1. MIPS Simplified Scoring
Strategic Healthcare Partners, LLC

2. Memorable factoids ≈95% of providers will participate in MIPS
MIPS is budget neutral. Losers’ penalties pay winners’ bonus
Congressional Lawmakers sought to “simplify” physician benchmarking
AHIP & CMS already agreed to harmonize quality metrics
MIPS scores will be publicly available
An Advanced Alternative Payment Model (APM) is a generic term to describe 2-sided risk based arrangements
April 2015
MACRA passed via bipartisan support
April 2016
Proposed Rule Released
November 2016
Final Rule Released
January 1, 2017
Reporting Year 1 Begins
1 minute

3. Acronym Guide
ACI – Advancing Care Information (Formerly Meaningful Use)
AHIP – American Health Insurance Plans
APM – Advanced Alternative Payment Model
CCM – Chronic Care Management (CPT 99490)
CERHT – Certified Electronic Health Record Technology
CPIA – Clinical Practice Improvement Activities
CPOE – Computerized Provide Order Entry (E-Prescribing)
CPS – Composite Performance Score
HIE – Health Information Exchange
MACRA – Medicare Access and CHIP Reauthorization Act of 2015
MSPB – Medicare Spending Per Beneficiary
MSSP – Medicare Shared Savings Program
PCMH – Patient Centered Medical Home
SDOH – Social Determinants of Health
TCM – Transitional Care Management (CPTs )
QPP - Quality Payment Program
QCDR – Qualified Clinical Data Registry

4. MACRA Status Update 9/8/16 CMS announced 4 Options for MIPS 1 2 3 4
Test Program: Submit any data to avoid negative payment adjustment 2
Participate for part of year for a “small positive adjustment” 3
Participate for the entire year for a “moderate positive adjustment” 4
Avoid MIPS via Advanced Alternative Payment Model (APM)
1 minute
Key Take Away: If you can, participate for the entire year.

5. ≈95% projected to participate in MIPS
*Estimations prior to recent update nullifying negative penalties in 2019
1 minute

6. MIPS Composite score Summary
Category
Formerly Known As:
Year 1 Weight
Scoring Methodology
Quality
PQRS
50%
Each measure 1-10 points compared to historical benchmark
0 points for non-reported measure
Bonus Points available
Measures are averaged for total categorical score
Advancing Care Information
Meaningful Use
25%
Base score of 50% points achieved by reporting at least one unique patient for each measure
Performance score of up to 80% points
Public Health Reporting Bonus Point
100% points = Full Credit
Clinical Practice Improvement Activities
N/A
15%
10 Point “medium weight” activities & 20 Point “high-value” activities available
60 Points = Full Credit
Resource Use
Value-Modifier
10%
Similar Scoring to Quality Category
No Reporting Necessary!
1 minute
Quality
Advancing Care Information
Clinical Practice Improvement Activities
Cost:
Resource Utilization
Key Take-Away: Quality & ACI Take priority.

7. Quality Performance Total Points
Each measure is converted to a decile point scale (1-10)
Zero points for a non-reported measure
Bonus points
Total Points
Total Points
Total Possible Points
Quality
Composite Performance Score
1 minute
Quality
Advancing Care Information
Clinical Practice Improvement Activities
Cost:
Resource Utilization

8. Quality Performance Decile 1 2 3 4 5 6 7 8 9 10 Possible Points
CMS publishes deciles based on national performance in baseline period
Eligible clinician’s performance is compared to baseline
If performance on a measure is clustered together (i.e. 70% of respondents are within 3 deciles, the midpoint decile will be assigned to all providers in this cluster)
All 80% of these providers will receive the midpoint decile of 8 points
Skip
Decile 1 2 3 4 5 6 7 8 9 10
Possible Points
% of Providers 0% 2% 3% 5%
10%
80%

9. Quality Performance- Bonus Points
Earn up to a possible 10% “extra credit” in bonus points
1 bonus point for other “high priority” measures (up to 5%)
1 bonus point for each measure reported using CEHRT (up to 5%)
2 bonus points awarded for additional outcome/patient experience
Not available for claims
30 seconds
Quality
Advancing Care Information
Clinical Practice Improvement Activities
Cost:
Resource Utilization

10. Quality Performance Scoring Example
Measure
Measure Type
# of Cases
Points Based on Performance
Total Possible Points (10 x Weight)
Quality Bonus Points for High Priority
Quality Bonus Points for EHR
Measure 1
Outcome Measure using CEHRT 20
4.1 10
0 (Required) 1
Measure 2
Process using CEHRT 21
9.3
Measure 3 22
Measure 4
Process 50
Measure 5
High Priority-Patient Safety 43
8.5
Measure 6 (Missing)
Cross-Cutting
N/A
Acute Composite
Admin. Claims
Not scored: below minimum sample size
Chronic Composite
6.3
Total Points
All Measures
48.2 70 3
1 minute
Quality
Advancing Care Information
Clinical Practice Improvement Activities
Cost:
Resource Utilization
Key Take-Away: Know your measures. Include 1 Outcome & 1 Cross-Cutting Measure. Consult CMS’ Core Set Measures.

11. Quality Performance 52.2 Total Points 48.2 Points
70 Possible Points
74.6% Quality Score
48.2 Points
1 Bonus Point for high priority measure
3 bonus points for CEHRT Reporting
52.2 Total Points
30 seconds
Quality
Advancing Care Information
Clinical Practice Improvement Activities
Cost:
Resource Utilization

12. Advancing Care Improvement
Base Score
Performance Score
Bonus Point
Composite Score
Represents 50 Points of ACI Score
Represents 80 Points of ACI Score
Up to 1 Point of ACI Score
100 Points = Full Credit in ACI Category
30 seconds
Quality
Advancing Care Information
Clinical Practice Improvement Activities
Cost:
Resource Utilization

13. ACI Base Score Protect PHI (Required) CPOE (E-Prescribing)
To receive full credit of the base score, physicians will need to report one unique patient in each category
ACI Base Score
Protect PHI
(Required)
CPOE
(E-Prescribing)
Patient Electronic Access
(Patient Portal)
Coordination of Care Through Patient Engagement
Health Information Exchange
Public Health/Clinical Data Registry Reporting (Required)
30 seconds
Quality
Advancing Care Information
Clinical Practice Improvement Activities
Cost:
Resource Utilization

14. ACI Base Score Proposed Examples
Protect PHI
Security Analysis (Required)
Electronic Prescribing
CPOE
Public Health and Clinical Data Registry Reporting
Immunization Registry Reporting (Required)
Syndromic Surveillance Reporting (Optional)
Electronic Case Reporting (Optional)
Public Health or Clinical Data Registry Reporting (Optional)
ACI Base Score Proposed Examples
* = Proposed Performance Score
Coordination of Care Through Patient Engagement
View, Download, and Transmit (VDT)*
Secure Messaging*
Patient-Generated Health Data*
Health Information Exchange
Exchange Information with Other Clinicians*
Exchange Information with Patients*
Clinical Information Reconciliation*
Patient Electronic Access
Patient Access to PHI*
Patient-Specific Education*
30 seconds-Skip Most
Quality
Advancing Care Information
Clinical Practice Improvement Activities
Cost:
Resource Utilization

15. ACI Performance Score Patient Electronic Access
Physicians will be proportionally scored against their peers in terms of patient engagement with these objectives
ACI Performance Score
Patient Electronic Access
Coordination of Care Through Patient Engagement
Health Information Exchange
30 seconds
Quality
Advancing Care Information
Clinical Practice Improvement Activities
Cost:
Resource Utilization
Key Take-Away: Get creative to encourage patients to utilize patient portal.

16. Clinical Practice Improvement Activities: Summary
90+ proposed activities categorized as “high” 20 point activities or “medium” 10 point categories
Full credit is achievement of 60 points
Patient-Centered Medical Home (PCMH) guarantees full credit
APM participation receives a minimum of half credit
30 seconds
Quality
Advancing Care Information
Clinical Practice Improvement Activities
Cost:
Resource Utilization

17. CPIA Reporting Options
Individual Reporting
Attestation
QCDR
Qualified Registry
Electronic Health Record
Administrative claims (if technically feasible, no submission required)
Group Reporting
CMS Web Interface (Groups of 25+)
15 seconds
Quality
Advancing Care Information
Clinical Practice Improvement Activities
Cost:
Resource Utilization

18. CPIA Subcategories These 3 subcategories are required in MACRA
Expanded Practice Access
Beneficiary Engagement
Population Health Management
Patient Safety and Practice Assessment
Care Coordination
Participation in an APM, including a medical home model
These 6 subcategories proposed in NPRM
Achieving Health Equity
Emergency Preparedness and Response
Integrated Behavioral & Mental Health
1 minute
These 3 subcategories are required in MACRA
Quality
Advancing Care Information
Clinical Practice Improvement Activities
Cost:
Resource Utilization

19. CPIA examples Expanded Practice Access Population Health Management
24/7 Access to Care team
Telehealth
Patient Experience used for QI Projects
Population Health Management
Participation in systemic anticoagulation program
Participation in a QCDR
Monitor health conditions
Care Coordination
Participate in Transforming Clinical Practice Initiative
Closing the referral loop
Timely HIE with patients & providers
Beneficiary Engagement
Collect & utilize patient experience data
Beneficiary Training for self-management
Patient portal
10 points!
20 points!
Full Credit = 60 points
1 minute
Quality
Advancing Care Information
Clinical Practice Improvement Activities
Cost:
Resource Utilization

20. CPIA examples Patient Safety & Assessment Achieving Health Equity
Opioid Management
Use of Surgical Checklists
STEPS Forward Program
Achieving Health Equity
Timely care for Medicaid patients
Participate in State Innovation Model activities
Screen for SDOH
Emergency Response
Participate in Disaster Medical Assistance teams
Participate in domestic or international humanitarian work
Integrated Behavioral & Mental Health
Co-location of mental health services in clinical settings
Depression Screening
Substance abuse prevention & treatment
10 points!
20 points!
Full Credit = 60 points
1 minute
Quality
Advancing Care Information
Clinical Practice Improvement Activities
Cost:
Resource Utilization

21. Use of Surgical Checklists
CPIA Scoring Summary
Participate in TCPI
Telehealth
Use of Surgical Checklists
Patient Portal
50 Total CPIA Points
50 Total CPIA Points
60 Points
83% CPIA Score
83% x 15% weight for CPIA = 12.5 points towards MIPS Composite Score
30 seconds
Quality
Advancing Care Information
Clinical Practice Improvement Activities
Cost:
Resource Utilization
20 Point
Activity
10 Point
Activity

22. CPIA Special scoring considerations
Non-patient facing eligible clinicians, small practices (15 or fewer professionals), rural practices, and clinicians in geographic health professional shortage areas:
1st activity earns 50% of the 60 points
2nd activity earns 100% of the 60 points
APM participation automatically earns 50% of the 60 points
PCMH’s receive 60 points
SKIP
Quality
Advancing Care Information
Clinical Practice Improvement Activities
Cost:
Resource Utilization

23. Resource Utilization: Key Changes
Value Modifier
6 Measures; Total per capita costs for all attributed beneficiaries
Medicare spending per Beneficiary (MSPB)
Total per capita cost measures for 4 condition-specific groups (COPD, CHF, CAD, Diabetes)
Attribution to group practice (TIN)
Proposed MIPS Resource Use Category
2 of the 6 VM measures; Total per capita costs for all attributed beneficiaries
Removes total per capita cost for the 4 condition-specific groups
Proposes up to 41 other episode-based measures
Attribution to group (TIN) or individual TIN or NPI
30 Seconds-Skip Most
Quality
Advancing Care Information
Clinical Practice Improvement Activities
Cost:
Resource Utilization

24. Resource Utilization: Key Changes - Attribution
Value Modifier
2-step process for claims-based measures
Proposed MIPS Resource Use Category
Expansion of primary care services to align with MSSPs:
Inclusion of CCM & TCM coding
Exclusion of nursing visits occurring in SNF
Skip
Quality
Advancing Care Information
Clinical Practice Improvement Activities
Cost:
Resource Utilization

25. Resource Utilization: Key Changes - MSPB
Value Modifier
MSPB measures care around a hospitalization
Adjusted for IP DRG & a separate adjustment is applied to specialty composition of group practice
Minimum of 125 cases to be “reliably” measured
Proposed MIPS Resource Use Category
Individual cases measured the same
2 technical adjustments for MIPS:
Modified individual case aggregation
Removed specialty adjustment
Two adjustments make MSPB more at the smaller case volume
20 cases is the proposed threshold for episode-groups
Skip
Quality
Advancing Care Information
Clinical Practice Improvement Activities
Cost:
Resource Utilization

26. Measure Performance Threshold
Resource Use Scoring Sample
Resource Use
Type of Measure
# of Cases
Performance
Measure Performance Threshold
Points Based on Decile
Total Possible Points M1
MSPB 20
$15,000
$13,000
4.0 10 M2
Total Per Capita 21
$12,000
$10,000
4.2 M3
Episode 1 22
$18,000
5.8 M4
Episode 2
$11,000
$9,000
Below Case Threshold
N/A M5
Episode 3
No attributed cases M6
Episode 4 45
$7,000
8.3
Total
22.3 40
30 seconds
Quality
Advancing Care Information
Clinical Practice Improvement Activities
Cost:
Resource Utilization

27. Resource Use Scoring 55.8% 40 possible points 22.3 points
Each measure is converted to decile points (1-10)
(Only Includes Case Volumes >20)
Total Points
22.3 points
40 possible points
55.8%
Resource Use Score
30 seconds
Quality
Advancing Care Information
Clinical Practice Improvement Activities
Cost:
Resource Utilization

28. MIPS Composite score Summary
Category
Formerly Known As:
Year 1 Weight
Scoring Methodology
Quality
PQRS
50%
Each measure 1-10 points compared to historical benchmark
0 points for non-reported measure
Bonus Points available
Measures are averaged for total categorical score
Advancing Care Information
Meaningful Use
25%
Base score of 50% points achieved by reporting at least one unique patient for each measure
Performance score of up to 80% points
Public Health Reporting Bonus Point
100% points = Full Credit
CPIA
N/A
15%
10 Point “medium weight” activities & 20 Point “high-value” activities available
60 Points = Full Credit
Resource Use
Value-Modifier
10%
Similar Scoring to Quality Category
Discussion Time…
Quality
Advancing Care Information
Clinical Practice Improvement Activities
Cost:
Resource Utilization

29. Transforming Clinical Practice Improvement Grant
CMS $685 million awarded to equip >140,000 clinicians with tools needed to:
Improve Care Quality
Increase Patients’ access to information
Assist in FFS>FFV Transformation
Population Health IT Infrastructure
Caravan Health
Also known as “National Rural Accountable Care Consortium”
Active in 43 states
Uses “Lightbeam” Population health Solution
Compass PTN
Iowa Health Collaborative-Partnered with GHA
Active in 6 states
Uses “Telligen” Population Health Solution

30. Transforming Clinical Practice Improvement Grant
Traditional Approach
Transformed Practice
Transforming Clinical Practice Improvement Grant
What?
Patient’s chief complaints determines care
Systemically assess all patient health needs
How?
Care is determined by today’s problem
Care is determined by proactive care plan
Via Population Health Infrastructure
When?
Care varies by scheduled time
Care is standardized according to evidence-based guidelines
Skip
Who?
Patients are responsible for coordinating their own care
A TEAM of professionals coordinate patient care

31. Questions?