Quality Payment Program Year 4:

Final Rule HighlightsThe information contained in this presentation is for general information purposes only. The information is provided by UK HealthCare’s Kentucky Regional Extension Center and while we endeavor to keep the information up to date and correct, we make no representations or warranties of any kind, express or implied, about the completeness, accuracy, reliability, suitability or availability with respect to content.

UK’s Kentucky REC is a trusted advisor and partner to healthcare organizations, supplying expert guidance to maximize quality, outcomes and financial performance.

To date, the Kentucky REC’s activities include:

• Assisting more than 5,000 individual providers across Kentucky, including primary care providers and specialists

• Helping more than 95% of the Federally Qualified Health Centers (FQHCs) and Rural Health Clinics (RHCs) within Kentucky

• Working with more than 1/2 of all Kentucky hospitals

• Supporting practices and health systems across the Commonwealth with practice transformation and preparation for value based payment

Physician Services

1. Promoting Interoperability (MU) & Mock Audit

2. HIPAA SRA, Project Management & Vulnerability Scanning

3. Patient Centered Medical Home (PCMH) Consulting

4. Patient Centered Specialty Practice (PCSP) Consulting

5. Value Based Payment & MACRA Support

6. Quality Improvement Support

7. Telehealth Services

Hospital Services

1. Promoting Interoperability (Meaningful Use)

2. HIPAA Security Analysis & Project Management

3. Hospital Quality Improvement Support

Kentucky REC Description

Kentucky Regional Extension Center Services

Vance DrakefordQIA

Megan McIntoshQIA

Jessica ElliottQIA

Your REC Advisors & Presenters

On November 1st, 2019 CMS released the QPP Final Rule • These changes went into effect on January 1st, 2020*

2020 QPP Final Rule

*Some changes are retrospective

Year 4 Quality Payment Program Overview

Merit-Based Incentive Payment System (MIPS) Track Updates

MIPS Value Pathways (MVPs)

Alternative Payment Model (APM) Track Update

Objectives

Polling Question #1

What is your greatest QPP concern for this year?

Enter your answer into the polling window on the

right side of your screen

2020 Quality Payment Program (QPP) Overview

QPP Y4: Program TracksBy law, MACRA requires CMS to implement an incentive program, referred to as the

Quality Payment Program, which provides two participation tracks for clinicians:

Quality Payment Program (QPP)

MIPS Merit-based Incentive

Payment System

MIPS ECs are subject to a performance-based payment adjustment

through MIPS

Advanced APMsAdvanced Alternative

Payment Models

QPs may earn an incentive payment for participating in one of

these models

QPP Y4: QPP Clinician Eligibility

Merit-Based Incentive Program(MIPS)

$90KPart B

200 Medicare Patients

200 PFS

Advanced Alternative Payment Model(APMs)

Advanced APM

Participant

50% Payment

or

35% Medicare Patients

QPP Track Eligibility Requirements

Eligible Clinician Types:Physicians (including Doctors of Medicine, Osteopathy, Dental Surgery, Dental Medicine, Podiatric Medicine,

and Optometry), Osteopathic Practitioners, Chiropractors, PA, NP, CNS, CRNA, PT, OT, Qualified Speech-Language Pathologist, Qualified Audiologist, Clinical Psychologist, Registered Dietitian or

Nutrition Professional

OR

Have you already submitted for Program Year 2019?

Polling Question #2

Enter your answer into the polling window on the

right side of your screen

2020 Merit-Based Incentive Payment System

QPP Y4: MIPS Thresholds

0 - 44 Points

MinimumPerformance

Threshold

45 Points

46 - 84 Points

Exceptional Performance

Threshold

+85Points

– Payment Adjustment Avoid Penalty Potential +

Adjustment+ Payment Adjustment

NEW for 2020–/+ 9%

Adjustment Factor!!!

QPP Y4: MIPS Overview

Must Submit by March 31st, 2021

Quality

PromotingInteroperability

Improvement Activities

Cost

2020 PROGRAM

YEAR&

2022 PAYMENT

YEAR

CAT

EGO

RY

WEI

GH

T

15%

25%

45%

15%

REP

OR

TIN

G

TIM

EFR

AMES

365 Days

365Days

90 Days

90 Days

QPP Y4: Reporting OptionsIn

divi

dual • Under an NPI

number & TIN where they reassign benefits

Gro

up • > 2 clinicians (NPIs) who have reassigned their billing rights to a single TIN

• As an APM Entity

Virt

ual G

roup • Combination

of > 2 TINs assigned to > 1 individual MIPS ECs, or to > 1 groups consisting of <10 ECs with > 1 MIPS EC

Quality:Added:

New Measures & Specialty Measure Sets

Removed/Altered:125 Measures

Increase of Data Completeness = 70%

IA:Cost:Attribution:

Set at Measure level Added:

10 New Episode-based Measures

QPP Y4: MIPS Performance Categories Changes

PI:Removed:

15 ActivitiesAdded/Modified:

9 Activities50% of ECs in Group MUST Perform Activity

Removed/Modified:Bonus Measure(s)

Hospital-Based as 75% or More of ECs Under TIN

Most Measures Updated Impacting Num/Den & Workflows

Pull Measure Spec Sheets to Verify

Every Measure Impacted

Patient-Relationship Process

Expanded Measures

Increased Documentation Burden

Requires Added Prep/Planning

Reduced Bonus Opp.

105 Possible Pts.

Expanded Flexibility for Hospital-Based ECs

Why It Matters…

Polling Question #3

What is your overall QPP performance goal for 2020 ?

Enter your answer into the polling window on the

right side of your screen

MIPS Value Pathways (MVPs)

QPP Y4: MIPS Value Pathways (MVPs)

MIPS Historical Categories

Quality, Cost, Improvement

Activities

Promoting Interoperability (Foundational)

Administrative Claims-Based

Quality Measures

Population & Public Health

Priorities

Condition Specific

Measures

Enhanced Data & Feedback

Increase in Comparable Performance

Data

Fewer Variations in Submissions

A conceptual participation framework that would apply to future proposals beginning with the 2021 performance year. The goal is to move away from siloed activities and measures and move towards an aligned set of

measure options more relevant to a clinician’s scope of practice that is meaningful to patient care.

QPP Y4: MVPs Framework

2020 APM Updates

QPP Y4: APM Overview

Must Submit by March 31st, 2021

Quality

PromotingInteroperability

Improvement Activities

Cost

2020 PROGRAM

YEAR&

2022 PAYMENT

YEAR

CAT

EGO

RY

WEI

GH

T

20%

30%

50%

0%

REP

OR

TIN

G

TIM

EFR

AMES

365 Days

365Days

90 Days

90 Days

MIPS APMUse of

certified EHR

Payment tied to Quality

Measures

Risk Bearing / Medical Home Model

QP Benefits:

• 5% bonus• APM-specific

reward• Exclusion

from MIPS

QPP Y4: Advanced APM Requirements

Qualified Participant (QP)

50% Payments APM

35% Patients

Part of Advanced APM

Partial QP

40% Payments

25% Patients

Part of Advanced APM

OR

QPP Y4: Advanced APMs for 2020

Bundled Payments for Care Improvement (BPCI) Advanced

Comprehensive ESRD Care (CEC) – Two-Sided Risk

Comprehensive Primary Care Plus (CPC+)

Medicare Accountable Care Organization (ACO) Track 1+ Model

Next Generation ACO Model Medicare Shared Savings Program – Tracks 2 and 3

Oncology Care Model (OCM) –Two-Sided Risk

Comprehensive Care for Joint Replacement (CJR) Payment Model (Track 1-CEHRT)

Vermont Medicare ACO Initiative (as part of the Vermont All-Payer ACO Model)

Comprehensive ESRD Care (CEC) Model

Maryland Models•All-Payer Model (Care Redesign Program)•Total Cost of Care Model (Maryland Primary Care Program)

•Total Cost of Care Model (Care Redesign Program

CMS will assign scores to MIPS eligible clinicians in the improvement activity performance category for participating in MIPS APMs. For the 2020 performance period, the list of MIPS APMs include:

APM Entities participating in this list of MIPS APMs above will receive a full score for the Improvement Activities performance category in performance period 2020, and therefore will not need to submit additional improvement activity information under MIPS. All MIPS APMs will receive 50% points for IA automatically

QPP Y4: Changes to APM IA

Maryland Primary Care Program (MD PCP)

Oncology Care Model (OCM; all Tracks)

Next Generation Accountable Care Organization (NGACO) Model

Comprehensive End-Stage Renal Disease Care (CEC) Model (all Tracks)

Bundled Payments for Care Improvement (BPCI) Advanced

Independence at Home (IAH) Demonstration

Comprehensive Primary Care Plus (CPC+) Model (all Tracks)

Vermont All-Payer ACO (VT ACO) Model

Medicare Shared Savings Program (MSSP) (all Tracks, including the Medicare ACO Track 1+ Model)

• Partial QPs will now be deemed Partial with the one TIN

• May be eligible for MIPS with other TIN/NPI combinations

Qualifying Participant Status

• Other Payer MIPS APMs• Due to reporting

issues the practice may submit Quality data

• Will receive a score > 50% of the Quality category total points

MIPS APMs

• Alignment of MSSP & Web Interface Measure Sets

• Non-ACO Group Reporters: score for each of the measures they report & 0 pts for unreported measures

Medicare Shared Savings

QPP Y4: Advanced APMs Update

45 Points Threshold; 60 for Year 5

50% IA

85 Points to be Exceptional Performer

Expanded Cost Measures; defined at measure level

MVPs 2021; Mandatory 2022

QCDR Push

Removal of IA’s PDMP

Quality Measures adjustments and removal

70% Data Validation

No Weight shifts

QPP Y4: Top 10 Final Rule Impacts

Polling Question #4

Was today’s content helpful for you or your practice?

Enter your answer into the polling window on the

right side of your screen

QPP Y4: Questions

Proven Success with the REC

KY REC Clients As Reported By CMS

82% of our Small & Rural Clients were Exceptional

Performers in 2018

13% of Small & Rural Practices NATIONWIDE will receive a

NEGATIVE payment adjustment

Averaged a Score of 84.74% Averaged a Score of 67.25%

Had a Median Score of 92.49% Had a Median Score of 81.36%

CELEBRATING 10 YEARS OF SUCCESS!

100% of Contracted

Clients Avoided the Penalty in

2018

Dive into YOUR Data &

Documentation

Examine Current Performance thru

Gap Analysis

Customized Recommendations & Action Planning

Individualized Advisor for YOU

Unlock your MAXIMUM

Performance Potential

How We Help YOU!

TO BE THE TRUSTED ADVISOR AND STRATEGIC PARTNER IN KENTUCKY

Upcoming QPP Webinars

QPP Y4: Quality

3.19.20

QPP Y4: MIPS APM

4.30.20

Client Only

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