Transcript MIPS Quality Component

MACRA
Quality Payment Program
MIPS Quality Component
Jill Sage | Quality Affairs Manager
DIVISION OF ADVOCACY AND HEALTH POLICY
MIPS Quality Component
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Overview of the quality data submission requirement
Reporting options and quality measures
Scoring the quality component
Tips on how to be successful
Quality Payment Program
MIPS Quality Component
MIPS: 2019 Payment Adjustment*
*CY
2019 payment adjustments based on CY 2017 performance
Quality
ACI
IA
Cost
(60%)
(25%)
(15%)
(0%)
Quality Payment Program
MIPS Quality Component
Final
Score
MIPS: Quality Data Submission Criteria
• MIPS submission mechanisms:
– Qualified Clinical Data Registry (QCDR), Qualified Registry, EHR,
Claims
• Report a minimum of six measures, including:Composite
Performanc
– One outcome measure OR
e Score
– One high-priority measure if an outcome measure is
not available
(CPS)
• Report on 50 percent of all-payer patients (50 percent of
Medicare patients for claims reporting)
Quality Payment Program
MIPS Quality Component
Pick Your Pace in MIPS: Quality Performance Category
Do Nothing
Test Pace
Partial
Participation
Full
Participation
• Do nothing
• Get a 4 percent
penalty
• Report one quality
measure for at
least one patient
• Avoid 4 percent
penalty
• Report six quality
measures for a
minimum of 90
days, including one
outcome or one
high-priority
measure
• May earn a positive
adjustment
• Report six quality
measures for a full
year, including
one outcome or
one high-priority
measure
• May earn a
positive
adjustment
Quality Payment Program
MIPS Quality Component
Important to Note
Positive adjustments are based on
performance, not the amount of
information or length of time providers
reported
Quality Payment Program
MIPS Quality Component
MIPS: Quality Measures
• Surgeons can select six measures from:
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–
–
–
List of approximately 300 MIPS quality measures
Specialty-specific set of measures
Qualified Clinical Data Registry (non-MIPS measures)
Composite
Performanc
Groups can continue to report via the Centers for Medicaid
&
e Score
Medicare Services (CMS) Web interface or Consumer
(CPS)
Assessment of Healthcare Providers and Systems (CAHPS) for
MIPS
Quality Payment Program
MIPS Quality Component
Specialty-Specific Measure Set Example
General Surgery
Perioperative Care: Selection of Prophylactic Antibiotic—
First OR Second Generation Cephalasporin
Anastomotic Leak Intervention
Perioperative Care: Venous Thromboembolism (VTE)
Prophylaxis (When Indicated in ALL Patients)
Unplanned Reoperation within the 30-Day Postoperative
Period
Care Plan
Unplanned Hospital Readmission within 30 Days of
Principal Procedure
Preventive Care and Screening: Body Mass Index (BMI)
Screening and Follow-Up Plan
Surgical Site Infection (SSI)
Documentation of Current Medications in the Medical
Record
Patient-Centered Surgical Risk Assessment and
Communication
Preventive Care and Screening: Tobacco Use—Screening
and Cessation Intervention
Closing the Referral Loop: Receipt of Specialist Report
Preventive Care and Screening: Screening for High Blood
Pressure and Follow-Up Documented
Tobacco Use and Help with Quitting among Adolescents
Quality Payment Program
MIPS Quality Component
Composite
Performanc
e Score
(CPS)
MIPS: ACS Registries for 2017 MIPS Reporting
The ACS has two registries that can be used for reporting MIPS for 2017:
The Surgeon Specific Registry (SSR) and the Metabolic and Bariatric
Surgery Accreditation and Quality Improvement Program (MBSAQIP)
Composite
Performanc
e Score
(CPS)
Offers two submission mechanisms:
• QCDR (non-MIPS measures)
• Traditional registry (MIPS
measures)
Quality Payment Program
MIPS Quality Component
Offers the QCDR (non-MIPS
measures) submission
mechanism
MIPS: Scoring for Quality
• Three to 10 points on each quality measure based on
performance against benchmarks
• Bonus points available:
Composite
– Two bonus points for each additional outcome or patient
Performanc
experience measure; one bonus point for each additional
highe Score
priority measure
(CPS)
– One point for end-to-end electronic reporting
• Failure to submit data will result in a score of zero
Quality Payment Program
MIPS Quality Component
MIPS: Tips for Success in Quality
• Report on at least six
measures, with as many
outcome and highpriority measures as you
can
• Review your PQRS
Feedback Reports
Quality Payment Program
MIPS Quality Component
• Report for a time period
that will allow you to have
reliable data or at least
meet the minimum case
volume
• Utilize ACS resources,
including ACS registries
available for reporting
MIPS