Episode Cost-Based Measures (MACRA) - November 9, 2017 - AAMC
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Episode Cost-Based Measures (MACRA)
November 9, 2017
© 2016 Vizient and AAMC Page 1Housekeeping
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© 2016 Vizient and AAMC Page 2Slides Prepared by: • Gayle Lee, galee@aamc.org • Keith Horvath, khorvath@aamc.org • Gregg Pane, gpane@aamc.org • Robert Dean, Robert.Dean@vizientinc.com © 2016 Vizient and AAMC Page 3
Agenda 1. Quality Payment Program (QPP): Background 2. Cost measures 3. CMS Field Testing and Request for Feedback 4. Explanation of Cost Measures and Feedback Reports 5. Discussion © 2016 Vizient and AAMC Page 4
April 2015: MACRA Is Enacted Starting in 2019 (based on performance in 2017) payments will be linked to quality and value under a Merit-based Incentive Payment System (MIPS) or Advanced Alternative Payment Model (APMs). Payment can be increased or decreased based on performance. © 2016 Vizient and AAMC Page 5
MACRA Crossroads: Quality Payment Programs
MIPS
+/- 4% in 2019 APMs
+5% for 2019-2024
+/-5% in 2020
Estimates 180,000 to 245,000
+/-9% in 2022 clinicians will become QPs for
CMS estimates 572,299 clinicians 2020 payment year
for 2020 payment year
© 2016 Vizient and AAMC Page 6MIPS: Composite Performance Score: Four
Categories (2018 performance year)
Four Categories
1. Cost (10 %)
2. Quality (50%) ACI, 25% Quality,
3. Improvement 50%
Activities (15%)
4. Advancing Care
Improvem
Information ent
(previously Activities
Meaningful Use 15%
Program) (25%) Cost,
In 2019 performance year, 10%
cost weight will become 30%
© 2016 Vizient and AAMC Page 7Cost (Weight 10%): 2018
• Based on current two Value Modifier Program
Measures
– Medicare Spending Per Beneficiary (MSPB)
– Total Per Capita Cost (includes Medicare Part A and
B payments)
• Plan in future to add episode-based cost measures to
developed in collaboration with expert clinicians and
stakeholders
• No additional reporting required; calculated from claims
data
• Will provide feedback to providers in July 2018
• Rewards improvement from year to year for significant
changes at the measure level .
© 2016 Vizient and AAMC Page 8What is a Cost Measure? Medicare payments for medical care furnished during an episode of care (includes Part A and Part B services) Includes 5 components • Defining the episode of care (trigger, length of episode) • Attributing the episode to physician/group • Assigning costs to episode group • Risk Adjusting • Aligning Cost and Quality © 2016 Vizient and AAMC Page 9
Attributing Episode Groups to Clinicians • Assignment of responsibility for an episode of care to a clinician. • Procedural episode groups are attributed to clinician responsible for triggering procedure (e.g. surgical procedure). • Acute inpatient medical condition groups are attributed to clinicians who billed at least 30% of inpatient evaluation services. © 2016 Vizient and AAMC Page 10
CMS Announces 8 Episode Groups 1. Elective Outpatient Percutaneous Coronary Intervention (PCI) 2. Knee Arthroplasty 3. Revascularization for Lower Extremity Chronic Critical Limb Ischemia 4. Routine Cataract Removal with Intraocular Lens (IOL) Implantation 5. Screening/Surveillance Colonoscopy 6. Intracranial Hemorrhage or Cerebral Infarction 7. Simple Pneumonia with Hospitalization 8. ST-Elevation Myocardial Infarction (STEMI) with (PCI) © 2016 Vizient and AAMC Page 11
Field Testing of 8 measures (10/16-11/16) • Providers have opportunity to Review Performance on 8 measures and provide feedback to CMS • Confidential Field Test Reports available on the CMS Enterprise Portal. • All stakeholders may review and provide feedback on the Mock Field Test Report and supplemental documentation, including Draft Cost Measure Methodology • Posted on the MACRA page under the “Quality Payment Program” section and “Episode-based cost measures” subsection. © 2016 Vizient and AAMC Page 12
CMS Is Seeking Feedback • Draft measure specifications for the 8 measures • Format of the Field Test Report • Supplemental Documentation (fact sheet, FAQs) • Can submit feedback via survey monkey or as a separate pdf file. © 2016 Vizient and AAMC Page 13
Structure of Field Test Reports
• Field test reports contain the following tabs:
– Overview
– High-level Summary Results (all cost measures)
– Results (1 tab per cost measure)
– Appendices
• A: Drill-Down Detail by Setting and Service Category (1
tab per cost measure)
• B: Episode-Level Table
• C. How to Interpret Your Report
© 2016 Vizient and AAMC Page 14© 2016 Vizient and AAMC Page 15
© 2016 Vizient and AAMC Page 16
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© 2016 Vizient and AAMC Page 18
Appendix A
• Medicare and service Categories include costs for:
– Outpatient evaluation and management services and
Therapy
– Ancillary services (e.g. labs, imaging, DME)
– Hospital Inpatient Services
– Emergency Room Services
– Post-Acute Services (home health, SNF, IRF)
– Hospice
– Other Services (ambulance, chemotherapy, dialysis)
© 2016 Vizient and AAMC Page 19© 2016 Vizient and AAMC Page 20
Appendices Tab
Appendix B
• Provides information at episode-level for all
episodes attributed to your TIN or TIN-NPI that
were used in calculating your score for each cost
measure
Appendix C
• Provides additional guidance for users to
understand contents of field test report
© 2016 Vizient and AAMC Page 21Feedback Questions Presentation and content of the field test report. For example, how can the reports be improved to be more readable and useful in helping to understand the clinician’s performance on the cost measure? Is the information provided actionable? Feedback on the 8 cost measures, including: methodology, measures code lists, definition of episode group trigger codes, window length selected for cost measures, service assigned to the episode, and risk adjusting the episode group. Feedback on other supplemental documentation (FAQ, Fact Sheet) © 2016 Vizient and AAMC Page 22
CMS Website For Information & Comment
Submission
https://www.cms.gov/Medicare/Quality-
Initiatives-Patient-Assessment-
Instruments/Value-Based-Programs/MACRA-
MIPS-and-APMs/MACRA-MIPS-and-APMs.html
© 2016 Vizient and AAMC Page 23Questions Please use the Q&A panel located on the right hand side of your screen to submit your questions. Send to All Panelists. © 2016 Vizient and AAMC Page 24
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