KENTUCKY REGIONAL EXTENSION CENTER

CMS raised the bar for Year 2 of the Quality Payment Program. In order to avoid a negative payment adjustment, you must now have a minimum score of 15 points (up from last year’s 3 points). In an effort to reduce the burden for small practices across the country, CMS has also raised the eligibility threshold. If you find yourself or your practice on the list of Eligible Clinicians for Year 2, you will have to do more than just submit a test this year to avoid the penalty.

If your practice is without certified electronic health record technology (CEHRT), don’t give up! There are still things you can do to avoid a negative payment adjustment. While use of CEHRT is required to participate in the Promoting Interoperability performance category, this is only one of the four performance categories. The Quality and Improvement Activities categories can both be reported on without an EHR and the fourth category, Cost, does not require submission, and therefore will also count toward your score.

Join us for our upcoming webinar where we will discuss approaches you can take to participate in QPP without a certified EHR.

Webinar – QPP: How You Can Participate Without an EHR

Thursday July 12th 12-1 p.m. ET

The CMS Quality Payment Program is comprised of four categories for Year 2: Cost, Quality, Promoting Interoperability, and Improvement Activities. Over half of your MIPS final score is made of Cost and Quality, which is a change for Year 2. While the Cost category does not require a submission, reviewing the feedback reports from CMS is essential to understanding your practice’s historical cost performance. This allows you to target strategic interventions for improvement in both cost and quality categories.

One method to gain a better understanding of the patients attributed to your practice is through identifying the Hierarchical Condition Category or HCC used for risk adjustment. A CMS Hierarchical Condition Categories (CMS-HCC) model generates a risk score for each beneficiary. CMS uses these CMS-HCC risk scores in the risk adjustment methodology for Medicare Advantage. This score summarizes each beneficiary’s expected cost of care relative to other beneficiaries using a mixture of demographics and diagnoses. Separate CMS-HCC models exist for new enrollees and continuing enrollees. The new enrollee CMS-HCC model accounts for each beneficiary’s age, sex, and disability status, and is used when a beneficiary has less than twelve months of medical history. The continuing enrollee CMS-HCC model accounts for each beneficiary’s age, sex, original reason for Medicare enrollment (age or disability), Medicaid enrollment, and clinical conditions as measured by CMS-HCCs.

Join us on our upcoming webinar as we take a closer look into the approach and factors CMS uses to determine a patient’s HCC score and how you can use this information to select clinical and process interventions to improve patient outcomes.

QPP Year 2 Webinar – What is a HCC Score and What Does it Tell You About Your Patients?

Thursday June 21st 12-1 p.m. ET

The Quality Payment Program is comprised of four performance categories: Cost, Quality, Advancing Care Information (ACI) and Improvement Activities (IA). The first three categories (Cost, Quality and ACI) are based on historical quality programs. However, Improvement Activities is a new category introduced by CMS at the beginning of the Quality Payment Program in 2017.

Improvement Activities (IA) includes an inventory of activities that assess how you improve your care processes, enhance patient engagement in care, and increase access to care. The inventory allows you to choose the activities appropriate to your practice from categories such as: enhancing care coordination, patient and clinician shared decision-making, and expansion of practice access.

Join us on our upcoming webinar where we will provide an overview of the Improvement Activities category. In addition to reviewing the Year 2 changes, we will discuss how this category and associated clinical and/or process interventions can be a catalyst for continuous improvement.

QPP Year 2: IA Deep Dive
Tuesday May 15th 12-1 p.m. ET