>> Molly MacHarris: The merit-based incentive
payment system performance categories.
I'm Molly MacHarris with CCSQ, and I will be leading
you through this discussion.
So what are the performance categories under the
MIPS program?
They are quality, cost, improvement activities, and
advancing care information.
There are specific weights that are assigned to these
four performance categories, and you'll note that these
weights or numbers of these categories roll up to
100 points.
That becomes important because each clinician,
under the MIPS program, will receive a final score that
will be a numerical value between one and 100, and
that specific number will determine the amount of
payment a clinician will receive in 2019.
There will be additional training modules that deal
with exactly how clinicians will be scored under the
MIPS program, so I would strongly encourage everyone
to take a look at those modules as well.
But the four performance categories for the
transition year: the weights are quality will count for
60 points, cost will count for zero points, so that
means we will not be measuring cost for the first
year, improvement activities will count for 15 points,
and advancing care information will count for
25 points.
So I'm going to talk through each of these performance
categories in more detail.
So to start off with quality, which counts for 60
points of a clinician's final score, the quality
performance category and the quality performance category
requirements are that the MIPS eligible clinicians
should select six measures from a list of close to 300
measures available.
Of those six measures, one should be an outcome measure
or if an outcome measure is not available to your
particular specialty or practice, please select
another high-priority measure.
And the high-priority measures are defined as
outcome measures, appropriate use measures,
patient experience, patient safety, efficiency, or care
coordination measures.
Please note that under the quality performance
category, we do have different performance
requirements for some of the submission mechanisms, most
notably the CMS web interface.
There are different performance requirements
than compared to the rest of the requirements under the
quality performance category.
For the cost performance category, again, we are not
measuring cost in the first year of the MIPS program.
We will, however, calculate the cost measures, and
provide information to clinicians on those cost
measures through informative feedback reports.
We want to ensure that clinicians have the ability
to see how they would perform under these cost
measures before we actually assess their performance.
For the improvement activities performance
category, remember this is the new category that's
available under the MIPS program; there are nine
subcategories, and over 90 activities the clinicians
can choose their activities from.
The majority of clinicians would need to choose
four activities.
Some clinicians will only have to choose two
activities, and those are some of the special
considerations that we have under the MIPS program.
So for those clinicians that are considered non-patient
facing, if they're in a rural or a HPSA area, if
they are part of a small practice they would only
have to do two activities to get the full points under
this category.
There are also additional special considerations for
clinicians that are part of an EPM, or part of a patient
centered medical home.
And so for the last performance category,
advancing care information, remember this category deals
with the usage of certified electronic health
record technology.
We really reworked this performance category, based
off of the feedback we received from clinicians
throughout this past year, and we have introduced a lot
of additional flexibility into this category.
Previously under the old meaningful use program,
there wasn't the ability for clinicians to choose which
measures and objectives that they would report on.
We now have that ability under the advancing care
information performance category.
With that flexibility, there are still some required
measures, which we feel all clinicians should do.
The number of those measures differ, based off of the
addition of certified EHR technology that the
clinician has available to them, and then on top of the
base measures there are additional performance
measures that clinicians can report on to increase their
total potential score under the advancing care
information performance category.
Additionally, under the advancing care information
performance category, there are a few exceptions.
For those clinicians who are hospital-based, meaning a
certain percentage of their time and services are
rendered at a hospital, they have the ability to be
excluded from the advancing care information
performance category.
There also are a few hardships that are available
under the advancing care information
performance category.
We know that there are still some pockets within the
United States where there's not high-speed Internet
access and, without that, it becomes hard to use your
electronic health records.
So in some of those instances we do have the
ability to exempt those providers.
It is on a case-by-case basis, however.
Thank you for viewing this presentation.
For more information please visit the quality payment
program website at qpp.cms.gov.