>> Adam Richards: Great.
Thanks, Mary.
We're going to enter into Part 2 of the webinar today.
And this is really the getting started, the "how
do I do it" portion of the webinar.
So, we're going to start, really, with the checklist
for preparing for and participating in MIPS.
And it's my pleasure to introduce another
colleague, Dr. Asbhy Wolfe, Chief Medical
Officer for Region 9 at CMS and a family
physician, to run us through this list and give
us some pointers on how to get started.
>> Ashby Wolfe: Thank you so much, Adam, and good
afternoon -- or good morning -- everyone,
depending on where you're accessing the call from.
It's my pleasure to be here, and I am going to be
walking you through the final segment where we'll
discuss the practical aspects of the program --
the how-to of the participating in this MIPS
pathway of the quality payment program.
And thank you, Tomali [phonetic sp] and Mary
for that detailed review of MIPS.
I'm going to try to break down some of what Molly
and Mary discussed and described on the next several slides.
If we move to slide 52, you'll see a checklist.
Really, we hope this will be useful to you
as clinicians, as practice managers, as part of
the care support team in preparing for participation
in this transition year, 2017.
And you'll see on this slide there are a number
of points to take a look at.
I'm going to be walking you through each of these
checks in the next several slides, including looking
at how you determine your eligibility, how you might
choose to submit your data, what submission
method to look at, and how to choose your measures, et cetera.
This checklist is really meant to serve as a
general guide to every clinician who would be
participating in MIPS, regardless of your level
of experience with prior reporting programs like
PQRS or Medicare Meaningful Use.
So, we're going to walk through each of these
items -- just remember, this checklist is really
a means to help you get started.
You have the flexibility to determine how many
elements are really applicable to you in your
practice, and don't feel that you need to complete
this checklist in order, or all at once.
We're going to talk through each step and you
can really personalize it as you see fit,
and as it would be helpful.
So, moving through slide 53 to slide 54, let's talk
about that first checkpoint -- determining your eligibility.
So, how do you this for your practice?
Well, to go back to the eligibility piece that
Molly mentioned earlier -- really, it's a question
of determining your annual patient count and billing
amount for Medicare Part B -- and getting back
to that specific question: did you bill more than
$30,000 in Part B allowed charges and provide care
for more than 100 Medicare patients in a given year?
Again, this applies to Medicare Part B fee for
service -- so really taking a look at your
claims for service provided between September
1, 2015 and August 31, 2016 will be key in order
to determine your eligibility.
Now, CMS will be providing additional information
to you this spring to help you in this effort.
The key thing I want you to take away from this is
that there is this two-part piece to the eligibility.
If you are a physician, a nurse practitioner, PA,
Certified Registered Nurse Anesthetist, or Nurse Specialist
you have to be able to answer that question: "Did you bill
more than $30,000 in Part B allowed charges, and provide
care for more than 100 Medicare patients in that year?"
Now, as I mentioned, CMS will be providing
additional information to help you determine this
eligibility, and we've been really deliberate
to make sure that all clinician information
is up to date and that our eligibility data is accurate.
So, let's move on to the next data point --
the next decision point here -- on slide 55.
How do you choose to submit data?
Do you participate as an individual or as part
of a group?
So, on slide 56 you'll see this particular checkpoint --
an eligible clinician has two options for participating
in the MIPS pathway, as was mentioned previously.
You can participate as an individual, meaning that
you, as a clinician, would report information under
your unique National Provider Identifier,
or NPI, combined with your Tax Identification Number, or TIN.
So, using this combination we can identify you as an
individual participant in MIPS.
Alternatively, if you and at least one other
clinician in the group would like to participate
as a group we would take a look at your data under
the single Tax Identification Number
to which you and your fellow clinicians have
re-assigned your billing rights.
So, it's important to note that if you,
as a clinician, decide you want to participate as a group,
your group is assessed as a group across all of the
MIPS performance categories.
Now, we encourage clinicians to begin
discussing how they want to participate
in this performance year.
It's not just about knowing that this choice
exists, it's about talking to your clinician
colleagues, if you have them, and really
identifying the best option for your practice
and the population of patients that you're serving.
Now let's talk about the next decision point --
choosing a submission method.
How do you do this?
How do you get your data to CMS?
So, on slide 58 you'll see a few suggestions.
The good news is that if you have already been
submitting data to CMS through either PQRS or
Meaningful Use, for example, chances are you
are already familiar with some of the submission
methods that we have as options to report
in the MIPS program.
As was mentioned earlier, depending on whether
you're participating as an individual or as a group,
our submission methods for MIPS include claims,
attestations, qualified registries, qualified
clinical data registries, electronic health records,
and, for groups of 25 or more, the CMS web
interface in the CAPS for MIPS survey.
So, in making this determination it's very
reasonable to speak with your specialty society
or to get additional help through one of our
technical assistance contractors.
You don't have to make these decisions on your own.
We have a list of technical assistants --
it's currently available on our website.
As was mentioned earlier you can visit qpp.cms.gov
for information on your submission options,
as well as information about using our technical assistance
program for decision support.
So, let's move to the next decision point.
Now that you've made some initial determinations
about eligibility and about how you're going
to get your data to CMS, you can prepare to participate in 2017.
So, on slide 60, you'll see a couple of additional
suggestions about how you do this additional preparation.
So, thinking through your practice readiness --
if you've previously participated in a quality
reporting program, like PQRS or Medicare
Meaningful Use, that's an opportunity where you can
build off what you've learned already.
Additionally, think through if you're prepared
to begin reporting data for the 2017 transition year.
You can review the options for participation,
including whether you simply want to test
the system, as Molly was mentioning earlier, or if
you'd like to participate more as a partial-year
participant, or for the full year.
So, there's a couple of different pieces here
on this slide that are worth thinking about as you
begin to plan your method of participation.
Now, let's talk about the data itself.
What information are you sending to CMS, and how
are you going to make that decision?
So, moving through slide 61 to slide 62, this slide
really details some of the information that would be
helpful as you choose your measures and activities --
what data you will be sending into CMS.
Step-by-step you can review the measures
or the improvement activities that make the most sense
to you based on your specialty and your scope of practice.
So, we highly recommend going to qpp.cms.gov
and clicking on the "Explore Measures" tab right
at the top of the page.
That will take you to an opportunity to review each
of the performance categories that
are available in MIPS, and you can select a performance
category of interest.
You'll have several different ways to sort
this information -- looking critically
at the Quality measures, the Advancing Care Information
measures, or the Improvement Activities.
And depending on which performance category you
choose, you can actually search by keyword, by
specialty -- you can even search by method of submission.
So, for example, if you are a clinician who wants
to report a quality measure, or wants
to take a look at what quality measures match up with
your specialty -- and let's say you take care
of a significant number of patients with arthritis --
you can actually go to the Quality Measures tab, type
in the keyword, "Arthritis," and the tool will actually sort
for you which measures are applicable there.
You can also search by specialty, so if you're
a dermatologist and you want to see what quality
measures apply to you, simply use the dropdown
menu and you can identify which quality measures apply there.
By searching these different options you can
actually see all of the information that's
pertinent to that measure, or to the improvement
activity that you're interested in reporting.
Now moving on to slide 63, a couple of tips
to think about here.
So, definitely consider your patient population
and the clinical conditions that you treat.
It's worth thinking about what areas of your
practice might be the most amenable to practice
improvement goals.
For myself, I'm an actively practicing family physician.
I continue to see patients as part of my job at CMS
and, for an example, if I wanted to really look
critically at my patients for whom I'm treating for
diabetes, I could really make that a theme in terms
of my practice improvement goals -- looking at, focusing
on increasing diabetic control among my patient populations,
choosing quality measures, and perhaps an improvement activity
that might support those goals.
And being able to sort through, on the Measures
tool, the valuable information that would
then be provided to me in the CMS feedback report.
So, those are things worth thinking about as you're
selecting what measures and improvement
activities, or Advancing Care Information measures
are the most applicable.
Now, for those of you who have not participated
in PQRS or Medicare Meaningful Use, you may
not be as familiar with the existing feedback
reports that clinicians receive under those programs.
The Quality Resource Use Report, or QRUR,
is currently the way we're providing information
to clinicians who are participating
in our legacy programs.
It's a report card of sorts, provided to
clinicians by CMS, and it provides an overview of
the quality of care that clinicians are providing
to their patients, as well as a review of the cost
of that care.
That quality information is actually pulled
from PQRS data and the cost information comes directly
from claims.
So, if you're a clinician who has been participating
in PQRS or Medicare Meaningful Use we would
highly recommend that you take a look at your
existing QRUR to potentially identify
measures that could match up with your practice
improvement goals, as well.
Now, let's move on to slide 64 and talk about
how to verify the information that you need to report.
Slide 65 provides an extensive list of this
information, and I do want to emphasize a few key
specifications that may be helpful to you in
reviewing the information that you need to report.
Taking a look at the measure number,
the measure title, of course, is important to know which
populations are applicable there, and looking at the
submission method options -- not every quality
measure or improvement activity can be submitted
by the same submission method.
So, looking at what submission method makes
the most sense to you is very important.
Additionally, the measure description
and instructions on reporting, as well as the criteria
for the measure, are key things to take a look at.
And remember, many of the measures for MIPS are
measures that have been developed by specialty
societies, they've been rigorously tested
and validated, and some of them have been in use
previously in PQRS and Medicare Meaningful Use.
So, some of the measures will probably look very
familiar to you if you have been participating
in those programs.
The new element of MIPS is the increased flexibility,
so making sure that you, as a clinician, can pick
measures that match up with your specialty
and your scope of practice.
So, definitely taking a look at these details will
be key ways to assist you in making a decision.
Now let's move to slide 66, and then 67.
And, finally, talking about the submission of
data -- making sure that you have an eye on the
timeframe for when you need to submit your data.
We at CMS highly recommend that you send in your data
to CMS before the submission deadline,
which is March 31, 2018.
So, depending on how you're participating in
MIPS, you're capturing data about your performance
in 2017, and you'll be tracking your progress
throughout the year.
You'll begin submitting this data on January 1, 2018
with the deadline for getting that information
to us by March 31, 2018.
So, again, highly recommended that you submit your data early
so as not to miss the deadline, and make sure that we have
timely receipt and accurate data.
So, remember -- these steps we've just been
discussing will help make participating in MIPS
possible for all eligible clinicians, really
regardless of their previous experience with
any of our legacy programs.
CMS would really encourage you to discuss MIPS with
your colleagues, with your specialty societies,
and with CMS, as we are working together to learn
from your experience and to continually improve
the program to the benefit of not only you,
our clinician partners, but also your patients.