Quality for Physician Reimbursement Brenden Wynn, regional operations manager Providence medical group

Quality Reporting Is No Longer Optional 4% - 4% 5% - 5% 7% - 7% 9% - 9% 2019 2020 2021 2022 Over the past decade, programs have been implemented by the Centers for Medicare and Medicaid Services that directly tie reimbursement to quality. Early programs had more upside than downside risk - but that balance is changing

Quality based programs are transforming into Merit Based Incentive Programs (MIPS) 25% 50% 15% 10% 25% Advancing Care Information – MU Measures 15% Clinical Practice Improvement – Care Coordination, PT Satisfaction, Access to Care 50% Quality PQRS 10% Resource Use – VBPM – Cost Measures

Unfortunately, Medical Groups have not excelled under PQRS 5477 Number of group practices hit with fines in 2014 for not meeting quality reporting standards $79.5 Million Dollar amount of VBM penalties for 5477 physician groups who did not meet quality reporting standards in 2014. In 2014 more than 5000 physician groups failed to meet physician quality reporting standards. This equated to $79.5 million dollars in penalties. These continuing adjustments for under performing physicians increase the urgency around improving your quality reporting structures. Not only will poorly performing physicians or groups experience an adjustement, they will see their more successful peers receiving upward adjustments. Those physicians or groups who don’t report at all will receive the largest penalties

Successfully navigating and managing quality reporting is no easy task $15.4 Billion spent on quality reporting in 2015 15.1 hours of physician time per week spent on quality reporting 785 hours of physician time per year spent on quality reporting Physician care teams and support staff are spending significant time and resources on activities such as tracking measures, reviewing, quality reports, collecting and transmitting quality data, and more. 15.4 Billion spent on reporting quality in 2015 15.1 hours of physician time per week reporting 785 hours - average time per physician per year.

Barriers To Quality Reporting Too few FTE’s to support quality reporting Different measures for each payer/program Lack of healthcare provider buy-in Missing quality infrastructure Lack of physician buy in Missing quality infrastructure Lack of performance benchmarks EMR Limitations It’s okay to Few FTE’s to support execution of Quality reporting Abundance of quality measures EMR limitations

Providence Quality Measure Progress 150 QM 33 QM 15 Quality Measures

Checklist for Quality Reporting Preparation Strategy Prioritize actionable measures Prioritize measures that maximize financial returns Track Quality Data Use data to emphasize opportunity Timely and scheduled performance updates Engage Stakeholders in Performance Risk Tie payer incentives to compensation Incentives to engage the entire care team Governance Structure Dedicate quality resources Determine quality mandate