>> Molly Mackerras: So, let's jump to slide 33
and then 34.
So, I'm going to dive into the four performance
categories and what you need to know.
So, on slide 34, the first performance category that
I'll talk about is quality.
Quality counts for 60 percent of your final score.
Your final score will be a number that ranges from
either 0 to 100.
And you want to ensure that your final score
is about the number 3.
If your final score is above the number 3, that
means that you will not be getting a penalty and that
you would be getting a slight or potentially
higher bonus depending upon where you rank
between that 3 to 100 scale.
So, what makes up your final score?
The first category, again, is quality.
Quality, we have finalized over 270 -- 80 measures
that are available.
The requirements are that you would need to select
six measures.
One of those would need to be an outcome measure.
If an outcome measure isn't available, you would
need to select another high priority measure
such as appropriate use, patient experience,
patient safety, efficiency, or care coordination.
And again, you can make the selection either
through our comprehensive set of close to 300
measures, or you could make this selection from
a specialty set.
Let's move on to slide 35.
So, what does this mean again within the context
of the pick your pace.
So, under pick your pace test for quality would be
submitting one quality measure, and partial in
full could mean submitting six quality measures with
one outcome or one high priority.
In all instances, it doesn't mean that you have
to do six quality measures.
If you find that you are able to do three or four
measures, we would encourage you to do that.
Let's move on to slide 36.
The cost performance category.
We haven't talked too much about cost, and the reason
why we haven't is because we are actually not
assessing costs for payment purposes in this first year.
Rather, we will be calculating the cost
performance category based off of your claims data
that you submit to us, and we will provide you
feedback on how you performed on the cost category.
We have included two measures that were
previously part of the physician value modifier,
the Medicare spending per beneficiary and a total
cost measure, and we also have included ten episode measures.
So, let's move on to slide 37, the improvement
activities performance category.
So, this is the new category that is available under MIPS.
This was not previously available under the PCARE
[unintelligible] or meaningful use program
and it's brand new.
And so, what improvement activities does is,
it really deals with practice improvements that you make
within your own practice.
We have over 90 activities to select from that span
nine categories.
Those categories are listed on the slide here,
and generally for most clinicians to get
the fullest point under improvement activities --
so, there are 15 points here, they would have
to do no more than four activities.
On slide 38, there are a couple special
considerations under this category for certain types
of clinicians.
So, the first is if you are part of a small
practice, you are a solo practitioner, if you work
in a rural or HPSA area, the most you would have
to do to get the fullest points here is two activities.
Also, if you are part of a patient-centered medical
home, you automatically get full credit under this
category, and then there are also some special
considerations if you are part of an APM where
you can get full points.
So, let's move on to slide 39.
So, what does improvement activities mean for
the pick your pace?
So, again test means the testing to one improvement
activity for 90 days.
Partial in full means a testing to either
the maximum of four activities or depending upon
the activities you select, you may have to do
a little bit less.
We do have a high weighting and a medium
weighting of these activities.
So, you could do two high weighted activities or
four medium activities or any combination to get you there.
So, let's move on to slide 40.
The last performance category which is
advancing care information.
Again, this deals with the usage of electronic health
records, and this counts for 25 points towards your final score.
What we've done with the advancing care information
performance categories, we've really restructured
this from the way it previously worked
under meaningful use.
We've heard a lot of feedback that the way it
was working wasn't working, that we didn't
have enough flexibility in there, and that if you
miss one measure you would potentially fail completely.
As we've reworked it to build in a base score
and a performance score, there are two sets of measures
to choose from based off of your addition of EHR.
So, on slide 41, you can see what those measure
sets are if you have either 2015 edition
certified EHR technology or if you have the 2014 edition.
And then on slide 42, so what does this mean under
the pick your pace?
So, the test would mean that you would do the base measures.
Again, those are either four or five measures
depending upon your edition of certified EHR
technology, and then partial or full would mean
doing more than the base, so doing some of the
elements that are part of the performance side of
advancing care information.
On slide 43, there are some additional
flexibilities under this category.
We will automatically reweight this category,
and what I mean by reweighting is that we
will zero it out and give those 25 points
to the quality category.
So, that means your quality portion of your
final score would now count for 85 points.
So, that happens if you are a hospital-based
clinician, if you are a nonpatient-facing
clinician, or if you are a nurse practitioner,
physician assistant, certified registered nurse
anesthetist, or clinical nurse specialist, you do
not have to participate in the advancing care category.
You can, however, choose to do so, and if you do,
then we will assess you based off of the
information you provide to us.
You also -- if you don't meet any of these under
number one, you can also ask for us to reweight
this category to quality for three reasons.
One, if you have insufficient internet
activity, if there are extreme and uncontrollable
circumstances, and then a third is if you have lack
of control over your ability of certified EHR technology.
For those of you who are familiar with the
meaningful use program, these are very similar to
the hardship exceptions that were previously
available there.