Value Based Payment Programs Quality Payment Program

What is MACRA The Medicare Access and CHIP Reauthorization Act of 2015 (MACRA) repeals the Medicare Sustainable Growth Rate (SGR) methodology for updates to the Physician Fee Schedule (PFS) and replaces it with a new approach to payment called the Quality Payment Program (QPP). Yale Medicine 2

What's the Quality Payment Program? The Quality Payment Program consolidates components of three existing programs, Physician Quality Reporting System (PQRS) Physician Value-based Payment Modifier (VM) Medicare Electronic Health Record (EHR) Incentive Program for Eligible Professionals (EPs) If you participate in Medicare Part B, you are part the Quality Payment Program. You can choose how you want to participate based on your practice size, specialty, location, or patient population. The Quality Payment Program has two tracks you can choose: Advanced Alternative Payment Models (APMs) or If you decide to participate in an Advanced APM, through Medicare Part B you may earn an incentive payment for participating in an innovative payment model. The Merit-based Incentive Payment System (MIPS) If you decide to participate in traditional Medicare Part B, then you will participate in MIPS where you earn a performance-based payment adjustment. Yale Medicine 3

Quality Payment Program? Who's Eligible for the Quality Payment Program? You are eligible for the the Quality Payment Program if you bill Medicare more than $30,000 a year and provide care for more than 100 Medicare patients a year, and are a: Physician Physician assistant Nurse practitioner Clinical nurse specialist Certified registered nurse anesthetist Yale Medicine 4

When to Start the Quality Payment Program You get to pick your pace for the Quality Payment Program. If you're ready, you can begin January 1, 2017 and start collecting your performance data. If you're not ready on January 1, you can choose to start anytime between January 1 and October 2, 2017. Whenever you choose to start, you'll need to send in your performance data by March 31, 2018. The first payment adjustments based on performance go into effect on January 1, 2019. Yale Medicine 5

Pick Your Pace in MIPS Yale Medicine 6

Payment Year Impact Thresholds Yale Medicine 7

Yale Medicine Estimated Yearly Payment Adjustments * Estimation based on $90,000,000 Medicare Part B payments 8

How does MIPS work? The cost category will be calculated in 2017, but will not be used to determine your payment adjustment. In 2018, CMS will start using the cost category to determine payment adjustment. Yale Medicine 9

Participate in MIPS as an Individual or a Group? 10

MIPS Overview Category What do you need to do? 2017 category weight Quality Replaces the Physician Quality Reporting System (PQRS). Report up to 6 quality measures, including an outcome measure, for a minimum of 90 days. 2017 CATEGORY WEIGHT 60% Improvement Activities New category. Attest that you completed up to 4 improvement activities for a minimum of 90 days. 15% Advancing Care Information Replaces the Medicare EHR Incentive Program, also known as Meaningful Use. Fulfill the required measures for a minimum of 90 days: Security Risk Analysis e-Prescribing Provide Patient Access Send Summary of Care Request/Accept Summary of Care Choose to submit up to 9 measures for a minimum of 90 days for additional credit. For bonus credit, you can: Report Public Health and Clinical Data Registry Reporting measures Use certified EHR technology to complete certain improvement activities in the improvement activities performance category 25% Cost Replaces Value-Based Modifier. No data submission required. Calculated from adjudicated claims. Counted starting in 2018 11

Need for a Value Based Payments Support Structure Quality Payment Program evaluates providers quality measures against national benchmarks 60% of QPP incentives are tied to quality performance CMS reimbursement for 2019 onward is at risk. For 2015 YM’s best performing measures were preventive care measures (= not specialty specific) Yale Medicine’s performance was average c/w national benchmarks Performance data will be publicly reported Attestation and reporting process infrastructure exists today, and will need to continue to function at current state. Medicaid Meaningful Use attestations will continue along with MIPS data submission 12 Yale Medicine

Proposed Value Based Payments Support Structure Yale Medicine Board Steering Committee (Quality Committee) Finance Workgroup Clinical/Operations Workgroup Yale Medicine 13

Value Based Payment Programs Steering Committee Yale Medicine Board has recommended creating a Yale Medicine Quality Committee to serve as the Steering Committee for the Value Based Payment Programs Support Structure. Yale Medicine 14

Value Based Payment Programs Steering Committee Responsibilities Provide the workgroups with strategic vision. Aid with decision making. Receive report-out on workgroup progress. Modify workgroup structure to align with program initiatives needed. Report to YM leadership on the progress of the MACRA program. Yale Medicine 15

Value Based Payment Programs Finance Workgroup Reports to the Steering Committee Workgroup Leader(s): Iain Burchell Dr. Steve Fleischman Workgroup Responsibilities: Forecast, budget and allocate payments/adjustments to the individual providers Assess and advise YM Administration of: Financial Risk Impact on Claims and Coding 16 Yale Medicine

Value Based Payment Programs Clinical Operations Workgroup Reports to the Steering Committee Workgroup Co-Leader(s): Maryam Saeri Dr. Brita Roy, YM Workgroup Responsibilities: Identify KPI’s to report and initiate practice improvements opportunities for to increase measure performance for MACRA and Value Based Payment programs. Develop/monitor benchmarks for practice and quality improvement to demonstrate improvement. Identify Clinical Quality measures for MACRA program and align with YHP. Work with the departments to bring awareness to the KPI’s/quality measures and communicate steps needed to ensure compliance. 17 Yale Medicine

Quality Payment Plan Website https://qpp.cms.gov/ 18 Yale Medicine

Cindy Kosh Cindy.Kosh@yale.edu 203-785-4957 Barbara King Contact Information Cindy Kosh Cindy.Kosh@yale.edu 203-785-4957 Barbara King Barbara.King@yale.edu 203-785-6325 19 Yale Medicine