Patrick Hamilton: Hello, and welcome to the "Medicare Quality Reporting
Programs -- What Eligible Professionals Need to Know in 2016"
presentation. My name is Patrick Hamilton with the Centers of Medicare
and Medicaid Services. Today's presentation gives an overview of the
Quality Reporting Programs currently under way at the Center of Medicare
and Medicaid Services, with a specific focus on the requirements that
Medicare providers need to meet in 2016. This includes an overview of
the 2016 Physician Quality Reporting System, or PQRS, and how your
participation in PQRS this year will determine how the value-based
payment modifier will be provided to eligible professionals'
reimbursement in 2018. We will also review the quality data that will
be added to the position compare website, as well as go over the changes
to the EHR Incentive Program for 2016.
This MLN connects video as part of the Medicare Learning Network. With
the passage of the Medicare Access and CHIP Reauthorization Act, or
MACRA, the individual payment adjustments for PQRS, the Value Modifier,
and the EHR Incentive Programs will sunset on December 31st, 2018, with
the new incentives through the Merit-based Incentive Payment System, or
MIPS, and through Alternative Payment Models, or APMs, starting on
January 1st, 2019. Since 2018 is the final year for the payment
adjustments for these three individual programs, 2016 is the performance
year to determine if Medicare-eligible professionals will be assessed to
various payment adjustments associated with these three programs.
For PQRS, performance in 2016 will determine if eligible professionals
will be assessed a two percent payment adjustment in 2018. It is also
the year in which performance in PQRS will determine the application of
the Value Modifier in 2018 for physicians in groups of all sizes,
physicians who work as solo practitioners, and for the first time
physician assistants, nurse practitioners, clinical nurse specialists,
and certified registered nurse anesthetists. The amount of the
adjustments both upward and downward, as well as how those adjustments
will be applied in 2018, will be discussed in the Valley Modifier
Module. And for the HER Incentive Program, Medicare-eligible
professionals will avoid the three percent meaningful use payment
adjustment in 2018 for successful attestation this year.
CMS has continued its outreach efforts with the Medicare provider
community to ensure that you have the most up-to-date knowledge and
information available to assist you in understanding the PQRS
value-based payment modifier and Meaningful Use programs. Joining me
today are Dr. Patrick Conway and Dr. Kate Goodrich. Dr. Conway is the
CMS acting principal deputy administrator and deputy administrator for
innovation and quality, and CMS chief medical officer. Dr. Conway is
responsible for overseeing the programs that serve the over 130 million
Americans that access healthcare services through Medicare, Medicaid,
the Children's Health Insurance Program, and the Health Insurance
Marketplace. Dr. Conway is also the director of the Center for
Medicare/Medicaid Innovation at CMS, which is responsible for testing
numerous new payment and service delivery models across the nation that
reward quality and value, including accountable care organizations,
bundled payments, primary care medical homes, state innovation models,
and many more. He's a practicing pediatric hospitalist.
Dr. Goodrich is the director of the Center for Clinical Standards and
Quality, which is responsible for over 20 quality measurement and
value-based purchasing programs, including the implementation of the new
merit-based incentive payment system. Previously, Dr. Goodrich served
as the director of the Quality Measurement and Value-Based Incentives
Group in CCSQ, where she oversaw the implementation of many quality
value-based purchasing and public reporting programs across multiple
settings. She also coed an HHS-wide group to align quality measures
across programs, and more recently has worked with numerous private
payers to align measures across the public and private sectors. Dr.
Goodrich continues to practice clinical medicine as a hospitalist and is
associate professor of medicine at George Washington University Medical
Center. Thank you both for joining me today.
Patrick Conway: Thank you.
Kate Goodrich: Thank you.
Patrick Hamilton: Dr. Conway, can you give us a brief synopsis of how
the MACRA legislation came to pass
Patrick Conway: Yes. So, CMS worked closely with Congress, with
physician and clinician groups, patients, other providers, and
stakeholders to put together the MACRA legislation. And we want to
thank Congress for that legislation. It really combines all the various
quality and value programs that, previous, CMS had to align on the
backend, if you will, the different statutory programs, into one
cohesive whole where physicians and clinicians are able to focus on
quality measures and quality improvement, resource use and efficient use
of resources, clinical practice improvement, and also electronic health
records as a tool to improve. So I think the beauty of the legislation
is increased engagement with physicians and clinicians focusing on
measures that matter most and really on a system that achieves better
care, smarter spending, and healthier people.
Patrick Hamilton: And Dr. Goodrich, how will the new MACRA law help with
the agency's focus of promoting better health, better care for patients,
and smarter spending
Kate Goodrich: So, the MACRA legislation really focuses on those three
aims in some very distinct ways. First, it transforms how CMS pays
physicians and other clinicians for the care that they provide to
patients by transitioning from paying clinicians for the volume of
services that they provide to the value that they provide to those
patients with a major focus on patient outcomes, patient experience, and
use -- and wise use of resources. Second, the legislation really
focuses on transforming how care is delivered with a big focus on care
coordination through the transition to alternative methods of payment,
also focusing on engaging patients and families and caregivers more in
their care. And then finally there's a major emphasis on transparency
of data through the requirements that -- we post about performance and
quality and cost and other factors on our physician compare website --
also that there is more frequent feedback of data to clinicians so that
they can know how they're doing in providing care to their patients and
be able to act on that in a more rapid fashion. And then finally the
legislation really reduces the current administrative burden that
physicians and other clinicians are feeling from having to report at --
to three separate programs -- condenses them into a single program,
thereby freeing up time for them to be able to focus more on the care of
their patients.
Patrick Hamilton: So it's evident that 2016 is a year of transition for
Medicare providers as the PQRS Value Modifier and the HER Incentive
Programs are sunsetting in advance of the new MIPS and APM Incentive
Programs. Dr. Conway, what advice would you give to providers who are
trying to keep track of all the changes in these programs
Patrick Conway: Yeah, so I think, first, for 2016 -- as you said, we
still have the various programs, the PQRS position Value Modifier
meaningful use. And our goal is to have as many providers and
physicians and clinicians that want to report to report and to report
successfully, so first and foremost, 2016, I would encourage groups and
clinicians to understand the various programs to understanding the
reporting requirements, to ask questions to CMS in our various methods.
When they have questions with the central office, the regional office --
technical questions -- we're here to help you be successful. So I'd
encourage physicians to report in 2016 and really focus on what matters
to them. The whole point of these programs is quality improvement for
your patients and the population you serve, so I'd encourage physicians
and clinicians to engage and report successfully.
Patrick Hamilton: So, Dr. Goodrich, one could see how it is important
for Medicare providers to continue their participation this year. How
do you address providers who think it might not be in their best
interest to do so in 2016
Kate Goodrich: Well, as Dr. Conway mentioned, many of these providers
are already subject to the current programs that we talked about: the
PQRS Value Modifier and the EHR Incentive Program. So they're already
being held accountable for the quality of the care they provide and for
reporting the quality information. We see 2016 as a year in which not
only, we think, they should continue that participation so they can
understand the quality measures that are available to them, what it is
that they need to do to succeed, but 2016 is also a year where we will
be doing an extensive amount of outreach and education to physicians and
other clinicians about the upcoming MIPS Program so that they can better
understand it. We would also think that physicians and other clinicians
should reach out to their own specialty societies and other
organizations that they work with regularly to better understand the
program. Those societies are very well-versed in not only the existing
programs but the upcoming MIPS Program, and can be a real source of
education and indeed direct assistance to be able to be successful with
the program.
Patrick Hamilton: People are wondering if the components of the new MIPS
Incentives will simply just be an extension of the current reporting
programs: PQRS Value Modifier and EHR. Dr. Conway, how would you
address these concerns and ensure providers that the new MIPS Program
builds upon lessons learned from the previous programs
Patrick Conway: Yeah, I do think the new program builds on those lessons
learned, and I caught a few aspects. One: flexibility. It allows a
much more flexible construct so that we can give physicians and
clinicians options in terms of how they report and what's meaningful to
them. Two: I think it is a much more simple framework. So our goal is
to implement it in a way that it's understandable, simplified reporting,
less administrative burden. And then lastly, I think it allows us
really to focus on the outcomes of care, so both the quality outcomes
and improvement over time. So you're really incentivizing the outcomes
in improvement, the care that's important both to clinicians and to
patients.
Patrick Hamilton: In closing -- and I would ask this of both of you --
what is your message to physicians as to how they can become a part of
this transformative process beyond participating in the programs
Kate Goodrich: So, I'll start. I think physicians already are doing
their very best to provide high-quality care to their patients. That is
clearly at the top of their minds. I would advise physicians and other
clinicians to, as I mentioned before, get in touch with their specialty
societies to learn more about the programs. Take advantage of much of
the -- what we call "technical assistance" or, boots-on-the-ground
frontline direct assistance that CMS and others are providing for
physicians to be able to transform how they practice care. So this
technical assistance is intended to help physicians understand -- how to
understand their performance and use data in order to improve, how to
maybe redesign systems of care within the healthcare systems that they
work in, just within their own offices practice, in order to be able to
provide higher-quality care. So there's lots of resources out there
that physicians and other clinicians can take advantage of in order to
get ready for 2017.
Patrick Conway: Yeah, I think -- building on that -- I definitely agree,
engaging with your specialty society, with the state societies -- really
the boots-on-the-ground, if you will, to be successful in these
programs, I think. Two, engaging with peers. So I can't tell you the
number of physicians and clinicians engaging with other peers about how
to be successful in the program. Well, we, CMS, are actually supporting
that type of work through things like transforming clinical practice,
which is an over $600 million investment to support physicians and
clinicians in the field. Additionally, you can shape these programs.
Both the policies of the programs through direct engagement with CMS,
but also things like clinical data registries, where you see societies
develop registries that are meaningful to the physicians and clinicians
in that specialty and utilize that as a mechanism for improvement and
reporting to CMS. So, you know, our goal is to create a cohesive whole
that really focuses, again, on that better care for patients, smarter
spending, and healthier people. And we know this aligns, as Kate said,
with the goals of physicians and clinicians providing care to patients.
Patrick Hamilton: Dr. Conway and Dr. Goodrich, I want to thank you for
your time and sharing your insights with the Medicare provider
community. This presentation has been broken down into six modules for
your convenience so that you may view the topic that is of interest to
you more efficiently. We encourage you to view all the modules so that
you can get the most comprehensive understanding of how these programs
are interrelated. In module one, we will give a high-level overview of
the Medicare Access and CHIP Reauthorization Act that was passed in
2015, which includes the new Merit-based Incentive Payment System, or
MIPS, as well as new Alternative Payment Models, or APMs. Module two
will summarize the incentives as well as the payment adjustments for
PQRS, the Value Modifier, and EHR Incentive Programs in 2016. Module
three will provide updates to the PQRS Program for 2016 and go into
detail regarding the various reporting methods for PQRS in 2016, for
both those EPs reporting as individuals and for those groups that choose
the Group Practice Reporting Option, or GPRO.
Module four will focus on the Value-Based Payment Modifier policies for
2018, including how the value modifier will be applied to the
reimbursement of physicians, physician assistants, nurse practitioners,
clinical nurse specialists, and certified registered nurse anesthetists
in 2018, how quality-tiering will work in 2018, and how your PQRS
activity in 2016 will determine your value modifier in 2018. We will
also briefly discuss how the value modifier will be applied to Eps for
participating in the Shared Savings Program, the pioneer ACO model, a
comprehensive primary care initiative, or other similar innovation
center models. Module five details the quality data that will be added
to the physician compare, and module six will focus on the new
requirements for the EHR Incentive Program in 2016 that stem from the
modifications to stage two final rule last year. Once again, I would
like to thank Dr. Conway and Dr. Goodrich for joining me in this
discussion, and thank you for viewing this MLN Connects video
presentation on the 2016 Medicare Quality Reporting Programs.
We encourage you to view all the modules that are listed below in the
"descriptions" section of this video. This MLN Connects video, as well
as all the associated video modules, is part of the Medicare Learning
Network. The information presented in these presentations was correct
as of the date they were recorded. These presentations are not legal
documents. Official medical program legal guidance is contained in the
relevant statutes, regulations, and rulings.