2016 PQRS Feedback Reports and Annual QRURs Available

As noted in last week’s listserv message, the 2016 Physician Quality Reporting System (PQRS) feedback reports and 2016 Annual Quality and Resource Use Reports (QRURs), which contain performance and payment adjustment information, are now available. Please note the following about these reports:

The payment adjustments shown in the reports are based on proposals that were included in the 2018 Medicare Physician Fee Schedule Proposed Rule (https://federalregister.gov/d/2017-14639).

  • Reducing the automatic downward Value-Based Payment Modifier (Value Modifier) adjustment by half for practices that did not meet the minimum quality reporting requirements;
  • Holding all practices that met the minimum quality reporting requirements harmless from downward Value Modifier payment adjustments based on performance;
  • Reducing the maximum upward Value Modifier payment adjustment for performance for large practices to align with the adjustment for small and solo practices.
  • Reducing the number of measures that must be satisfactorily reported for the 2016 PQRS to avoid the 2018 downward payment adjustment from 9 measures across 3 National Quality Strategy domains to 6 measures with no domain requirement.

If the policies are not finalized as proposed, we will provide an update to report recipients.

To find out which reports are available for your practice and your current and past PQRS and Value Modifier payment adjustments, you can use the new Payment Adjustments and Reports Lookup feature on the CMS Enterprise Portal. An Enterprise Identify Management (EIDM) account is not needed to use this feature. Instructions for using this feature are located in the “Guide for Accessing the Payment Adjustment and Reports Lookup Feature”.

If you perceive that your payment adjustment status was made in error, you may request an informal review of your 2016 PQRS results and/or 2018 Value Modifier calculation during the informal review period that will close on December 1, 2017, at 8 p.m. ET.

An EIDM account with the appropriate role is required for participants to obtain their 2016 PQRS feedback reports and 2016 Annual QRURs. Both reports can be accessed on theCMS Enterprise Portal using the same EIDM account. Visit the How to Obtain a QRUR webpage for instructions on accessing both reports.

For more information on your PQRS feedback report:

For more Information on your Annual QRUR:

For the 2016 reporting period, the majority of EPs successfully reported to PQRS and avoided the downward payment adjustment. Under the new Quality Payment Program, CMS is anticipating that this trend of success will continue. The Quality Payment Program began January 2017 and replaces PQRS, the Value Modifier program, as well as the separate payment adjustments under the Medicare Electronic Health Record (EHR) Incentive Program for eligible professionals. The Quality Payment Program streamlines these legacy programs, reduces quality reporting requirements and offers many flexibilities that allow eligible clinicians to pick their pace for participating in the first year. To prepare for success in the Quality Payment Program, we encourage EPs to review their PQRS feedback report, Annual QRUR, and visit qpp.cms.gov to learn about the Quality Payment Program.

Questions:

Both help desks are available Monday through Friday from 7:00 am to 7:00 pm CT.

Source: Centers for Medicare & Medicaid Services Email Newsletter Thursday, September 28, 2017.

2016 EHR Incentive Program

What a gorgeous fall day it is here in the Midwest and we even have some good news to share. The Centers for Medicare and Medicaid Services published a final rule on 11-2-16 allowing providers in the Medicare EHR Incentive Program to report based on a 90-day reporting period in 2016 and 2017, instead of a full calendar year.  That’s a nice bit of news for those who have been a bit slow in starting this year.

This had first been proposed in July, but was finally approved this week.  In addition to changes allowing all returning participants in the EHR Incentive Programs to report on a 90-day EHR reporting period in 2016 and 2017, CMS is also showing flexibility in other Meaningful Use requirements. Starting in 2017, they will be eliminating the Clinical Decision Support (CDS) and Computerized Order Entry (CPOE) objectives, so for DCs that do both labs and x-rays, you will no longer have to track those. You can read the final rule here

All that good news and more, we have read through the 2400 page MACRA final rule here at the Academy and have the updated information ready for you in our Quality Payment Program.  Healthcare is in a massive transition away from fee for service to a value-based reimbursement and the MACRA law lays out the blue prints of successfully reporting under that new reimbursement model. It is important for all of you to understand.  Ignorance is not bliss. Empower yourself by learning what you can do now to participate in this movement toward value and patient centeredness.

As CMS Acting Administrator, Andy Slavitt stated yesterday at the American Academy of Actuaries annual meeting, “We can’t expect to do things the same way and make progress. And we have to take the opportunities we have for progress. Unlike many periods over the last 20 years, our opportunity for progress is richer than ever.” At the Academy, we believe there are tremendous opportunities for chiropractic in the value-based model,  DCs can add new service lines to their practice that branch out from doing these measures, and they set themselves up for better care coordination and relationships with other provider types and health systems. You can read the rest of his address here.

Call Best Practices Academy and let us help you thrive in the new healthcare environment.

The New Macra Law and MIPS: Read carefully.

Many of us are familiar with the annual Medicare sustained growth rate discussion that Congress has regarding the provider fee schedule. What most do not realize is that this formula has now been replaced.

Why would Congress, in a bipartisan and nearly unanimous vote, replace an existing formula for payment to providers for Medicare? Clearly costs of care have been skyrocketing without the quality of care understood and now pay for performance has finally arrived. For years we have heard of pay for performance, reimbursement based on outcomes, value-based reimbursement, etc. For years we have not seen any substantial progress towards coming up with a way to make this work, but in April 2015, President Obama signed into law the Medicare Access and CHIP Reauthorization Act 2015 (MACRA). This is an act to amend title XVIII of the Social Security Act to repeal the Medicare sustainable growth rate and strengthen Medicare access by improving physician payments and making other improvements, to reauthorize the Children’s Health Insurance Program, and for other purposes. Within this law are two different payment options, one is the Advanced Payment Model (APM) and the other is the initiation of the Merit-based Incentive Payment System (MIPS). This is the blueprint for pay for performance by Medicare.

There are five key principles of the MACRA law you should understand:

1. Every Medicare enrollee needs a dedicated and well-organized primary care team.

MACRA actively promotes patient-centered medical homes (PCMH) and patient-centered specialty practices (PCSP). These are types of practice recognition programs accredited by organizations such as the NCQA to validate that these practices meet specific qualifications for value-based reimbursement.

2. Measurement must be specified appropriately for each different unit of accountability.

If you are familiar with clinical quality measures and meaningful use, then you will have a basis to help you understand this aspect of the MACRA. The MACRA states that measures must be specified for each payment model, or unit of accountability, yet still facilitate comparison between and among all payment models. Measures also must be tailored for the different types of care furnished by clinicians in different payment models.

3. Measurement should support rapid improvement and clinical decision making.

Beyond assessing and paying for value, measurement also needs to help clinicians rapidly identify gaps in quality in order to improve their performance. The EHR “Meaningful Use” program that MACRA incorporates into MIPS already encourages use of data for population health, decision support, and measuring quality. Meaningful Use requirements must include accurate, prompt reports for clinician quality improvement efforts.

4. A core set of measures will let all stakeholders make comparisons across programs.

Core measures will be specified appropriately for the differing situations for individual clinicians, practice teams, accountable care organizations (ACOs) and Medicare Advantage plans, yet aligned in concept and intent to allow meaningful comparisons. The measures will draw from data in claims, electronic health records (EHRs) and patient surveys to aggregate up to levels that matter most to consumers, clinicians, plans, the community or state. Measures also must continually transform for advances in clinical evidence.

5. Quality measure results should be easy for consumers and payers to get and use.

MACRA provides for transparency through the Physician Compare website. All stakeholders need user-friendly information to make meaningful comparisons across all payment models. Clinicians need more specific data about how they compare to local and national peers to identify improvement opportunities and achieve value-based payment rewards. Clinicians also need timely, actionable feedback as close as possible to delivery of care. Embedding results in clinical care workflow is essential.

Doctors of chiropractic must begin now to understand this new payment environment that is quickly approaching, as 2016 is setting the stage for the MIPS program going into effect January of 2017. The draft rules for MIPS will come out by June or July and the final rule by November of 2016. Stay tuned for more on the MACRA law and MIPS in upcoming articles from the Best Practices Academy.

Dr. Scott Munsterman is founder and CEO of Best Practices Academy (BPA) and is an acknowledged expert on the transforming model of health care delivery with a commitment to the promotion and advancement of the chiropractic profession. BPA assists chiropractic physicians to focus on growth, risk management, technology and quality improvement through a value-based practice management system.

Are You Hindering Your Practice and Hurting Your Profession?

Here we are past the mid-point of the second month in 2016. How are you doing in preparing yourself for the huge changes rolling down the Healthcare highway? If you are one of those who though you could withstand the 2% penalty for not reporting PQRS and think you dodged that bullet, because you heard PQRS is ending…You are wrong! Not only is PQRS not ending, it is morphing into a much larger program called MIPS. That stands for Merit-based Incentive Payment System and it is part of the MACRA law that was signed in April 2015. MACRA stands for the Medicare Access and CHIP Reauthorization Act. It replaces the sustainable growth rate (SGR) and is not going away as it was passed by a HUGE bi-partisan vote. If you want to read more about it, you can do so here: http://www.aafp.org/practice-management/payment/medicare-payment.html

MIPS is PQRS on steroids and those of you who are trained in Chiropractic understand the impact of steroids on the body! You are part of the Healthcare provider body that will be impacted by MIPS. MIPS overlays and reaffirms Meaningful Use, PQRS and adds what they call a value-based modifier (VBM). (More on the VBM in a future blog article)

Starting CY2017, MIPS will annually measure Medicare Part B providers in four performance categories to derive a “MIPS score” (0 to 100), which can significantly change your Medicare reimbursements. Now if you are thinking well, I don’t have a lot of Medicare patients, take note many of the private insurance companies are following closely in step with CMS, in fact some of them are running even faster in how they are changing their reimbursements to value-based (i.e. based on performance outcomes).

Here at the Academy, we know you just want to treat your patients, but at the end of the day you have to have money to keep your practice operating and keep treating patients. That’s where we can help you! We understand how to collect the data these new programs require. This data is really what you have been waiting for to prove to other healthcare providers the value you bring to your patients’ and the efficacy of your treatments.

Give us a call, let’s work together. If you are not collecting and sharing that data, you are hindering your Practice and hurting your Profession!

Growing Pains?

So as you have all been experiencing in the past few years, healthcare in the U.S. is changing rapidly. The last blog gave a bit of history of those changes. The questions being asked now; are we creating technology that is being resisted and resented that is intended to provide *Better Care, Smarter Spending, and Healthier People? (*That’s the current way to express the Triple Aim.) Or are we just feeling the growing pains of change?

We definitely caught a break or you could say the screams of resentment were effective in the passage of the Patient Access and Medicare Protection Act, which brings immediate relief for eligible professionals  that were rushing to try and attest to Stage 2 of the Meaningful Use program. The legislation reduces the risk that providers will be hit with financial penalties for failing to achieve Stage 2 in 2015. It’s 2016 and if you are reporting Stage 2, you are in for a full 12 months, not the 90 days as last year. I doubt the protesting will prevail, so if you need help, call the Academy, we will help you focus on your patients and we will help you reduce the reporting burdens and make sense out of the current and upcoming outcome measures.  We are fast leaving the familiar shores of Fee for Service and heading for new lands of Value-based reimbursements.  Volume is no longer King, Value is!  That creates great opportunities for Doctors of Chiropractic, but if you don’t understand how, you will miss the boat.

Is your EHR performing as you need to thrive in this new healthcare environment?  If it is not, give us a call, we are here to serve your needs.

Happy New Year! Check out the new FREE webinars on how to deal with those Medicare Part B probe Audit letters you may be getting in the mail.

The incentives during this transition period over the next couple of years will spell the difference between thriving and barely surviving. Give us a call, let’s work together. Let’s make 2016 a year to celebrate Chiropractic!

Decide to make 2016 NOT drab. Invest in your practice for great returns.

Investing money has always had an appeal to most of us. The idea of investing a small amount of money in a stock or mutual fund that skyrockets are what dreams are made of. Or are they? Why do we want to hinge our success on someone else’s business? On someone else’s ability to run a successful business in an industry we know little to nothing about?
One of the most common mistakes doctors make is the one that causes them to look elsewhere for diamonds. One of my favorite books is “Acres of Diamonds” authored by Russell H Conwell. It is a story about a man who wanted to be rich and have diamonds, so he sold his farm and searched. What he didn’t know is that the person he sold his farm to found diamonds on that property.
All too often we look elsewhere to find what we want and dream. BPA can help you rediscover your practice, your purpose, and your dreams. Invest in your practice with the help of our team of experts. And make 2016 great.