CMS Quality Reporting Training Session

Overview of POM ACO and Quality Reporting Agenda Introductions Overview of POM ACO and Quality Reporting Timeline Review How to Properly Document Review the Measurements

Introductions

Abstraction Team Project Lead: James Malayang, Sr. Project Manager Lead Team Project Lead: James Malayang, Sr. Project Manager Email: malayang@med.umich.edu Office: 734-232-1478 Fax:734-232-1480 Mobile: 734-678-7185 Lead Abstractor: Cana Howard, MSN, RN, Performance Improvement Coordinator Email: cmshims@med.umich.edu Office: 734-615-8892 Fax: 734-615-4849

Abstraction Team AHPO: Joan Kirk, Kirk Agerson, Grace Calderon QRO Leads AHPO: Joan Kirk, Kirk Agerson, Grace Calderon HVPA: Deb Roberts IHA: Christy Hankins MCCO: Sarah Travis OMS: Melissa Kirshner OSP: Carla Lough SMPHO: Matt Meisel UM: Cana Howard UP: Kim Coleman, Tesia Looper, Denise Mercatante WCM: Beth Oberhaus, Tina Champion

Abstraction Team AHPO: 4 HVPA: 7 IHA: 3 MCCO: 3 OM: 4 OSP: 7 UM: 9 Abstractors AHPO: 4 HVPA: 7 IHA: 3 MCCO: 3 OM: 4 OSP: 7 UM: 9 UP: 6 WCM: 4 Total: 47

Overview of POM ACO

Accountable Care Organizations What is an ACO? Accountable Care Organizations Groups of doctors, hospitals, and other health care providers, who come together to give coordinated care to their Medicare patients. When an ACO succeeds both in delivering high-quality care and spending health care dollars better, it shares in the savings it achieves for Medicare. ACOs emerged from the ACA as a way to incentivize coordinated care and reduce health care costs.

What is a Medicare Shared Savings Program (MSSP) ACO? Affordable Care Act A key component of the Medicare delivery system reform The aim is to facilitate coordination and cooperation among providers to improve the quality of care for Medicare Fee-For-Service beneficiaries and reduce unnecessary costs. MSSPs create a formal legal structure by which they distribute the shared savings. Must have a minimum of 5,000 beneficiaries.

Purposes of POM ACO Develop an integrated approach to health care delivery to provide the highest quality of care in the most cost effective way possible; Address the “triple aims” of health care: Better care for individuals; Better health for populations; and Lower growth in expenditures. Provide the necessary administration and infrastructure to achieve these goals. Physician-governed and led.

POM ACO Partnerships

The plan is to move to a Track 1+ Future State of POM ACO The plan is to move to a Track 1+ 2018 = Track 1 ACO 2019 = Track 1+ This is an upside/downside risk ACO that will qualify as an Advanced Alternative Payment Model. Track 1 ACO 2017 Track 1 ACO 2018 Track 1+ ACO 2019

CMS How CMS Sees POM ACO POM ACO QROs QROs QROs QROs TIN TIN AGREEMENT

Overview of Quality Measurement

AKA “MACRA=Medicare “Quality Payment Program” Medicare Access and CHIP Reauthorization Act of 2015 AKA “MACRA=Medicare “Quality Payment Program” MACRA creates a framework to reward physicians for higher quality and lower cost performance in 2 tracks: MACRA consolidates 3 existing quality payment programs into each of the tracks including Meaningful Use, PQRS, and VBM Merit Based Incentive Payment System (MIPS) OR Advanced Alternative Payment Model

MIPS APM Reporting Requirement From THE MERIT-BASED INCENTIVE PAYMENT SYSTEM: MIPS Scoring Methodology Overview.pdf (https://www.cms.gov/Medicare/Quality-Payment-Program/Resource-Library/Medicare-Shared-Savings-Program-and-the-Quality-Payment-Program.pdf ) CATEGORY Who Submits Quality Performance POM ACO is required to report quality measures through the CMS Web Interface. The quality data will be used to score the MIPS Quality performance category and the score will apply to each MIPS clinician in the ACO. Improvement Activities MIPS APM clinicians in MSSP ACOs shouldn’t need to report any data for this because they automatically receive full points for this category. Cost MIPS APM clinicians in MSSP ACOs shouldn’t need to report because they won’t be assessed on the MIPS Cost performance category. Advancing Care Information All POM ACO participant TINs are responsible for submitting data on the Advancing Care Information performance category apart from the ACO as specified by MIPS. This information is necessary for the Shared Savings Program to measure the level of CEHRT use among clinicians participating in the ACO. APM Scoring Standard The Shared Savings Program is a MIPS APM, and all MIPS clinicians in POM ACO will receive special scoring for MIPS under the APM scoring standard. Consequently, all MIPS clinicians in your ACO will receive the same MIPS final score.

POM ACO and MACRA Track 1 ACO Reports MIPS as an ACO Aggregate MIPS performance of ACO accounts for Medicare payment adjustment 2 years after performance year

Quality Measure Data Collection and Performance Rate Calculations Quality Score Claims Quality Scores CAHPS CMS calculates performance rates for each measure for each ACO based on the algorithms specified in the measures documentation For the CAHPS for ACOs, CMS Web Interface measures, and claims-based measures.

How Has POM ACO Fared? In 2016 our spending benchmark goal was $9,904 per beneficiary for the year. Through your hard work and dedication we were able to beat that target by 0.79%. Our quality score was excellent at 94.2%. 2016 marks the 4th consecutive year POM ACO providers have successfully lowered the cost of care provided to Medicare beneficiaries and provided outstanding quality at the same time. We are among the very few ACOs with this track record of success.

Our Historic Performance Performance Year % Savings Achieved Dollars Saved CMS Quality Score 2016 0.79% $8.0 Million 94.2% 2015 1.4% $17.7 Million 97.7% 2014 2.46% $27 Million 91.3% 2013 0.68% $4.7 Million 100% (Pay for Reporting only)

CMS required us to achieve a 2% savings threshold Despite our Success CMS required us to achieve a 2% savings threshold Not eligible for a shared savings payment we could distribute. We managed to decrease Medicare’s costs by $78/person this year. We need to have decreased costs by $120/person more than we did. That equates to 10% fewer ER visits or 1 day less in a Skilled Nursing Facility for our patients.

Timeline Review

Explanation of the color-coded activities. Pre-Abstraction Calendar Explanation of the color-coded activities. Date Item Examples Green POM ACO Training and Activities EIDM Accounts, Training Sessions, Weekly Q&A Orange POM ACO Communication Upcoming Activities, Status Report, Completeness Report Blue CMS Webinars and Dates Kickoff Webinars Red Key Dates and Milestones Tool Available, Abstraction Milestones Pink Important POM ACO Tasks Beneficiary Sample Prep, Final Review

Completeness Activities and Quality Review Every week Review the tool for completion based on documentation standards Quality Review After 100% Completeness Milestone Each QRO will be given 10 patients for each measure to review If they don’t pass, fix so it can.

How to Properly Document

Review the Measurements

Questions? Project Lead: James Malayang, Sr. Project Manager Email: malayang@med.umich.edu Office: 734-232-1478 Fax:734-232-1480 Mobile: 734-678-7185 Lead Abstractor: Cana Howard, MSN, RN, Performance Improvement Coordinator Email: cmshims@med.umich.edu Office: 734-615-8892 Fax: 734-615-4849