
ndash Rural or HPSA practices
ndash Non-patient facing MIPS eligible clinicians
bull Reporting Options Qualified Registry EHR QCDR or CMS Web Interface (for groups 25 clinicians or more)
28
MIPS Performance Categories for 2017
Focus on
CostPerformance Category
29
2017 Requirements for Cost Category
bull Cost scoring weightndash 2017 0
ndash 2018 10
ndash 2019 30
bull CMS will calculate from claims over 40 episode-specific measures to account for differences among specialtiesndash Clinicians that deliver more efficient care achieve better
performance and score the highest points for cost measures
bull ldquoEpisodes of carerdquo roll up all costs of inpatient and outpatient care (including imaging laboratory drugs rehabilitation etc)
30
2017 Requirements for Cost Category
bull Expected Changes from the Value-Modifier Programndash Patients attributed at the TIN-NPI level
ndash Attributed to one PCP (group) to provider with highest volume by cost provides primary care
ndash Cost compared by decile ranking instead of + 1 standard deviation
ndash Risk adjustments for geographic payment rate beneficiary risk on socio-economic status and others
bull Episodes of Carendash Anticipate 10 for 2018 ndash most operational
ndash 40 being tracked
ndash Plan to develop patient condition groups and patient relationship categories
31
Initial Episode-based Cost Measures
bull Aorticmitral valve surgery
bull CABG
bull HipFemur Fracture or Dislocation Treatment
bull Cholecystectomy and common duct exploration
bull Colonoscopy and biopsy
bull TURP for BPH
bull Lens and cataract procedures
bull Hip replacement or repair
bull Knee arthroplasty
bull Mastectomy
CMS will still provide feedback on performance in these categories in 2017 but it will not affect your 2019 payments
32
Alternative Payment Model (APMs)
bull Create the adoption of payment models that move away from FFS and tie payment to value
bull Must be in an Advanced APM to participate
bull Must meet specific thresholds of ldquosubstantial portionsrdquo of revenue from ldquoapprovedrdquo alternate payment models
bull Receive 5 lump sum bonus for 2019 -2024
bull Receive higher fee schedule update for 2026 and beyond
Which Path is Right for You
33
What are Advanced APMs
Requirements to be an Advanced APM
bull Requires use of certified EHR technology
bull Base payment on quality measures comparable to those in MIPS
bull The practice must bear more than nominal financial risk or is in a Medical Home Model expanded under CMS Innovation Center authority
2017 Eligible Advanced APMs Include
Comprehensive ESRD Care Model
Comprehensive Primary Care Plus (CPC+)
Medicare Shared SavingsProgram Track 2 and 3
Next Generation ACO Model
Oncology Care Model Two-Sided Risk Arrangement
34
APM Scoring Standards
Category Reporting Requirements Category Scoring CategoryWeight
Quality (PQRS) The ACO submits Medicare Shared Savings Program quality measures on behalf of ACO participant TINs and their MIPS eligible clinicians via the CMS Web Interface Data is submitted on the first 248 consecutively ranked and assigned Medicare beneficiaries The ACO submits this information once for purposes of both the Medicare Shared Savings Program and MIPS
MIPS benchmarks will be used to assign one score at the APM Entity Group (ACO) level In other words all MIPS eligible clinicians on the certified ACO ProviderSupplier list will receive the same score (unless they are excluded from MIPS) Note that the performance of all clinicians in the ACO will contribute to this score even if they are not subject to MIPS payment adjustments
50
Cost (VM) MIPS eligible clinicians participating in the MSSP will not be assessed on cost No reporting necessary
NA 0
Improvement Activities (new)
No additional reporting necessary Full credit for the APM Entity group by virtue of MSSP participation
20
Advancing Care Information (MU)
ACO participant TINs will submit directly to MIPS via a MIPS data submission mechanism
ACO participant TIN scores will be aggregated as a weighted average to yield one score for the APM Entity group
30
35
Quality Payment Program Paths
Subsets of MIPS and APM Paths
Eligible Clinician
MIPSAPM
MIPS-APM Advanced
APM
36
MIPS-APM Reporting Option
Requirements to be considered a MIPS-APM includebull Participate in the APM under an
agreement with CMS
bull Include one or more MIPS eligible clinicians on a Participation List
ndash On at least one of the snapshot dates
(Mar 31 June 30 or Aug 31)
bull Bases payment incentives on performance (either at the APM Entity or eligible clinician level) on costutilization and quality
2017 Eligible MIPS-APMs
CEC Model CPC+ Model MSSP Track 12 amp 3 Next Gen ACO OCM All arrangements
Note APM scoring standard applies to APMs that meet these criteria
37
MIPS-APM Benefits
bull Streamlined quality reporting
bull Still eligible for shared savings payment
ndash Financial risk payments do not impact eligibility for positive MIPS payment adjustments
bull Favorable scoring under lsquoAPM Scoring Standardrsquo
ndash ACO participants receive full credit in the Improvement Activities Category by virtue of MSSP participation
ndash ACO participants are not subject to the Cost performance category of MIPS
ndash Potential lsquoliftingrsquo of final MIPS score by being assessed at the ACO level
38
We Are All Part of the Quality Payment Program
Creating an Identity Toward a Common Goal
bull CMS
bull Clinicians
bull Patients
bull Our Care Teams
bull Service Providers
We all share a similar goal to improve patient outcomes
39
Quality Payment Program
Where Can Eligible Clinicians Go For Help
40copy 2016 Telligen Inc
All Eligible Clinicians are supported by
bull Quality Payment Program Websitendash Learn about the program explore the measures and find educational tools and
resources
ndash httpsqppcmsgov
bull Quality Payment Program Service Centerndash Assist with questions
ndash qppCMShhsgov
ndash 1-866-288-8292
bull Innovations Centerrsquos Learning Systemsndash Provides specialized information on Advanced Alternative Payment Models (APMs)
ndash httpsinnovationcmsgov
Self Service Technical Support
41copy 2016 Telligen Inc
We are here to help
bull Experienced quality improvement advisors to provide expert technical assistance and support for participating providers across the state especially those in large practices health systems and ACO at no charge
bull Helps in meeting MIPS requirements through customized technical assistance including one-on-one assistance when needed
bull Offers monthly webinars and Coffee Talk open discussion
ndash Focused QPP topic
ndash Open discuss with Q amp A ndash dedicated to your questions
ndash 2nd Thursday every month
ndash 1100 am CST for 1 hour
Telligen QIN-QIO
42copy 2016 Telligen Inc
We are here to help
bull Provides monthly electronic newsletter with resources the latest research and healthcare news relevant to you
bull Provides the ldquoWeekly Digestrdquo with electronic email on upcoming learning opportunities
bull Offers a website with the latest resources and tools and post recorded webinars for future reference
bull Partner with Telligen QIO on practice improvement activitiesndash Participation with a QIO in a self-management training program (diabetes)
ndash Implementation of antibiotic stewardship program
ndash Implementation of a cardiac quality improvement program
Telligen QIN-QIO
43copy 2016 Telligen Inc
Primary Care amp Specialist Physicians
Model
bull Align with the criteria for innovative models set forth in the Quality Payment Program
bull Build the evidence base on practice transformation so that effective solutions can be scaled
bull Move clinician practices through 5 phases of transformation with support from
ndash Practice Transformation Networks (PTN)
ndash Support amp Alignment Networks (SAN)
ndash Quality Improvement Organizations and others
Transforming Clinical Practice Initiative
44copy 2016 Telligen Inc
Primary Care amp Specialist Physicians
Goalsbull Support clinicians in their practice transformation goals
bull Improve health outcomes for millions of Medicare Medicaid and CHIP beneficiaries
bull Build the evidence base on practice transformation so that effective solutions can be scale
bull Sustain efficient care delivery by reducing unnecessary testing and procedures
bull Reduce unnecessary hospitalizations
Contact Melissa Kapping kappingmihconlineorg
Transforming Clinical Practice Initiative
45copy 2016 Telligen Inc
bull SURS (Small Underserved and Rural Support) ndash Recently announced February 16
ndash 11 organizations awarded contracts
ndash Telligen provides assistance to Iowa Nebraska South Dakota and North Dakota
ndash No cost to practices
bull Solo or small practices (15 or fewer clinicians) ndash Rural health professional shortage areas (HPSA)
ndash Medically underserved areas (MUA)
bull Outreach guidance and direct technical assistancendash Practice readiness education health IT optimization
ndash Strategic planning assisting in the full transition to APM
Telligen QPP Resource Center
46
Contact Info
Michelle Brunsen Sr QI Advisor
515-453-8180
mbrunsentelligencom
Sandy Swallow Program Specialist
515-223-2105
Sandyswallowarea-dhcqisorg
Websites
bull wwwtelligenqinqiocom
bull wwwtelligenqppcom
bull wwwqppcmsgov
THANK YOU
This material was prepared by Telligen the Quality Payment Program Small
Underserved and Rural Support contractor for Iowa Nebraska North Dakota and
South Dakota under contract with the Centers for Medicare amp Medicaid Services
(CMS) an agency of the US Department of Health and Human Services The
contents presented do not necessarily reflect CMS policy HHSM-500-2017-00012C
This material was prepared by Telligen the Medicare Quality Innovation
Network Quality Improvement Organization under contract with the
Centers for Medicare amp Medicaid Services (CMS) an agency of the US
Department of Health and Human Services The contents presented do
not necessarily reflect CMS policy
17
How much can MIPS adjust payments
bull Calculate the final score by sum of performance categories
bull Positive negative neutral adjustments based on CMS-established threshold
ndash Budget neutral program
bull Clinicians at or above performance threshold will receive a neutral or positive adjustment factor based on a linear sliding scale
bull Adjustments applied to a clinicianrsquos Medicare Part B claims
18copy 2016 Telligen Inc
Based on Reporting for Transition Year 2017
Final Score Payment Adjustment
gt 70 points bull Positive adjustmentbull Eligible for exceptional performance bonus ndash
minimum additional 05
4-69 points bull Neutral or Positive adjustment 0-4bull Not eligible for exceptional performance bonus
3 points bull Neutral 0 adjustment
0 points bull Negative payment adjustment of -4bull 0 points = does not participate
MIPS Payment Adjustments in CY 2019
Payment adjustment is based on Medicare Part B reimbursement at the TINNPI level
19
MIPS Performance Categories for 2017
Focus on
QualityPerformance Category
20
2017 Requirements for Quality Submissions
bull Most Participants report up to 6 Measuresndash 1 Outcome Measure (or intermediate outcome)
ndash If no Outcome Measure High Priority Measure
ndash If fewer than 6 measures apply submit all that apply
ndash 10 point decile scale minimum 3 pts for submission in 2017
ndash Use benchmarks to estimate points to predict your quality score
2017 Quality Benchmarks available at httpsqppcmsgovresourceseducation
bull Groups (25+) using the web interface report 15 quality measures for a full year
21
2017 Requirements for Quality Submissions
bull Quality Measure Bonus Points
ndash 2 Points for extra Outcome or Patient Experience Measures
ndash 1 Point for any other high priority measure
ndash Bonus points capped at 10 denominator
ndash Electronic submission bonus points 1 Point per measure for end-to-end electronic reporting
Qualification
o Clinical Data must be documented in CEHRT
o Processing must not include abstraction or pre-aggregation
o All mechanisms eligible except claims
EHR direct DSV Qualified Registry QCDR Web Interface
22
2017 Requirements for Quality Submissions
Payers Period
2017
Patient
Threshold
Rate
Period
2018
Patient
Threshold
Rate
Long Term
Rate
Claims Medicare Part
B
90 days 50 1 Year 60 90
Web
Interface
Medicare Part
B
1 Year 248 patients 1 Year 248 patients 248 patients
Qualified
Registry
All 90 days 50 1 Year 60 90
Qualified
Clinical Data
Registry
All 90 days 50 1 Year 60 90
EHR amp Data
Submission
Vendor
All 90 days 50 1 Year 60 90
23
MIPS Performance Categories for 2017
Focus on
Advancing Care Information
(ACI)Performance Category
24
2017 Requirements for ACI Submissions
Base Score bull Must report on either 4 or 5 measures specific to the EHR certification
bull Report either ldquoYesrdquo or a numerator of at least 1 bull All 50 Base Score points have to be earned to earn
Performance Points
Performance Score bull Based on performance rates for selected measures
Bonus Points bull Extra registry data connections (ie immunization clinical data registry)
bull Use of CEHRT in Improvement Activities
Reporting bull Attestation QCDR Qualified Registry EHR vendor or CMS Web Interface (groups of 25 or more)
HardshipsThresholds bull Allow for reweighting
ACI Scoring Methodology
25
2017 Requirements for ACI Submissions
Measures will contribute to the score in the
Performance Score measure set grouping
Base Measures
Security Risk Analysis
E-Prescribing
Provide Patient Access
HIE - Send a Summary of Care
HIE - RequestAccept a Summary of Care
(2015 only)
Performance Measures
Provide Patient Access
Patient-Specific Education
View Download and Transmit (VDT)
Secure Messaging
Patient-Generated Health Data
Send a Summary of Care
RequestAccept a Summary of Care
Clinical Information Reconciliation
Immunization Registry Reporting
26
MIPS Performance Categories for 2017
Focus on
Improvement Activities
(IA)Performance Category
27
2017 Requirements for IA Submissions
bull Maximum Points = 40 Pointsndash High weighted activities = 20 points
ndash Medium weighted activities = 10 points
bull Participation Thresholdsndash 90 days required
bull PCMH = Maximum Possible Points (40)
bull APM Participation = 50-100 of Maximum Possible Points at CMS discretion
bull Special Populations Points Doubledndash Practices with lt 15 providers
ndash Rural or HPSA practices
ndash Non-patient facing MIPS eligible clinicians
bull Reporting Options Qualified Registry EHR QCDR or CMS Web Interface (for groups 25 clinicians or more)
28
MIPS Performance Categories for 2017
Focus on
CostPerformance Category
29
2017 Requirements for Cost Category
bull Cost scoring weightndash 2017 0
ndash 2018 10
ndash 2019 30
bull CMS will calculate from claims over 40 episode-specific measures to account for differences among specialtiesndash Clinicians that deliver more efficient care achieve better
performance and score the highest points for cost measures
bull ldquoEpisodes of carerdquo roll up all costs of inpatient and outpatient care (including imaging laboratory drugs rehabilitation etc)
30
2017 Requirements for Cost Category
bull Expected Changes from the Value-Modifier Programndash Patients attributed at the TIN-NPI level
ndash Attributed to one PCP (group) to provider with highest volume by cost provides primary care
ndash Cost compared by decile ranking instead of + 1 standard deviation
ndash Risk adjustments for geographic payment rate beneficiary risk on socio-economic status and others
bull Episodes of Carendash Anticipate 10 for 2018 ndash most operational
ndash 40 being tracked
ndash Plan to develop patient condition groups and patient relationship categories
31
Initial Episode-based Cost Measures
bull Aorticmitral valve surgery
bull CABG
bull HipFemur Fracture or Dislocation Treatment
bull Cholecystectomy and common duct exploration
bull Colonoscopy and biopsy
bull TURP for BPH
bull Lens and cataract procedures
bull Hip replacement or repair
bull Knee arthroplasty
bull Mastectomy
CMS will still provide feedback on performance in these categories in 2017 but it will not affect your 2019 payments
32
Alternative Payment Model (APMs)
bull Create the adoption of payment models that move away from FFS and tie payment to value
bull Must be in an Advanced APM to participate
bull Must meet specific thresholds of ldquosubstantial portionsrdquo of revenue from ldquoapprovedrdquo alternate payment models
bull Receive 5 lump sum bonus for 2019 -2024
bull Receive higher fee schedule update for 2026 and beyond
Which Path is Right for You
33
What are Advanced APMs
Requirements to be an Advanced APM
bull Requires use of certified EHR technology
bull Base payment on quality measures comparable to those in MIPS
bull The practice must bear more than nominal financial risk or is in a Medical Home Model expanded under CMS Innovation Center authority
2017 Eligible Advanced APMs Include
Comprehensive ESRD Care Model
Comprehensive Primary Care Plus (CPC+)
Medicare Shared SavingsProgram Track 2 and 3
Next Generation ACO Model
Oncology Care Model Two-Sided Risk Arrangement
34
APM Scoring Standards
Category Reporting Requirements Category Scoring CategoryWeight
Quality (PQRS) The ACO submits Medicare Shared Savings Program quality measures on behalf of ACO participant TINs and their MIPS eligible clinicians via the CMS Web Interface Data is submitted on the first 248 consecutively ranked and assigned Medicare beneficiaries The ACO submits this information once for purposes of both the Medicare Shared Savings Program and MIPS
MIPS benchmarks will be used to assign one score at the APM Entity Group (ACO) level In other words all MIPS eligible clinicians on the certified ACO ProviderSupplier list will receive the same score (unless they are excluded from MIPS) Note that the performance of all clinicians in the ACO will contribute to this score even if they are not subject to MIPS payment adjustments
50
Cost (VM) MIPS eligible clinicians participating in the MSSP will not be assessed on cost No reporting necessary
NA 0
Improvement Activities (new)
No additional reporting necessary Full credit for the APM Entity group by virtue of MSSP participation
20
Advancing Care Information (MU)
ACO participant TINs will submit directly to MIPS via a MIPS data submission mechanism
ACO participant TIN scores will be aggregated as a weighted average to yield one score for the APM Entity group
30
35
Quality Payment Program Paths
Subsets of MIPS and APM Paths
Eligible Clinician
MIPSAPM
MIPS-APM Advanced
APM
36
MIPS-APM Reporting Option
Requirements to be considered a MIPS-APM includebull Participate in the APM under an
agreement with CMS
bull Include one or more MIPS eligible clinicians on a Participation List
ndash On at least one of the snapshot dates
(Mar 31 June 30 or Aug 31)
bull Bases payment incentives on performance (either at the APM Entity or eligible clinician level) on costutilization and quality
2017 Eligible MIPS-APMs
CEC Model CPC+ Model MSSP Track 12 amp 3 Next Gen ACO OCM All arrangements
Note APM scoring standard applies to APMs that meet these criteria
37
MIPS-APM Benefits
bull Streamlined quality reporting
bull Still eligible for shared savings payment
ndash Financial risk payments do not impact eligibility for positive MIPS payment adjustments
bull Favorable scoring under lsquoAPM Scoring Standardrsquo
ndash ACO participants receive full credit in the Improvement Activities Category by virtue of MSSP participation
ndash ACO participants are not subject to the Cost performance category of MIPS
ndash Potential lsquoliftingrsquo of final MIPS score by being assessed at the ACO level
38
We Are All Part of the Quality Payment Program
Creating an Identity Toward a Common Goal
bull CMS
bull Clinicians
bull Patients
bull Our Care Teams
bull Service Providers
We all share a similar goal to improve patient outcomes
39
Quality Payment Program
Where Can Eligible Clinicians Go For Help
40copy 2016 Telligen Inc
All Eligible Clinicians are supported by
bull Quality Payment Program Websitendash Learn about the program explore the measures and find educational tools and
resources
ndash httpsqppcmsgov
bull Quality Payment Program Service Centerndash Assist with questions
ndash qppCMShhsgov
ndash 1-866-288-8292
bull Innovations Centerrsquos Learning Systemsndash Provides specialized information on Advanced Alternative Payment Models (APMs)
ndash httpsinnovationcmsgov
Self Service Technical Support
41copy 2016 Telligen Inc
We are here to help
bull Experienced quality improvement advisors to provide expert technical assistance and support for participating providers across the state especially those in large practices health systems and ACO at no charge
bull Helps in meeting MIPS requirements through customized technical assistance including one-on-one assistance when needed
bull Offers monthly webinars and Coffee Talk open discussion
ndash Focused QPP topic
ndash Open discuss with Q amp A ndash dedicated to your questions
ndash 2nd Thursday every month
ndash 1100 am CST for 1 hour
Telligen QIN-QIO
42copy 2016 Telligen Inc
We are here to help
bull Provides monthly electronic newsletter with resources the latest research and healthcare news relevant to you
bull Provides the ldquoWeekly Digestrdquo with electronic email on upcoming learning opportunities
bull Offers a website with the latest resources and tools and post recorded webinars for future reference
bull Partner with Telligen QIO on practice improvement activitiesndash Participation with a QIO in a self-management training program (diabetes)
ndash Implementation of antibiotic stewardship program
ndash Implementation of a cardiac quality improvement program
Telligen QIN-QIO
43copy 2016 Telligen Inc
Primary Care amp Specialist Physicians
Model
bull Align with the criteria for innovative models set forth in the Quality Payment Program
bull Build the evidence base on practice transformation so that effective solutions can be scaled
bull Move clinician practices through 5 phases of transformation with support from
ndash Practice Transformation Networks (PTN)
ndash Support amp Alignment Networks (SAN)
ndash Quality Improvement Organizations and others
Transforming Clinical Practice Initiative
44copy 2016 Telligen Inc
Primary Care amp Specialist Physicians
Goalsbull Support clinicians in their practice transformation goals
bull Improve health outcomes for millions of Medicare Medicaid and CHIP beneficiaries
bull Build the evidence base on practice transformation so that effective solutions can be scale
bull Sustain efficient care delivery by reducing unnecessary testing and procedures
bull Reduce unnecessary hospitalizations
Contact Melissa Kapping kappingmihconlineorg
Transforming Clinical Practice Initiative
45copy 2016 Telligen Inc
bull SURS (Small Underserved and Rural Support) ndash Recently announced February 16
ndash 11 organizations awarded contracts
ndash Telligen provides assistance to Iowa Nebraska South Dakota and North Dakota
ndash No cost to practices
bull Solo or small practices (15 or fewer clinicians) ndash Rural health professional shortage areas (HPSA)
ndash Medically underserved areas (MUA)
bull Outreach guidance and direct technical assistancendash Practice readiness education health IT optimization
ndash Strategic planning assisting in the full transition to APM
Telligen QPP Resource Center
46
Contact Info
Michelle Brunsen Sr QI Advisor
515-453-8180
mbrunsentelligencom
Sandy Swallow Program Specialist
515-223-2105
Sandyswallowarea-dhcqisorg
Websites
bull wwwtelligenqinqiocom
bull wwwtelligenqppcom
bull wwwqppcmsgov
THANK YOU
This material was prepared by Telligen the Quality Payment Program Small
Underserved and Rural Support contractor for Iowa Nebraska North Dakota and
South Dakota under contract with the Centers for Medicare amp Medicaid Services
(CMS) an agency of the US Department of Health and Human Services The
contents presented do not necessarily reflect CMS policy HHSM-500-2017-00012C
This material was prepared by Telligen the Medicare Quality Innovation
Network Quality Improvement Organization under contract with the
Centers for Medicare amp Medicaid Services (CMS) an agency of the US
Department of Health and Human Services The contents presented do
not necessarily reflect CMS policy
18copy 2016 Telligen Inc
Based on Reporting for Transition Year 2017
Final Score Payment Adjustment
gt 70 points bull Positive adjustmentbull Eligible for exceptional performance bonus ndash
minimum additional 05
4-69 points bull Neutral or Positive adjustment 0-4bull Not eligible for exceptional performance bonus
3 points bull Neutral 0 adjustment
0 points bull Negative payment adjustment of -4bull 0 points = does not participate
MIPS Payment Adjustments in CY 2019
Payment adjustment is based on Medicare Part B reimbursement at the TINNPI level
19
MIPS Performance Categories for 2017
Focus on
QualityPerformance Category
20
2017 Requirements for Quality Submissions
bull Most Participants report up to 6 Measuresndash 1 Outcome Measure (or intermediate outcome)
ndash If no Outcome Measure High Priority Measure
ndash If fewer than 6 measures apply submit all that apply
ndash 10 point decile scale minimum 3 pts for submission in 2017
ndash Use benchmarks to estimate points to predict your quality score
2017 Quality Benchmarks available at httpsqppcmsgovresourceseducation
bull Groups (25+) using the web interface report 15 quality measures for a full year
21
2017 Requirements for Quality Submissions
bull Quality Measure Bonus Points
ndash 2 Points for extra Outcome or Patient Experience Measures
ndash 1 Point for any other high priority measure
ndash Bonus points capped at 10 denominator
ndash Electronic submission bonus points 1 Point per measure for end-to-end electronic reporting
Qualification
o Clinical Data must be documented in CEHRT
o Processing must not include abstraction or pre-aggregation
o All mechanisms eligible except claims
EHR direct DSV Qualified Registry QCDR Web Interface
22
2017 Requirements for Quality Submissions
Payers Period
2017
Patient
Threshold
Rate
Period
2018
Patient
Threshold
Rate
Long Term
Rate
Claims Medicare Part
B
90 days 50 1 Year 60 90
Web
Interface
Medicare Part
B
1 Year 248 patients 1 Year 248 patients 248 patients
Qualified
Registry
All 90 days 50 1 Year 60 90
Qualified
Clinical Data
Registry
All 90 days 50 1 Year 60 90
EHR amp Data
Submission
Vendor
All 90 days 50 1 Year 60 90
23
MIPS Performance Categories for 2017
Focus on
Advancing Care Information
(ACI)Performance Category
24
2017 Requirements for ACI Submissions
Base Score bull Must report on either 4 or 5 measures specific to the EHR certification
bull Report either ldquoYesrdquo or a numerator of at least 1 bull All 50 Base Score points have to be earned to earn
Performance Points
Performance Score bull Based on performance rates for selected measures
Bonus Points bull Extra registry data connections (ie immunization clinical data registry)
bull Use of CEHRT in Improvement Activities
Reporting bull Attestation QCDR Qualified Registry EHR vendor or CMS Web Interface (groups of 25 or more)
HardshipsThresholds bull Allow for reweighting
ACI Scoring Methodology
25
2017 Requirements for ACI Submissions
Measures will contribute to the score in the
Performance Score measure set grouping
Base Measures
Security Risk Analysis
E-Prescribing
Provide Patient Access
HIE - Send a Summary of Care
HIE - RequestAccept a Summary of Care
(2015 only)
Performance Measures
Provide Patient Access
Patient-Specific Education
View Download and Transmit (VDT)
Secure Messaging
Patient-Generated Health Data
Send a Summary of Care
RequestAccept a Summary of Care
Clinical Information Reconciliation
Immunization Registry Reporting
26
MIPS Performance Categories for 2017
Focus on
Improvement Activities
(IA)Performance Category
27
2017 Requirements for IA Submissions
bull Maximum Points = 40 Pointsndash High weighted activities = 20 points
ndash Medium weighted activities = 10 points
bull Participation Thresholdsndash 90 days required
bull PCMH = Maximum Possible Points (40)
bull APM Participation = 50-100 of Maximum Possible Points at CMS discretion
bull Special Populations Points Doubledndash Practices with lt 15 providers
ndash Rural or HPSA practices
ndash Non-patient facing MIPS eligible clinicians
bull Reporting Options Qualified Registry EHR QCDR or CMS Web Interface (for groups 25 clinicians or more)
28
MIPS Performance Categories for 2017
Focus on
CostPerformance Category
29
2017 Requirements for Cost Category
bull Cost scoring weightndash 2017 0
ndash 2018 10
ndash 2019 30
bull CMS will calculate from claims over 40 episode-specific measures to account for differences among specialtiesndash Clinicians that deliver more efficient care achieve better
performance and score the highest points for cost measures
bull ldquoEpisodes of carerdquo roll up all costs of inpatient and outpatient care (including imaging laboratory drugs rehabilitation etc)
30
2017 Requirements for Cost Category
bull Expected Changes from the Value-Modifier Programndash Patients attributed at the TIN-NPI level
ndash Attributed to one PCP (group) to provider with highest volume by cost provides primary care
ndash Cost compared by decile ranking instead of + 1 standard deviation
ndash Risk adjustments for geographic payment rate beneficiary risk on socio-economic status and others
bull Episodes of Carendash Anticipate 10 for 2018 ndash most operational
ndash 40 being tracked
ndash Plan to develop patient condition groups and patient relationship categories
31
Initial Episode-based Cost Measures
bull Aorticmitral valve surgery
bull CABG
bull HipFemur Fracture or Dislocation Treatment
bull Cholecystectomy and common duct exploration
bull Colonoscopy and biopsy
bull TURP for BPH
bull Lens and cataract procedures
bull Hip replacement or repair
bull Knee arthroplasty
bull Mastectomy
CMS will still provide feedback on performance in these categories in 2017 but it will not affect your 2019 payments
32
Alternative Payment Model (APMs)
bull Create the adoption of payment models that move away from FFS and tie payment to value
bull Must be in an Advanced APM to participate
bull Must meet specific thresholds of ldquosubstantial portionsrdquo of revenue from ldquoapprovedrdquo alternate payment models
bull Receive 5 lump sum bonus for 2019 -2024
bull Receive higher fee schedule update for 2026 and beyond
Which Path is Right for You
33
What are Advanced APMs
Requirements to be an Advanced APM
bull Requires use of certified EHR technology
bull Base payment on quality measures comparable to those in MIPS
bull The practice must bear more than nominal financial risk or is in a Medical Home Model expanded under CMS Innovation Center authority
2017 Eligible Advanced APMs Include
Comprehensive ESRD Care Model
Comprehensive Primary Care Plus (CPC+)
Medicare Shared SavingsProgram Track 2 and 3
Next Generation ACO Model
Oncology Care Model Two-Sided Risk Arrangement
34
APM Scoring Standards
Category Reporting Requirements Category Scoring CategoryWeight
Quality (PQRS) The ACO submits Medicare Shared Savings Program quality measures on behalf of ACO participant TINs and their MIPS eligible clinicians via the CMS Web Interface Data is submitted on the first 248 consecutively ranked and assigned Medicare beneficiaries The ACO submits this information once for purposes of both the Medicare Shared Savings Program and MIPS
MIPS benchmarks will be used to assign one score at the APM Entity Group (ACO) level In other words all MIPS eligible clinicians on the certified ACO ProviderSupplier list will receive the same score (unless they are excluded from MIPS) Note that the performance of all clinicians in the ACO will contribute to this score even if they are not subject to MIPS payment adjustments
50
Cost (VM) MIPS eligible clinicians participating in the MSSP will not be assessed on cost No reporting necessary
NA 0
Improvement Activities (new)
No additional reporting necessary Full credit for the APM Entity group by virtue of MSSP participation
20
Advancing Care Information (MU)
ACO participant TINs will submit directly to MIPS via a MIPS data submission mechanism
ACO participant TIN scores will be aggregated as a weighted average to yield one score for the APM Entity group
30
35
Quality Payment Program Paths
Subsets of MIPS and APM Paths
Eligible Clinician
MIPSAPM
MIPS-APM Advanced
APM
36
MIPS-APM Reporting Option
Requirements to be considered a MIPS-APM includebull Participate in the APM under an
agreement with CMS
bull Include one or more MIPS eligible clinicians on a Participation List
ndash On at least one of the snapshot dates
(Mar 31 June 30 or Aug 31)
bull Bases payment incentives on performance (either at the APM Entity or eligible clinician level) on costutilization and quality
2017 Eligible MIPS-APMs
CEC Model CPC+ Model MSSP Track 12 amp 3 Next Gen ACO OCM All arrangements
Note APM scoring standard applies to APMs that meet these criteria
37
MIPS-APM Benefits
bull Streamlined quality reporting
bull Still eligible for shared savings payment
ndash Financial risk payments do not impact eligibility for positive MIPS payment adjustments
bull Favorable scoring under lsquoAPM Scoring Standardrsquo
ndash ACO participants receive full credit in the Improvement Activities Category by virtue of MSSP participation
ndash ACO participants are not subject to the Cost performance category of MIPS
ndash Potential lsquoliftingrsquo of final MIPS score by being assessed at the ACO level
38
We Are All Part of the Quality Payment Program
Creating an Identity Toward a Common Goal
bull CMS
bull Clinicians
bull Patients
bull Our Care Teams
bull Service Providers
We all share a similar goal to improve patient outcomes
39
Quality Payment Program
Where Can Eligible Clinicians Go For Help
40copy 2016 Telligen Inc
All Eligible Clinicians are supported by
bull Quality Payment Program Websitendash Learn about the program explore the measures and find educational tools and
resources
ndash httpsqppcmsgov
bull Quality Payment Program Service Centerndash Assist with questions
ndash qppCMShhsgov
ndash 1-866-288-8292
bull Innovations Centerrsquos Learning Systemsndash Provides specialized information on Advanced Alternative Payment Models (APMs)
ndash httpsinnovationcmsgov
Self Service Technical Support
41copy 2016 Telligen Inc
We are here to help
bull Experienced quality improvement advisors to provide expert technical assistance and support for participating providers across the state especially those in large practices health systems and ACO at no charge
bull Helps in meeting MIPS requirements through customized technical assistance including one-on-one assistance when needed
bull Offers monthly webinars and Coffee Talk open discussion
ndash Focused QPP topic
ndash Open discuss with Q amp A ndash dedicated to your questions
ndash 2nd Thursday every month
ndash 1100 am CST for 1 hour
Telligen QIN-QIO
42copy 2016 Telligen Inc
We are here to help
bull Provides monthly electronic newsletter with resources the latest research and healthcare news relevant to you
bull Provides the ldquoWeekly Digestrdquo with electronic email on upcoming learning opportunities
bull Offers a website with the latest resources and tools and post recorded webinars for future reference
bull Partner with Telligen QIO on practice improvement activitiesndash Participation with a QIO in a self-management training program (diabetes)
ndash Implementation of antibiotic stewardship program
ndash Implementation of a cardiac quality improvement program
Telligen QIN-QIO
43copy 2016 Telligen Inc
Primary Care amp Specialist Physicians
Model
bull Align with the criteria for innovative models set forth in the Quality Payment Program
bull Build the evidence base on practice transformation so that effective solutions can be scaled
bull Move clinician practices through 5 phases of transformation with support from
ndash Practice Transformation Networks (PTN)
ndash Support amp Alignment Networks (SAN)
ndash Quality Improvement Organizations and others
Transforming Clinical Practice Initiative
44copy 2016 Telligen Inc
Primary Care amp Specialist Physicians
Goalsbull Support clinicians in their practice transformation goals
bull Improve health outcomes for millions of Medicare Medicaid and CHIP beneficiaries
bull Build the evidence base on practice transformation so that effective solutions can be scale
bull Sustain efficient care delivery by reducing unnecessary testing and procedures
bull Reduce unnecessary hospitalizations
Contact Melissa Kapping kappingmihconlineorg
Transforming Clinical Practice Initiative
45copy 2016 Telligen Inc
bull SURS (Small Underserved and Rural Support) ndash Recently announced February 16
ndash 11 organizations awarded contracts
ndash Telligen provides assistance to Iowa Nebraska South Dakota and North Dakota
ndash No cost to practices
bull Solo or small practices (15 or fewer clinicians) ndash Rural health professional shortage areas (HPSA)
ndash Medically underserved areas (MUA)
bull Outreach guidance and direct technical assistancendash Practice readiness education health IT optimization
ndash Strategic planning assisting in the full transition to APM
Telligen QPP Resource Center
46
Contact Info
Michelle Brunsen Sr QI Advisor
515-453-8180
mbrunsentelligencom
Sandy Swallow Program Specialist
515-223-2105
Sandyswallowarea-dhcqisorg
Websites
bull wwwtelligenqinqiocom
bull wwwtelligenqppcom
bull wwwqppcmsgov
THANK YOU
This material was prepared by Telligen the Quality Payment Program Small
Underserved and Rural Support contractor for Iowa Nebraska North Dakota and
South Dakota under contract with the Centers for Medicare amp Medicaid Services
(CMS) an agency of the US Department of Health and Human Services The
contents presented do not necessarily reflect CMS policy HHSM-500-2017-00012C
This material was prepared by Telligen the Medicare Quality Innovation
Network Quality Improvement Organization under contract with the
Centers for Medicare amp Medicaid Services (CMS) an agency of the US
Department of Health and Human Services The contents presented do
not necessarily reflect CMS policy
19
MIPS Performance Categories for 2017
Focus on
QualityPerformance Category
20
2017 Requirements for Quality Submissions
bull Most Participants report up to 6 Measuresndash 1 Outcome Measure (or intermediate outcome)
ndash If no Outcome Measure High Priority Measure
ndash If fewer than 6 measures apply submit all that apply
ndash 10 point decile scale minimum 3 pts for submission in 2017
ndash Use benchmarks to estimate points to predict your quality score
2017 Quality Benchmarks available at httpsqppcmsgovresourceseducation
bull Groups (25+) using the web interface report 15 quality measures for a full year
21
2017 Requirements for Quality Submissions
bull Quality Measure Bonus Points
ndash 2 Points for extra Outcome or Patient Experience Measures
ndash 1 Point for any other high priority measure
ndash Bonus points capped at 10 denominator
ndash Electronic submission bonus points 1 Point per measure for end-to-end electronic reporting
Qualification
o Clinical Data must be documented in CEHRT
o Processing must not include abstraction or pre-aggregation
o All mechanisms eligible except claims
EHR direct DSV Qualified Registry QCDR Web Interface
22
2017 Requirements for Quality Submissions
Payers Period
2017
Patient
Threshold
Rate
Period
2018
Patient
Threshold
Rate
Long Term
Rate
Claims Medicare Part
B
90 days 50 1 Year 60 90
Web
Interface
Medicare Part
B
1 Year 248 patients 1 Year 248 patients 248 patients
Qualified
Registry
All 90 days 50 1 Year 60 90
Qualified
Clinical Data
Registry
All 90 days 50 1 Year 60 90
EHR amp Data
Submission
Vendor
All 90 days 50 1 Year 60 90
23
MIPS Performance Categories for 2017
Focus on
Advancing Care Information
(ACI)Performance Category
24
2017 Requirements for ACI Submissions
Base Score bull Must report on either 4 or 5 measures specific to the EHR certification
bull Report either ldquoYesrdquo or a numerator of at least 1 bull All 50 Base Score points have to be earned to earn
Performance Points
Performance Score bull Based on performance rates for selected measures
Bonus Points bull Extra registry data connections (ie immunization clinical data registry)
bull Use of CEHRT in Improvement Activities
Reporting bull Attestation QCDR Qualified Registry EHR vendor or CMS Web Interface (groups of 25 or more)
HardshipsThresholds bull Allow for reweighting
ACI Scoring Methodology
25
2017 Requirements for ACI Submissions
Measures will contribute to the score in the
Performance Score measure set grouping
Base Measures
Security Risk Analysis
E-Prescribing
Provide Patient Access
HIE - Send a Summary of Care
HIE - RequestAccept a Summary of Care
(2015 only)
Performance Measures
Provide Patient Access
Patient-Specific Education
View Download and Transmit (VDT)
Secure Messaging
Patient-Generated Health Data
Send a Summary of Care
RequestAccept a Summary of Care
Clinical Information Reconciliation
Immunization Registry Reporting
26
MIPS Performance Categories for 2017
Focus on
Improvement Activities
(IA)Performance Category
27
2017 Requirements for IA Submissions
bull Maximum Points = 40 Pointsndash High weighted activities = 20 points
ndash Medium weighted activities = 10 points
bull Participation Thresholdsndash 90 days required
bull PCMH = Maximum Possible Points (40)
bull APM Participation = 50-100 of Maximum Possible Points at CMS discretion
bull Special Populations Points Doubledndash Practices with lt 15 providers
ndash Rural or HPSA practices
ndash Non-patient facing MIPS eligible clinicians
bull Reporting Options Qualified Registry EHR QCDR or CMS Web Interface (for groups 25 clinicians or more)
28
MIPS Performance Categories for 2017
Focus on
CostPerformance Category
29
2017 Requirements for Cost Category
bull Cost scoring weightndash 2017 0
ndash 2018 10
ndash 2019 30
bull CMS will calculate from claims over 40 episode-specific measures to account for differences among specialtiesndash Clinicians that deliver more efficient care achieve better
performance and score the highest points for cost measures
bull ldquoEpisodes of carerdquo roll up all costs of inpatient and outpatient care (including imaging laboratory drugs rehabilitation etc)
30
2017 Requirements for Cost Category
bull Expected Changes from the Value-Modifier Programndash Patients attributed at the TIN-NPI level
ndash Attributed to one PCP (group) to provider with highest volume by cost provides primary care
ndash Cost compared by decile ranking instead of + 1 standard deviation
ndash Risk adjustments for geographic payment rate beneficiary risk on socio-economic status and others
bull Episodes of Carendash Anticipate 10 for 2018 ndash most operational
ndash 40 being tracked
ndash Plan to develop patient condition groups and patient relationship categories
31
Initial Episode-based Cost Measures
bull Aorticmitral valve surgery
bull CABG
bull HipFemur Fracture or Dislocation Treatment
bull Cholecystectomy and common duct exploration
bull Colonoscopy and biopsy
bull TURP for BPH
bull Lens and cataract procedures
bull Hip replacement or repair
bull Knee arthroplasty
bull Mastectomy
CMS will still provide feedback on performance in these categories in 2017 but it will not affect your 2019 payments
32
Alternative Payment Model (APMs)
bull Create the adoption of payment models that move away from FFS and tie payment to value
bull Must be in an Advanced APM to participate
bull Must meet specific thresholds of ldquosubstantial portionsrdquo of revenue from ldquoapprovedrdquo alternate payment models
bull Receive 5 lump sum bonus for 2019 -2024
bull Receive higher fee schedule update for 2026 and beyond
Which Path is Right for You
33
What are Advanced APMs
Requirements to be an Advanced APM
bull Requires use of certified EHR technology
bull Base payment on quality measures comparable to those in MIPS
bull The practice must bear more than nominal financial risk or is in a Medical Home Model expanded under CMS Innovation Center authority
2017 Eligible Advanced APMs Include
Comprehensive ESRD Care Model
Comprehensive Primary Care Plus (CPC+)
Medicare Shared SavingsProgram Track 2 and 3
Next Generation ACO Model
Oncology Care Model Two-Sided Risk Arrangement
34
APM Scoring Standards
Category Reporting Requirements Category Scoring CategoryWeight
Quality (PQRS) The ACO submits Medicare Shared Savings Program quality measures on behalf of ACO participant TINs and their MIPS eligible clinicians via the CMS Web Interface Data is submitted on the first 248 consecutively ranked and assigned Medicare beneficiaries The ACO submits this information once for purposes of both the Medicare Shared Savings Program and MIPS
MIPS benchmarks will be used to assign one score at the APM Entity Group (ACO) level In other words all MIPS eligible clinicians on the certified ACO ProviderSupplier list will receive the same score (unless they are excluded from MIPS) Note that the performance of all clinicians in the ACO will contribute to this score even if they are not subject to MIPS payment adjustments
50
Cost (VM) MIPS eligible clinicians participating in the MSSP will not be assessed on cost No reporting necessary
NA 0
Improvement Activities (new)
No additional reporting necessary Full credit for the APM Entity group by virtue of MSSP participation
20
Advancing Care Information (MU)
ACO participant TINs will submit directly to MIPS via a MIPS data submission mechanism
ACO participant TIN scores will be aggregated as a weighted average to yield one score for the APM Entity group
30
35
Quality Payment Program Paths
Subsets of MIPS and APM Paths
Eligible Clinician
MIPSAPM
MIPS-APM Advanced
APM
36
MIPS-APM Reporting Option
Requirements to be considered a MIPS-APM includebull Participate in the APM under an
agreement with CMS
bull Include one or more MIPS eligible clinicians on a Participation List
ndash On at least one of the snapshot dates
(Mar 31 June 30 or Aug 31)
bull Bases payment incentives on performance (either at the APM Entity or eligible clinician level) on costutilization and quality
2017 Eligible MIPS-APMs
CEC Model CPC+ Model MSSP Track 12 amp 3 Next Gen ACO OCM All arrangements
Note APM scoring standard applies to APMs that meet these criteria
37
MIPS-APM Benefits
bull Streamlined quality reporting
bull Still eligible for shared savings payment
ndash Financial risk payments do not impact eligibility for positive MIPS payment adjustments
bull Favorable scoring under lsquoAPM Scoring Standardrsquo
ndash ACO participants receive full credit in the Improvement Activities Category by virtue of MSSP participation
ndash ACO participants are not subject to the Cost performance category of MIPS
ndash Potential lsquoliftingrsquo of final MIPS score by being assessed at the ACO level
38
We Are All Part of the Quality Payment Program
Creating an Identity Toward a Common Goal
bull CMS
bull Clinicians
bull Patients
bull Our Care Teams
bull Service Providers
We all share a similar goal to improve patient outcomes
39
Quality Payment Program
Where Can Eligible Clinicians Go For Help
40copy 2016 Telligen Inc
All Eligible Clinicians are supported by
bull Quality Payment Program Websitendash Learn about the program explore the measures and find educational tools and
resources
ndash httpsqppcmsgov
bull Quality Payment Program Service Centerndash Assist with questions
ndash qppCMShhsgov
ndash 1-866-288-8292
bull Innovations Centerrsquos Learning Systemsndash Provides specialized information on Advanced Alternative Payment Models (APMs)
ndash httpsinnovationcmsgov
Self Service Technical Support
41copy 2016 Telligen Inc
We are here to help
bull Experienced quality improvement advisors to provide expert technical assistance and support for participating providers across the state especially those in large practices health systems and ACO at no charge
bull Helps in meeting MIPS requirements through customized technical assistance including one-on-one assistance when needed
bull Offers monthly webinars and Coffee Talk open discussion
ndash Focused QPP topic
ndash Open discuss with Q amp A ndash dedicated to your questions
ndash 2nd Thursday every month
ndash 1100 am CST for 1 hour
Telligen QIN-QIO
42copy 2016 Telligen Inc
We are here to help
bull Provides monthly electronic newsletter with resources the latest research and healthcare news relevant to you
bull Provides the ldquoWeekly Digestrdquo with electronic email on upcoming learning opportunities
bull Offers a website with the latest resources and tools and post recorded webinars for future reference
bull Partner with Telligen QIO on practice improvement activitiesndash Participation with a QIO in a self-management training program (diabetes)
ndash Implementation of antibiotic stewardship program
ndash Implementation of a cardiac quality improvement program
Telligen QIN-QIO
43copy 2016 Telligen Inc
Primary Care amp Specialist Physicians
Model
bull Align with the criteria for innovative models set forth in the Quality Payment Program
bull Build the evidence base on practice transformation so that effective solutions can be scaled
bull Move clinician practices through 5 phases of transformation with support from
ndash Practice Transformation Networks (PTN)
ndash Support amp Alignment Networks (SAN)
ndash Quality Improvement Organizations and others
Transforming Clinical Practice Initiative
44copy 2016 Telligen Inc
Primary Care amp Specialist Physicians
Goalsbull Support clinicians in their practice transformation goals
bull Improve health outcomes for millions of Medicare Medicaid and CHIP beneficiaries
bull Build the evidence base on practice transformation so that effective solutions can be scale
bull Sustain efficient care delivery by reducing unnecessary testing and procedures
bull Reduce unnecessary hospitalizations
Contact Melissa Kapping kappingmihconlineorg
Transforming Clinical Practice Initiative
45copy 2016 Telligen Inc
bull SURS (Small Underserved and Rural Support) ndash Recently announced February 16
ndash 11 organizations awarded contracts
ndash Telligen provides assistance to Iowa Nebraska South Dakota and North Dakota
ndash No cost to practices
bull Solo or small practices (15 or fewer clinicians) ndash Rural health professional shortage areas (HPSA)
ndash Medically underserved areas (MUA)
bull Outreach guidance and direct technical assistancendash Practice readiness education health IT optimization
ndash Strategic planning assisting in the full transition to APM
Telligen QPP Resource Center
46
Contact Info
Michelle Brunsen Sr QI Advisor
515-453-8180
mbrunsentelligencom
Sandy Swallow Program Specialist
515-223-2105
Sandyswallowarea-dhcqisorg
Websites
bull wwwtelligenqinqiocom
bull wwwtelligenqppcom
bull wwwqppcmsgov
THANK YOU
This material was prepared by Telligen the Quality Payment Program Small
Underserved and Rural Support contractor for Iowa Nebraska North Dakota and
South Dakota under contract with the Centers for Medicare amp Medicaid Services
(CMS) an agency of the US Department of Health and Human Services The
contents presented do not necessarily reflect CMS policy HHSM-500-2017-00012C
This material was prepared by Telligen the Medicare Quality Innovation
Network Quality Improvement Organization under contract with the
Centers for Medicare amp Medicaid Services (CMS) an agency of the US
Department of Health and Human Services The contents presented do
not necessarily reflect CMS policy
20
2017 Requirements for Quality Submissions
bull Most Participants report up to 6 Measuresndash 1 Outcome Measure (or intermediate outcome)
ndash If no Outcome Measure High Priority Measure
ndash If fewer than 6 measures apply submit all that apply
ndash 10 point decile scale minimum 3 pts for submission in 2017
ndash Use benchmarks to estimate points to predict your quality score
2017 Quality Benchmarks available at httpsqppcmsgovresourceseducation
bull Groups (25+) using the web interface report 15 quality measures for a full year
21
2017 Requirements for Quality Submissions
bull Quality Measure Bonus Points
ndash 2 Points for extra Outcome or Patient Experience Measures
ndash 1 Point for any other high priority measure
ndash Bonus points capped at 10 denominator
ndash Electronic submission bonus points 1 Point per measure for end-to-end electronic reporting
Qualification
o Clinical Data must be documented in CEHRT
o Processing must not include abstraction or pre-aggregation
o All mechanisms eligible except claims
EHR direct DSV Qualified Registry QCDR Web Interface
22
2017 Requirements for Quality Submissions
Payers Period
2017
Patient
Threshold
Rate
Period
2018
Patient
Threshold
Rate
Long Term
Rate
Claims Medicare Part
B
90 days 50 1 Year 60 90
Web
Interface
Medicare Part
B
1 Year 248 patients 1 Year 248 patients 248 patients
Qualified
Registry
All 90 days 50 1 Year 60 90
Qualified
Clinical Data
Registry
All 90 days 50 1 Year 60 90
EHR amp Data
Submission
Vendor
All 90 days 50 1 Year 60 90
23
MIPS Performance Categories for 2017
Focus on
Advancing Care Information
(ACI)Performance Category
24
2017 Requirements for ACI Submissions
Base Score bull Must report on either 4 or 5 measures specific to the EHR certification
bull Report either ldquoYesrdquo or a numerator of at least 1 bull All 50 Base Score points have to be earned to earn
Performance Points
Performance Score bull Based on performance rates for selected measures
Bonus Points bull Extra registry data connections (ie immunization clinical data registry)
bull Use of CEHRT in Improvement Activities
Reporting bull Attestation QCDR Qualified Registry EHR vendor or CMS Web Interface (groups of 25 or more)
HardshipsThresholds bull Allow for reweighting
ACI Scoring Methodology
25
2017 Requirements for ACI Submissions
Measures will contribute to the score in the
Performance Score measure set grouping
Base Measures
Security Risk Analysis
E-Prescribing
Provide Patient Access
HIE - Send a Summary of Care
HIE - RequestAccept a Summary of Care
(2015 only)
Performance Measures
Provide Patient Access
Patient-Specific Education
View Download and Transmit (VDT)
Secure Messaging
Patient-Generated Health Data
Send a Summary of Care
RequestAccept a Summary of Care
Clinical Information Reconciliation
Immunization Registry Reporting
26
MIPS Performance Categories for 2017
Focus on
Improvement Activities
(IA)Performance Category
27
2017 Requirements for IA Submissions
bull Maximum Points = 40 Pointsndash High weighted activities = 20 points
ndash Medium weighted activities = 10 points
bull Participation Thresholdsndash 90 days required
bull PCMH = Maximum Possible Points (40)
bull APM Participation = 50-100 of Maximum Possible Points at CMS discretion
bull Special Populations Points Doubledndash Practices with lt 15 providers
ndash Rural or HPSA practices
ndash Non-patient facing MIPS eligible clinicians
bull Reporting Options Qualified Registry EHR QCDR or CMS Web Interface (for groups 25 clinicians or more)
28
MIPS Performance Categories for 2017
Focus on
CostPerformance Category
29
2017 Requirements for Cost Category
bull Cost scoring weightndash 2017 0
ndash 2018 10
ndash 2019 30
bull CMS will calculate from claims over 40 episode-specific measures to account for differences among specialtiesndash Clinicians that deliver more efficient care achieve better
performance and score the highest points for cost measures
bull ldquoEpisodes of carerdquo roll up all costs of inpatient and outpatient care (including imaging laboratory drugs rehabilitation etc)
30
2017 Requirements for Cost Category
bull Expected Changes from the Value-Modifier Programndash Patients attributed at the TIN-NPI level
ndash Attributed to one PCP (group) to provider with highest volume by cost provides primary care
ndash Cost compared by decile ranking instead of + 1 standard deviation
ndash Risk adjustments for geographic payment rate beneficiary risk on socio-economic status and others
bull Episodes of Carendash Anticipate 10 for 2018 ndash most operational
ndash 40 being tracked
ndash Plan to develop patient condition groups and patient relationship categories
31
Initial Episode-based Cost Measures
bull Aorticmitral valve surgery
bull CABG
bull HipFemur Fracture or Dislocation Treatment
bull Cholecystectomy and common duct exploration
bull Colonoscopy and biopsy
bull TURP for BPH
bull Lens and cataract procedures
bull Hip replacement or repair
bull Knee arthroplasty
bull Mastectomy
CMS will still provide feedback on performance in these categories in 2017 but it will not affect your 2019 payments
32
Alternative Payment Model (APMs)
bull Create the adoption of payment models that move away from FFS and tie payment to value
bull Must be in an Advanced APM to participate
bull Must meet specific thresholds of ldquosubstantial portionsrdquo of revenue from ldquoapprovedrdquo alternate payment models
bull Receive 5 lump sum bonus for 2019 -2024
bull Receive higher fee schedule update for 2026 and beyond
Which Path is Right for You
33
What are Advanced APMs
Requirements to be an Advanced APM
bull Requires use of certified EHR technology
bull Base payment on quality measures comparable to those in MIPS
bull The practice must bear more than nominal financial risk or is in a Medical Home Model expanded under CMS Innovation Center authority
2017 Eligible Advanced APMs Include
Comprehensive ESRD Care Model
Comprehensive Primary Care Plus (CPC+)
Medicare Shared SavingsProgram Track 2 and 3
Next Generation ACO Model
Oncology Care Model Two-Sided Risk Arrangement
34
APM Scoring Standards
Category Reporting Requirements Category Scoring CategoryWeight
Quality (PQRS) The ACO submits Medicare Shared Savings Program quality measures on behalf of ACO participant TINs and their MIPS eligible clinicians via the CMS Web Interface Data is submitted on the first 248 consecutively ranked and assigned Medicare beneficiaries The ACO submits this information once for purposes of both the Medicare Shared Savings Program and MIPS
MIPS benchmarks will be used to assign one score at the APM Entity Group (ACO) level In other words all MIPS eligible clinicians on the certified ACO ProviderSupplier list will receive the same score (unless they are excluded from MIPS) Note that the performance of all clinicians in the ACO will contribute to this score even if they are not subject to MIPS payment adjustments
50
Cost (VM) MIPS eligible clinicians participating in the MSSP will not be assessed on cost No reporting necessary
NA 0
Improvement Activities (new)
No additional reporting necessary Full credit for the APM Entity group by virtue of MSSP participation
20
Advancing Care Information (MU)
ACO participant TINs will submit directly to MIPS via a MIPS data submission mechanism
ACO participant TIN scores will be aggregated as a weighted average to yield one score for the APM Entity group
30
35
Quality Payment Program Paths
Subsets of MIPS and APM Paths
Eligible Clinician
MIPSAPM
MIPS-APM Advanced
APM
36
MIPS-APM Reporting Option
Requirements to be considered a MIPS-APM includebull Participate in the APM under an
agreement with CMS
bull Include one or more MIPS eligible clinicians on a Participation List
ndash On at least one of the snapshot dates
(Mar 31 June 30 or Aug 31)
bull Bases payment incentives on performance (either at the APM Entity or eligible clinician level) on costutilization and quality
2017 Eligible MIPS-APMs
CEC Model CPC+ Model MSSP Track 12 amp 3 Next Gen ACO OCM All arrangements
Note APM scoring standard applies to APMs that meet these criteria
37
MIPS-APM Benefits
bull Streamlined quality reporting
bull Still eligible for shared savings payment
ndash Financial risk payments do not impact eligibility for positive MIPS payment adjustments
bull Favorable scoring under lsquoAPM Scoring Standardrsquo
ndash ACO participants receive full credit in the Improvement Activities Category by virtue of MSSP participation
ndash ACO participants are not subject to the Cost performance category of MIPS
ndash Potential lsquoliftingrsquo of final MIPS score by being assessed at the ACO level
38
We Are All Part of the Quality Payment Program
Creating an Identity Toward a Common Goal
bull CMS
bull Clinicians
bull Patients
bull Our Care Teams
bull Service Providers
We all share a similar goal to improve patient outcomes
39
Quality Payment Program
Where Can Eligible Clinicians Go For Help
40copy 2016 Telligen Inc
All Eligible Clinicians are supported by
bull Quality Payment Program Websitendash Learn about the program explore the measures and find educational tools and
resources
ndash httpsqppcmsgov
bull Quality Payment Program Service Centerndash Assist with questions
ndash qppCMShhsgov
ndash 1-866-288-8292
bull Innovations Centerrsquos Learning Systemsndash Provides specialized information on Advanced Alternative Payment Models (APMs)
ndash httpsinnovationcmsgov
Self Service Technical Support
41copy 2016 Telligen Inc
We are here to help
bull Experienced quality improvement advisors to provide expert technical assistance and support for participating providers across the state especially those in large practices health systems and ACO at no charge
bull Helps in meeting MIPS requirements through customized technical assistance including one-on-one assistance when needed
bull Offers monthly webinars and Coffee Talk open discussion
ndash Focused QPP topic
ndash Open discuss with Q amp A ndash dedicated to your questions
ndash 2nd Thursday every month
ndash 1100 am CST for 1 hour
Telligen QIN-QIO
42copy 2016 Telligen Inc
We are here to help
bull Provides monthly electronic newsletter with resources the latest research and healthcare news relevant to you
bull Provides the ldquoWeekly Digestrdquo with electronic email on upcoming learning opportunities
bull Offers a website with the latest resources and tools and post recorded webinars for future reference
bull Partner with Telligen QIO on practice improvement activitiesndash Participation with a QIO in a self-management training program (diabetes)
ndash Implementation of antibiotic stewardship program
ndash Implementation of a cardiac quality improvement program
Telligen QIN-QIO
43copy 2016 Telligen Inc
Primary Care amp Specialist Physicians
Model
bull Align with the criteria for innovative models set forth in the Quality Payment Program
bull Build the evidence base on practice transformation so that effective solutions can be scaled
bull Move clinician practices through 5 phases of transformation with support from
ndash Practice Transformation Networks (PTN)
ndash Support amp Alignment Networks (SAN)
ndash Quality Improvement Organizations and others
Transforming Clinical Practice Initiative
44copy 2016 Telligen Inc
Primary Care amp Specialist Physicians
Goalsbull Support clinicians in their practice transformation goals
bull Improve health outcomes for millions of Medicare Medicaid and CHIP beneficiaries
bull Build the evidence base on practice transformation so that effective solutions can be scale
bull Sustain efficient care delivery by reducing unnecessary testing and procedures
bull Reduce unnecessary hospitalizations
Contact Melissa Kapping kappingmihconlineorg
Transforming Clinical Practice Initiative
45copy 2016 Telligen Inc
bull SURS (Small Underserved and Rural Support) ndash Recently announced February 16
ndash 11 organizations awarded contracts
ndash Telligen provides assistance to Iowa Nebraska South Dakota and North Dakota
ndash No cost to practices
bull Solo or small practices (15 or fewer clinicians) ndash Rural health professional shortage areas (HPSA)
ndash Medically underserved areas (MUA)
bull Outreach guidance and direct technical assistancendash Practice readiness education health IT optimization
ndash Strategic planning assisting in the full transition to APM
Telligen QPP Resource Center
46
Contact Info
Michelle Brunsen Sr QI Advisor
515-453-8180
mbrunsentelligencom
Sandy Swallow Program Specialist
515-223-2105
Sandyswallowarea-dhcqisorg
Websites
bull wwwtelligenqinqiocom
bull wwwtelligenqppcom
bull wwwqppcmsgov
THANK YOU
This material was prepared by Telligen the Quality Payment Program Small
Underserved and Rural Support contractor for Iowa Nebraska North Dakota and
South Dakota under contract with the Centers for Medicare amp Medicaid Services
(CMS) an agency of the US Department of Health and Human Services The
contents presented do not necessarily reflect CMS policy HHSM-500-2017-00012C
This material was prepared by Telligen the Medicare Quality Innovation
Network Quality Improvement Organization under contract with the
Centers for Medicare amp Medicaid Services (CMS) an agency of the US
Department of Health and Human Services The contents presented do
not necessarily reflect CMS policy
21
2017 Requirements for Quality Submissions
bull Quality Measure Bonus Points
ndash 2 Points for extra Outcome or Patient Experience Measures
ndash 1 Point for any other high priority measure
ndash Bonus points capped at 10 denominator
ndash Electronic submission bonus points 1 Point per measure for end-to-end electronic reporting
Qualification
o Clinical Data must be documented in CEHRT
o Processing must not include abstraction or pre-aggregation
o All mechanisms eligible except claims
EHR direct DSV Qualified Registry QCDR Web Interface
22
2017 Requirements for Quality Submissions
Payers Period
2017
Patient
Threshold
Rate
Period
2018
Patient
Threshold
Rate
Long Term
Rate
Claims Medicare Part
B
90 days 50 1 Year 60 90
Web
Interface
Medicare Part
B
1 Year 248 patients 1 Year 248 patients 248 patients
Qualified
Registry
All 90 days 50 1 Year 60 90
Qualified
Clinical Data
Registry
All 90 days 50 1 Year 60 90
EHR amp Data
Submission
Vendor
All 90 days 50 1 Year 60 90
23
MIPS Performance Categories for 2017
Focus on
Advancing Care Information
(ACI)Performance Category
24
2017 Requirements for ACI Submissions
Base Score bull Must report on either 4 or 5 measures specific to the EHR certification
bull Report either ldquoYesrdquo or a numerator of at least 1 bull All 50 Base Score points have to be earned to earn
Performance Points
Performance Score bull Based on performance rates for selected measures
Bonus Points bull Extra registry data connections (ie immunization clinical data registry)
bull Use of CEHRT in Improvement Activities
Reporting bull Attestation QCDR Qualified Registry EHR vendor or CMS Web Interface (groups of 25 or more)
HardshipsThresholds bull Allow for reweighting
ACI Scoring Methodology
25
2017 Requirements for ACI Submissions
Measures will contribute to the score in the
Performance Score measure set grouping
Base Measures
Security Risk Analysis
E-Prescribing
Provide Patient Access
HIE - Send a Summary of Care
HIE - RequestAccept a Summary of Care
(2015 only)
Performance Measures
Provide Patient Access
Patient-Specific Education
View Download and Transmit (VDT)
Secure Messaging
Patient-Generated Health Data
Send a Summary of Care
RequestAccept a Summary of Care
Clinical Information Reconciliation
Immunization Registry Reporting
26
MIPS Performance Categories for 2017
Focus on
Improvement Activities
(IA)Performance Category
27
2017 Requirements for IA Submissions
bull Maximum Points = 40 Pointsndash High weighted activities = 20 points
ndash Medium weighted activities = 10 points
bull Participation Thresholdsndash 90 days required
bull PCMH = Maximum Possible Points (40)
bull APM Participation = 50-100 of Maximum Possible Points at CMS discretion
bull Special Populations Points Doubledndash Practices with lt 15 providers
ndash Rural or HPSA practices
ndash Non-patient facing MIPS eligible clinicians
bull Reporting Options Qualified Registry EHR QCDR or CMS Web Interface (for groups 25 clinicians or more)
28
MIPS Performance Categories for 2017
Focus on
CostPerformance Category
29
2017 Requirements for Cost Category
bull Cost scoring weightndash 2017 0
ndash 2018 10
ndash 2019 30
bull CMS will calculate from claims over 40 episode-specific measures to account for differences among specialtiesndash Clinicians that deliver more efficient care achieve better
performance and score the highest points for cost measures
bull ldquoEpisodes of carerdquo roll up all costs of inpatient and outpatient care (including imaging laboratory drugs rehabilitation etc)
30
2017 Requirements for Cost Category
bull Expected Changes from the Value-Modifier Programndash Patients attributed at the TIN-NPI level
ndash Attributed to one PCP (group) to provider with highest volume by cost provides primary care
ndash Cost compared by decile ranking instead of + 1 standard deviation
ndash Risk adjustments for geographic payment rate beneficiary risk on socio-economic status and others
bull Episodes of Carendash Anticipate 10 for 2018 ndash most operational
ndash 40 being tracked
ndash Plan to develop patient condition groups and patient relationship categories
31
Initial Episode-based Cost Measures
bull Aorticmitral valve surgery
bull CABG
bull HipFemur Fracture or Dislocation Treatment
bull Cholecystectomy and common duct exploration
bull Colonoscopy and biopsy
bull TURP for BPH
bull Lens and cataract procedures
bull Hip replacement or repair
bull Knee arthroplasty
bull Mastectomy
CMS will still provide feedback on performance in these categories in 2017 but it will not affect your 2019 payments
32
Alternative Payment Model (APMs)
bull Create the adoption of payment models that move away from FFS and tie payment to value
bull Must be in an Advanced APM to participate
bull Must meet specific thresholds of ldquosubstantial portionsrdquo of revenue from ldquoapprovedrdquo alternate payment models
bull Receive 5 lump sum bonus for 2019 -2024
bull Receive higher fee schedule update for 2026 and beyond
Which Path is Right for You
33
What are Advanced APMs
Requirements to be an Advanced APM
bull Requires use of certified EHR technology
bull Base payment on quality measures comparable to those in MIPS
bull The practice must bear more than nominal financial risk or is in a Medical Home Model expanded under CMS Innovation Center authority
2017 Eligible Advanced APMs Include
Comprehensive ESRD Care Model
Comprehensive Primary Care Plus (CPC+)
Medicare Shared SavingsProgram Track 2 and 3
Next Generation ACO Model
Oncology Care Model Two-Sided Risk Arrangement
34
APM Scoring Standards
Category Reporting Requirements Category Scoring CategoryWeight
Quality (PQRS) The ACO submits Medicare Shared Savings Program quality measures on behalf of ACO participant TINs and their MIPS eligible clinicians via the CMS Web Interface Data is submitted on the first 248 consecutively ranked and assigned Medicare beneficiaries The ACO submits this information once for purposes of both the Medicare Shared Savings Program and MIPS
MIPS benchmarks will be used to assign one score at the APM Entity Group (ACO) level In other words all MIPS eligible clinicians on the certified ACO ProviderSupplier list will receive the same score (unless they are excluded from MIPS) Note that the performance of all clinicians in the ACO will contribute to this score even if they are not subject to MIPS payment adjustments
50
Cost (VM) MIPS eligible clinicians participating in the MSSP will not be assessed on cost No reporting necessary
NA 0
Improvement Activities (new)
No additional reporting necessary Full credit for the APM Entity group by virtue of MSSP participation
20
Advancing Care Information (MU)
ACO participant TINs will submit directly to MIPS via a MIPS data submission mechanism
ACO participant TIN scores will be aggregated as a weighted average to yield one score for the APM Entity group
30
35
Quality Payment Program Paths
Subsets of MIPS and APM Paths
Eligible Clinician
MIPSAPM
MIPS-APM Advanced
APM
36
MIPS-APM Reporting Option
Requirements to be considered a MIPS-APM includebull Participate in the APM under an
agreement with CMS
bull Include one or more MIPS eligible clinicians on a Participation List
ndash On at least one of the snapshot dates
(Mar 31 June 30 or Aug 31)
bull Bases payment incentives on performance (either at the APM Entity or eligible clinician level) on costutilization and quality
2017 Eligible MIPS-APMs
CEC Model CPC+ Model MSSP Track 12 amp 3 Next Gen ACO OCM All arrangements
Note APM scoring standard applies to APMs that meet these criteria
37
MIPS-APM Benefits
bull Streamlined quality reporting
bull Still eligible for shared savings payment
ndash Financial risk payments do not impact eligibility for positive MIPS payment adjustments
bull Favorable scoring under lsquoAPM Scoring Standardrsquo
ndash ACO participants receive full credit in the Improvement Activities Category by virtue of MSSP participation
ndash ACO participants are not subject to the Cost performance category of MIPS
ndash Potential lsquoliftingrsquo of final MIPS score by being assessed at the ACO level
38
We Are All Part of the Quality Payment Program
Creating an Identity Toward a Common Goal
bull CMS
bull Clinicians
bull Patients
bull Our Care Teams
bull Service Providers
We all share a similar goal to improve patient outcomes
39
Quality Payment Program
Where Can Eligible Clinicians Go For Help
40copy 2016 Telligen Inc
All Eligible Clinicians are supported by
bull Quality Payment Program Websitendash Learn about the program explore the measures and find educational tools and
resources
ndash httpsqppcmsgov
bull Quality Payment Program Service Centerndash Assist with questions
ndash qppCMShhsgov
ndash 1-866-288-8292
bull Innovations Centerrsquos Learning Systemsndash Provides specialized information on Advanced Alternative Payment Models (APMs)
ndash httpsinnovationcmsgov
Self Service Technical Support
41copy 2016 Telligen Inc
We are here to help
bull Experienced quality improvement advisors to provide expert technical assistance and support for participating providers across the state especially those in large practices health systems and ACO at no charge
bull Helps in meeting MIPS requirements through customized technical assistance including one-on-one assistance when needed
bull Offers monthly webinars and Coffee Talk open discussion
ndash Focused QPP topic
ndash Open discuss with Q amp A ndash dedicated to your questions
ndash 2nd Thursday every month
ndash 1100 am CST for 1 hour
Telligen QIN-QIO
42copy 2016 Telligen Inc
We are here to help
bull Provides monthly electronic newsletter with resources the latest research and healthcare news relevant to you
bull Provides the ldquoWeekly Digestrdquo with electronic email on upcoming learning opportunities
bull Offers a website with the latest resources and tools and post recorded webinars for future reference
bull Partner with Telligen QIO on practice improvement activitiesndash Participation with a QIO in a self-management training program (diabetes)
ndash Implementation of antibiotic stewardship program
ndash Implementation of a cardiac quality improvement program
Telligen QIN-QIO
43copy 2016 Telligen Inc
Primary Care amp Specialist Physicians
Model
bull Align with the criteria for innovative models set forth in the Quality Payment Program
bull Build the evidence base on practice transformation so that effective solutions can be scaled
bull Move clinician practices through 5 phases of transformation with support from
ndash Practice Transformation Networks (PTN)
ndash Support amp Alignment Networks (SAN)
ndash Quality Improvement Organizations and others
Transforming Clinical Practice Initiative
44copy 2016 Telligen Inc
Primary Care amp Specialist Physicians
Goalsbull Support clinicians in their practice transformation goals
bull Improve health outcomes for millions of Medicare Medicaid and CHIP beneficiaries
bull Build the evidence base on practice transformation so that effective solutions can be scale
bull Sustain efficient care delivery by reducing unnecessary testing and procedures
bull Reduce unnecessary hospitalizations
Contact Melissa Kapping kappingmihconlineorg
Transforming Clinical Practice Initiative
45copy 2016 Telligen Inc
bull SURS (Small Underserved and Rural Support) ndash Recently announced February 16
ndash 11 organizations awarded contracts
ndash Telligen provides assistance to Iowa Nebraska South Dakota and North Dakota
ndash No cost to practices
bull Solo or small practices (15 or fewer clinicians) ndash Rural health professional shortage areas (HPSA)
ndash Medically underserved areas (MUA)
bull Outreach guidance and direct technical assistancendash Practice readiness education health IT optimization
ndash Strategic planning assisting in the full transition to APM
Telligen QPP Resource Center
46
Contact Info
Michelle Brunsen Sr QI Advisor
515-453-8180
mbrunsentelligencom
Sandy Swallow Program Specialist
515-223-2105
Sandyswallowarea-dhcqisorg
Websites
bull wwwtelligenqinqiocom
bull wwwtelligenqppcom
bull wwwqppcmsgov
THANK YOU
This material was prepared by Telligen the Quality Payment Program Small
Underserved and Rural Support contractor for Iowa Nebraska North Dakota and
South Dakota under contract with the Centers for Medicare amp Medicaid Services
(CMS) an agency of the US Department of Health and Human Services The
contents presented do not necessarily reflect CMS policy HHSM-500-2017-00012C
This material was prepared by Telligen the Medicare Quality Innovation
Network Quality Improvement Organization under contract with the
Centers for Medicare amp Medicaid Services (CMS) an agency of the US
Department of Health and Human Services The contents presented do
not necessarily reflect CMS policy
22
2017 Requirements for Quality Submissions
Payers Period
2017
Patient
Threshold
Rate
Period
2018
Patient
Threshold
Rate
Long Term
Rate
Claims Medicare Part
B
90 days 50 1 Year 60 90
Web
Interface
Medicare Part
B
1 Year 248 patients 1 Year 248 patients 248 patients
Qualified
Registry
All 90 days 50 1 Year 60 90
Qualified
Clinical Data
Registry
All 90 days 50 1 Year 60 90
EHR amp Data
Submission
Vendor
All 90 days 50 1 Year 60 90
23
MIPS Performance Categories for 2017
Focus on
Advancing Care Information
(ACI)Performance Category
24
2017 Requirements for ACI Submissions
Base Score bull Must report on either 4 or 5 measures specific to the EHR certification
bull Report either ldquoYesrdquo or a numerator of at least 1 bull All 50 Base Score points have to be earned to earn
Performance Points
Performance Score bull Based on performance rates for selected measures
Bonus Points bull Extra registry data connections (ie immunization clinical data registry)
bull Use of CEHRT in Improvement Activities
Reporting bull Attestation QCDR Qualified Registry EHR vendor or CMS Web Interface (groups of 25 or more)
HardshipsThresholds bull Allow for reweighting
ACI Scoring Methodology
25
2017 Requirements for ACI Submissions
Measures will contribute to the score in the
Performance Score measure set grouping
Base Measures
Security Risk Analysis
E-Prescribing
Provide Patient Access
HIE - Send a Summary of Care
HIE - RequestAccept a Summary of Care
(2015 only)
Performance Measures
Provide Patient Access
Patient-Specific Education
View Download and Transmit (VDT)
Secure Messaging
Patient-Generated Health Data
Send a Summary of Care
RequestAccept a Summary of Care
Clinical Information Reconciliation
Immunization Registry Reporting
26
MIPS Performance Categories for 2017
Focus on
Improvement Activities
(IA)Performance Category
27
2017 Requirements for IA Submissions
bull Maximum Points = 40 Pointsndash High weighted activities = 20 points
ndash Medium weighted activities = 10 points
bull Participation Thresholdsndash 90 days required
bull PCMH = Maximum Possible Points (40)
bull APM Participation = 50-100 of Maximum Possible Points at CMS discretion
bull Special Populations Points Doubledndash Practices with lt 15 providers
ndash Rural or HPSA practices
ndash Non-patient facing MIPS eligible clinicians
bull Reporting Options Qualified Registry EHR QCDR or CMS Web Interface (for groups 25 clinicians or more)
28
MIPS Performance Categories for 2017
Focus on
CostPerformance Category
29
2017 Requirements for Cost Category
bull Cost scoring weightndash 2017 0
ndash 2018 10
ndash 2019 30
bull CMS will calculate from claims over 40 episode-specific measures to account for differences among specialtiesndash Clinicians that deliver more efficient care achieve better
performance and score the highest points for cost measures
bull ldquoEpisodes of carerdquo roll up all costs of inpatient and outpatient care (including imaging laboratory drugs rehabilitation etc)
30
2017 Requirements for Cost Category
bull Expected Changes from the Value-Modifier Programndash Patients attributed at the TIN-NPI level
ndash Attributed to one PCP (group) to provider with highest volume by cost provides primary care
ndash Cost compared by decile ranking instead of + 1 standard deviation
ndash Risk adjustments for geographic payment rate beneficiary risk on socio-economic status and others
bull Episodes of Carendash Anticipate 10 for 2018 ndash most operational
ndash 40 being tracked
ndash Plan to develop patient condition groups and patient relationship categories
31
Initial Episode-based Cost Measures
bull Aorticmitral valve surgery
bull CABG
bull HipFemur Fracture or Dislocation Treatment
bull Cholecystectomy and common duct exploration
bull Colonoscopy and biopsy
bull TURP for BPH
bull Lens and cataract procedures
bull Hip replacement or repair
bull Knee arthroplasty
bull Mastectomy
CMS will still provide feedback on performance in these categories in 2017 but it will not affect your 2019 payments
32
Alternative Payment Model (APMs)
bull Create the adoption of payment models that move away from FFS and tie payment to value
bull Must be in an Advanced APM to participate
bull Must meet specific thresholds of ldquosubstantial portionsrdquo of revenue from ldquoapprovedrdquo alternate payment models
bull Receive 5 lump sum bonus for 2019 -2024
bull Receive higher fee schedule update for 2026 and beyond
Which Path is Right for You
33
What are Advanced APMs
Requirements to be an Advanced APM
bull Requires use of certified EHR technology
bull Base payment on quality measures comparable to those in MIPS
bull The practice must bear more than nominal financial risk or is in a Medical Home Model expanded under CMS Innovation Center authority
2017 Eligible Advanced APMs Include
Comprehensive ESRD Care Model
Comprehensive Primary Care Plus (CPC+)
Medicare Shared SavingsProgram Track 2 and 3
Next Generation ACO Model
Oncology Care Model Two-Sided Risk Arrangement
34
APM Scoring Standards
Category Reporting Requirements Category Scoring CategoryWeight
Quality (PQRS) The ACO submits Medicare Shared Savings Program quality measures on behalf of ACO participant TINs and their MIPS eligible clinicians via the CMS Web Interface Data is submitted on the first 248 consecutively ranked and assigned Medicare beneficiaries The ACO submits this information once for purposes of both the Medicare Shared Savings Program and MIPS
MIPS benchmarks will be used to assign one score at the APM Entity Group (ACO) level In other words all MIPS eligible clinicians on the certified ACO ProviderSupplier list will receive the same score (unless they are excluded from MIPS) Note that the performance of all clinicians in the ACO will contribute to this score even if they are not subject to MIPS payment adjustments
50
Cost (VM) MIPS eligible clinicians participating in the MSSP will not be assessed on cost No reporting necessary
NA 0
Improvement Activities (new)
No additional reporting necessary Full credit for the APM Entity group by virtue of MSSP participation
20
Advancing Care Information (MU)
ACO participant TINs will submit directly to MIPS via a MIPS data submission mechanism
ACO participant TIN scores will be aggregated as a weighted average to yield one score for the APM Entity group
30
35
Quality Payment Program Paths
Subsets of MIPS and APM Paths
Eligible Clinician
MIPSAPM
MIPS-APM Advanced
APM
36
MIPS-APM Reporting Option
Requirements to be considered a MIPS-APM includebull Participate in the APM under an
agreement with CMS
bull Include one or more MIPS eligible clinicians on a Participation List
ndash On at least one of the snapshot dates
(Mar 31 June 30 or Aug 31)
bull Bases payment incentives on performance (either at the APM Entity or eligible clinician level) on costutilization and quality
2017 Eligible MIPS-APMs
CEC Model CPC+ Model MSSP Track 12 amp 3 Next Gen ACO OCM All arrangements
Note APM scoring standard applies to APMs that meet these criteria
37
MIPS-APM Benefits
bull Streamlined quality reporting
bull Still eligible for shared savings payment
ndash Financial risk payments do not impact eligibility for positive MIPS payment adjustments
bull Favorable scoring under lsquoAPM Scoring Standardrsquo
ndash ACO participants receive full credit in the Improvement Activities Category by virtue of MSSP participation
ndash ACO participants are not subject to the Cost performance category of MIPS
ndash Potential lsquoliftingrsquo of final MIPS score by being assessed at the ACO level
38
We Are All Part of the Quality Payment Program
Creating an Identity Toward a Common Goal
bull CMS
bull Clinicians
bull Patients
bull Our Care Teams
bull Service Providers
We all share a similar goal to improve patient outcomes
39
Quality Payment Program
Where Can Eligible Clinicians Go For Help
40copy 2016 Telligen Inc
All Eligible Clinicians are supported by
bull Quality Payment Program Websitendash Learn about the program explore the measures and find educational tools and
resources
ndash httpsqppcmsgov
bull Quality Payment Program Service Centerndash Assist with questions
ndash qppCMShhsgov
ndash 1-866-288-8292
bull Innovations Centerrsquos Learning Systemsndash Provides specialized information on Advanced Alternative Payment Models (APMs)
ndash httpsinnovationcmsgov
Self Service Technical Support
41copy 2016 Telligen Inc
We are here to help
bull Experienced quality improvement advisors to provide expert technical assistance and support for participating providers across the state especially those in large practices health systems and ACO at no charge
bull Helps in meeting MIPS requirements through customized technical assistance including one-on-one assistance when needed
bull Offers monthly webinars and Coffee Talk open discussion
ndash Focused QPP topic
ndash Open discuss with Q amp A ndash dedicated to your questions
ndash 2nd Thursday every month
ndash 1100 am CST for 1 hour
Telligen QIN-QIO
42copy 2016 Telligen Inc
We are here to help
bull Provides monthly electronic newsletter with resources the latest research and healthcare news relevant to you
bull Provides the ldquoWeekly Digestrdquo with electronic email on upcoming learning opportunities
bull Offers a website with the latest resources and tools and post recorded webinars for future reference
bull Partner with Telligen QIO on practice improvement activitiesndash Participation with a QIO in a self-management training program (diabetes)
ndash Implementation of antibiotic stewardship program
ndash Implementation of a cardiac quality improvement program
Telligen QIN-QIO
43copy 2016 Telligen Inc
Primary Care amp Specialist Physicians
Model
bull Align with the criteria for innovative models set forth in the Quality Payment Program
bull Build the evidence base on practice transformation so that effective solutions can be scaled
bull Move clinician practices through 5 phases of transformation with support from
ndash Practice Transformation Networks (PTN)
ndash Support amp Alignment Networks (SAN)
ndash Quality Improvement Organizations and others
Transforming Clinical Practice Initiative
44copy 2016 Telligen Inc
Primary Care amp Specialist Physicians
Goalsbull Support clinicians in their practice transformation goals
bull Improve health outcomes for millions of Medicare Medicaid and CHIP beneficiaries
bull Build the evidence base on practice transformation so that effective solutions can be scale
bull Sustain efficient care delivery by reducing unnecessary testing and procedures
bull Reduce unnecessary hospitalizations
Contact Melissa Kapping kappingmihconlineorg
Transforming Clinical Practice Initiative
45copy 2016 Telligen Inc
bull SURS (Small Underserved and Rural Support) ndash Recently announced February 16
ndash 11 organizations awarded contracts
ndash Telligen provides assistance to Iowa Nebraska South Dakota and North Dakota
ndash No cost to practices
bull Solo or small practices (15 or fewer clinicians) ndash Rural health professional shortage areas (HPSA)
ndash Medically underserved areas (MUA)
bull Outreach guidance and direct technical assistancendash Practice readiness education health IT optimization
ndash Strategic planning assisting in the full transition to APM
Telligen QPP Resource Center
46
Contact Info
Michelle Brunsen Sr QI Advisor
515-453-8180
mbrunsentelligencom
Sandy Swallow Program Specialist
515-223-2105
Sandyswallowarea-dhcqisorg
Websites
bull wwwtelligenqinqiocom
bull wwwtelligenqppcom
bull wwwqppcmsgov
THANK YOU
This material was prepared by Telligen the Quality Payment Program Small
Underserved and Rural Support contractor for Iowa Nebraska North Dakota and
South Dakota under contract with the Centers for Medicare amp Medicaid Services
(CMS) an agency of the US Department of Health and Human Services The
contents presented do not necessarily reflect CMS policy HHSM-500-2017-00012C
This material was prepared by Telligen the Medicare Quality Innovation
Network Quality Improvement Organization under contract with the
Centers for Medicare amp Medicaid Services (CMS) an agency of the US
Department of Health and Human Services The contents presented do
not necessarily reflect CMS policy
23
MIPS Performance Categories for 2017
Focus on
Advancing Care Information
(ACI)Performance Category
24
2017 Requirements for ACI Submissions
Base Score bull Must report on either 4 or 5 measures specific to the EHR certification
bull Report either ldquoYesrdquo or a numerator of at least 1 bull All 50 Base Score points have to be earned to earn
Performance Points
Performance Score bull Based on performance rates for selected measures
Bonus Points bull Extra registry data connections (ie immunization clinical data registry)
bull Use of CEHRT in Improvement Activities
Reporting bull Attestation QCDR Qualified Registry EHR vendor or CMS Web Interface (groups of 25 or more)
HardshipsThresholds bull Allow for reweighting
ACI Scoring Methodology
25
2017 Requirements for ACI Submissions
Measures will contribute to the score in the
Performance Score measure set grouping
Base Measures
Security Risk Analysis
E-Prescribing
Provide Patient Access
HIE - Send a Summary of Care
HIE - RequestAccept a Summary of Care
(2015 only)
Performance Measures
Provide Patient Access
Patient-Specific Education
View Download and Transmit (VDT)
Secure Messaging
Patient-Generated Health Data
Send a Summary of Care
RequestAccept a Summary of Care
Clinical Information Reconciliation
Immunization Registry Reporting
26
MIPS Performance Categories for 2017
Focus on
Improvement Activities
(IA)Performance Category
27
2017 Requirements for IA Submissions
bull Maximum Points = 40 Pointsndash High weighted activities = 20 points
ndash Medium weighted activities = 10 points
bull Participation Thresholdsndash 90 days required
bull PCMH = Maximum Possible Points (40)
bull APM Participation = 50-100 of Maximum Possible Points at CMS discretion
bull Special Populations Points Doubledndash Practices with lt 15 providers
ndash Rural or HPSA practices
ndash Non-patient facing MIPS eligible clinicians
bull Reporting Options Qualified Registry EHR QCDR or CMS Web Interface (for groups 25 clinicians or more)
28
MIPS Performance Categories for 2017
Focus on
CostPerformance Category
29
2017 Requirements for Cost Category
bull Cost scoring weightndash 2017 0
ndash 2018 10
ndash 2019 30
bull CMS will calculate from claims over 40 episode-specific measures to account for differences among specialtiesndash Clinicians that deliver more efficient care achieve better
performance and score the highest points for cost measures
bull ldquoEpisodes of carerdquo roll up all costs of inpatient and outpatient care (including imaging laboratory drugs rehabilitation etc)
30
2017 Requirements for Cost Category
bull Expected Changes from the Value-Modifier Programndash Patients attributed at the TIN-NPI level
ndash Attributed to one PCP (group) to provider with highest volume by cost provides primary care
ndash Cost compared by decile ranking instead of + 1 standard deviation
ndash Risk adjustments for geographic payment rate beneficiary risk on socio-economic status and others
bull Episodes of Carendash Anticipate 10 for 2018 ndash most operational
ndash 40 being tracked
ndash Plan to develop patient condition groups and patient relationship categories
31
Initial Episode-based Cost Measures
bull Aorticmitral valve surgery
bull CABG
bull HipFemur Fracture or Dislocation Treatment
bull Cholecystectomy and common duct exploration
bull Colonoscopy and biopsy
bull TURP for BPH
bull Lens and cataract procedures
bull Hip replacement or repair
bull Knee arthroplasty
bull Mastectomy
CMS will still provide feedback on performance in these categories in 2017 but it will not affect your 2019 payments
32
Alternative Payment Model (APMs)
bull Create the adoption of payment models that move away from FFS and tie payment to value
bull Must be in an Advanced APM to participate
bull Must meet specific thresholds of ldquosubstantial portionsrdquo of revenue from ldquoapprovedrdquo alternate payment models
bull Receive 5 lump sum bonus for 2019 -2024
bull Receive higher fee schedule update for 2026 and beyond
Which Path is Right for You
33
What are Advanced APMs
Requirements to be an Advanced APM
bull Requires use of certified EHR technology
bull Base payment on quality measures comparable to those in MIPS
bull The practice must bear more than nominal financial risk or is in a Medical Home Model expanded under CMS Innovation Center authority
2017 Eligible Advanced APMs Include
Comprehensive ESRD Care Model
Comprehensive Primary Care Plus (CPC+)
Medicare Shared SavingsProgram Track 2 and 3
Next Generation ACO Model
Oncology Care Model Two-Sided Risk Arrangement
34
APM Scoring Standards
Category Reporting Requirements Category Scoring CategoryWeight
Quality (PQRS) The ACO submits Medicare Shared Savings Program quality measures on behalf of ACO participant TINs and their MIPS eligible clinicians via the CMS Web Interface Data is submitted on the first 248 consecutively ranked and assigned Medicare beneficiaries The ACO submits this information once for purposes of both the Medicare Shared Savings Program and MIPS
MIPS benchmarks will be used to assign one score at the APM Entity Group (ACO) level In other words all MIPS eligible clinicians on the certified ACO ProviderSupplier list will receive the same score (unless they are excluded from MIPS) Note that the performance of all clinicians in the ACO will contribute to this score even if they are not subject to MIPS payment adjustments
50
Cost (VM) MIPS eligible clinicians participating in the MSSP will not be assessed on cost No reporting necessary
NA 0
Improvement Activities (new)
No additional reporting necessary Full credit for the APM Entity group by virtue of MSSP participation
20
Advancing Care Information (MU)
ACO participant TINs will submit directly to MIPS via a MIPS data submission mechanism
ACO participant TIN scores will be aggregated as a weighted average to yield one score for the APM Entity group
30
35
Quality Payment Program Paths
Subsets of MIPS and APM Paths
Eligible Clinician
MIPSAPM
MIPS-APM Advanced
APM
36
MIPS-APM Reporting Option
Requirements to be considered a MIPS-APM includebull Participate in the APM under an
agreement with CMS
bull Include one or more MIPS eligible clinicians on a Participation List
ndash On at least one of the snapshot dates
(Mar 31 June 30 or Aug 31)
bull Bases payment incentives on performance (either at the APM Entity or eligible clinician level) on costutilization and quality
2017 Eligible MIPS-APMs
CEC Model CPC+ Model MSSP Track 12 amp 3 Next Gen ACO OCM All arrangements
Note APM scoring standard applies to APMs that meet these criteria
37
MIPS-APM Benefits
bull Streamlined quality reporting
bull Still eligible for shared savings payment
ndash Financial risk payments do not impact eligibility for positive MIPS payment adjustments
bull Favorable scoring under lsquoAPM Scoring Standardrsquo
ndash ACO participants receive full credit in the Improvement Activities Category by virtue of MSSP participation
ndash ACO participants are not subject to the Cost performance category of MIPS
ndash Potential lsquoliftingrsquo of final MIPS score by being assessed at the ACO level
38
We Are All Part of the Quality Payment Program
Creating an Identity Toward a Common Goal
bull CMS
bull Clinicians
bull Patients
bull Our Care Teams
bull Service Providers
We all share a similar goal to improve patient outcomes
39
Quality Payment Program
Where Can Eligible Clinicians Go For Help
40copy 2016 Telligen Inc
All Eligible Clinicians are supported by
bull Quality Payment Program Websitendash Learn about the program explore the measures and find educational tools and
resources
ndash httpsqppcmsgov
bull Quality Payment Program Service Centerndash Assist with questions
ndash qppCMShhsgov
ndash 1-866-288-8292
bull Innovations Centerrsquos Learning Systemsndash Provides specialized information on Advanced Alternative Payment Models (APMs)
ndash httpsinnovationcmsgov
Self Service Technical Support
41copy 2016 Telligen Inc
We are here to help
bull Experienced quality improvement advisors to provide expert technical assistance and support for participating providers across the state especially those in large practices health systems and ACO at no charge
bull Helps in meeting MIPS requirements through customized technical assistance including one-on-one assistance when needed
bull Offers monthly webinars and Coffee Talk open discussion
ndash Focused QPP topic
ndash Open discuss with Q amp A ndash dedicated to your questions
ndash 2nd Thursday every month
ndash 1100 am CST for 1 hour
Telligen QIN-QIO
42copy 2016 Telligen Inc
We are here to help
bull Provides monthly electronic newsletter with resources the latest research and healthcare news relevant to you
bull Provides the ldquoWeekly Digestrdquo with electronic email on upcoming learning opportunities
bull Offers a website with the latest resources and tools and post recorded webinars for future reference
bull Partner with Telligen QIO on practice improvement activitiesndash Participation with a QIO in a self-management training program (diabetes)
ndash Implementation of antibiotic stewardship program
ndash Implementation of a cardiac quality improvement program
Telligen QIN-QIO
43copy 2016 Telligen Inc
Primary Care amp Specialist Physicians
Model
bull Align with the criteria for innovative models set forth in the Quality Payment Program
bull Build the evidence base on practice transformation so that effective solutions can be scaled
bull Move clinician practices through 5 phases of transformation with support from
ndash Practice Transformation Networks (PTN)
ndash Support amp Alignment Networks (SAN)
ndash Quality Improvement Organizations and others
Transforming Clinical Practice Initiative
44copy 2016 Telligen Inc
Primary Care amp Specialist Physicians
Goalsbull Support clinicians in their practice transformation goals
bull Improve health outcomes for millions of Medicare Medicaid and CHIP beneficiaries
bull Build the evidence base on practice transformation so that effective solutions can be scale
bull Sustain efficient care delivery by reducing unnecessary testing and procedures
bull Reduce unnecessary hospitalizations
Contact Melissa Kapping kappingmihconlineorg
Transforming Clinical Practice Initiative
45copy 2016 Telligen Inc
bull SURS (Small Underserved and Rural Support) ndash Recently announced February 16
ndash 11 organizations awarded contracts
ndash Telligen provides assistance to Iowa Nebraska South Dakota and North Dakota
ndash No cost to practices
bull Solo or small practices (15 or fewer clinicians) ndash Rural health professional shortage areas (HPSA)
ndash Medically underserved areas (MUA)
bull Outreach guidance and direct technical assistancendash Practice readiness education health IT optimization
ndash Strategic planning assisting in the full transition to APM
Telligen QPP Resource Center
46
Contact Info
Michelle Brunsen Sr QI Advisor
515-453-8180
mbrunsentelligencom
Sandy Swallow Program Specialist
515-223-2105
Sandyswallowarea-dhcqisorg
Websites
bull wwwtelligenqinqiocom
bull wwwtelligenqppcom
bull wwwqppcmsgov
THANK YOU
This material was prepared by Telligen the Quality Payment Program Small
Underserved and Rural Support contractor for Iowa Nebraska North Dakota and
South Dakota under contract with the Centers for Medicare amp Medicaid Services
(CMS) an agency of the US Department of Health and Human Services The
contents presented do not necessarily reflect CMS policy HHSM-500-2017-00012C
This material was prepared by Telligen the Medicare Quality Innovation
Network Quality Improvement Organization under contract with the
Centers for Medicare amp Medicaid Services (CMS) an agency of the US
Department of Health and Human Services The contents presented do
not necessarily reflect CMS policy
24
2017 Requirements for ACI Submissions
Base Score bull Must report on either 4 or 5 measures specific to the EHR certification
bull Report either ldquoYesrdquo or a numerator of at least 1 bull All 50 Base Score points have to be earned to earn
Performance Points
Performance Score bull Based on performance rates for selected measures
Bonus Points bull Extra registry data connections (ie immunization clinical data registry)
bull Use of CEHRT in Improvement Activities
Reporting bull Attestation QCDR Qualified Registry EHR vendor or CMS Web Interface (groups of 25 or more)
HardshipsThresholds bull Allow for reweighting
ACI Scoring Methodology
25
2017 Requirements for ACI Submissions
Measures will contribute to the score in the
Performance Score measure set grouping
Base Measures
Security Risk Analysis
E-Prescribing
Provide Patient Access
HIE - Send a Summary of Care
HIE - RequestAccept a Summary of Care
(2015 only)
Performance Measures
Provide Patient Access
Patient-Specific Education
View Download and Transmit (VDT)
Secure Messaging
Patient-Generated Health Data
Send a Summary of Care
RequestAccept a Summary of Care
Clinical Information Reconciliation
Immunization Registry Reporting
26
MIPS Performance Categories for 2017
Focus on
Improvement Activities
(IA)Performance Category
27
2017 Requirements for IA Submissions
bull Maximum Points = 40 Pointsndash High weighted activities = 20 points
ndash Medium weighted activities = 10 points
bull Participation Thresholdsndash 90 days required
bull PCMH = Maximum Possible Points (40)
bull APM Participation = 50-100 of Maximum Possible Points at CMS discretion
bull Special Populations Points Doubledndash Practices with lt 15 providers
ndash Rural or HPSA practices
ndash Non-patient facing MIPS eligible clinicians
bull Reporting Options Qualified Registry EHR QCDR or CMS Web Interface (for groups 25 clinicians or more)
28
MIPS Performance Categories for 2017
Focus on
CostPerformance Category
29
2017 Requirements for Cost Category
bull Cost scoring weightndash 2017 0
ndash 2018 10
ndash 2019 30
bull CMS will calculate from claims over 40 episode-specific measures to account for differences among specialtiesndash Clinicians that deliver more efficient care achieve better
performance and score the highest points for cost measures
bull ldquoEpisodes of carerdquo roll up all costs of inpatient and outpatient care (including imaging laboratory drugs rehabilitation etc)
30
2017 Requirements for Cost Category
bull Expected Changes from the Value-Modifier Programndash Patients attributed at the TIN-NPI level
ndash Attributed to one PCP (group) to provider with highest volume by cost provides primary care
ndash Cost compared by decile ranking instead of + 1 standard deviation
ndash Risk adjustments for geographic payment rate beneficiary risk on socio-economic status and others
bull Episodes of Carendash Anticipate 10 for 2018 ndash most operational
ndash 40 being tracked
ndash Plan to develop patient condition groups and patient relationship categories
31
Initial Episode-based Cost Measures
bull Aorticmitral valve surgery
bull CABG
bull HipFemur Fracture or Dislocation Treatment
bull Cholecystectomy and common duct exploration
bull Colonoscopy and biopsy
bull TURP for BPH
bull Lens and cataract procedures
bull Hip replacement or repair
bull Knee arthroplasty
bull Mastectomy
CMS will still provide feedback on performance in these categories in 2017 but it will not affect your 2019 payments
32
Alternative Payment Model (APMs)
bull Create the adoption of payment models that move away from FFS and tie payment to value
bull Must be in an Advanced APM to participate
bull Must meet specific thresholds of ldquosubstantial portionsrdquo of revenue from ldquoapprovedrdquo alternate payment models
bull Receive 5 lump sum bonus for 2019 -2024
bull Receive higher fee schedule update for 2026 and beyond
Which Path is Right for You
33
What are Advanced APMs
Requirements to be an Advanced APM
bull Requires use of certified EHR technology
bull Base payment on quality measures comparable to those in MIPS
bull The practice must bear more than nominal financial risk or is in a Medical Home Model expanded under CMS Innovation Center authority
2017 Eligible Advanced APMs Include
Comprehensive ESRD Care Model
Comprehensive Primary Care Plus (CPC+)
Medicare Shared SavingsProgram Track 2 and 3
Next Generation ACO Model
Oncology Care Model Two-Sided Risk Arrangement
34
APM Scoring Standards
Category Reporting Requirements Category Scoring CategoryWeight
Quality (PQRS) The ACO submits Medicare Shared Savings Program quality measures on behalf of ACO participant TINs and their MIPS eligible clinicians via the CMS Web Interface Data is submitted on the first 248 consecutively ranked and assigned Medicare beneficiaries The ACO submits this information once for purposes of both the Medicare Shared Savings Program and MIPS
MIPS benchmarks will be used to assign one score at the APM Entity Group (ACO) level In other words all MIPS eligible clinicians on the certified ACO ProviderSupplier list will receive the same score (unless they are excluded from MIPS) Note that the performance of all clinicians in the ACO will contribute to this score even if they are not subject to MIPS payment adjustments
50
Cost (VM) MIPS eligible clinicians participating in the MSSP will not be assessed on cost No reporting necessary
NA 0
Improvement Activities (new)
No additional reporting necessary Full credit for the APM Entity group by virtue of MSSP participation
20
Advancing Care Information (MU)
ACO participant TINs will submit directly to MIPS via a MIPS data submission mechanism
ACO participant TIN scores will be aggregated as a weighted average to yield one score for the APM Entity group
30
35
Quality Payment Program Paths
Subsets of MIPS and APM Paths
Eligible Clinician
MIPSAPM
MIPS-APM Advanced
APM
36
MIPS-APM Reporting Option
Requirements to be considered a MIPS-APM includebull Participate in the APM under an
agreement with CMS
bull Include one or more MIPS eligible clinicians on a Participation List
ndash On at least one of the snapshot dates
(Mar 31 June 30 or Aug 31)
bull Bases payment incentives on performance (either at the APM Entity or eligible clinician level) on costutilization and quality
2017 Eligible MIPS-APMs
CEC Model CPC+ Model MSSP Track 12 amp 3 Next Gen ACO OCM All arrangements
Note APM scoring standard applies to APMs that meet these criteria
37
MIPS-APM Benefits
bull Streamlined quality reporting
bull Still eligible for shared savings payment
ndash Financial risk payments do not impact eligibility for positive MIPS payment adjustments
bull Favorable scoring under lsquoAPM Scoring Standardrsquo
ndash ACO participants receive full credit in the Improvement Activities Category by virtue of MSSP participation
ndash ACO participants are not subject to the Cost performance category of MIPS
ndash Potential lsquoliftingrsquo of final MIPS score by being assessed at the ACO level
38
We Are All Part of the Quality Payment Program
Creating an Identity Toward a Common Goal
bull CMS
bull Clinicians
bull Patients
bull Our Care Teams
bull Service Providers
We all share a similar goal to improve patient outcomes
39
Quality Payment Program
Where Can Eligible Clinicians Go For Help
40copy 2016 Telligen Inc
All Eligible Clinicians are supported by
bull Quality Payment Program Websitendash Learn about the program explore the measures and find educational tools and
resources
ndash httpsqppcmsgov
bull Quality Payment Program Service Centerndash Assist with questions
ndash qppCMShhsgov
ndash 1-866-288-8292
bull Innovations Centerrsquos Learning Systemsndash Provides specialized information on Advanced Alternative Payment Models (APMs)
ndash httpsinnovationcmsgov
Self Service Technical Support
41copy 2016 Telligen Inc
We are here to help
bull Experienced quality improvement advisors to provide expert technical assistance and support for participating providers across the state especially those in large practices health systems and ACO at no charge
bull Helps in meeting MIPS requirements through customized technical assistance including one-on-one assistance when needed
bull Offers monthly webinars and Coffee Talk open discussion
ndash Focused QPP topic
ndash Open discuss with Q amp A ndash dedicated to your questions
ndash 2nd Thursday every month
ndash 1100 am CST for 1 hour
Telligen QIN-QIO
42copy 2016 Telligen Inc
We are here to help
bull Provides monthly electronic newsletter with resources the latest research and healthcare news relevant to you
bull Provides the ldquoWeekly Digestrdquo with electronic email on upcoming learning opportunities
bull Offers a website with the latest resources and tools and post recorded webinars for future reference
bull Partner with Telligen QIO on practice improvement activitiesndash Participation with a QIO in a self-management training program (diabetes)
ndash Implementation of antibiotic stewardship program
ndash Implementation of a cardiac quality improvement program
Telligen QIN-QIO
43copy 2016 Telligen Inc
Primary Care amp Specialist Physicians
Model
bull Align with the criteria for innovative models set forth in the Quality Payment Program
bull Build the evidence base on practice transformation so that effective solutions can be scaled
bull Move clinician practices through 5 phases of transformation with support from
ndash Practice Transformation Networks (PTN)
ndash Support amp Alignment Networks (SAN)
ndash Quality Improvement Organizations and others
Transforming Clinical Practice Initiative
44copy 2016 Telligen Inc
Primary Care amp Specialist Physicians
Goalsbull Support clinicians in their practice transformation goals
bull Improve health outcomes for millions of Medicare Medicaid and CHIP beneficiaries
bull Build the evidence base on practice transformation so that effective solutions can be scale
bull Sustain efficient care delivery by reducing unnecessary testing and procedures
bull Reduce unnecessary hospitalizations
Contact Melissa Kapping kappingmihconlineorg
Transforming Clinical Practice Initiative
45copy 2016 Telligen Inc
bull SURS (Small Underserved and Rural Support) ndash Recently announced February 16
ndash 11 organizations awarded contracts
ndash Telligen provides assistance to Iowa Nebraska South Dakota and North Dakota
ndash No cost to practices
bull Solo or small practices (15 or fewer clinicians) ndash Rural health professional shortage areas (HPSA)
ndash Medically underserved areas (MUA)
bull Outreach guidance and direct technical assistancendash Practice readiness education health IT optimization
ndash Strategic planning assisting in the full transition to APM
Telligen QPP Resource Center
46
Contact Info
Michelle Brunsen Sr QI Advisor
515-453-8180
mbrunsentelligencom
Sandy Swallow Program Specialist
515-223-2105
Sandyswallowarea-dhcqisorg
Websites
bull wwwtelligenqinqiocom
bull wwwtelligenqppcom
bull wwwqppcmsgov
THANK YOU
This material was prepared by Telligen the Quality Payment Program Small
Underserved and Rural Support contractor for Iowa Nebraska North Dakota and
South Dakota under contract with the Centers for Medicare amp Medicaid Services
(CMS) an agency of the US Department of Health and Human Services The
contents presented do not necessarily reflect CMS policy HHSM-500-2017-00012C
This material was prepared by Telligen the Medicare Quality Innovation
Network Quality Improvement Organization under contract with the
Centers for Medicare amp Medicaid Services (CMS) an agency of the US
Department of Health and Human Services The contents presented do
not necessarily reflect CMS policy
25
2017 Requirements for ACI Submissions
Measures will contribute to the score in the
Performance Score measure set grouping
Base Measures
Security Risk Analysis
E-Prescribing
Provide Patient Access
HIE - Send a Summary of Care
HIE - RequestAccept a Summary of Care
(2015 only)
Performance Measures
Provide Patient Access
Patient-Specific Education
View Download and Transmit (VDT)
Secure Messaging
Patient-Generated Health Data
Send a Summary of Care
RequestAccept a Summary of Care
Clinical Information Reconciliation
Immunization Registry Reporting
26
MIPS Performance Categories for 2017
Focus on
Improvement Activities
(IA)Performance Category
27
2017 Requirements for IA Submissions
bull Maximum Points = 40 Pointsndash High weighted activities = 20 points
ndash Medium weighted activities = 10 points
bull Participation Thresholdsndash 90 days required
bull PCMH = Maximum Possible Points (40)
bull APM Participation = 50-100 of Maximum Possible Points at CMS discretion
bull Special Populations Points Doubledndash Practices with lt 15 providers
ndash Rural or HPSA practices
ndash Non-patient facing MIPS eligible clinicians
bull Reporting Options Qualified Registry EHR QCDR or CMS Web Interface (for groups 25 clinicians or more)
28
MIPS Performance Categories for 2017
Focus on
CostPerformance Category
29
2017 Requirements for Cost Category
bull Cost scoring weightndash 2017 0
ndash 2018 10
ndash 2019 30
bull CMS will calculate from claims over 40 episode-specific measures to account for differences among specialtiesndash Clinicians that deliver more efficient care achieve better
performance and score the highest points for cost measures
bull ldquoEpisodes of carerdquo roll up all costs of inpatient and outpatient care (including imaging laboratory drugs rehabilitation etc)
30
2017 Requirements for Cost Category
bull Expected Changes from the Value-Modifier Programndash Patients attributed at the TIN-NPI level
ndash Attributed to one PCP (group) to provider with highest volume by cost provides primary care
ndash Cost compared by decile ranking instead of + 1 standard deviation
ndash Risk adjustments for geographic payment rate beneficiary risk on socio-economic status and others
bull Episodes of Carendash Anticipate 10 for 2018 ndash most operational
ndash 40 being tracked
ndash Plan to develop patient condition groups and patient relationship categories
31
Initial Episode-based Cost Measures
bull Aorticmitral valve surgery
bull CABG
bull HipFemur Fracture or Dislocation Treatment
bull Cholecystectomy and common duct exploration
bull Colonoscopy and biopsy
bull TURP for BPH
bull Lens and cataract procedures
bull Hip replacement or repair
bull Knee arthroplasty
bull Mastectomy
CMS will still provide feedback on performance in these categories in 2017 but it will not affect your 2019 payments
32
Alternative Payment Model (APMs)
bull Create the adoption of payment models that move away from FFS and tie payment to value
bull Must be in an Advanced APM to participate
bull Must meet specific thresholds of ldquosubstantial portionsrdquo of revenue from ldquoapprovedrdquo alternate payment models
bull Receive 5 lump sum bonus for 2019 -2024
bull Receive higher fee schedule update for 2026 and beyond
Which Path is Right for You
33
What are Advanced APMs
Requirements to be an Advanced APM
bull Requires use of certified EHR technology
bull Base payment on quality measures comparable to those in MIPS
bull The practice must bear more than nominal financial risk or is in a Medical Home Model expanded under CMS Innovation Center authority
2017 Eligible Advanced APMs Include
Comprehensive ESRD Care Model
Comprehensive Primary Care Plus (CPC+)
Medicare Shared SavingsProgram Track 2 and 3
Next Generation ACO Model
Oncology Care Model Two-Sided Risk Arrangement
34
APM Scoring Standards
Category Reporting Requirements Category Scoring CategoryWeight
Quality (PQRS) The ACO submits Medicare Shared Savings Program quality measures on behalf of ACO participant TINs and their MIPS eligible clinicians via the CMS Web Interface Data is submitted on the first 248 consecutively ranked and assigned Medicare beneficiaries The ACO submits this information once for purposes of both the Medicare Shared Savings Program and MIPS
MIPS benchmarks will be used to assign one score at the APM Entity Group (ACO) level In other words all MIPS eligible clinicians on the certified ACO ProviderSupplier list will receive the same score (unless they are excluded from MIPS) Note that the performance of all clinicians in the ACO will contribute to this score even if they are not subject to MIPS payment adjustments
50
Cost (VM) MIPS eligible clinicians participating in the MSSP will not be assessed on cost No reporting necessary
NA 0
Improvement Activities (new)
No additional reporting necessary Full credit for the APM Entity group by virtue of MSSP participation
20
Advancing Care Information (MU)
ACO participant TINs will submit directly to MIPS via a MIPS data submission mechanism
ACO participant TIN scores will be aggregated as a weighted average to yield one score for the APM Entity group
30
35
Quality Payment Program Paths
Subsets of MIPS and APM Paths
Eligible Clinician
MIPSAPM
MIPS-APM Advanced
APM
36
MIPS-APM Reporting Option
Requirements to be considered a MIPS-APM includebull Participate in the APM under an
agreement with CMS
bull Include one or more MIPS eligible clinicians on a Participation List
ndash On at least one of the snapshot dates
(Mar 31 June 30 or Aug 31)
bull Bases payment incentives on performance (either at the APM Entity or eligible clinician level) on costutilization and quality
2017 Eligible MIPS-APMs
CEC Model CPC+ Model MSSP Track 12 amp 3 Next Gen ACO OCM All arrangements
Note APM scoring standard applies to APMs that meet these criteria
37
MIPS-APM Benefits
bull Streamlined quality reporting
bull Still eligible for shared savings payment
ndash Financial risk payments do not impact eligibility for positive MIPS payment adjustments
bull Favorable scoring under lsquoAPM Scoring Standardrsquo
ndash ACO participants receive full credit in the Improvement Activities Category by virtue of MSSP participation
ndash ACO participants are not subject to the Cost performance category of MIPS
ndash Potential lsquoliftingrsquo of final MIPS score by being assessed at the ACO level
38
We Are All Part of the Quality Payment Program
Creating an Identity Toward a Common Goal
bull CMS
bull Clinicians
bull Patients
bull Our Care Teams
bull Service Providers
We all share a similar goal to improve patient outcomes
39
Quality Payment Program
Where Can Eligible Clinicians Go For Help
40copy 2016 Telligen Inc
All Eligible Clinicians are supported by
bull Quality Payment Program Websitendash Learn about the program explore the measures and find educational tools and
resources
ndash httpsqppcmsgov
bull Quality Payment Program Service Centerndash Assist with questions
ndash qppCMShhsgov
ndash 1-866-288-8292
bull Innovations Centerrsquos Learning Systemsndash Provides specialized information on Advanced Alternative Payment Models (APMs)
ndash httpsinnovationcmsgov
Self Service Technical Support
41copy 2016 Telligen Inc
We are here to help
bull Experienced quality improvement advisors to provide expert technical assistance and support for participating providers across the state especially those in large practices health systems and ACO at no charge
bull Helps in meeting MIPS requirements through customized technical assistance including one-on-one assistance when needed
bull Offers monthly webinars and Coffee Talk open discussion
ndash Focused QPP topic
ndash Open discuss with Q amp A ndash dedicated to your questions
ndash 2nd Thursday every month
ndash 1100 am CST for 1 hour
Telligen QIN-QIO
42copy 2016 Telligen Inc
We are here to help
bull Provides monthly electronic newsletter with resources the latest research and healthcare news relevant to you
bull Provides the ldquoWeekly Digestrdquo with electronic email on upcoming learning opportunities
bull Offers a website with the latest resources and tools and post recorded webinars for future reference
bull Partner with Telligen QIO on practice improvement activitiesndash Participation with a QIO in a self-management training program (diabetes)
ndash Implementation of antibiotic stewardship program
ndash Implementation of a cardiac quality improvement program
Telligen QIN-QIO
43copy 2016 Telligen Inc
Primary Care amp Specialist Physicians
Model
bull Align with the criteria for innovative models set forth in the Quality Payment Program
bull Build the evidence base on practice transformation so that effective solutions can be scaled
bull Move clinician practices through 5 phases of transformation with support from
ndash Practice Transformation Networks (PTN)
ndash Support amp Alignment Networks (SAN)
ndash Quality Improvement Organizations and others
Transforming Clinical Practice Initiative
44copy 2016 Telligen Inc
Primary Care amp Specialist Physicians
Goalsbull Support clinicians in their practice transformation goals
bull Improve health outcomes for millions of Medicare Medicaid and CHIP beneficiaries
bull Build the evidence base on practice transformation so that effective solutions can be scale
bull Sustain efficient care delivery by reducing unnecessary testing and procedures
bull Reduce unnecessary hospitalizations
Contact Melissa Kapping kappingmihconlineorg
Transforming Clinical Practice Initiative
45copy 2016 Telligen Inc
bull SURS (Small Underserved and Rural Support) ndash Recently announced February 16
ndash 11 organizations awarded contracts
ndash Telligen provides assistance to Iowa Nebraska South Dakota and North Dakota
ndash No cost to practices
bull Solo or small practices (15 or fewer clinicians) ndash Rural health professional shortage areas (HPSA)
ndash Medically underserved areas (MUA)
bull Outreach guidance and direct technical assistancendash Practice readiness education health IT optimization
ndash Strategic planning assisting in the full transition to APM
Telligen QPP Resource Center
46
Contact Info
Michelle Brunsen Sr QI Advisor
515-453-8180
mbrunsentelligencom
Sandy Swallow Program Specialist
515-223-2105
Sandyswallowarea-dhcqisorg
Websites
bull wwwtelligenqinqiocom
bull wwwtelligenqppcom
bull wwwqppcmsgov
THANK YOU
This material was prepared by Telligen the Quality Payment Program Small
Underserved and Rural Support contractor for Iowa Nebraska North Dakota and
South Dakota under contract with the Centers for Medicare amp Medicaid Services
(CMS) an agency of the US Department of Health and Human Services The
contents presented do not necessarily reflect CMS policy HHSM-500-2017-00012C
This material was prepared by Telligen the Medicare Quality Innovation
Network Quality Improvement Organization under contract with the
Centers for Medicare amp Medicaid Services (CMS) an agency of the US
Department of Health and Human Services The contents presented do
not necessarily reflect CMS policy
26
MIPS Performance Categories for 2017
Focus on
Improvement Activities
(IA)Performance Category
27
2017 Requirements for IA Submissions
bull Maximum Points = 40 Pointsndash High weighted activities = 20 points
ndash Medium weighted activities = 10 points
bull Participation Thresholdsndash 90 days required
bull PCMH = Maximum Possible Points (40)
bull APM Participation = 50-100 of Maximum Possible Points at CMS discretion
bull Special Populations Points Doubledndash Practices with lt 15 providers
ndash Rural or HPSA practices
ndash Non-patient facing MIPS eligible clinicians
bull Reporting Options Qualified Registry EHR QCDR or CMS Web Interface (for groups 25 clinicians or more)
28
MIPS Performance Categories for 2017
Focus on
CostPerformance Category
29
2017 Requirements for Cost Category
bull Cost scoring weightndash 2017 0
ndash 2018 10
ndash 2019 30
bull CMS will calculate from claims over 40 episode-specific measures to account for differences among specialtiesndash Clinicians that deliver more efficient care achieve better
performance and score the highest points for cost measures
bull ldquoEpisodes of carerdquo roll up all costs of inpatient and outpatient care (including imaging laboratory drugs rehabilitation etc)
30
2017 Requirements for Cost Category
bull Expected Changes from the Value-Modifier Programndash Patients attributed at the TIN-NPI level
ndash Attributed to one PCP (group) to provider with highest volume by cost provides primary care
ndash Cost compared by decile ranking instead of + 1 standard deviation
ndash Risk adjustments for geographic payment rate beneficiary risk on socio-economic status and others
bull Episodes of Carendash Anticipate 10 for 2018 ndash most operational
ndash 40 being tracked
ndash Plan to develop patient condition groups and patient relationship categories
31
Initial Episode-based Cost Measures
bull Aorticmitral valve surgery
bull CABG
bull HipFemur Fracture or Dislocation Treatment
bull Cholecystectomy and common duct exploration
bull Colonoscopy and biopsy
bull TURP for BPH
bull Lens and cataract procedures
bull Hip replacement or repair
bull Knee arthroplasty
bull Mastectomy
CMS will still provide feedback on performance in these categories in 2017 but it will not affect your 2019 payments
32
Alternative Payment Model (APMs)
bull Create the adoption of payment models that move away from FFS and tie payment to value
bull Must be in an Advanced APM to participate
bull Must meet specific thresholds of ldquosubstantial portionsrdquo of revenue from ldquoapprovedrdquo alternate payment models
bull Receive 5 lump sum bonus for 2019 -2024
bull Receive higher fee schedule update for 2026 and beyond
Which Path is Right for You
33
What are Advanced APMs
Requirements to be an Advanced APM
bull Requires use of certified EHR technology
bull Base payment on quality measures comparable to those in MIPS
bull The practice must bear more than nominal financial risk or is in a Medical Home Model expanded under CMS Innovation Center authority
2017 Eligible Advanced APMs Include
Comprehensive ESRD Care Model
Comprehensive Primary Care Plus (CPC+)
Medicare Shared SavingsProgram Track 2 and 3
Next Generation ACO Model
Oncology Care Model Two-Sided Risk Arrangement
34
APM Scoring Standards
Category Reporting Requirements Category Scoring CategoryWeight
Quality (PQRS) The ACO submits Medicare Shared Savings Program quality measures on behalf of ACO participant TINs and their MIPS eligible clinicians via the CMS Web Interface Data is submitted on the first 248 consecutively ranked and assigned Medicare beneficiaries The ACO submits this information once for purposes of both the Medicare Shared Savings Program and MIPS
MIPS benchmarks will be used to assign one score at the APM Entity Group (ACO) level In other words all MIPS eligible clinicians on the certified ACO ProviderSupplier list will receive the same score (unless they are excluded from MIPS) Note that the performance of all clinicians in the ACO will contribute to this score even if they are not subject to MIPS payment adjustments
50
Cost (VM) MIPS eligible clinicians participating in the MSSP will not be assessed on cost No reporting necessary
NA 0
Improvement Activities (new)
No additional reporting necessary Full credit for the APM Entity group by virtue of MSSP participation
20
Advancing Care Information (MU)
ACO participant TINs will submit directly to MIPS via a MIPS data submission mechanism
ACO participant TIN scores will be aggregated as a weighted average to yield one score for the APM Entity group
30
35
Quality Payment Program Paths
Subsets of MIPS and APM Paths
Eligible Clinician
MIPSAPM
MIPS-APM Advanced
APM
36
MIPS-APM Reporting Option
Requirements to be considered a MIPS-APM includebull Participate in the APM under an
agreement with CMS
bull Include one or more MIPS eligible clinicians on a Participation List
ndash On at least one of the snapshot dates
(Mar 31 June 30 or Aug 31)
bull Bases payment incentives on performance (either at the APM Entity or eligible clinician level) on costutilization and quality
2017 Eligible MIPS-APMs
CEC Model CPC+ Model MSSP Track 12 amp 3 Next Gen ACO OCM All arrangements
Note APM scoring standard applies to APMs that meet these criteria
37
MIPS-APM Benefits
bull Streamlined quality reporting
bull Still eligible for shared savings payment
ndash Financial risk payments do not impact eligibility for positive MIPS payment adjustments
bull Favorable scoring under lsquoAPM Scoring Standardrsquo
ndash ACO participants receive full credit in the Improvement Activities Category by virtue of MSSP participation
ndash ACO participants are not subject to the Cost performance category of MIPS
ndash Potential lsquoliftingrsquo of final MIPS score by being assessed at the ACO level
38
We Are All Part of the Quality Payment Program
Creating an Identity Toward a Common Goal
bull CMS
bull Clinicians
bull Patients
bull Our Care Teams
bull Service Providers
We all share a similar goal to improve patient outcomes
39
Quality Payment Program
Where Can Eligible Clinicians Go For Help
40copy 2016 Telligen Inc
All Eligible Clinicians are supported by
bull Quality Payment Program Websitendash Learn about the program explore the measures and find educational tools and
resources
ndash httpsqppcmsgov
bull Quality Payment Program Service Centerndash Assist with questions
ndash qppCMShhsgov
ndash 1-866-288-8292
bull Innovations Centerrsquos Learning Systemsndash Provides specialized information on Advanced Alternative Payment Models (APMs)
ndash httpsinnovationcmsgov
Self Service Technical Support
41copy 2016 Telligen Inc
We are here to help
bull Experienced quality improvement advisors to provide expert technical assistance and support for participating providers across the state especially those in large practices health systems and ACO at no charge
bull Helps in meeting MIPS requirements through customized technical assistance including one-on-one assistance when needed
bull Offers monthly webinars and Coffee Talk open discussion
ndash Focused QPP topic
ndash Open discuss with Q amp A ndash dedicated to your questions
ndash 2nd Thursday every month
ndash 1100 am CST for 1 hour
Telligen QIN-QIO
42copy 2016 Telligen Inc
We are here to help
bull Provides monthly electronic newsletter with resources the latest research and healthcare news relevant to you
bull Provides the ldquoWeekly Digestrdquo with electronic email on upcoming learning opportunities
bull Offers a website with the latest resources and tools and post recorded webinars for future reference
bull Partner with Telligen QIO on practice improvement activitiesndash Participation with a QIO in a self-management training program (diabetes)
ndash Implementation of antibiotic stewardship program
ndash Implementation of a cardiac quality improvement program
Telligen QIN-QIO
43copy 2016 Telligen Inc
Primary Care amp Specialist Physicians
Model
bull Align with the criteria for innovative models set forth in the Quality Payment Program
bull Build the evidence base on practice transformation so that effective solutions can be scaled
bull Move clinician practices through 5 phases of transformation with support from
ndash Practice Transformation Networks (PTN)
ndash Support amp Alignment Networks (SAN)
ndash Quality Improvement Organizations and others
Transforming Clinical Practice Initiative
44copy 2016 Telligen Inc
Primary Care amp Specialist Physicians
Goalsbull Support clinicians in their practice transformation goals
bull Improve health outcomes for millions of Medicare Medicaid and CHIP beneficiaries
bull Build the evidence base on practice transformation so that effective solutions can be scale
bull Sustain efficient care delivery by reducing unnecessary testing and procedures
bull Reduce unnecessary hospitalizations
Contact Melissa Kapping kappingmihconlineorg
Transforming Clinical Practice Initiative
45copy 2016 Telligen Inc
bull SURS (Small Underserved and Rural Support) ndash Recently announced February 16
ndash 11 organizations awarded contracts
ndash Telligen provides assistance to Iowa Nebraska South Dakota and North Dakota
ndash No cost to practices
bull Solo or small practices (15 or fewer clinicians) ndash Rural health professional shortage areas (HPSA)
ndash Medically underserved areas (MUA)
bull Outreach guidance and direct technical assistancendash Practice readiness education health IT optimization
ndash Strategic planning assisting in the full transition to APM
Telligen QPP Resource Center
46
Contact Info
Michelle Brunsen Sr QI Advisor
515-453-8180
mbrunsentelligencom
Sandy Swallow Program Specialist
515-223-2105
Sandyswallowarea-dhcqisorg
Websites
bull wwwtelligenqinqiocom
bull wwwtelligenqppcom
bull wwwqppcmsgov
THANK YOU
This material was prepared by Telligen the Quality Payment Program Small
Underserved and Rural Support contractor for Iowa Nebraska North Dakota and
South Dakota under contract with the Centers for Medicare amp Medicaid Services
(CMS) an agency of the US Department of Health and Human Services The
contents presented do not necessarily reflect CMS policy HHSM-500-2017-00012C
This material was prepared by Telligen the Medicare Quality Innovation
Network Quality Improvement Organization under contract with the
Centers for Medicare amp Medicaid Services (CMS) an agency of the US
Department of Health and Human Services The contents presented do
not necessarily reflect CMS policy
27
2017 Requirements for IA Submissions
bull Maximum Points = 40 Pointsndash High weighted activities = 20 points
ndash Medium weighted activities = 10 points
bull Participation Thresholdsndash 90 days required
bull PCMH = Maximum Possible Points (40)
bull APM Participation = 50-100 of Maximum Possible Points at CMS discretion
bull Special Populations Points Doubledndash Practices with lt 15 providers
ndash Rural or HPSA practices
ndash Non-patient facing MIPS eligible clinicians
bull Reporting Options Qualified Registry EHR QCDR or CMS Web Interface (for groups 25 clinicians or more)
28
MIPS Performance Categories for 2017
Focus on
CostPerformance Category
29
2017 Requirements for Cost Category
bull Cost scoring weightndash 2017 0
ndash 2018 10
ndash 2019 30
bull CMS will calculate from claims over 40 episode-specific measures to account for differences among specialtiesndash Clinicians that deliver more efficient care achieve better
performance and score the highest points for cost measures
bull ldquoEpisodes of carerdquo roll up all costs of inpatient and outpatient care (including imaging laboratory drugs rehabilitation etc)
30
2017 Requirements for Cost Category
bull Expected Changes from the Value-Modifier Programndash Patients attributed at the TIN-NPI level
ndash Attributed to one PCP (group) to provider with highest volume by cost provides primary care
ndash Cost compared by decile ranking instead of + 1 standard deviation
ndash Risk adjustments for geographic payment rate beneficiary risk on socio-economic status and others
bull Episodes of Carendash Anticipate 10 for 2018 ndash most operational
ndash 40 being tracked
ndash Plan to develop patient condition groups and patient relationship categories
31
Initial Episode-based Cost Measures
bull Aorticmitral valve surgery
bull CABG
bull HipFemur Fracture or Dislocation Treatment
bull Cholecystectomy and common duct exploration
bull Colonoscopy and biopsy
bull TURP for BPH
bull Lens and cataract procedures
bull Hip replacement or repair
bull Knee arthroplasty
bull Mastectomy
CMS will still provide feedback on performance in these categories in 2017 but it will not affect your 2019 payments
32
Alternative Payment Model (APMs)
bull Create the adoption of payment models that move away from FFS and tie payment to value
bull Must be in an Advanced APM to participate
bull Must meet specific thresholds of ldquosubstantial portionsrdquo of revenue from ldquoapprovedrdquo alternate payment models
bull Receive 5 lump sum bonus for 2019 -2024
bull Receive higher fee schedule update for 2026 and beyond
Which Path is Right for You
33
What are Advanced APMs
Requirements to be an Advanced APM
bull Requires use of certified EHR technology
bull Base payment on quality measures comparable to those in MIPS
bull The practice must bear more than nominal financial risk or is in a Medical Home Model expanded under CMS Innovation Center authority
2017 Eligible Advanced APMs Include
Comprehensive ESRD Care Model
Comprehensive Primary Care Plus (CPC+)
Medicare Shared SavingsProgram Track 2 and 3
Next Generation ACO Model
Oncology Care Model Two-Sided Risk Arrangement
34
APM Scoring Standards
Category Reporting Requirements Category Scoring CategoryWeight
Quality (PQRS) The ACO submits Medicare Shared Savings Program quality measures on behalf of ACO participant TINs and their MIPS eligible clinicians via the CMS Web Interface Data is submitted on the first 248 consecutively ranked and assigned Medicare beneficiaries The ACO submits this information once for purposes of both the Medicare Shared Savings Program and MIPS
MIPS benchmarks will be used to assign one score at the APM Entity Group (ACO) level In other words all MIPS eligible clinicians on the certified ACO ProviderSupplier list will receive the same score (unless they are excluded from MIPS) Note that the performance of all clinicians in the ACO will contribute to this score even if they are not subject to MIPS payment adjustments
50
Cost (VM) MIPS eligible clinicians participating in the MSSP will not be assessed on cost No reporting necessary
NA 0
Improvement Activities (new)
No additional reporting necessary Full credit for the APM Entity group by virtue of MSSP participation
20
Advancing Care Information (MU)
ACO participant TINs will submit directly to MIPS via a MIPS data submission mechanism
ACO participant TIN scores will be aggregated as a weighted average to yield one score for the APM Entity group
30
35
Quality Payment Program Paths
Subsets of MIPS and APM Paths
Eligible Clinician
MIPSAPM
MIPS-APM Advanced
APM
36
MIPS-APM Reporting Option
Requirements to be considered a MIPS-APM includebull Participate in the APM under an
agreement with CMS
bull Include one or more MIPS eligible clinicians on a Participation List
ndash On at least one of the snapshot dates
(Mar 31 June 30 or Aug 31)
bull Bases payment incentives on performance (either at the APM Entity or eligible clinician level) on costutilization and quality
2017 Eligible MIPS-APMs
CEC Model CPC+ Model MSSP Track 12 amp 3 Next Gen ACO OCM All arrangements
Note APM scoring standard applies to APMs that meet these criteria
37
MIPS-APM Benefits
bull Streamlined quality reporting
bull Still eligible for shared savings payment
ndash Financial risk payments do not impact eligibility for positive MIPS payment adjustments
bull Favorable scoring under lsquoAPM Scoring Standardrsquo
ndash ACO participants receive full credit in the Improvement Activities Category by virtue of MSSP participation
ndash ACO participants are not subject to the Cost performance category of MIPS
ndash Potential lsquoliftingrsquo of final MIPS score by being assessed at the ACO level
38
We Are All Part of the Quality Payment Program
Creating an Identity Toward a Common Goal
bull CMS
bull Clinicians
bull Patients
bull Our Care Teams
bull Service Providers
We all share a similar goal to improve patient outcomes
39
Quality Payment Program
Where Can Eligible Clinicians Go For Help
40copy 2016 Telligen Inc
All Eligible Clinicians are supported by
bull Quality Payment Program Websitendash Learn about the program explore the measures and find educational tools and
resources
ndash httpsqppcmsgov
bull Quality Payment Program Service Centerndash Assist with questions
ndash qppCMShhsgov
ndash 1-866-288-8292
bull Innovations Centerrsquos Learning Systemsndash Provides specialized information on Advanced Alternative Payment Models (APMs)
ndash httpsinnovationcmsgov
Self Service Technical Support
41copy 2016 Telligen Inc
We are here to help
bull Experienced quality improvement advisors to provide expert technical assistance and support for participating providers across the state especially those in large practices health systems and ACO at no charge
bull Helps in meeting MIPS requirements through customized technical assistance including one-on-one assistance when needed
bull Offers monthly webinars and Coffee Talk open discussion
ndash Focused QPP topic
ndash Open discuss with Q amp A ndash dedicated to your questions
ndash 2nd Thursday every month
ndash 1100 am CST for 1 hour
Telligen QIN-QIO
42copy 2016 Telligen Inc
We are here to help
bull Provides monthly electronic newsletter with resources the latest research and healthcare news relevant to you
bull Provides the ldquoWeekly Digestrdquo with electronic email on upcoming learning opportunities
bull Offers a website with the latest resources and tools and post recorded webinars for future reference
bull Partner with Telligen QIO on practice improvement activitiesndash Participation with a QIO in a self-management training program (diabetes)
ndash Implementation of antibiotic stewardship program
ndash Implementation of a cardiac quality improvement program
Telligen QIN-QIO
43copy 2016 Telligen Inc
Primary Care amp Specialist Physicians
Model
bull Align with the criteria for innovative models set forth in the Quality Payment Program
bull Build the evidence base on practice transformation so that effective solutions can be scaled
bull Move clinician practices through 5 phases of transformation with support from
ndash Practice Transformation Networks (PTN)
ndash Support amp Alignment Networks (SAN)
ndash Quality Improvement Organizations and others
Transforming Clinical Practice Initiative
44copy 2016 Telligen Inc
Primary Care amp Specialist Physicians
Goalsbull Support clinicians in their practice transformation goals
bull Improve health outcomes for millions of Medicare Medicaid and CHIP beneficiaries
bull Build the evidence base on practice transformation so that effective solutions can be scale
bull Sustain efficient care delivery by reducing unnecessary testing and procedures
bull Reduce unnecessary hospitalizations
Contact Melissa Kapping kappingmihconlineorg
Transforming Clinical Practice Initiative
45copy 2016 Telligen Inc
bull SURS (Small Underserved and Rural Support) ndash Recently announced February 16
ndash 11 organizations awarded contracts
ndash Telligen provides assistance to Iowa Nebraska South Dakota and North Dakota
ndash No cost to practices
bull Solo or small practices (15 or fewer clinicians) ndash Rural health professional shortage areas (HPSA)
ndash Medically underserved areas (MUA)
bull Outreach guidance and direct technical assistancendash Practice readiness education health IT optimization
ndash Strategic planning assisting in the full transition to APM
Telligen QPP Resource Center
46
Contact Info
Michelle Brunsen Sr QI Advisor
515-453-8180
mbrunsentelligencom
Sandy Swallow Program Specialist
515-223-2105
Sandyswallowarea-dhcqisorg
Websites
bull wwwtelligenqinqiocom
bull wwwtelligenqppcom
bull wwwqppcmsgov
THANK YOU
This material was prepared by Telligen the Quality Payment Program Small
Underserved and Rural Support contractor for Iowa Nebraska North Dakota and
South Dakota under contract with the Centers for Medicare amp Medicaid Services
(CMS) an agency of the US Department of Health and Human Services The
contents presented do not necessarily reflect CMS policy HHSM-500-2017-00012C
This material was prepared by Telligen the Medicare Quality Innovation
Network Quality Improvement Organization under contract with the
Centers for Medicare amp Medicaid Services (CMS) an agency of the US
Department of Health and Human Services The contents presented do
not necessarily reflect CMS policy
28
MIPS Performance Categories for 2017
Focus on
CostPerformance Category
29
2017 Requirements for Cost Category
bull Cost scoring weightndash 2017 0
ndash 2018 10
ndash 2019 30
bull CMS will calculate from claims over 40 episode-specific measures to account for differences among specialtiesndash Clinicians that deliver more efficient care achieve better
performance and score the highest points for cost measures
bull ldquoEpisodes of carerdquo roll up all costs of inpatient and outpatient care (including imaging laboratory drugs rehabilitation etc)
30
2017 Requirements for Cost Category
bull Expected Changes from the Value-Modifier Programndash Patients attributed at the TIN-NPI level
ndash Attributed to one PCP (group) to provider with highest volume by cost provides primary care
ndash Cost compared by decile ranking instead of + 1 standard deviation
ndash Risk adjustments for geographic payment rate beneficiary risk on socio-economic status and others
bull Episodes of Carendash Anticipate 10 for 2018 ndash most operational
ndash 40 being tracked
ndash Plan to develop patient condition groups and patient relationship categories
31
Initial Episode-based Cost Measures
bull Aorticmitral valve surgery
bull CABG
bull HipFemur Fracture or Dislocation Treatment
bull Cholecystectomy and common duct exploration
bull Colonoscopy and biopsy
bull TURP for BPH
bull Lens and cataract procedures
bull Hip replacement or repair
bull Knee arthroplasty
bull Mastectomy
CMS will still provide feedback on performance in these categories in 2017 but it will not affect your 2019 payments
32
Alternative Payment Model (APMs)
bull Create the adoption of payment models that move away from FFS and tie payment to value
bull Must be in an Advanced APM to participate
bull Must meet specific thresholds of ldquosubstantial portionsrdquo of revenue from ldquoapprovedrdquo alternate payment models
bull Receive 5 lump sum bonus for 2019 -2024
bull Receive higher fee schedule update for 2026 and beyond
Which Path is Right for You
33
What are Advanced APMs
Requirements to be an Advanced APM
bull Requires use of certified EHR technology
bull Base payment on quality measures comparable to those in MIPS
bull The practice must bear more than nominal financial risk or is in a Medical Home Model expanded under CMS Innovation Center authority
2017 Eligible Advanced APMs Include
Comprehensive ESRD Care Model
Comprehensive Primary Care Plus (CPC+)
Medicare Shared SavingsProgram Track 2 and 3
Next Generation ACO Model
Oncology Care Model Two-Sided Risk Arrangement
34
APM Scoring Standards
Category Reporting Requirements Category Scoring CategoryWeight
Quality (PQRS) The ACO submits Medicare Shared Savings Program quality measures on behalf of ACO participant TINs and their MIPS eligible clinicians via the CMS Web Interface Data is submitted on the first 248 consecutively ranked and assigned Medicare beneficiaries The ACO submits this information once for purposes of both the Medicare Shared Savings Program and MIPS
MIPS benchmarks will be used to assign one score at the APM Entity Group (ACO) level In other words all MIPS eligible clinicians on the certified ACO ProviderSupplier list will receive the same score (unless they are excluded from MIPS) Note that the performance of all clinicians in the ACO will contribute to this score even if they are not subject to MIPS payment adjustments
50
Cost (VM) MIPS eligible clinicians participating in the MSSP will not be assessed on cost No reporting necessary
NA 0
Improvement Activities (new)
No additional reporting necessary Full credit for the APM Entity group by virtue of MSSP participation
20
Advancing Care Information (MU)
ACO participant TINs will submit directly to MIPS via a MIPS data submission mechanism
ACO participant TIN scores will be aggregated as a weighted average to yield one score for the APM Entity group
30
35
Quality Payment Program Paths
Subsets of MIPS and APM Paths
Eligible Clinician
MIPSAPM
MIPS-APM Advanced
APM
36
MIPS-APM Reporting Option
Requirements to be considered a MIPS-APM includebull Participate in the APM under an
agreement with CMS
bull Include one or more MIPS eligible clinicians on a Participation List
ndash On at least one of the snapshot dates
(Mar 31 June 30 or Aug 31)
bull Bases payment incentives on performance (either at the APM Entity or eligible clinician level) on costutilization and quality
2017 Eligible MIPS-APMs
CEC Model CPC+ Model MSSP Track 12 amp 3 Next Gen ACO OCM All arrangements
Note APM scoring standard applies to APMs that meet these criteria
37
MIPS-APM Benefits
bull Streamlined quality reporting
bull Still eligible for shared savings payment
ndash Financial risk payments do not impact eligibility for positive MIPS payment adjustments
bull Favorable scoring under lsquoAPM Scoring Standardrsquo
ndash ACO participants receive full credit in the Improvement Activities Category by virtue of MSSP participation
ndash ACO participants are not subject to the Cost performance category of MIPS
ndash Potential lsquoliftingrsquo of final MIPS score by being assessed at the ACO level
38
We Are All Part of the Quality Payment Program
Creating an Identity Toward a Common Goal
bull CMS
bull Clinicians
bull Patients
bull Our Care Teams
bull Service Providers
We all share a similar goal to improve patient outcomes
39
Quality Payment Program
Where Can Eligible Clinicians Go For Help
40copy 2016 Telligen Inc
All Eligible Clinicians are supported by
bull Quality Payment Program Websitendash Learn about the program explore the measures and find educational tools and
resources
ndash httpsqppcmsgov
bull Quality Payment Program Service Centerndash Assist with questions
ndash qppCMShhsgov
ndash 1-866-288-8292
bull Innovations Centerrsquos Learning Systemsndash Provides specialized information on Advanced Alternative Payment Models (APMs)
ndash httpsinnovationcmsgov
Self Service Technical Support
41copy 2016 Telligen Inc
We are here to help
bull Experienced quality improvement advisors to provide expert technical assistance and support for participating providers across the state especially those in large practices health systems and ACO at no charge
bull Helps in meeting MIPS requirements through customized technical assistance including one-on-one assistance when needed
bull Offers monthly webinars and Coffee Talk open discussion
ndash Focused QPP topic
ndash Open discuss with Q amp A ndash dedicated to your questions
ndash 2nd Thursday every month
ndash 1100 am CST for 1 hour
Telligen QIN-QIO
42copy 2016 Telligen Inc
We are here to help
bull Provides monthly electronic newsletter with resources the latest research and healthcare news relevant to you
bull Provides the ldquoWeekly Digestrdquo with electronic email on upcoming learning opportunities
bull Offers a website with the latest resources and tools and post recorded webinars for future reference
bull Partner with Telligen QIO on practice improvement activitiesndash Participation with a QIO in a self-management training program (diabetes)
ndash Implementation of antibiotic stewardship program
ndash Implementation of a cardiac quality improvement program
Telligen QIN-QIO
43copy 2016 Telligen Inc
Primary Care amp Specialist Physicians
Model
bull Align with the criteria for innovative models set forth in the Quality Payment Program
bull Build the evidence base on practice transformation so that effective solutions can be scaled
bull Move clinician practices through 5 phases of transformation with support from
ndash Practice Transformation Networks (PTN)
ndash Support amp Alignment Networks (SAN)
ndash Quality Improvement Organizations and others
Transforming Clinical Practice Initiative
44copy 2016 Telligen Inc
Primary Care amp Specialist Physicians
Goalsbull Support clinicians in their practice transformation goals
bull Improve health outcomes for millions of Medicare Medicaid and CHIP beneficiaries
bull Build the evidence base on practice transformation so that effective solutions can be scale
bull Sustain efficient care delivery by reducing unnecessary testing and procedures
bull Reduce unnecessary hospitalizations
Contact Melissa Kapping kappingmihconlineorg
Transforming Clinical Practice Initiative
45copy 2016 Telligen Inc
bull SURS (Small Underserved and Rural Support) ndash Recently announced February 16
ndash 11 organizations awarded contracts
ndash Telligen provides assistance to Iowa Nebraska South Dakota and North Dakota
ndash No cost to practices
bull Solo or small practices (15 or fewer clinicians) ndash Rural health professional shortage areas (HPSA)
ndash Medically underserved areas (MUA)
bull Outreach guidance and direct technical assistancendash Practice readiness education health IT optimization
ndash Strategic planning assisting in the full transition to APM
Telligen QPP Resource Center
46
Contact Info
Michelle Brunsen Sr QI Advisor
515-453-8180
mbrunsentelligencom
Sandy Swallow Program Specialist
515-223-2105
Sandyswallowarea-dhcqisorg
Websites
bull wwwtelligenqinqiocom
bull wwwtelligenqppcom
bull wwwqppcmsgov
THANK YOU
This material was prepared by Telligen the Quality Payment Program Small
Underserved and Rural Support contractor for Iowa Nebraska North Dakota and
South Dakota under contract with the Centers for Medicare amp Medicaid Services
(CMS) an agency of the US Department of Health and Human Services The
contents presented do not necessarily reflect CMS policy HHSM-500-2017-00012C
This material was prepared by Telligen the Medicare Quality Innovation
Network Quality Improvement Organization under contract with the
Centers for Medicare amp Medicaid Services (CMS) an agency of the US
Department of Health and Human Services The contents presented do
not necessarily reflect CMS policy
29
2017 Requirements for Cost Category
bull Cost scoring weightndash 2017 0
ndash 2018 10
ndash 2019 30
bull CMS will calculate from claims over 40 episode-specific measures to account for differences among specialtiesndash Clinicians that deliver more efficient care achieve better
performance and score the highest points for cost measures
bull ldquoEpisodes of carerdquo roll up all costs of inpatient and outpatient care (including imaging laboratory drugs rehabilitation etc)
30
2017 Requirements for Cost Category
bull Expected Changes from the Value-Modifier Programndash Patients attributed at the TIN-NPI level
ndash Attributed to one PCP (group) to provider with highest volume by cost provides primary care
ndash Cost compared by decile ranking instead of + 1 standard deviation
ndash Risk adjustments for geographic payment rate beneficiary risk on socio-economic status and others
bull Episodes of Carendash Anticipate 10 for 2018 ndash most operational
ndash 40 being tracked
ndash Plan to develop patient condition groups and patient relationship categories
31
Initial Episode-based Cost Measures
bull Aorticmitral valve surgery
bull CABG
bull HipFemur Fracture or Dislocation Treatment
bull Cholecystectomy and common duct exploration
bull Colonoscopy and biopsy
bull TURP for BPH
bull Lens and cataract procedures
bull Hip replacement or repair
bull Knee arthroplasty
bull Mastectomy
CMS will still provide feedback on performance in these categories in 2017 but it will not affect your 2019 payments
32
Alternative Payment Model (APMs)
bull Create the adoption of payment models that move away from FFS and tie payment to value
bull Must be in an Advanced APM to participate
bull Must meet specific thresholds of ldquosubstantial portionsrdquo of revenue from ldquoapprovedrdquo alternate payment models
bull Receive 5 lump sum bonus for 2019 -2024
bull Receive higher fee schedule update for 2026 and beyond
Which Path is Right for You
33
What are Advanced APMs
Requirements to be an Advanced APM
bull Requires use of certified EHR technology
bull Base payment on quality measures comparable to those in MIPS
bull The practice must bear more than nominal financial risk or is in a Medical Home Model expanded under CMS Innovation Center authority
2017 Eligible Advanced APMs Include
Comprehensive ESRD Care Model
Comprehensive Primary Care Plus (CPC+)
Medicare Shared SavingsProgram Track 2 and 3
Next Generation ACO Model
Oncology Care Model Two-Sided Risk Arrangement
34
APM Scoring Standards
Category Reporting Requirements Category Scoring CategoryWeight
Quality (PQRS) The ACO submits Medicare Shared Savings Program quality measures on behalf of ACO participant TINs and their MIPS eligible clinicians via the CMS Web Interface Data is submitted on the first 248 consecutively ranked and assigned Medicare beneficiaries The ACO submits this information once for purposes of both the Medicare Shared Savings Program and MIPS
MIPS benchmarks will be used to assign one score at the APM Entity Group (ACO) level In other words all MIPS eligible clinicians on the certified ACO ProviderSupplier list will receive the same score (unless they are excluded from MIPS) Note that the performance of all clinicians in the ACO will contribute to this score even if they are not subject to MIPS payment adjustments
50
Cost (VM) MIPS eligible clinicians participating in the MSSP will not be assessed on cost No reporting necessary
NA 0
Improvement Activities (new)
No additional reporting necessary Full credit for the APM Entity group by virtue of MSSP participation
20
Advancing Care Information (MU)
ACO participant TINs will submit directly to MIPS via a MIPS data submission mechanism
ACO participant TIN scores will be aggregated as a weighted average to yield one score for the APM Entity group
30
35
Quality Payment Program Paths
Subsets of MIPS and APM Paths
Eligible Clinician
MIPSAPM
MIPS-APM Advanced
APM
36
MIPS-APM Reporting Option
Requirements to be considered a MIPS-APM includebull Participate in the APM under an
agreement with CMS
bull Include one or more MIPS eligible clinicians on a Participation List
ndash On at least one of the snapshot dates
(Mar 31 June 30 or Aug 31)
bull Bases payment incentives on performance (either at the APM Entity or eligible clinician level) on costutilization and quality
2017 Eligible MIPS-APMs
CEC Model CPC+ Model MSSP Track 12 amp 3 Next Gen ACO OCM All arrangements
Note APM scoring standard applies to APMs that meet these criteria
37
MIPS-APM Benefits
bull Streamlined quality reporting
bull Still eligible for shared savings payment
ndash Financial risk payments do not impact eligibility for positive MIPS payment adjustments
bull Favorable scoring under lsquoAPM Scoring Standardrsquo
ndash ACO participants receive full credit in the Improvement Activities Category by virtue of MSSP participation
ndash ACO participants are not subject to the Cost performance category of MIPS
ndash Potential lsquoliftingrsquo of final MIPS score by being assessed at the ACO level
38
We Are All Part of the Quality Payment Program
Creating an Identity Toward a Common Goal
bull CMS
bull Clinicians
bull Patients
bull Our Care Teams
bull Service Providers
We all share a similar goal to improve patient outcomes
39
Quality Payment Program
Where Can Eligible Clinicians Go For Help
40copy 2016 Telligen Inc
All Eligible Clinicians are supported by
bull Quality Payment Program Websitendash Learn about the program explore the measures and find educational tools and
resources
ndash httpsqppcmsgov
bull Quality Payment Program Service Centerndash Assist with questions
ndash qppCMShhsgov
ndash 1-866-288-8292
bull Innovations Centerrsquos Learning Systemsndash Provides specialized information on Advanced Alternative Payment Models (APMs)
ndash httpsinnovationcmsgov
Self Service Technical Support
41copy 2016 Telligen Inc
We are here to help
bull Experienced quality improvement advisors to provide expert technical assistance and support for participating providers across the state especially those in large practices health systems and ACO at no charge
bull Helps in meeting MIPS requirements through customized technical assistance including one-on-one assistance when needed
bull Offers monthly webinars and Coffee Talk open discussion
ndash Focused QPP topic
ndash Open discuss with Q amp A ndash dedicated to your questions
ndash 2nd Thursday every month
ndash 1100 am CST for 1 hour
Telligen QIN-QIO
42copy 2016 Telligen Inc
We are here to help
bull Provides monthly electronic newsletter with resources the latest research and healthcare news relevant to you
bull Provides the ldquoWeekly Digestrdquo with electronic email on upcoming learning opportunities
bull Offers a website with the latest resources and tools and post recorded webinars for future reference
bull Partner with Telligen QIO on practice improvement activitiesndash Participation with a QIO in a self-management training program (diabetes)
ndash Implementation of antibiotic stewardship program
ndash Implementation of a cardiac quality improvement program
Telligen QIN-QIO
43copy 2016 Telligen Inc
Primary Care amp Specialist Physicians
Model
bull Align with the criteria for innovative models set forth in the Quality Payment Program
bull Build the evidence base on practice transformation so that effective solutions can be scaled
bull Move clinician practices through 5 phases of transformation with support from
ndash Practice Transformation Networks (PTN)
ndash Support amp Alignment Networks (SAN)
ndash Quality Improvement Organizations and others
Transforming Clinical Practice Initiative
44copy 2016 Telligen Inc
Primary Care amp Specialist Physicians
Goalsbull Support clinicians in their practice transformation goals
bull Improve health outcomes for millions of Medicare Medicaid and CHIP beneficiaries
bull Build the evidence base on practice transformation so that effective solutions can be scale
bull Sustain efficient care delivery by reducing unnecessary testing and procedures
bull Reduce unnecessary hospitalizations
Contact Melissa Kapping kappingmihconlineorg
Transforming Clinical Practice Initiative
45copy 2016 Telligen Inc
bull SURS (Small Underserved and Rural Support) ndash Recently announced February 16
ndash 11 organizations awarded contracts
ndash Telligen provides assistance to Iowa Nebraska South Dakota and North Dakota
ndash No cost to practices
bull Solo or small practices (15 or fewer clinicians) ndash Rural health professional shortage areas (HPSA)
ndash Medically underserved areas (MUA)
bull Outreach guidance and direct technical assistancendash Practice readiness education health IT optimization
ndash Strategic planning assisting in the full transition to APM
Telligen QPP Resource Center
46
Contact Info
Michelle Brunsen Sr QI Advisor
515-453-8180
mbrunsentelligencom
Sandy Swallow Program Specialist
515-223-2105
Sandyswallowarea-dhcqisorg
Websites
bull wwwtelligenqinqiocom
bull wwwtelligenqppcom
bull wwwqppcmsgov
THANK YOU
This material was prepared by Telligen the Quality Payment Program Small
Underserved and Rural Support contractor for Iowa Nebraska North Dakota and
South Dakota under contract with the Centers for Medicare amp Medicaid Services
(CMS) an agency of the US Department of Health and Human Services The
contents presented do not necessarily reflect CMS policy HHSM-500-2017-00012C
This material was prepared by Telligen the Medicare Quality Innovation
Network Quality Improvement Organization under contract with the
Centers for Medicare amp Medicaid Services (CMS) an agency of the US
Department of Health and Human Services The contents presented do
not necessarily reflect CMS policy
30
2017 Requirements for Cost Category
bull Expected Changes from the Value-Modifier Programndash Patients attributed at the TIN-NPI level
ndash Attributed to one PCP (group) to provider with highest volume by cost provides primary care
ndash Cost compared by decile ranking instead of + 1 standard deviation
ndash Risk adjustments for geographic payment rate beneficiary risk on socio-economic status and others
bull Episodes of Carendash Anticipate 10 for 2018 ndash most operational
ndash 40 being tracked
ndash Plan to develop patient condition groups and patient relationship categories
31
Initial Episode-based Cost Measures
bull Aorticmitral valve surgery
bull CABG
bull HipFemur Fracture or Dislocation Treatment
bull Cholecystectomy and common duct exploration
bull Colonoscopy and biopsy
bull TURP for BPH
bull Lens and cataract procedures
bull Hip replacement or repair
bull Knee arthroplasty
bull Mastectomy
CMS will still provide feedback on performance in these categories in 2017 but it will not affect your 2019 payments
32
Alternative Payment Model (APMs)
bull Create the adoption of payment models that move away from FFS and tie payment to value
bull Must be in an Advanced APM to participate
bull Must meet specific thresholds of ldquosubstantial portionsrdquo of revenue from ldquoapprovedrdquo alternate payment models
bull Receive 5 lump sum bonus for 2019 -2024
bull Receive higher fee schedule update for 2026 and beyond
Which Path is Right for You
33
What are Advanced APMs
Requirements to be an Advanced APM
bull Requires use of certified EHR technology
bull Base payment on quality measures comparable to those in MIPS
bull The practice must bear more than nominal financial risk or is in a Medical Home Model expanded under CMS Innovation Center authority
2017 Eligible Advanced APMs Include
Comprehensive ESRD Care Model
Comprehensive Primary Care Plus (CPC+)
Medicare Shared SavingsProgram Track 2 and 3
Next Generation ACO Model
Oncology Care Model Two-Sided Risk Arrangement
34
APM Scoring Standards
Category Reporting Requirements Category Scoring CategoryWeight
Quality (PQRS) The ACO submits Medicare Shared Savings Program quality measures on behalf of ACO participant TINs and their MIPS eligible clinicians via the CMS Web Interface Data is submitted on the first 248 consecutively ranked and assigned Medicare beneficiaries The ACO submits this information once for purposes of both the Medicare Shared Savings Program and MIPS
MIPS benchmarks will be used to assign one score at the APM Entity Group (ACO) level In other words all MIPS eligible clinicians on the certified ACO ProviderSupplier list will receive the same score (unless they are excluded from MIPS) Note that the performance of all clinicians in the ACO will contribute to this score even if they are not subject to MIPS payment adjustments
50
Cost (VM) MIPS eligible clinicians participating in the MSSP will not be assessed on cost No reporting necessary
NA 0
Improvement Activities (new)
No additional reporting necessary Full credit for the APM Entity group by virtue of MSSP participation
20
Advancing Care Information (MU)
ACO participant TINs will submit directly to MIPS via a MIPS data submission mechanism
ACO participant TIN scores will be aggregated as a weighted average to yield one score for the APM Entity group
30
35
Quality Payment Program Paths
Subsets of MIPS and APM Paths
Eligible Clinician
MIPSAPM
MIPS-APM Advanced
APM
36
MIPS-APM Reporting Option
Requirements to be considered a MIPS-APM includebull Participate in the APM under an
agreement with CMS
bull Include one or more MIPS eligible clinicians on a Participation List
ndash On at least one of the snapshot dates
(Mar 31 June 30 or Aug 31)
bull Bases payment incentives on performance (either at the APM Entity or eligible clinician level) on costutilization and quality
2017 Eligible MIPS-APMs
CEC Model CPC+ Model MSSP Track 12 amp 3 Next Gen ACO OCM All arrangements
Note APM scoring standard applies to APMs that meet these criteria
37
MIPS-APM Benefits
bull Streamlined quality reporting
bull Still eligible for shared savings payment
ndash Financial risk payments do not impact eligibility for positive MIPS payment adjustments
bull Favorable scoring under lsquoAPM Scoring Standardrsquo
ndash ACO participants receive full credit in the Improvement Activities Category by virtue of MSSP participation
ndash ACO participants are not subject to the Cost performance category of MIPS
ndash Potential lsquoliftingrsquo of final MIPS score by being assessed at the ACO level
38
We Are All Part of the Quality Payment Program
Creating an Identity Toward a Common Goal
bull CMS
bull Clinicians
bull Patients
bull Our Care Teams
bull Service Providers
We all share a similar goal to improve patient outcomes
39
Quality Payment Program
Where Can Eligible Clinicians Go For Help
40copy 2016 Telligen Inc
All Eligible Clinicians are supported by
bull Quality Payment Program Websitendash Learn about the program explore the measures and find educational tools and
resources
ndash httpsqppcmsgov
bull Quality Payment Program Service Centerndash Assist with questions
ndash qppCMShhsgov
ndash 1-866-288-8292
bull Innovations Centerrsquos Learning Systemsndash Provides specialized information on Advanced Alternative Payment Models (APMs)
ndash httpsinnovationcmsgov
Self Service Technical Support
41copy 2016 Telligen Inc
We are here to help
bull Experienced quality improvement advisors to provide expert technical assistance and support for participating providers across the state especially those in large practices health systems and ACO at no charge
bull Helps in meeting MIPS requirements through customized technical assistance including one-on-one assistance when needed
bull Offers monthly webinars and Coffee Talk open discussion
ndash Focused QPP topic
ndash Open discuss with Q amp A ndash dedicated to your questions
ndash 2nd Thursday every month
ndash 1100 am CST for 1 hour
Telligen QIN-QIO
42copy 2016 Telligen Inc
We are here to help
bull Provides monthly electronic newsletter with resources the latest research and healthcare news relevant to you
bull Provides the ldquoWeekly Digestrdquo with electronic email on upcoming learning opportunities
bull Offers a website with the latest resources and tools and post recorded webinars for future reference
bull Partner with Telligen QIO on practice improvement activitiesndash Participation with a QIO in a self-management training program (diabetes)
ndash Implementation of antibiotic stewardship program
ndash Implementation of a cardiac quality improvement program
Telligen QIN-QIO
43copy 2016 Telligen Inc
Primary Care amp Specialist Physicians
Model
bull Align with the criteria for innovative models set forth in the Quality Payment Program
bull Build the evidence base on practice transformation so that effective solutions can be scaled
bull Move clinician practices through 5 phases of transformation with support from
ndash Practice Transformation Networks (PTN)
ndash Support amp Alignment Networks (SAN)
ndash Quality Improvement Organizations and others
Transforming Clinical Practice Initiative
44copy 2016 Telligen Inc
Primary Care amp Specialist Physicians
Goalsbull Support clinicians in their practice transformation goals
bull Improve health outcomes for millions of Medicare Medicaid and CHIP beneficiaries
bull Build the evidence base on practice transformation so that effective solutions can be scale
bull Sustain efficient care delivery by reducing unnecessary testing and procedures
bull Reduce unnecessary hospitalizations
Contact Melissa Kapping kappingmihconlineorg
Transforming Clinical Practice Initiative
45copy 2016 Telligen Inc
bull SURS (Small Underserved and Rural Support) ndash Recently announced February 16
ndash 11 organizations awarded contracts
ndash Telligen provides assistance to Iowa Nebraska South Dakota and North Dakota
ndash No cost to practices
bull Solo or small practices (15 or fewer clinicians) ndash Rural health professional shortage areas (HPSA)
ndash Medically underserved areas (MUA)
bull Outreach guidance and direct technical assistancendash Practice readiness education health IT optimization
ndash Strategic planning assisting in the full transition to APM
Telligen QPP Resource Center
46
Contact Info
Michelle Brunsen Sr QI Advisor
515-453-8180
mbrunsentelligencom
Sandy Swallow Program Specialist
515-223-2105
Sandyswallowarea-dhcqisorg
Websites
bull wwwtelligenqinqiocom
bull wwwtelligenqppcom
bull wwwqppcmsgov
THANK YOU
This material was prepared by Telligen the Quality Payment Program Small
Underserved and Rural Support contractor for Iowa Nebraska North Dakota and
South Dakota under contract with the Centers for Medicare amp Medicaid Services
(CMS) an agency of the US Department of Health and Human Services The
contents presented do not necessarily reflect CMS policy HHSM-500-2017-00012C
This material was prepared by Telligen the Medicare Quality Innovation
Network Quality Improvement Organization under contract with the
Centers for Medicare amp Medicaid Services (CMS) an agency of the US
Department of Health and Human Services The contents presented do
not necessarily reflect CMS policy
31
Initial Episode-based Cost Measures
bull Aorticmitral valve surgery
bull CABG
bull HipFemur Fracture or Dislocation Treatment
bull Cholecystectomy and common duct exploration
bull Colonoscopy and biopsy
bull TURP for BPH
bull Lens and cataract procedures
bull Hip replacement or repair
bull Knee arthroplasty
bull Mastectomy
CMS will still provide feedback on performance in these categories in 2017 but it will not affect your 2019 payments
32
Alternative Payment Model (APMs)
bull Create the adoption of payment models that move away from FFS and tie payment to value
bull Must be in an Advanced APM to participate
bull Must meet specific thresholds of ldquosubstantial portionsrdquo of revenue from ldquoapprovedrdquo alternate payment models
bull Receive 5 lump sum bonus for 2019 -2024
bull Receive higher fee schedule update for 2026 and beyond
Which Path is Right for You
33
What are Advanced APMs
Requirements to be an Advanced APM
bull Requires use of certified EHR technology
bull Base payment on quality measures comparable to those in MIPS
bull The practice must bear more than nominal financial risk or is in a Medical Home Model expanded under CMS Innovation Center authority
2017 Eligible Advanced APMs Include
Comprehensive ESRD Care Model
Comprehensive Primary Care Plus (CPC+)
Medicare Shared SavingsProgram Track 2 and 3
Next Generation ACO Model
Oncology Care Model Two-Sided Risk Arrangement
34
APM Scoring Standards
Category Reporting Requirements Category Scoring CategoryWeight
Quality (PQRS) The ACO submits Medicare Shared Savings Program quality measures on behalf of ACO participant TINs and their MIPS eligible clinicians via the CMS Web Interface Data is submitted on the first 248 consecutively ranked and assigned Medicare beneficiaries The ACO submits this information once for purposes of both the Medicare Shared Savings Program and MIPS
MIPS benchmarks will be used to assign one score at the APM Entity Group (ACO) level In other words all MIPS eligible clinicians on the certified ACO ProviderSupplier list will receive the same score (unless they are excluded from MIPS) Note that the performance of all clinicians in the ACO will contribute to this score even if they are not subject to MIPS payment adjustments
50
Cost (VM) MIPS eligible clinicians participating in the MSSP will not be assessed on cost No reporting necessary
NA 0
Improvement Activities (new)
No additional reporting necessary Full credit for the APM Entity group by virtue of MSSP participation
20
Advancing Care Information (MU)
ACO participant TINs will submit directly to MIPS via a MIPS data submission mechanism
ACO participant TIN scores will be aggregated as a weighted average to yield one score for the APM Entity group
30
35
Quality Payment Program Paths
Subsets of MIPS and APM Paths
Eligible Clinician
MIPSAPM
MIPS-APM Advanced
APM
36
MIPS-APM Reporting Option
Requirements to be considered a MIPS-APM includebull Participate in the APM under an
agreement with CMS
bull Include one or more MIPS eligible clinicians on a Participation List
ndash On at least one of the snapshot dates
(Mar 31 June 30 or Aug 31)
bull Bases payment incentives on performance (either at the APM Entity or eligible clinician level) on costutilization and quality
2017 Eligible MIPS-APMs
CEC Model CPC+ Model MSSP Track 12 amp 3 Next Gen ACO OCM All arrangements
Note APM scoring standard applies to APMs that meet these criteria
37
MIPS-APM Benefits
bull Streamlined quality reporting
bull Still eligible for shared savings payment
ndash Financial risk payments do not impact eligibility for positive MIPS payment adjustments
bull Favorable scoring under lsquoAPM Scoring Standardrsquo
ndash ACO participants receive full credit in the Improvement Activities Category by virtue of MSSP participation
ndash ACO participants are not subject to the Cost performance category of MIPS
ndash Potential lsquoliftingrsquo of final MIPS score by being assessed at the ACO level
38
We Are All Part of the Quality Payment Program
Creating an Identity Toward a Common Goal
bull CMS
bull Clinicians
bull Patients
bull Our Care Teams
bull Service Providers
We all share a similar goal to improve patient outcomes
39
Quality Payment Program
Where Can Eligible Clinicians Go For Help
40copy 2016 Telligen Inc
All Eligible Clinicians are supported by
bull Quality Payment Program Websitendash Learn about the program explore the measures and find educational tools and
resources
ndash httpsqppcmsgov
bull Quality Payment Program Service Centerndash Assist with questions
ndash qppCMShhsgov
ndash 1-866-288-8292
bull Innovations Centerrsquos Learning Systemsndash Provides specialized information on Advanced Alternative Payment Models (APMs)
ndash httpsinnovationcmsgov
Self Service Technical Support
41copy 2016 Telligen Inc
We are here to help
bull Experienced quality improvement advisors to provide expert technical assistance and support for participating providers across the state especially those in large practices health systems and ACO at no charge
bull Helps in meeting MIPS requirements through customized technical assistance including one-on-one assistance when needed
bull Offers monthly webinars and Coffee Talk open discussion
ndash Focused QPP topic
ndash Open discuss with Q amp A ndash dedicated to your questions
ndash 2nd Thursday every month
ndash 1100 am CST for 1 hour
Telligen QIN-QIO
42copy 2016 Telligen Inc
We are here to help
bull Provides monthly electronic newsletter with resources the latest research and healthcare news relevant to you
bull Provides the ldquoWeekly Digestrdquo with electronic email on upcoming learning opportunities
bull Offers a website with the latest resources and tools and post recorded webinars for future reference
bull Partner with Telligen QIO on practice improvement activitiesndash Participation with a QIO in a self-management training program (diabetes)
ndash Implementation of antibiotic stewardship program
ndash Implementation of a cardiac quality improvement program
Telligen QIN-QIO
43copy 2016 Telligen Inc
Primary Care amp Specialist Physicians
Model
bull Align with the criteria for innovative models set forth in the Quality Payment Program
bull Build the evidence base on practice transformation so that effective solutions can be scaled
bull Move clinician practices through 5 phases of transformation with support from
ndash Practice Transformation Networks (PTN)
ndash Support amp Alignment Networks (SAN)
ndash Quality Improvement Organizations and others
Transforming Clinical Practice Initiative
44copy 2016 Telligen Inc
Primary Care amp Specialist Physicians
Goalsbull Support clinicians in their practice transformation goals
bull Improve health outcomes for millions of Medicare Medicaid and CHIP beneficiaries
bull Build the evidence base on practice transformation so that effective solutions can be scale
bull Sustain efficient care delivery by reducing unnecessary testing and procedures
bull Reduce unnecessary hospitalizations
Contact Melissa Kapping kappingmihconlineorg
Transforming Clinical Practice Initiative
45copy 2016 Telligen Inc
bull SURS (Small Underserved and Rural Support) ndash Recently announced February 16
ndash 11 organizations awarded contracts
ndash Telligen provides assistance to Iowa Nebraska South Dakota and North Dakota
ndash No cost to practices
bull Solo or small practices (15 or fewer clinicians) ndash Rural health professional shortage areas (HPSA)
ndash Medically underserved areas (MUA)
bull Outreach guidance and direct technical assistancendash Practice readiness education health IT optimization
ndash Strategic planning assisting in the full transition to APM
Telligen QPP Resource Center
46
Contact Info
Michelle Brunsen Sr QI Advisor
515-453-8180
mbrunsentelligencom
Sandy Swallow Program Specialist
515-223-2105
Sandyswallowarea-dhcqisorg
Websites
bull wwwtelligenqinqiocom
bull wwwtelligenqppcom
bull wwwqppcmsgov
THANK YOU
This material was prepared by Telligen the Quality Payment Program Small
Underserved and Rural Support contractor for Iowa Nebraska North Dakota and
South Dakota under contract with the Centers for Medicare amp Medicaid Services
(CMS) an agency of the US Department of Health and Human Services The
contents presented do not necessarily reflect CMS policy HHSM-500-2017-00012C
This material was prepared by Telligen the Medicare Quality Innovation
Network Quality Improvement Organization under contract with the
Centers for Medicare amp Medicaid Services (CMS) an agency of the US
Department of Health and Human Services The contents presented do
not necessarily reflect CMS policy
32
Alternative Payment Model (APMs)
bull Create the adoption of payment models that move away from FFS and tie payment to value
bull Must be in an Advanced APM to participate
bull Must meet specific thresholds of ldquosubstantial portionsrdquo of revenue from ldquoapprovedrdquo alternate payment models
bull Receive 5 lump sum bonus for 2019 -2024
bull Receive higher fee schedule update for 2026 and beyond
Which Path is Right for You
33
What are Advanced APMs
Requirements to be an Advanced APM
bull Requires use of certified EHR technology
bull Base payment on quality measures comparable to those in MIPS
bull The practice must bear more than nominal financial risk or is in a Medical Home Model expanded under CMS Innovation Center authority
2017 Eligible Advanced APMs Include
Comprehensive ESRD Care Model
Comprehensive Primary Care Plus (CPC+)
Medicare Shared SavingsProgram Track 2 and 3
Next Generation ACO Model
Oncology Care Model Two-Sided Risk Arrangement
34
APM Scoring Standards
Category Reporting Requirements Category Scoring CategoryWeight
Quality (PQRS) The ACO submits Medicare Shared Savings Program quality measures on behalf of ACO participant TINs and their MIPS eligible clinicians via the CMS Web Interface Data is submitted on the first 248 consecutively ranked and assigned Medicare beneficiaries The ACO submits this information once for purposes of both the Medicare Shared Savings Program and MIPS
MIPS benchmarks will be used to assign one score at the APM Entity Group (ACO) level In other words all MIPS eligible clinicians on the certified ACO ProviderSupplier list will receive the same score (unless they are excluded from MIPS) Note that the performance of all clinicians in the ACO will contribute to this score even if they are not subject to MIPS payment adjustments
50
Cost (VM) MIPS eligible clinicians participating in the MSSP will not be assessed on cost No reporting necessary
NA 0
Improvement Activities (new)
No additional reporting necessary Full credit for the APM Entity group by virtue of MSSP participation
20
Advancing Care Information (MU)
ACO participant TINs will submit directly to MIPS via a MIPS data submission mechanism
ACO participant TIN scores will be aggregated as a weighted average to yield one score for the APM Entity group
30
35
Quality Payment Program Paths
Subsets of MIPS and APM Paths
Eligible Clinician
MIPSAPM
MIPS-APM Advanced
APM
36
MIPS-APM Reporting Option
Requirements to be considered a MIPS-APM includebull Participate in the APM under an
agreement with CMS
bull Include one or more MIPS eligible clinicians on a Participation List
ndash On at least one of the snapshot dates
(Mar 31 June 30 or Aug 31)
bull Bases payment incentives on performance (either at the APM Entity or eligible clinician level) on costutilization and quality
2017 Eligible MIPS-APMs
CEC Model CPC+ Model MSSP Track 12 amp 3 Next Gen ACO OCM All arrangements
Note APM scoring standard applies to APMs that meet these criteria
37
MIPS-APM Benefits
bull Streamlined quality reporting
bull Still eligible for shared savings payment
ndash Financial risk payments do not impact eligibility for positive MIPS payment adjustments
bull Favorable scoring under lsquoAPM Scoring Standardrsquo
ndash ACO participants receive full credit in the Improvement Activities Category by virtue of MSSP participation
ndash ACO participants are not subject to the Cost performance category of MIPS
ndash Potential lsquoliftingrsquo of final MIPS score by being assessed at the ACO level
38
We Are All Part of the Quality Payment Program
Creating an Identity Toward a Common Goal
bull CMS
bull Clinicians
bull Patients
bull Our Care Teams
bull Service Providers
We all share a similar goal to improve patient outcomes
39
Quality Payment Program
Where Can Eligible Clinicians Go For Help
40copy 2016 Telligen Inc
All Eligible Clinicians are supported by
bull Quality Payment Program Websitendash Learn about the program explore the measures and find educational tools and
resources
ndash httpsqppcmsgov
bull Quality Payment Program Service Centerndash Assist with questions
ndash qppCMShhsgov
ndash 1-866-288-8292
bull Innovations Centerrsquos Learning Systemsndash Provides specialized information on Advanced Alternative Payment Models (APMs)
ndash httpsinnovationcmsgov
Self Service Technical Support
41copy 2016 Telligen Inc
We are here to help
bull Experienced quality improvement advisors to provide expert technical assistance and support for participating providers across the state especially those in large practices health systems and ACO at no charge
bull Helps in meeting MIPS requirements through customized technical assistance including one-on-one assistance when needed
bull Offers monthly webinars and Coffee Talk open discussion
ndash Focused QPP topic
ndash Open discuss with Q amp A ndash dedicated to your questions
ndash 2nd Thursday every month
ndash 1100 am CST for 1 hour
Telligen QIN-QIO
42copy 2016 Telligen Inc
We are here to help
bull Provides monthly electronic newsletter with resources the latest research and healthcare news relevant to you
bull Provides the ldquoWeekly Digestrdquo with electronic email on upcoming learning opportunities
bull Offers a website with the latest resources and tools and post recorded webinars for future reference
bull Partner with Telligen QIO on practice improvement activitiesndash Participation with a QIO in a self-management training program (diabetes)
ndash Implementation of antibiotic stewardship program
ndash Implementation of a cardiac quality improvement program
Telligen QIN-QIO
43copy 2016 Telligen Inc
Primary Care amp Specialist Physicians
Model
bull Align with the criteria for innovative models set forth in the Quality Payment Program
bull Build the evidence base on practice transformation so that effective solutions can be scaled
bull Move clinician practices through 5 phases of transformation with support from
ndash Practice Transformation Networks (PTN)
ndash Support amp Alignment Networks (SAN)
ndash Quality Improvement Organizations and others
Transforming Clinical Practice Initiative
44copy 2016 Telligen Inc
Primary Care amp Specialist Physicians
Goalsbull Support clinicians in their practice transformation goals
bull Improve health outcomes for millions of Medicare Medicaid and CHIP beneficiaries
bull Build the evidence base on practice transformation so that effective solutions can be scale
bull Sustain efficient care delivery by reducing unnecessary testing and procedures
bull Reduce unnecessary hospitalizations
Contact Melissa Kapping kappingmihconlineorg
Transforming Clinical Practice Initiative
45copy 2016 Telligen Inc
bull SURS (Small Underserved and Rural Support) ndash Recently announced February 16
ndash 11 organizations awarded contracts
ndash Telligen provides assistance to Iowa Nebraska South Dakota and North Dakota
ndash No cost to practices
bull Solo or small practices (15 or fewer clinicians) ndash Rural health professional shortage areas (HPSA)
ndash Medically underserved areas (MUA)
bull Outreach guidance and direct technical assistancendash Practice readiness education health IT optimization
ndash Strategic planning assisting in the full transition to APM
Telligen QPP Resource Center
46
Contact Info
Michelle Brunsen Sr QI Advisor
515-453-8180
mbrunsentelligencom
Sandy Swallow Program Specialist
515-223-2105
Sandyswallowarea-dhcqisorg
Websites
bull wwwtelligenqinqiocom
bull wwwtelligenqppcom
bull wwwqppcmsgov
THANK YOU
This material was prepared by Telligen the Quality Payment Program Small
Underserved and Rural Support contractor for Iowa Nebraska North Dakota and
South Dakota under contract with the Centers for Medicare amp Medicaid Services
(CMS) an agency of the US Department of Health and Human Services The
contents presented do not necessarily reflect CMS policy HHSM-500-2017-00012C
This material was prepared by Telligen the Medicare Quality Innovation
Network Quality Improvement Organization under contract with the
Centers for Medicare amp Medicaid Services (CMS) an agency of the US
Department of Health and Human Services The contents presented do
not necessarily reflect CMS policy
33
What are Advanced APMs
Requirements to be an Advanced APM
bull Requires use of certified EHR technology
bull Base payment on quality measures comparable to those in MIPS
bull The practice must bear more than nominal financial risk or is in a Medical Home Model expanded under CMS Innovation Center authority
2017 Eligible Advanced APMs Include
Comprehensive ESRD Care Model
Comprehensive Primary Care Plus (CPC+)
Medicare Shared SavingsProgram Track 2 and 3
Next Generation ACO Model
Oncology Care Model Two-Sided Risk Arrangement
34
APM Scoring Standards
Category Reporting Requirements Category Scoring CategoryWeight
Quality (PQRS) The ACO submits Medicare Shared Savings Program quality measures on behalf of ACO participant TINs and their MIPS eligible clinicians via the CMS Web Interface Data is submitted on the first 248 consecutively ranked and assigned Medicare beneficiaries The ACO submits this information once for purposes of both the Medicare Shared Savings Program and MIPS
MIPS benchmarks will be used to assign one score at the APM Entity Group (ACO) level In other words all MIPS eligible clinicians on the certified ACO ProviderSupplier list will receive the same score (unless they are excluded from MIPS) Note that the performance of all clinicians in the ACO will contribute to this score even if they are not subject to MIPS payment adjustments
50
Cost (VM) MIPS eligible clinicians participating in the MSSP will not be assessed on cost No reporting necessary
NA 0
Improvement Activities (new)
No additional reporting necessary Full credit for the APM Entity group by virtue of MSSP participation
20
Advancing Care Information (MU)
ACO participant TINs will submit directly to MIPS via a MIPS data submission mechanism
ACO participant TIN scores will be aggregated as a weighted average to yield one score for the APM Entity group
30
35
Quality Payment Program Paths
Subsets of MIPS and APM Paths
Eligible Clinician
MIPSAPM
MIPS-APM Advanced
APM
36
MIPS-APM Reporting Option
Requirements to be considered a MIPS-APM includebull Participate in the APM under an
agreement with CMS
bull Include one or more MIPS eligible clinicians on a Participation List
ndash On at least one of the snapshot dates
(Mar 31 June 30 or Aug 31)
bull Bases payment incentives on performance (either at the APM Entity or eligible clinician level) on costutilization and quality
2017 Eligible MIPS-APMs
CEC Model CPC+ Model MSSP Track 12 amp 3 Next Gen ACO OCM All arrangements
Note APM scoring standard applies to APMs that meet these criteria
37
MIPS-APM Benefits
bull Streamlined quality reporting
bull Still eligible for shared savings payment
ndash Financial risk payments do not impact eligibility for positive MIPS payment adjustments
bull Favorable scoring under lsquoAPM Scoring Standardrsquo
ndash ACO participants receive full credit in the Improvement Activities Category by virtue of MSSP participation
ndash ACO participants are not subject to the Cost performance category of MIPS
ndash Potential lsquoliftingrsquo of final MIPS score by being assessed at the ACO level
38
We Are All Part of the Quality Payment Program
Creating an Identity Toward a Common Goal
bull CMS
bull Clinicians
bull Patients
bull Our Care Teams
bull Service Providers
We all share a similar goal to improve patient outcomes
39
Quality Payment Program
Where Can Eligible Clinicians Go For Help
40copy 2016 Telligen Inc
All Eligible Clinicians are supported by
bull Quality Payment Program Websitendash Learn about the program explore the measures and find educational tools and
resources
ndash httpsqppcmsgov
bull Quality Payment Program Service Centerndash Assist with questions
ndash qppCMShhsgov
ndash 1-866-288-8292
bull Innovations Centerrsquos Learning Systemsndash Provides specialized information on Advanced Alternative Payment Models (APMs)
ndash httpsinnovationcmsgov
Self Service Technical Support
41copy 2016 Telligen Inc
We are here to help
bull Experienced quality improvement advisors to provide expert technical assistance and support for participating providers across the state especially those in large practices health systems and ACO at no charge
bull Helps in meeting MIPS requirements through customized technical assistance including one-on-one assistance when needed
bull Offers monthly webinars and Coffee Talk open discussion
ndash Focused QPP topic
ndash Open discuss with Q amp A ndash dedicated to your questions
ndash 2nd Thursday every month
ndash 1100 am CST for 1 hour
Telligen QIN-QIO
42copy 2016 Telligen Inc
We are here to help
bull Provides monthly electronic newsletter with resources the latest research and healthcare news relevant to you
bull Provides the ldquoWeekly Digestrdquo with electronic email on upcoming learning opportunities
bull Offers a website with the latest resources and tools and post recorded webinars for future reference
bull Partner with Telligen QIO on practice improvement activitiesndash Participation with a QIO in a self-management training program (diabetes)
ndash Implementation of antibiotic stewardship program
ndash Implementation of a cardiac quality improvement program
Telligen QIN-QIO
43copy 2016 Telligen Inc
Primary Care amp Specialist Physicians
Model
bull Align with the criteria for innovative models set forth in the Quality Payment Program
bull Build the evidence base on practice transformation so that effective solutions can be scaled
bull Move clinician practices through 5 phases of transformation with support from
ndash Practice Transformation Networks (PTN)
ndash Support amp Alignment Networks (SAN)
ndash Quality Improvement Organizations and others
Transforming Clinical Practice Initiative
44copy 2016 Telligen Inc
Primary Care amp Specialist Physicians
Goalsbull Support clinicians in their practice transformation goals
bull Improve health outcomes for millions of Medicare Medicaid and CHIP beneficiaries
bull Build the evidence base on practice transformation so that effective solutions can be scale
bull Sustain efficient care delivery by reducing unnecessary testing and procedures
bull Reduce unnecessary hospitalizations
Contact Melissa Kapping kappingmihconlineorg
Transforming Clinical Practice Initiative
45copy 2016 Telligen Inc
bull SURS (Small Underserved and Rural Support) ndash Recently announced February 16
ndash 11 organizations awarded contracts
ndash Telligen provides assistance to Iowa Nebraska South Dakota and North Dakota
ndash No cost to practices
bull Solo or small practices (15 or fewer clinicians) ndash Rural health professional shortage areas (HPSA)
ndash Medically underserved areas (MUA)
bull Outreach guidance and direct technical assistancendash Practice readiness education health IT optimization
ndash Strategic planning assisting in the full transition to APM
Telligen QPP Resource Center
46
Contact Info
Michelle Brunsen Sr QI Advisor
515-453-8180
mbrunsentelligencom
Sandy Swallow Program Specialist
515-223-2105
Sandyswallowarea-dhcqisorg
Websites
bull wwwtelligenqinqiocom
bull wwwtelligenqppcom
bull wwwqppcmsgov
THANK YOU
This material was prepared by Telligen the Quality Payment Program Small
Underserved and Rural Support contractor for Iowa Nebraska North Dakota and
South Dakota under contract with the Centers for Medicare amp Medicaid Services
(CMS) an agency of the US Department of Health and Human Services The
contents presented do not necessarily reflect CMS policy HHSM-500-2017-00012C
This material was prepared by Telligen the Medicare Quality Innovation
Network Quality Improvement Organization under contract with the
Centers for Medicare amp Medicaid Services (CMS) an agency of the US
Department of Health and Human Services The contents presented do
not necessarily reflect CMS policy
34
APM Scoring Standards
Category Reporting Requirements Category Scoring CategoryWeight
Quality (PQRS) The ACO submits Medicare Shared Savings Program quality measures on behalf of ACO participant TINs and their MIPS eligible clinicians via the CMS Web Interface Data is submitted on the first 248 consecutively ranked and assigned Medicare beneficiaries The ACO submits this information once for purposes of both the Medicare Shared Savings Program and MIPS
MIPS benchmarks will be used to assign one score at the APM Entity Group (ACO) level In other words all MIPS eligible clinicians on the certified ACO ProviderSupplier list will receive the same score (unless they are excluded from MIPS) Note that the performance of all clinicians in the ACO will contribute to this score even if they are not subject to MIPS payment adjustments
50
Cost (VM) MIPS eligible clinicians participating in the MSSP will not be assessed on cost No reporting necessary
NA 0
Improvement Activities (new)
No additional reporting necessary Full credit for the APM Entity group by virtue of MSSP participation
20
Advancing Care Information (MU)
ACO participant TINs will submit directly to MIPS via a MIPS data submission mechanism
ACO participant TIN scores will be aggregated as a weighted average to yield one score for the APM Entity group
30
35
Quality Payment Program Paths
Subsets of MIPS and APM Paths
Eligible Clinician
MIPSAPM
MIPS-APM Advanced
APM
36
MIPS-APM Reporting Option
Requirements to be considered a MIPS-APM includebull Participate in the APM under an
agreement with CMS
bull Include one or more MIPS eligible clinicians on a Participation List
ndash On at least one of the snapshot dates
(Mar 31 June 30 or Aug 31)
bull Bases payment incentives on performance (either at the APM Entity or eligible clinician level) on costutilization and quality
2017 Eligible MIPS-APMs
CEC Model CPC+ Model MSSP Track 12 amp 3 Next Gen ACO OCM All arrangements
Note APM scoring standard applies to APMs that meet these criteria
37
MIPS-APM Benefits
bull Streamlined quality reporting
bull Still eligible for shared savings payment
ndash Financial risk payments do not impact eligibility for positive MIPS payment adjustments
bull Favorable scoring under lsquoAPM Scoring Standardrsquo
ndash ACO participants receive full credit in the Improvement Activities Category by virtue of MSSP participation
ndash ACO participants are not subject to the Cost performance category of MIPS
ndash Potential lsquoliftingrsquo of final MIPS score by being assessed at the ACO level
38
We Are All Part of the Quality Payment Program
Creating an Identity Toward a Common Goal
bull CMS
bull Clinicians
bull Patients
bull Our Care Teams
bull Service Providers
We all share a similar goal to improve patient outcomes
39
Quality Payment Program
Where Can Eligible Clinicians Go For Help
40copy 2016 Telligen Inc
All Eligible Clinicians are supported by
bull Quality Payment Program Websitendash Learn about the program explore the measures and find educational tools and
resources
ndash httpsqppcmsgov
bull Quality Payment Program Service Centerndash Assist with questions
ndash qppCMShhsgov
ndash 1-866-288-8292
bull Innovations Centerrsquos Learning Systemsndash Provides specialized information on Advanced Alternative Payment Models (APMs)
ndash httpsinnovationcmsgov
Self Service Technical Support
41copy 2016 Telligen Inc
We are here to help
bull Experienced quality improvement advisors to provide expert technical assistance and support for participating providers across the state especially those in large practices health systems and ACO at no charge
bull Helps in meeting MIPS requirements through customized technical assistance including one-on-one assistance when needed
bull Offers monthly webinars and Coffee Talk open discussion
ndash Focused QPP topic
ndash Open discuss with Q amp A ndash dedicated to your questions
ndash 2nd Thursday every month
ndash 1100 am CST for 1 hour
Telligen QIN-QIO
42copy 2016 Telligen Inc
We are here to help
bull Provides monthly electronic newsletter with resources the latest research and healthcare news relevant to you
bull Provides the ldquoWeekly Digestrdquo with electronic email on upcoming learning opportunities
bull Offers a website with the latest resources and tools and post recorded webinars for future reference
bull Partner with Telligen QIO on practice improvement activitiesndash Participation with a QIO in a self-management training program (diabetes)
ndash Implementation of antibiotic stewardship program
ndash Implementation of a cardiac quality improvement program
Telligen QIN-QIO
43copy 2016 Telligen Inc
Primary Care amp Specialist Physicians
Model
bull Align with the criteria for innovative models set forth in the Quality Payment Program
bull Build the evidence base on practice transformation so that effective solutions can be scaled
bull Move clinician practices through 5 phases of transformation with support from
ndash Practice Transformation Networks (PTN)
ndash Support amp Alignment Networks (SAN)
ndash Quality Improvement Organizations and others
Transforming Clinical Practice Initiative
44copy 2016 Telligen Inc
Primary Care amp Specialist Physicians
Goalsbull Support clinicians in their practice transformation goals
bull Improve health outcomes for millions of Medicare Medicaid and CHIP beneficiaries
bull Build the evidence base on practice transformation so that effective solutions can be scale
bull Sustain efficient care delivery by reducing unnecessary testing and procedures
bull Reduce unnecessary hospitalizations
Contact Melissa Kapping kappingmihconlineorg
Transforming Clinical Practice Initiative
45copy 2016 Telligen Inc
bull SURS (Small Underserved and Rural Support) ndash Recently announced February 16
ndash 11 organizations awarded contracts
ndash Telligen provides assistance to Iowa Nebraska South Dakota and North Dakota
ndash No cost to practices
bull Solo or small practices (15 or fewer clinicians) ndash Rural health professional shortage areas (HPSA)
ndash Medically underserved areas (MUA)
bull Outreach guidance and direct technical assistancendash Practice readiness education health IT optimization
ndash Strategic planning assisting in the full transition to APM
Telligen QPP Resource Center
46
Contact Info
Michelle Brunsen Sr QI Advisor
515-453-8180
mbrunsentelligencom
Sandy Swallow Program Specialist
515-223-2105
Sandyswallowarea-dhcqisorg
Websites
bull wwwtelligenqinqiocom
bull wwwtelligenqppcom
bull wwwqppcmsgov
THANK YOU
This material was prepared by Telligen the Quality Payment Program Small
Underserved and Rural Support contractor for Iowa Nebraska North Dakota and
South Dakota under contract with the Centers for Medicare amp Medicaid Services
(CMS) an agency of the US Department of Health and Human Services The
contents presented do not necessarily reflect CMS policy HHSM-500-2017-00012C
This material was prepared by Telligen the Medicare Quality Innovation
Network Quality Improvement Organization under contract with the
Centers for Medicare amp Medicaid Services (CMS) an agency of the US
Department of Health and Human Services The contents presented do
not necessarily reflect CMS policy
35
Quality Payment Program Paths
Subsets of MIPS and APM Paths
Eligible Clinician
MIPSAPM
MIPS-APM Advanced
APM
36
MIPS-APM Reporting Option
Requirements to be considered a MIPS-APM includebull Participate in the APM under an
agreement with CMS
bull Include one or more MIPS eligible clinicians on a Participation List
ndash On at least one of the snapshot dates
(Mar 31 June 30 or Aug 31)
bull Bases payment incentives on performance (either at the APM Entity or eligible clinician level) on costutilization and quality
2017 Eligible MIPS-APMs
CEC Model CPC+ Model MSSP Track 12 amp 3 Next Gen ACO OCM All arrangements
Note APM scoring standard applies to APMs that meet these criteria
37
MIPS-APM Benefits
bull Streamlined quality reporting
bull Still eligible for shared savings payment
ndash Financial risk payments do not impact eligibility for positive MIPS payment adjustments
bull Favorable scoring under lsquoAPM Scoring Standardrsquo
ndash ACO participants receive full credit in the Improvement Activities Category by virtue of MSSP participation
ndash ACO participants are not subject to the Cost performance category of MIPS
ndash Potential lsquoliftingrsquo of final MIPS score by being assessed at the ACO level
38
We Are All Part of the Quality Payment Program
Creating an Identity Toward a Common Goal
bull CMS
bull Clinicians
bull Patients
bull Our Care Teams
bull Service Providers
We all share a similar goal to improve patient outcomes
39
Quality Payment Program
Where Can Eligible Clinicians Go For Help
40copy 2016 Telligen Inc
All Eligible Clinicians are supported by
bull Quality Payment Program Websitendash Learn about the program explore the measures and find educational tools and
resources
ndash httpsqppcmsgov
bull Quality Payment Program Service Centerndash Assist with questions
ndash qppCMShhsgov
ndash 1-866-288-8292
bull Innovations Centerrsquos Learning Systemsndash Provides specialized information on Advanced Alternative Payment Models (APMs)
ndash httpsinnovationcmsgov
Self Service Technical Support
41copy 2016 Telligen Inc
We are here to help
bull Experienced quality improvement advisors to provide expert technical assistance and support for participating providers across the state especially those in large practices health systems and ACO at no charge
bull Helps in meeting MIPS requirements through customized technical assistance including one-on-one assistance when needed
bull Offers monthly webinars and Coffee Talk open discussion
ndash Focused QPP topic
ndash Open discuss with Q amp A ndash dedicated to your questions
ndash 2nd Thursday every month
ndash 1100 am CST for 1 hour
Telligen QIN-QIO
42copy 2016 Telligen Inc
We are here to help
bull Provides monthly electronic newsletter with resources the latest research and healthcare news relevant to you
bull Provides the ldquoWeekly Digestrdquo with electronic email on upcoming learning opportunities
bull Offers a website with the latest resources and tools and post recorded webinars for future reference
bull Partner with Telligen QIO on practice improvement activitiesndash Participation with a QIO in a self-management training program (diabetes)
ndash Implementation of antibiotic stewardship program
ndash Implementation of a cardiac quality improvement program
Telligen QIN-QIO
43copy 2016 Telligen Inc
Primary Care amp Specialist Physicians
Model
bull Align with the criteria for innovative models set forth in the Quality Payment Program
bull Build the evidence base on practice transformation so that effective solutions can be scaled
bull Move clinician practices through 5 phases of transformation with support from
ndash Practice Transformation Networks (PTN)
ndash Support amp Alignment Networks (SAN)
ndash Quality Improvement Organizations and others
Transforming Clinical Practice Initiative
44copy 2016 Telligen Inc
Primary Care amp Specialist Physicians
Goalsbull Support clinicians in their practice transformation goals
bull Improve health outcomes for millions of Medicare Medicaid and CHIP beneficiaries
bull Build the evidence base on practice transformation so that effective solutions can be scale
bull Sustain efficient care delivery by reducing unnecessary testing and procedures
bull Reduce unnecessary hospitalizations
Contact Melissa Kapping kappingmihconlineorg
Transforming Clinical Practice Initiative
45copy 2016 Telligen Inc
bull SURS (Small Underserved and Rural Support) ndash Recently announced February 16
ndash 11 organizations awarded contracts
ndash Telligen provides assistance to Iowa Nebraska South Dakota and North Dakota
ndash No cost to practices
bull Solo or small practices (15 or fewer clinicians) ndash Rural health professional shortage areas (HPSA)
ndash Medically underserved areas (MUA)
bull Outreach guidance and direct technical assistancendash Practice readiness education health IT optimization
ndash Strategic planning assisting in the full transition to APM
Telligen QPP Resource Center
46
Contact Info
Michelle Brunsen Sr QI Advisor
515-453-8180
mbrunsentelligencom
Sandy Swallow Program Specialist
515-223-2105
Sandyswallowarea-dhcqisorg
Websites
bull wwwtelligenqinqiocom
bull wwwtelligenqppcom
bull wwwqppcmsgov
THANK YOU
This material was prepared by Telligen the Quality Payment Program Small
Underserved and Rural Support contractor for Iowa Nebraska North Dakota and
South Dakota under contract with the Centers for Medicare amp Medicaid Services
(CMS) an agency of the US Department of Health and Human Services The
contents presented do not necessarily reflect CMS policy HHSM-500-2017-00012C
This material was prepared by Telligen the Medicare Quality Innovation
Network Quality Improvement Organization under contract with the
Centers for Medicare amp Medicaid Services (CMS) an agency of the US
Department of Health and Human Services The contents presented do
not necessarily reflect CMS policy
36
MIPS-APM Reporting Option
Requirements to be considered a MIPS-APM includebull Participate in the APM under an
agreement with CMS
bull Include one or more MIPS eligible clinicians on a Participation List
ndash On at least one of the snapshot dates
(Mar 31 June 30 or Aug 31)
bull Bases payment incentives on performance (either at the APM Entity or eligible clinician level) on costutilization and quality
2017 Eligible MIPS-APMs
CEC Model CPC+ Model MSSP Track 12 amp 3 Next Gen ACO OCM All arrangements
Note APM scoring standard applies to APMs that meet these criteria
37
MIPS-APM Benefits
bull Streamlined quality reporting
bull Still eligible for shared savings payment
ndash Financial risk payments do not impact eligibility for positive MIPS payment adjustments
bull Favorable scoring under lsquoAPM Scoring Standardrsquo
ndash ACO participants receive full credit in the Improvement Activities Category by virtue of MSSP participation
ndash ACO participants are not subject to the Cost performance category of MIPS
ndash Potential lsquoliftingrsquo of final MIPS score by being assessed at the ACO level
38
We Are All Part of the Quality Payment Program
Creating an Identity Toward a Common Goal
bull CMS
bull Clinicians
bull Patients
bull Our Care Teams
bull Service Providers
We all share a similar goal to improve patient outcomes
39
Quality Payment Program
Where Can Eligible Clinicians Go For Help
40copy 2016 Telligen Inc
All Eligible Clinicians are supported by
bull Quality Payment Program Websitendash Learn about the program explore the measures and find educational tools and
resources
ndash httpsqppcmsgov
bull Quality Payment Program Service Centerndash Assist with questions
ndash qppCMShhsgov
ndash 1-866-288-8292
bull Innovations Centerrsquos Learning Systemsndash Provides specialized information on Advanced Alternative Payment Models (APMs)
ndash httpsinnovationcmsgov
Self Service Technical Support
41copy 2016 Telligen Inc
We are here to help
bull Experienced quality improvement advisors to provide expert technical assistance and support for participating providers across the state especially those in large practices health systems and ACO at no charge
bull Helps in meeting MIPS requirements through customized technical assistance including one-on-one assistance when needed
bull Offers monthly webinars and Coffee Talk open discussion
ndash Focused QPP topic
ndash Open discuss with Q amp A ndash dedicated to your questions
ndash 2nd Thursday every month
ndash 1100 am CST for 1 hour
Telligen QIN-QIO
42copy 2016 Telligen Inc
We are here to help
bull Provides monthly electronic newsletter with resources the latest research and healthcare news relevant to you
bull Provides the ldquoWeekly Digestrdquo with electronic email on upcoming learning opportunities
bull Offers a website with the latest resources and tools and post recorded webinars for future reference
bull Partner with Telligen QIO on practice improvement activitiesndash Participation with a QIO in a self-management training program (diabetes)
ndash Implementation of antibiotic stewardship program
ndash Implementation of a cardiac quality improvement program
Telligen QIN-QIO
43copy 2016 Telligen Inc
Primary Care amp Specialist Physicians
Model
bull Align with the criteria for innovative models set forth in the Quality Payment Program
bull Build the evidence base on practice transformation so that effective solutions can be scaled
bull Move clinician practices through 5 phases of transformation with support from
ndash Practice Transformation Networks (PTN)
ndash Support amp Alignment Networks (SAN)
ndash Quality Improvement Organizations and others
Transforming Clinical Practice Initiative
44copy 2016 Telligen Inc
Primary Care amp Specialist Physicians
Goalsbull Support clinicians in their practice transformation goals
bull Improve health outcomes for millions of Medicare Medicaid and CHIP beneficiaries
bull Build the evidence base on practice transformation so that effective solutions can be scale
bull Sustain efficient care delivery by reducing unnecessary testing and procedures
bull Reduce unnecessary hospitalizations
Contact Melissa Kapping kappingmihconlineorg
Transforming Clinical Practice Initiative
45copy 2016 Telligen Inc
bull SURS (Small Underserved and Rural Support) ndash Recently announced February 16
ndash 11 organizations awarded contracts
ndash Telligen provides assistance to Iowa Nebraska South Dakota and North Dakota
ndash No cost to practices
bull Solo or small practices (15 or fewer clinicians) ndash Rural health professional shortage areas (HPSA)
ndash Medically underserved areas (MUA)
bull Outreach guidance and direct technical assistancendash Practice readiness education health IT optimization
ndash Strategic planning assisting in the full transition to APM
Telligen QPP Resource Center
46
Contact Info
Michelle Brunsen Sr QI Advisor
515-453-8180
mbrunsentelligencom
Sandy Swallow Program Specialist
515-223-2105
Sandyswallowarea-dhcqisorg
Websites
bull wwwtelligenqinqiocom
bull wwwtelligenqppcom
bull wwwqppcmsgov
THANK YOU
This material was prepared by Telligen the Quality Payment Program Small
Underserved and Rural Support contractor for Iowa Nebraska North Dakota and
South Dakota under contract with the Centers for Medicare amp Medicaid Services
(CMS) an agency of the US Department of Health and Human Services The
contents presented do not necessarily reflect CMS policy HHSM-500-2017-00012C
This material was prepared by Telligen the Medicare Quality Innovation
Network Quality Improvement Organization under contract with the
Centers for Medicare amp Medicaid Services (CMS) an agency of the US
Department of Health and Human Services The contents presented do
not necessarily reflect CMS policy
37
MIPS-APM Benefits
bull Streamlined quality reporting
bull Still eligible for shared savings payment
ndash Financial risk payments do not impact eligibility for positive MIPS payment adjustments
bull Favorable scoring under lsquoAPM Scoring Standardrsquo
ndash ACO participants receive full credit in the Improvement Activities Category by virtue of MSSP participation
ndash ACO participants are not subject to the Cost performance category of MIPS
ndash Potential lsquoliftingrsquo of final MIPS score by being assessed at the ACO level
38
We Are All Part of the Quality Payment Program
Creating an Identity Toward a Common Goal
bull CMS
bull Clinicians
bull Patients
bull Our Care Teams
bull Service Providers
We all share a similar goal to improve patient outcomes
39
Quality Payment Program
Where Can Eligible Clinicians Go For Help
40copy 2016 Telligen Inc
All Eligible Clinicians are supported by
bull Quality Payment Program Websitendash Learn about the program explore the measures and find educational tools and
resources
ndash httpsqppcmsgov
bull Quality Payment Program Service Centerndash Assist with questions
ndash qppCMShhsgov
ndash 1-866-288-8292
bull Innovations Centerrsquos Learning Systemsndash Provides specialized information on Advanced Alternative Payment Models (APMs)
ndash httpsinnovationcmsgov
Self Service Technical Support
41copy 2016 Telligen Inc
We are here to help
bull Experienced quality improvement advisors to provide expert technical assistance and support for participating providers across the state especially those in large practices health systems and ACO at no charge
bull Helps in meeting MIPS requirements through customized technical assistance including one-on-one assistance when needed
bull Offers monthly webinars and Coffee Talk open discussion
ndash Focused QPP topic
ndash Open discuss with Q amp A ndash dedicated to your questions
ndash 2nd Thursday every month
ndash 1100 am CST for 1 hour
Telligen QIN-QIO
42copy 2016 Telligen Inc
We are here to help
bull Provides monthly electronic newsletter with resources the latest research and healthcare news relevant to you
bull Provides the ldquoWeekly Digestrdquo with electronic email on upcoming learning opportunities
bull Offers a website with the latest resources and tools and post recorded webinars for future reference
bull Partner with Telligen QIO on practice improvement activitiesndash Participation with a QIO in a self-management training program (diabetes)
ndash Implementation of antibiotic stewardship program
ndash Implementation of a cardiac quality improvement program
Telligen QIN-QIO
43copy 2016 Telligen Inc
Primary Care amp Specialist Physicians
Model
bull Align with the criteria for innovative models set forth in the Quality Payment Program
bull Build the evidence base on practice transformation so that effective solutions can be scaled
bull Move clinician practices through 5 phases of transformation with support from
ndash Practice Transformation Networks (PTN)
ndash Support amp Alignment Networks (SAN)
ndash Quality Improvement Organizations and others
Transforming Clinical Practice Initiative
44copy 2016 Telligen Inc
Primary Care amp Specialist Physicians
Goalsbull Support clinicians in their practice transformation goals
bull Improve health outcomes for millions of Medicare Medicaid and CHIP beneficiaries
bull Build the evidence base on practice transformation so that effective solutions can be scale
bull Sustain efficient care delivery by reducing unnecessary testing and procedures
bull Reduce unnecessary hospitalizations
Contact Melissa Kapping kappingmihconlineorg
Transforming Clinical Practice Initiative
45copy 2016 Telligen Inc
bull SURS (Small Underserved and Rural Support) ndash Recently announced February 16
ndash 11 organizations awarded contracts
ndash Telligen provides assistance to Iowa Nebraska South Dakota and North Dakota
ndash No cost to practices
bull Solo or small practices (15 or fewer clinicians) ndash Rural health professional shortage areas (HPSA)
ndash Medically underserved areas (MUA)
bull Outreach guidance and direct technical assistancendash Practice readiness education health IT optimization
ndash Strategic planning assisting in the full transition to APM
Telligen QPP Resource Center
46
Contact Info
Michelle Brunsen Sr QI Advisor
515-453-8180
mbrunsentelligencom
Sandy Swallow Program Specialist
515-223-2105
Sandyswallowarea-dhcqisorg
Websites
bull wwwtelligenqinqiocom
bull wwwtelligenqppcom
bull wwwqppcmsgov
THANK YOU
This material was prepared by Telligen the Quality Payment Program Small
Underserved and Rural Support contractor for Iowa Nebraska North Dakota and
South Dakota under contract with the Centers for Medicare amp Medicaid Services
(CMS) an agency of the US Department of Health and Human Services The
contents presented do not necessarily reflect CMS policy HHSM-500-2017-00012C
This material was prepared by Telligen the Medicare Quality Innovation
Network Quality Improvement Organization under contract with the
Centers for Medicare amp Medicaid Services (CMS) an agency of the US
Department of Health and Human Services The contents presented do
not necessarily reflect CMS policy
38
We Are All Part of the Quality Payment Program
Creating an Identity Toward a Common Goal
bull CMS
bull Clinicians
bull Patients
bull Our Care Teams
bull Service Providers
We all share a similar goal to improve patient outcomes
39
Quality Payment Program
Where Can Eligible Clinicians Go For Help
40copy 2016 Telligen Inc
All Eligible Clinicians are supported by
bull Quality Payment Program Websitendash Learn about the program explore the measures and find educational tools and
resources
ndash httpsqppcmsgov
bull Quality Payment Program Service Centerndash Assist with questions
ndash qppCMShhsgov
ndash 1-866-288-8292
bull Innovations Centerrsquos Learning Systemsndash Provides specialized information on Advanced Alternative Payment Models (APMs)
ndash httpsinnovationcmsgov
Self Service Technical Support
41copy 2016 Telligen Inc
We are here to help
bull Experienced quality improvement advisors to provide expert technical assistance and support for participating providers across the state especially those in large practices health systems and ACO at no charge
bull Helps in meeting MIPS requirements through customized technical assistance including one-on-one assistance when needed
bull Offers monthly webinars and Coffee Talk open discussion
ndash Focused QPP topic
ndash Open discuss with Q amp A ndash dedicated to your questions
ndash 2nd Thursday every month
ndash 1100 am CST for 1 hour
Telligen QIN-QIO
42copy 2016 Telligen Inc
We are here to help
bull Provides monthly electronic newsletter with resources the latest research and healthcare news relevant to you
bull Provides the ldquoWeekly Digestrdquo with electronic email on upcoming learning opportunities
bull Offers a website with the latest resources and tools and post recorded webinars for future reference
bull Partner with Telligen QIO on practice improvement activitiesndash Participation with a QIO in a self-management training program (diabetes)
ndash Implementation of antibiotic stewardship program
ndash Implementation of a cardiac quality improvement program
Telligen QIN-QIO
43copy 2016 Telligen Inc
Primary Care amp Specialist Physicians
Model
bull Align with the criteria for innovative models set forth in the Quality Payment Program
bull Build the evidence base on practice transformation so that effective solutions can be scaled
bull Move clinician practices through 5 phases of transformation with support from
ndash Practice Transformation Networks (PTN)
ndash Support amp Alignment Networks (SAN)
ndash Quality Improvement Organizations and others
Transforming Clinical Practice Initiative
44copy 2016 Telligen Inc
Primary Care amp Specialist Physicians
Goalsbull Support clinicians in their practice transformation goals
bull Improve health outcomes for millions of Medicare Medicaid and CHIP beneficiaries
bull Build the evidence base on practice transformation so that effective solutions can be scale
bull Sustain efficient care delivery by reducing unnecessary testing and procedures
bull Reduce unnecessary hospitalizations
Contact Melissa Kapping kappingmihconlineorg
Transforming Clinical Practice Initiative
45copy 2016 Telligen Inc
bull SURS (Small Underserved and Rural Support) ndash Recently announced February 16
ndash 11 organizations awarded contracts
ndash Telligen provides assistance to Iowa Nebraska South Dakota and North Dakota
ndash No cost to practices
bull Solo or small practices (15 or fewer clinicians) ndash Rural health professional shortage areas (HPSA)
ndash Medically underserved areas (MUA)
bull Outreach guidance and direct technical assistancendash Practice readiness education health IT optimization
ndash Strategic planning assisting in the full transition to APM
Telligen QPP Resource Center
46
Contact Info
Michelle Brunsen Sr QI Advisor
515-453-8180
mbrunsentelligencom
Sandy Swallow Program Specialist
515-223-2105
Sandyswallowarea-dhcqisorg
Websites
bull wwwtelligenqinqiocom
bull wwwtelligenqppcom
bull wwwqppcmsgov
THANK YOU
This material was prepared by Telligen the Quality Payment Program Small
Underserved and Rural Support contractor for Iowa Nebraska North Dakota and
South Dakota under contract with the Centers for Medicare amp Medicaid Services
(CMS) an agency of the US Department of Health and Human Services The
contents presented do not necessarily reflect CMS policy HHSM-500-2017-00012C
This material was prepared by Telligen the Medicare Quality Innovation
Network Quality Improvement Organization under contract with the
Centers for Medicare amp Medicaid Services (CMS) an agency of the US
Department of Health and Human Services The contents presented do
not necessarily reflect CMS policy
39
Quality Payment Program
Where Can Eligible Clinicians Go For Help
40copy 2016 Telligen Inc
All Eligible Clinicians are supported by
bull Quality Payment Program Websitendash Learn about the program explore the measures and find educational tools and
resources
ndash httpsqppcmsgov
bull Quality Payment Program Service Centerndash Assist with questions
ndash qppCMShhsgov
ndash 1-866-288-8292
bull Innovations Centerrsquos Learning Systemsndash Provides specialized information on Advanced Alternative Payment Models (APMs)
ndash httpsinnovationcmsgov
Self Service Technical Support
41copy 2016 Telligen Inc
We are here to help
bull Experienced quality improvement advisors to provide expert technical assistance and support for participating providers across the state especially those in large practices health systems and ACO at no charge
bull Helps in meeting MIPS requirements through customized technical assistance including one-on-one assistance when needed
bull Offers monthly webinars and Coffee Talk open discussion
ndash Focused QPP topic
ndash Open discuss with Q amp A ndash dedicated to your questions
ndash 2nd Thursday every month
ndash 1100 am CST for 1 hour
Telligen QIN-QIO
42copy 2016 Telligen Inc
We are here to help
bull Provides monthly electronic newsletter with resources the latest research and healthcare news relevant to you
bull Provides the ldquoWeekly Digestrdquo with electronic email on upcoming learning opportunities
bull Offers a website with the latest resources and tools and post recorded webinars for future reference
bull Partner with Telligen QIO on practice improvement activitiesndash Participation with a QIO in a self-management training program (diabetes)
ndash Implementation of antibiotic stewardship program
ndash Implementation of a cardiac quality improvement program
Telligen QIN-QIO
43copy 2016 Telligen Inc
Primary Care amp Specialist Physicians
Model
bull Align with the criteria for innovative models set forth in the Quality Payment Program
bull Build the evidence base on practice transformation so that effective solutions can be scaled
bull Move clinician practices through 5 phases of transformation with support from
ndash Practice Transformation Networks (PTN)
ndash Support amp Alignment Networks (SAN)
ndash Quality Improvement Organizations and others
Transforming Clinical Practice Initiative
44copy 2016 Telligen Inc
Primary Care amp Specialist Physicians
Goalsbull Support clinicians in their practice transformation goals
bull Improve health outcomes for millions of Medicare Medicaid and CHIP beneficiaries
bull Build the evidence base on practice transformation so that effective solutions can be scale
bull Sustain efficient care delivery by reducing unnecessary testing and procedures
bull Reduce unnecessary hospitalizations
Contact Melissa Kapping kappingmihconlineorg
Transforming Clinical Practice Initiative
45copy 2016 Telligen Inc
bull SURS (Small Underserved and Rural Support) ndash Recently announced February 16
ndash 11 organizations awarded contracts
ndash Telligen provides assistance to Iowa Nebraska South Dakota and North Dakota
ndash No cost to practices
bull Solo or small practices (15 or fewer clinicians) ndash Rural health professional shortage areas (HPSA)
ndash Medically underserved areas (MUA)
bull Outreach guidance and direct technical assistancendash Practice readiness education health IT optimization
ndash Strategic planning assisting in the full transition to APM
Telligen QPP Resource Center
46
Contact Info
Michelle Brunsen Sr QI Advisor
515-453-8180
mbrunsentelligencom
Sandy Swallow Program Specialist
515-223-2105
Sandyswallowarea-dhcqisorg
Websites
bull wwwtelligenqinqiocom
bull wwwtelligenqppcom
bull wwwqppcmsgov
THANK YOU
This material was prepared by Telligen the Quality Payment Program Small
Underserved and Rural Support contractor for Iowa Nebraska North Dakota and
South Dakota under contract with the Centers for Medicare amp Medicaid Services
(CMS) an agency of the US Department of Health and Human Services The
contents presented do not necessarily reflect CMS policy HHSM-500-2017-00012C
This material was prepared by Telligen the Medicare Quality Innovation
Network Quality Improvement Organization under contract with the
Centers for Medicare amp Medicaid Services (CMS) an agency of the US
Department of Health and Human Services The contents presented do
not necessarily reflect CMS policy
40copy 2016 Telligen Inc
All Eligible Clinicians are supported by
bull Quality Payment Program Websitendash Learn about the program explore the measures and find educational tools and
resources
ndash httpsqppcmsgov
bull Quality Payment Program Service Centerndash Assist with questions
ndash qppCMShhsgov
ndash 1-866-288-8292
bull Innovations Centerrsquos Learning Systemsndash Provides specialized information on Advanced Alternative Payment Models (APMs)
ndash httpsinnovationcmsgov
Self Service Technical Support
41copy 2016 Telligen Inc
We are here to help
bull Experienced quality improvement advisors to provide expert technical assistance and support for participating providers across the state especially those in large practices health systems and ACO at no charge
bull Helps in meeting MIPS requirements through customized technical assistance including one-on-one assistance when needed
bull Offers monthly webinars and Coffee Talk open discussion
ndash Focused QPP topic
ndash Open discuss with Q amp A ndash dedicated to your questions
ndash 2nd Thursday every month
ndash 1100 am CST for 1 hour
Telligen QIN-QIO
42copy 2016 Telligen Inc
We are here to help
bull Provides monthly electronic newsletter with resources the latest research and healthcare news relevant to you
bull Provides the ldquoWeekly Digestrdquo with electronic email on upcoming learning opportunities
bull Offers a website with the latest resources and tools and post recorded webinars for future reference
bull Partner with Telligen QIO on practice improvement activitiesndash Participation with a QIO in a self-management training program (diabetes)
ndash Implementation of antibiotic stewardship program
ndash Implementation of a cardiac quality improvement program
Telligen QIN-QIO
43copy 2016 Telligen Inc
Primary Care amp Specialist Physicians
Model
bull Align with the criteria for innovative models set forth in the Quality Payment Program
bull Build the evidence base on practice transformation so that effective solutions can be scaled
bull Move clinician practices through 5 phases of transformation with support from
ndash Practice Transformation Networks (PTN)
ndash Support amp Alignment Networks (SAN)
ndash Quality Improvement Organizations and others
Transforming Clinical Practice Initiative
44copy 2016 Telligen Inc
Primary Care amp Specialist Physicians
Goalsbull Support clinicians in their practice transformation goals
bull Improve health outcomes for millions of Medicare Medicaid and CHIP beneficiaries
bull Build the evidence base on practice transformation so that effective solutions can be scale
bull Sustain efficient care delivery by reducing unnecessary testing and procedures
bull Reduce unnecessary hospitalizations
Contact Melissa Kapping kappingmihconlineorg
Transforming Clinical Practice Initiative
45copy 2016 Telligen Inc
bull SURS (Small Underserved and Rural Support) ndash Recently announced February 16
ndash 11 organizations awarded contracts
ndash Telligen provides assistance to Iowa Nebraska South Dakota and North Dakota
ndash No cost to practices
bull Solo or small practices (15 or fewer clinicians) ndash Rural health professional shortage areas (HPSA)
ndash Medically underserved areas (MUA)
bull Outreach guidance and direct technical assistancendash Practice readiness education health IT optimization
ndash Strategic planning assisting in the full transition to APM
Telligen QPP Resource Center
46
Contact Info
Michelle Brunsen Sr QI Advisor
515-453-8180
mbrunsentelligencom
Sandy Swallow Program Specialist
515-223-2105
Sandyswallowarea-dhcqisorg
Websites
bull wwwtelligenqinqiocom
bull wwwtelligenqppcom
bull wwwqppcmsgov
THANK YOU
This material was prepared by Telligen the Quality Payment Program Small
Underserved and Rural Support contractor for Iowa Nebraska North Dakota and
South Dakota under contract with the Centers for Medicare amp Medicaid Services
(CMS) an agency of the US Department of Health and Human Services The
contents presented do not necessarily reflect CMS policy HHSM-500-2017-00012C
This material was prepared by Telligen the Medicare Quality Innovation
Network Quality Improvement Organization under contract with the
Centers for Medicare amp Medicaid Services (CMS) an agency of the US
Department of Health and Human Services The contents presented do
not necessarily reflect CMS policy
41copy 2016 Telligen Inc
We are here to help
bull Experienced quality improvement advisors to provide expert technical assistance and support for participating providers across the state especially those in large practices health systems and ACO at no charge
bull Helps in meeting MIPS requirements through customized technical assistance including one-on-one assistance when needed
bull Offers monthly webinars and Coffee Talk open discussion
ndash Focused QPP topic
ndash Open discuss with Q amp A ndash dedicated to your questions
ndash 2nd Thursday every month
ndash 1100 am CST for 1 hour
Telligen QIN-QIO
42copy 2016 Telligen Inc
We are here to help
bull Provides monthly electronic newsletter with resources the latest research and healthcare news relevant to you
bull Provides the ldquoWeekly Digestrdquo with electronic email on upcoming learning opportunities
bull Offers a website with the latest resources and tools and post recorded webinars for future reference
bull Partner with Telligen QIO on practice improvement activitiesndash Participation with a QIO in a self-management training program (diabetes)
ndash Implementation of antibiotic stewardship program
ndash Implementation of a cardiac quality improvement program
Telligen QIN-QIO
43copy 2016 Telligen Inc
Primary Care amp Specialist Physicians
Model
bull Align with the criteria for innovative models set forth in the Quality Payment Program
bull Build the evidence base on practice transformation so that effective solutions can be scaled
bull Move clinician practices through 5 phases of transformation with support from
ndash Practice Transformation Networks (PTN)
ndash Support amp Alignment Networks (SAN)
ndash Quality Improvement Organizations and others
Transforming Clinical Practice Initiative
44copy 2016 Telligen Inc
Primary Care amp Specialist Physicians
Goalsbull Support clinicians in their practice transformation goals
bull Improve health outcomes for millions of Medicare Medicaid and CHIP beneficiaries
bull Build the evidence base on practice transformation so that effective solutions can be scale
bull Sustain efficient care delivery by reducing unnecessary testing and procedures
bull Reduce unnecessary hospitalizations
Contact Melissa Kapping kappingmihconlineorg
Transforming Clinical Practice Initiative
45copy 2016 Telligen Inc
bull SURS (Small Underserved and Rural Support) ndash Recently announced February 16
ndash 11 organizations awarded contracts
ndash Telligen provides assistance to Iowa Nebraska South Dakota and North Dakota
ndash No cost to practices
bull Solo or small practices (15 or fewer clinicians) ndash Rural health professional shortage areas (HPSA)
ndash Medically underserved areas (MUA)
bull Outreach guidance and direct technical assistancendash Practice readiness education health IT optimization
ndash Strategic planning assisting in the full transition to APM
Telligen QPP Resource Center
46
Contact Info
Michelle Brunsen Sr QI Advisor
515-453-8180
mbrunsentelligencom
Sandy Swallow Program Specialist
515-223-2105
Sandyswallowarea-dhcqisorg
Websites
bull wwwtelligenqinqiocom
bull wwwtelligenqppcom
bull wwwqppcmsgov
THANK YOU
This material was prepared by Telligen the Quality Payment Program Small
Underserved and Rural Support contractor for Iowa Nebraska North Dakota and
South Dakota under contract with the Centers for Medicare amp Medicaid Services
(CMS) an agency of the US Department of Health and Human Services The
contents presented do not necessarily reflect CMS policy HHSM-500-2017-00012C
This material was prepared by Telligen the Medicare Quality Innovation
Network Quality Improvement Organization under contract with the
Centers for Medicare amp Medicaid Services (CMS) an agency of the US
Department of Health and Human Services The contents presented do
not necessarily reflect CMS policy
42copy 2016 Telligen Inc
We are here to help
bull Provides monthly electronic newsletter with resources the latest research and healthcare news relevant to you
bull Provides the ldquoWeekly Digestrdquo with electronic email on upcoming learning opportunities
bull Offers a website with the latest resources and tools and post recorded webinars for future reference
bull Partner with Telligen QIO on practice improvement activitiesndash Participation with a QIO in a self-management training program (diabetes)
ndash Implementation of antibiotic stewardship program
ndash Implementation of a cardiac quality improvement program
Telligen QIN-QIO
43copy 2016 Telligen Inc
Primary Care amp Specialist Physicians
Model
bull Align with the criteria for innovative models set forth in the Quality Payment Program
bull Build the evidence base on practice transformation so that effective solutions can be scaled
bull Move clinician practices through 5 phases of transformation with support from
ndash Practice Transformation Networks (PTN)
ndash Support amp Alignment Networks (SAN)
ndash Quality Improvement Organizations and others
Transforming Clinical Practice Initiative
44copy 2016 Telligen Inc
Primary Care amp Specialist Physicians
Goalsbull Support clinicians in their practice transformation goals
bull Improve health outcomes for millions of Medicare Medicaid and CHIP beneficiaries
bull Build the evidence base on practice transformation so that effective solutions can be scale
bull Sustain efficient care delivery by reducing unnecessary testing and procedures
bull Reduce unnecessary hospitalizations
Contact Melissa Kapping kappingmihconlineorg
Transforming Clinical Practice Initiative
45copy 2016 Telligen Inc
bull SURS (Small Underserved and Rural Support) ndash Recently announced February 16
ndash 11 organizations awarded contracts
ndash Telligen provides assistance to Iowa Nebraska South Dakota and North Dakota
ndash No cost to practices
bull Solo or small practices (15 or fewer clinicians) ndash Rural health professional shortage areas (HPSA)
ndash Medically underserved areas (MUA)
bull Outreach guidance and direct technical assistancendash Practice readiness education health IT optimization
ndash Strategic planning assisting in the full transition to APM
Telligen QPP Resource Center
46
Contact Info
Michelle Brunsen Sr QI Advisor
515-453-8180
mbrunsentelligencom
Sandy Swallow Program Specialist
515-223-2105
Sandyswallowarea-dhcqisorg
Websites
bull wwwtelligenqinqiocom
bull wwwtelligenqppcom
bull wwwqppcmsgov
THANK YOU
This material was prepared by Telligen the Quality Payment Program Small
Underserved and Rural Support contractor for Iowa Nebraska North Dakota and
South Dakota under contract with the Centers for Medicare amp Medicaid Services
(CMS) an agency of the US Department of Health and Human Services The
contents presented do not necessarily reflect CMS policy HHSM-500-2017-00012C
This material was prepared by Telligen the Medicare Quality Innovation
Network Quality Improvement Organization under contract with the
Centers for Medicare amp Medicaid Services (CMS) an agency of the US
Department of Health and Human Services The contents presented do
not necessarily reflect CMS policy
43copy 2016 Telligen Inc
Primary Care amp Specialist Physicians
Model
bull Align with the criteria for innovative models set forth in the Quality Payment Program
bull Build the evidence base on practice transformation so that effective solutions can be scaled
bull Move clinician practices through 5 phases of transformation with support from
ndash Practice Transformation Networks (PTN)
ndash Support amp Alignment Networks (SAN)
ndash Quality Improvement Organizations and others
Transforming Clinical Practice Initiative
44copy 2016 Telligen Inc
Primary Care amp Specialist Physicians
Goalsbull Support clinicians in their practice transformation goals
bull Improve health outcomes for millions of Medicare Medicaid and CHIP beneficiaries
bull Build the evidence base on practice transformation so that effective solutions can be scale
bull Sustain efficient care delivery by reducing unnecessary testing and procedures
bull Reduce unnecessary hospitalizations
Contact Melissa Kapping kappingmihconlineorg
Transforming Clinical Practice Initiative
45copy 2016 Telligen Inc
bull SURS (Small Underserved and Rural Support) ndash Recently announced February 16
ndash 11 organizations awarded contracts
ndash Telligen provides assistance to Iowa Nebraska South Dakota and North Dakota
ndash No cost to practices
bull Solo or small practices (15 or fewer clinicians) ndash Rural health professional shortage areas (HPSA)
ndash Medically underserved areas (MUA)
bull Outreach guidance and direct technical assistancendash Practice readiness education health IT optimization
ndash Strategic planning assisting in the full transition to APM
Telligen QPP Resource Center
46
Contact Info
Michelle Brunsen Sr QI Advisor
515-453-8180
mbrunsentelligencom
Sandy Swallow Program Specialist
515-223-2105
Sandyswallowarea-dhcqisorg
Websites
bull wwwtelligenqinqiocom
bull wwwtelligenqppcom
bull wwwqppcmsgov
THANK YOU
This material was prepared by Telligen the Quality Payment Program Small
Underserved and Rural Support contractor for Iowa Nebraska North Dakota and
South Dakota under contract with the Centers for Medicare amp Medicaid Services
(CMS) an agency of the US Department of Health and Human Services The
contents presented do not necessarily reflect CMS policy HHSM-500-2017-00012C
This material was prepared by Telligen the Medicare Quality Innovation
Network Quality Improvement Organization under contract with the
Centers for Medicare amp Medicaid Services (CMS) an agency of the US
Department of Health and Human Services The contents presented do
not necessarily reflect CMS policy
44copy 2016 Telligen Inc
Primary Care amp Specialist Physicians
Goalsbull Support clinicians in their practice transformation goals
bull Improve health outcomes for millions of Medicare Medicaid and CHIP beneficiaries
bull Build the evidence base on practice transformation so that effective solutions can be scale
bull Sustain efficient care delivery by reducing unnecessary testing and procedures
bull Reduce unnecessary hospitalizations
Contact Melissa Kapping kappingmihconlineorg
Transforming Clinical Practice Initiative
45copy 2016 Telligen Inc
bull SURS (Small Underserved and Rural Support) ndash Recently announced February 16
ndash 11 organizations awarded contracts
ndash Telligen provides assistance to Iowa Nebraska South Dakota and North Dakota
ndash No cost to practices
bull Solo or small practices (15 or fewer clinicians) ndash Rural health professional shortage areas (HPSA)
ndash Medically underserved areas (MUA)
bull Outreach guidance and direct technical assistancendash Practice readiness education health IT optimization
ndash Strategic planning assisting in the full transition to APM
Telligen QPP Resource Center
46
Contact Info
Michelle Brunsen Sr QI Advisor
515-453-8180
mbrunsentelligencom
Sandy Swallow Program Specialist
515-223-2105
Sandyswallowarea-dhcqisorg
Websites
bull wwwtelligenqinqiocom
bull wwwtelligenqppcom
bull wwwqppcmsgov
THANK YOU
This material was prepared by Telligen the Quality Payment Program Small
Underserved and Rural Support contractor for Iowa Nebraska North Dakota and
South Dakota under contract with the Centers for Medicare amp Medicaid Services
(CMS) an agency of the US Department of Health and Human Services The
contents presented do not necessarily reflect CMS policy HHSM-500-2017-00012C
This material was prepared by Telligen the Medicare Quality Innovation
Network Quality Improvement Organization under contract with the
Centers for Medicare amp Medicaid Services (CMS) an agency of the US
Department of Health and Human Services The contents presented do
not necessarily reflect CMS policy
45copy 2016 Telligen Inc
bull SURS (Small Underserved and Rural Support) ndash Recently announced February 16
ndash 11 organizations awarded contracts
ndash Telligen provides assistance to Iowa Nebraska South Dakota and North Dakota
ndash No cost to practices
bull Solo or small practices (15 or fewer clinicians) ndash Rural health professional shortage areas (HPSA)
ndash Medically underserved areas (MUA)
bull Outreach guidance and direct technical assistancendash Practice readiness education health IT optimization
ndash Strategic planning assisting in the full transition to APM
Telligen QPP Resource Center
46
Contact Info
Michelle Brunsen Sr QI Advisor
515-453-8180
mbrunsentelligencom
Sandy Swallow Program Specialist
515-223-2105
Sandyswallowarea-dhcqisorg
Websites
bull wwwtelligenqinqiocom
bull wwwtelligenqppcom
bull wwwqppcmsgov
THANK YOU
This material was prepared by Telligen the Quality Payment Program Small
Underserved and Rural Support contractor for Iowa Nebraska North Dakota and
South Dakota under contract with the Centers for Medicare amp Medicaid Services
(CMS) an agency of the US Department of Health and Human Services The
contents presented do not necessarily reflect CMS policy HHSM-500-2017-00012C
This material was prepared by Telligen the Medicare Quality Innovation
Network Quality Improvement Organization under contract with the
Centers for Medicare amp Medicaid Services (CMS) an agency of the US
Department of Health and Human Services The contents presented do
not necessarily reflect CMS policy
46
Contact Info
Michelle Brunsen Sr QI Advisor
515-453-8180
mbrunsentelligencom
Sandy Swallow Program Specialist
515-223-2105
Sandyswallowarea-dhcqisorg
Websites
bull wwwtelligenqinqiocom
bull wwwtelligenqppcom
bull wwwqppcmsgov
THANK YOU
This material was prepared by Telligen the Quality Payment Program Small
Underserved and Rural Support contractor for Iowa Nebraska North Dakota and
South Dakota under contract with the Centers for Medicare amp Medicaid Services
(CMS) an agency of the US Department of Health and Human Services The
contents presented do not necessarily reflect CMS policy HHSM-500-2017-00012C
This material was prepared by Telligen the Medicare Quality Innovation
Network Quality Improvement Organization under contract with the
Centers for Medicare amp Medicaid Services (CMS) an agency of the US
Department of Health and Human Services The contents presented do
not necessarily reflect CMS policy