>> Molly Mackerras: Moving on to Slide 44.
From here, I'm going to go ahead and pass it back
over to Adam.
Thank you.
>> Adam Richards: Thank you, Molly.
So now we're going to talk a little bit about the MIPS
scoring methodology, and I'm going to hand
it over to Mary Wheatley, our principal health care
policy analyst with the MITRE Corporation, to walk
us through a few slides on scoring.
>> Mary Wheatley: Great.
Thank you, Adam.
So if we can move on to the next slide.
So, then, so we're going to go -- so, Molly just
gave you an overview of all the measures and
activities that are going to go into your MIPS
score, so I'm just going to briefly talk about how
we kind of create that score.
We're going to go category by category so you can see
how this all kind of translates into
a single score at the end.
So, we'll start with Quality,
the Quality Performance category.
And, again, for most people this is going
to be 60 percent of your final score.
And to recap, generally people have to submit
approximately 60 measures of the available measures.
When you submit a measure to us, whether it's a test
or "pick your pace", we're going to look at that
measure and we're going to try and score it.
We're going to assign that measure somewhere between
three to 10 points based on certain criteria.
And if we have enough data that we can reliably score
it against the benchmark -- well, at a minimum,
if you submit a quality measure we're going
to give you three out of 10 points just for giving
us the information.
If we're able to reliably score it against
a benchmark -- and we won't go into that in too much
detail -- but if we have enough sample size, if we
have a benchmark that we're able to do that,
then we can give up to 10 points based on how well
you do on those measures.
But the biggest thing here is that if you don't
submit a measure, you get zero points.
So, if you submit even a tester case you get a
minimum of three points, but you can get up to 10
points, especially -- which is easier to do if
you submit more cases so that we can actually measure you.
We will say that there are some bonus points
available for certain types of measures -- and,
again, more information is available, especially
through the technical assistance, and such --
but there are bonus points for electronic reporting,
there are bonus points for selecting, you know,
measures with -- you know, outcome measures or other
high priority measures.
So, if we can go to the next slide, please.
And -- it's not quite showing up here.
So, the next category is the Cost category, and for
this year we just want people to kind of get used
to the Cost measurement and what that means in MIPS.
So for Cost, no one is required to submit
measures -- it's something that CMS will calculate --
and we do it through claims data.
And, again -- similar to the Quality measure --
we're going to assign a certain number of points
for each measure and how it compares to a benchmark.
Those benchmarks are available on the QPP
website, if you're interested in it.
What's important to notice -- again, for this year --
the cost score is -- while we're calculating this
score for you, it's not going to contribute
to the final score that gets used for the payment adjustment.
So it's really for informational purposes
for the first year.
Next slide.
So, for Improvement Activities, again the idea
here is you choose the inventory of activities
that Molly mentioned before, and it's really,
like, how many and -- with the goal of you're getting
towards 40 points.
I think, particularly for this group, what's
important to know is that if you're in a small,
rural practice, or you served an underserved
practice, then the number of activities that you
need to report is less.
So, we basically have said that basically each
objective that you report is worth, you know, double
the amount, so you get -- so you only have to report
a maximum of two medium activities, or one
high-rated activity in order to get the maximum
number of points for the Improvement Activities.
But the way, again, the way the scoring works
is that you just report each activity, each activity
is worth a certain number of points.
And if you're in a patient-centered medical
home you automatically get -- you automatically get
full credit in the Improvement Activity.
Next slide.
And so, the last report category is Advancing Care
Information, and as Melissa discussed, it got
restructured so that the base score is worth 50 percent
of your score.
So, if you leave that base score you will
automatically get 50 percent credit, and as you
report additional measures against -- the measures
change based on your certification --
you can increase your score up to a maximum of 100 percent.
And so, in general, when you consider all the ways
you can report -- you have the base score, you have
ways you can get additional performance
in certain measures, and you can get bonus points for
reporting to additional registries, or for using
electronic health records for your Improvement
Activities -- you have the ability to get up to 155
points, which means there's multiple ways
to get to that maximum credit because the maximum credit
for any score is 100 percent.
So, there's lots of ways to get to 100 percent
in the Advancing Care Information.
And so, if you take that -- so, what we do is we take
these algorithms, we apply it to all these
activities that are submitted for these
different categories.
And as you go to the next slide, what we do to calculate
your final score is -- you know, similar
to when you were in school -- we say, we take your score
for each category which is somewhere between zero and
100 percent for each of these categories and then
we multiply it by the weight, and then we end up
with a final score that is somewhere between zero
and 100 points.
And that final score is important because that
final score is what we use to determine your payments
for the -- payments for 2019.
And so, if you go to slide 50, I want to spend
a little time talking about these points.
So, what we have done in this first year for "pick
your pace" we have set the -- we have said that if
you get three out of 100 points for your total
score, you can avoid a negative payment adjustment.
And that means if you report a Quality measure,
if you report an Improvement Activity,
if you report the base score for Advancing Care
Information -- you will get at least three points,
and you'll get a neutral point.
So, the only way -- it's only if you don't
participate you get zero points -- is where you get
a negative four percent payment adjustment.
And this is a policy that we certainly implemented
for the first year because we want people to really
get, you know, used to the MIPS program, and used to
the scoring, and learn how these -- how all the pieces sort of
fit together.
We also created a point, a target, and that's 70 points.
And so, in MIPS, we have this algorithm that we
have to calculate to determine what your
payment adjustment will be if you exceed three points.
And the short answer -- and what we have to do is
we have to get everyone's scores in, and we have
to see how much money's available to distribute,
and how many people qualify for additional
bonuses, and then we have to calculate what the amount is.
But the reason why I'm bringing up the 70-point
mark is that at 70 points there's a $500 million set
of funds from the first few years and if you get
70 points you get access to that additional funds.
So, what we can say is at 70 points we get a minimum
additional half percent adjustment along with
whatever adjustments we calculate for MIPS.
So, what does that mean?
It means that if you score at least three points, you
avoid a negative adjustment.
The higher your score, the higher your adjustment
will be but we can't tell you exactly what that is
-- we have to calculate all the scores first and
see how much, how many people we have to
distribute -- how much money there is to
redistribute and how many people we have to
redistribute to.
But if you get to 70 points, you know that
you'll get a little bit of a bump up because you can
access those additional funds for exceptional performance.